Overview of GHWA and Experiences with Country Coordination & …€¦ · Outline of the...

transcript

Overview of GHWA andExperiences with Country

Coordination & Facilitation

1st November 2011Abuja

Dr George W. Pariyo (Dr George W. Pariyo (MBChBMBChB, MSc, PhD), MSc, PhD)

Medical Officer, Country Facilitation TeamMedical Officer, Country Facilitation Team

Global Health Workforce Alliance SecretariatGlobal Health Workforce Alliance Secretariat

Outline of the presentation

Overview of the GHWAPart 1

International Experiences and Country

Coordination and Facilitation

Part 2

The Global Health Workforce Alliance

Part 1

Countries with a critical HRH shortage

[Source] WHO. (2006). World Health Report 2006. WHO: Geneva.

In Sub-Saharan Africa…� 24% of global burden of disease but only 3% of

world's health workers

� 1 of 4 doctors and 1 of 20 nurses trained in Africa are working in developed countries.

Global health workforce crisis

Globally…� Shortfall of 4.3 million health workers globally

� Education and training insufficient

� Monthly wages: < $100 in some countries vs> $14 000 in other countries

Global health workforce crisis and health outcomes

Lower health service coverage

Higher mortality rate and disease burden

Fewer health workers

Lower macro economic outcome

� Vision: Access for all to a skilled, motivated, and supported health worker as part of a functioning health system

What is the GHWA?

� Mission: Mobilize all stakeholders to advocate and take

appropriate actions to achieve access for all to health

workers, with a focus on the 57 countries in crisis.

� Composition: 336 Alliance members and 27 Alliance partners from a variety of constituencies

� Organization: The Alliance is an international partnershiphosted by WHO, which brings together a variety of stakeholders� Government ministries and agencies, professional associations,

academia, civil society, UN agencies, donor agencies, private sector, etc

Three core functions “ABC”:

Core functions of GHWA

Convening all stakeholders => (1) CCF, (2) Global

consultation on community health workers.

Advocating for keeping HRH issues high on the global agenda => (1) Global forum on HRH, (2) High level

commitment at G8 2008 and 2009, (3) Global code of practice on int’l recruitment of health personnel

Brokering knowledge => (1) Task forces, (2) technical tools, (3) community of practice, (4) knowledge centres, etc.

Brokering Knowledge: Tools and manualsfor country use

1. Scaling Up, Saving Lives:=> Education & training

2. Resource Requirement Tools:=> HRH financing

3. HW migration policy initiative:=> Code of practice on int’l

recruitment

4. HRH Action Framework (HAF):=> Situation analysis, planning,

Implementation and M&E

The Human Resources for Health Action Framework

(Source: GHWA Technical Working Group on Tools and Guidelines. WHO, USAID/Capacity Project and partners)

International Experiences and International Experiences and

Country CoCountry Co--ordination and ordination and

Facilitation for HRHFacilitation for HRH

Part 2

Lessons learned from regional meetings

1. Inadequate dialogues between stakeholders=> Information was not adequately shared between

the sectors

2. In particular, health professional associations arenot adequately involved.=> involvement of non-state stakeholders is key.

3. Stakeholders’ involvement had been limited tovalidation of HRH strategy and plan.=> they would like themselves to be more involved.

Addressing health workforce challenges through

Country coordination and Facilitation (CCF) process

Quantity

Quality:

In-service train

fessional d

ev’t

Recruitment

Deployment &distribution

Migration & retention

Accred

itation

al rec

ognitio

(1) MOH

(4) MOL(5) MOFA

(2) MOE=>Education

(3) MOF=> Investment

(6) Health professional association

(7) Private sector

(1) MOH

(4) Civil society

(5) NGO

Why? HRH as a complex polyhedron

Countries with a critical HRH shortage

OuagadougouHanoi

Islamabad

San Salvador

and key HRH sensitization events

Bangkok

Kampala

What is “Country Coordination and Facilitation” (CCF)?

� Transparency => All the stakeholders share the information and decision making process

CCF is the process which brings all the key stakeholdersin the country to develop and implement a comprehensive costed HRH plan

� Ownership => All the stakeholders share the roles and responsibilities

� Comprehensive solution => All the stakeholders work together as a multi-sectoral team

� Maximizing existing mechanism => Reinforce the existing HRH committee, if there is.

CCF principles CCF principles

Building on the existing mechanism/s.Building on the existing mechanism/s.

Representation of HRH stakeholders' constituencies.Representation of HRH stakeholders' constituencies.

Coordinated leadership and stewardship.Coordinated leadership and stewardship.

Defined roles of relevant stakeholders. Defined roles of relevant stakeholders.

Coherent HRH strategies linked with national health policy.Coherent HRH strategies linked with national health policy.

Joint efforts and actions with increased investment in HRH.Joint efforts and actions with increased investment in HRH.

Linkages with other coordination mechanisms.Linkages with other coordination mechanisms.

Contributing to a Contributing to a

solutionsolution

Design, implement, monitor and evaluatea comprehensive costed HRH plan

Academia

society

Prof Ass’n

Private

Sector

National HRH committee

Expected outcomes of CCF

[Outcome 1] Preparation of HRH country profile

[Outcome 2] Development of comprehensive costedHRH plan

[Outcome 3] Implementation of comprehensive costedHRH plan

[Outcome 4] M&E of implementation of comprehensivecosted HRH plan

National HRH Committee throughout the processes & outcome

A series of CCF activities

2009 2010 2011

Global

Regional

Country

Partners mtg

Institution trg

regional sensitization mtg

National HRH committee

Comprehensive costed HRH plan

2nd Global Forum

Strengthened Ab

HRH as a complex “polyhedron”

uality:

In-service training

Professional

dev’t

Recruitment

Deployment &distribution

Migration & retention

Accreditation

al rec

(1) MOH

(4) MOL(5) MOFA

(2) MOE=>Education

(3) MOF=> Investment

(6) Health professional association

(7) Private sector

(1) MOH

(4) Civil society

(5) NGOCOORDINATION CHALLENGESCOORDINATION CHALLENGES

Inadequate dialogue

Poor information sharing

Stakeholders engagement

Coordination mechanisms

Coordination capacity

Consensus building

To tackle critical issues on HRH, all the stakeholders should work together at country, regional, and global levels

Key message from the GHWA

CCF principles

Building on the existing mechanism/s.

Representation of HRH stakeholders' constituencies.

Coordinated leadership and stewardship.

Defined roles of relevant stakeholders.

Coherent HRH strategies linked with national health policy.

Joint efforts and actions with increased investment in HRH.

Linkages with other coordination mechanisms.

Engagement of stakeholders for resource mobilization, implementation, monitoring, and evaluation of HRH plan

[ Step 5 ]

Involve HRH committee and technical working groups in developing evidence-based, comprehensive, costed HRH plan

[ Step 4 ]

Establishment of HRH committee and technical working groups and their capacity building

[ Step 3 ]

Stakeholders identification and analysis at country level

[ Step 2 ]

Flow of the CCF process

Sensitization and orientation of stakeholders to kick start

[ Step 1 ]

The CCF PROCESS

HRH PLANCompressive, Costed, Evidence-based

REDUCED HRH CRISIS

HRH COMMITTEE

Ministry of Health

Ministry of

Education

Ministry of

Labour

Ministry of

Finance

Ministry of

Local Govt.

Academia Researchers

Professional associations

Regulatory

bodies

NGOs and

civil society

Private

sector

UN agencies and International organizations

Other HRH related stakeholders

Implement

Added value of the CCF

Inclusiveness

Engagement

Mutual accountability

HRH committee functions

� Build an evidence base and identify HRH priorities

� Share information and promote policy dialogue

� Advocate HRH as a building block of health system

� Develop comprehensive and costed HRH plan

� Mobilize resources to finance the HRH plan

� Monitor implementation of the HRH plan

� Evaluate and document the progress on HRH

Output

Outcome

Impact

Evidence based, comprehensive and costed HRH plan

(developed, financed and implement)

Access to adequate number of skilled health workers, distributed according to service requirements

Equitable access of all to essential health services

Progress activities (1)

Orientationmeetings in Africa , Asia,Latin America

Objective: To orient the countries on the CCF

principles and process

Output: Coordination challenges in the countries were discussed and recommendations for implementing CCF process

Partners' meeting in Geneva

Objective: To engage partners to support the HRH coordination process at the country level

Output: HRH coordination issues were highlighted, roles of the partners were identified, criteria for effectiveness of the CCF were identified

Progress activities (2)

National institutescapacity building

meeting on HRH

coordination

Objective : To engage national institutes in the CCF process for stakeholders capacity building and technical backstopping

Output : Core competencies required for better HRH coordination were identified, and country CCF action plans' were finalised

Catalytic support to the HRH

crisis countries

Objective: To support the countries in

implementing the CCF process for addressing HRH challenges

Output: 16 countries received the Alliance catalytic support

More engagement of partners, HRH on global agenda, evidence used

Advocacy and networking with

partners to foster collaboration among

HRH stakeholders

Brokering knowledge to

support actions based on evidence and best practices

Convening country stakeholders for an

integrated and coordinated HRH

development

2 main objectives in 2011 and beyond

Objective 2:Transnational policy challenges addressed

Objective 1:country leadership mobilized for HRH

Facilitation coordination and intersectoral

collaboration

Outputs through the CCF approach

Total Completed Under process Planned

Total Completed

Under process Planned

Total Completed Under

process

Planned

Total Completed

Under process Planned

HRH situation analysis

through the CCF process

Evidence based, and costed

HRH plan through the CCF process

Planned DoneDoneInformal DoneZambia

Planned Planned Planned Planned PlannedPlannedSouth Sudan

Planned DoneDone Done Informal DoneSudan

Planned DoneDone Informal Informal DonePeru

Planned DoneDone Informal Informal DoneParaguay

Papua New Guinea

Planned PlannedDoneDoneDone DonePakistan

Planned DoneOn-going DoneOn-goingDoneNigeria

Planned On-going Done DoneInformal DoneNepal

Done DoneDoneDoneDoneDoneMali

Planned On-goingDoneDoneDoneDoneIndonesia

Planned PlannedOn-going DoneOn-goingDoneGuinea

Planned Done DoneInformal Informal DoneEritrea

Planned DoneDone Informal Informal DoneEl Salvador

Planned Planned Planned Planned PlannedPlannedDjibouti

DoneDoneDoneOn-goingDoneComoros

Planned PlannedPlanned On-going On-going DoneCongo

Done Done DoneDoneOn-going DoneChad

Planned On-goingOn-goingDoneDoneDoneCameroon

Planned On-going On-going DoneOn-goingDoneBurkina Faso

Planned DraftDraftDoneDoneDoneAfghanistan

HRH Operational plan

HRH policy / strategic plan

HRH situation analysis

HRH coordination structure

Stakeholder analysis

CCF orientation

Country

The Roadmap: Kampala Declaration The Roadmap: Kampala Declaration

and Agenda for Global Actionand Agenda for Global Action

1. Building coherent national and global leadership for HW solution

2. Ensuring capacity for an informed responsebased on evidence and joint learning

3. Scaling up education and training

4. Retaining an effective, responsive and equitably distributed health workforce

5. Managing pressures of the international health workforce market and its impact on migration

6. Securing additional and more productive investment in the health workforce

Global health workforce crisis and health outcomes

Lower health service coverage

Higher mortality rate and disease burden

Fewer health workers

Lower macro economic outcome

What is “Country Coordination and

Facilitation” (CCF)?� CCF is a process that brings key stakeholders on one

table to develop and implement an evidence-based, comprehensive and costed HRH plan.

� CCF accelerates country actions for resolving the HRH crisis.

� In-country partnership involves all key stakeholders: ministry of health, ministry of education, ministry of labour, ministry of finance, private sector, professionalassociations, NGOs, and development agencies, etc.

Way forward

Continue catalytic support to crisis countries to strengthen HRH coordination processes involving the Alliance members

Support the countries' development of evidence-based, comprehensive and costed HRH plans

Continue advocacy and facilitation for engagement of the partners in financing the countries' HRH plans

Generate evidence-base on the effectiveness of investments in HRH and improved co-ordination

URL: http://www.who.int/workforcealliance/en/

Health Workers for All and All for Health WorkersHealth Workers for All and All for Health Workers

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