Post on 30-May-2018
transcript
8/14/2019 Seble PPTs
1/19
1
Human Resources for Maternal
Health and Task-Shifting
January 6th, 2010
Woodrow Wilson Center
Washington, DC
Seble Frehywot MD, MHSA
Assistant Research Professor of Health Policy and Global HealthThe George Washington University
8/14/2019 Seble PPTs
2/19
2
Outline
Current Human Resources for Health (HRH) status formaternal health
Types of task shifting
Regulation of task shifting and expanded service roles
Key lessons learnt from the "WHO Task-shifting
Recommendation and Guidelines
Key future challenges and strategies
8/14/2019 Seble PPTs
3/19
3
World Workforce & Health Status:
The Global Picture
SOURCE: JLI 2004./ WHO 2006 World Health Report
< 23 HCP/10,000 unlikely to achieve MDG
2 physicians/10,000
11 nurses and
mid wives/10,000
8/14/2019 Seble PPTs
4/19
4
Maternal Mortality Ratio (per 100,000 live
births) and Regional Averages
Source: WHO (2005). The World Health Report 2005 Make Every Mother and Child Count. Geneva, World Health Organization
Source: for Regional Averages : WHO: World Health Statistics 2009
AFRO
900
SEARO
450
AMR
O
99
EMR
O
420
WPR
O
82
EURO
27
The average global Maternal Mortality Ratio of 400 maternal death
per 100,00 live births in 2005 has barely changed since 1990.
Source: for Regional Averages : WHO: World Health Statistics 2009
8/14/2019 Seble PPTs
5/19
5
Global Causes of Maternal Mortality and
the Need for Skilled Workforce
Hemorrha25%
Infectio
15%
Ec lamp s i
12%
Obs tructed La
7%
Unsafe Abo rti
13%
Other Direct Ca u
8%
Indirect Cau s
20%
Source: World health Report, 2005
**Good quality maternal health services
are not universally available
and accessible
** > 35% receive no
Antenatal Care
** ~ 50% of deliveries unattended
by skilled provider
** ~ 70% receive no postpartum care
during 1st 6 weeks following delivery
8/14/2019 Seble PPTs
6/19
6
Health Workers Save Lives
8/14/2019 Seble PPTs
7/19
7
Too Many Preventable Deaths!!...
Source: WHO (2005). The World Health Report 2005 Make Every Mother and Child Count. Geneva, World Health Organization
Source: for annual numbers : WHO: World Health Statistics 2009
Annually,
536,000women
die of pregnancy related
complications
99% in developing countries
(1 per minute)
~ 1% in developed
countries
8/14/2019 Seble PPTs
8/19
8
Task Shifting Types
Task shifting I
Task shifting II
Task shifting III
Task shifting IV
Specialized Physicians
Doctors
Non-physician clinicians(clinical officers, health officers)
Registered Nurses
& nurse mid-wives
Nursing
Assistants&
CommunityHealth Care
Worker
Enrolled nurses
Expert Patients
REGULATIONSupervision, Delegation,
Substitution,Enhancement, Innovation
Task shifting 0
8/14/2019 Seble PPTs
9/19
9
Expanded Service Roles (ESR)(Example TS I)
Medical Doctor Non-physician Clinicians(e.g. AMO, Clinical Officers, Health Officers)
Diagnostic, Prescriptive
Case Treatment andManagement Authority
Delegation or
Supervision
Pre-service trainingcoupled
with additional in-
service
training
Expanded Service Roles
(ESR)SOP include:
Medical care and management, OBGYN (C/S),minor Surgery, Anesthesia,
Orthopedics, Ophthalmology,
Dermatology etc.
Regulatory
Fram
ework
8/14/2019 Seble PPTs
10/19
10
Expanded Services Role (ESR)
TS0 and TS I
ESR from specialists to GPs
- C/S, management of complicated cases
ESR and NPCs
- C/S, management of complicated cases
Matching tasks needed with competency
Review of curricula to reflect the need on the ground
Buy-in from professional associations
8/14/2019 Seble PPTs
11/19
11
Expanded Services Role (ESR)
TS IIITBA, CHWs
Traditional Birth Attendants---Community based, community women comfortable with them
Limited technical skills
Need adequate training, supervision and supplies
Tasks--ESR
Antenatal care
- Risk screening..train to identify risk cases earlier on and refer to higher care site
- Motivate/empower not to keep women away from life-saving interventions due to
false reassurance
8/14/2019 Seble PPTs
12/19
12
Scope of Practice &
Competencies
Standards of Care
Standard Pre-Service
Education & TrainingLicensing &Registration &
Certification
Standard
In-Service Training &
Certificate
Recruitment, Deployment,
Promotion, Salary, &
Other HR Issues
Working Conditions
Supervision/Mentoring& Accountability
Health CareWorkers
Financing &
Sub-national
Implementation
1
2
3
4
5
6
7
8 9
Professional
Councils
MOH
ProfessionalPractice Acts
Professional Councils,
Professional Associations,
MOH
Normative Bodies (WHO)
MOE, MOH
Training Institutions,
Professional Councils,
Professional AssociationsProfessional Councils, MOH
MOH. MOE,
Training Institutions,
Professional Councils
Professional Associations
Public Service
Agency,MOH,MOF, IMF,
Local Government,
Professional Association
MOL, ILO,MOH,
Professional Association,
Local Government
MOF, Local Government,
MOH, IMF, WB
Professional Council, MOH,
Other Health Care Providers
Maternal Health
Treatment and Care
Policies & Guidelines
Labor Policies
Regulating HCWs and Who is Involved?
Decentralization Policy
Civil Service Policies
8/14/2019 Seble PPTs
13/19
13
Types of Regulation
Laws and statutes
Regulations
Guidelines
General and specific maternal health care provider policies
Program guidance
8/14/2019 Seble PPTs
14/19
14
Why Develop A Regulatory Framework?
To build national and international support and commitment
To ensure quality and safety in the delivery treatment, care and preventionwhile task-shifting occurs
To promote the sustainability of task-shifting/task-reallocation practices Legal conditions and rights of practice Hiring and promotion policies and procedures Standardize remuneration and salaries
To guide the development of standardized education and training programs
to support task-shifting/task-reallocation
8/14/2019 Seble PPTs
15/19
15
Lessons from the "WHO Task-shifting
Recommendation and Guidelines?
Adaptability of the TS R&G to other issues
Outlining/identifying task
Matching task with competency
Creating optimal skill mix
Developing regulatory framework to ensure quality and
safety of care and services
8/14/2019 Seble PPTs
16/19
16
Challenges and Strategies
Not enough HCWs
No optimal skill-mix at different care-site levels
Competency not matching need on the ground
Buy-in for revision of curricula
Creating critical mass and retaining faculty/supervisors at different levels---quality/supervision
Decentralizing targeted tertiary care to District Hospitals
Retaining needed HCWs in needed geographical areasretention and motivationpolicies
8/14/2019 Seble PPTs
17/19
17
Policies need to address interventions at needed levels
Regional Referral Hospitals
also calledTertiary Care Centers
Health Centers (Type A and B)also called
Primary (First)-Level Health Care Facilities
or
Health Clinics
District Hospitalsalso called
Second-Level Health Care Facilities
orFirst-Referral Level Facilities
SOURCE: WHO (2005): WHO Recommendations for Clinical Mentoring to Support Scale-up Of HIV Care, Antiretroviral Therapy
and Prevention in Resource-Constrained Settings.
Health PostsAlso called
Health Houses
CONCE
NTR
ATE
ON
THESE
3
8/14/2019 Seble PPTs
18/19
18
Pregnancy is NOT a Disease
Global initiatives to scale up health workforce
The Question is
Whom to train?
Where will they be trained?
How will they be trained?
What will they be trained for?
To work where will they be trained?
How will quality & safety of service be ensured?
How will they be retained in needed areas?
8/14/2019 Seble PPTs
19/19
19
Pregnancy is NOT a Disease
There is a tide in the affairs of (wo)men
which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their lifeIs bound in shallows and in miseries.
On such a full sea are we now afloat;
And we must take the current when it serves,
or lose the ventures before us. William Shakespeare, Julius Caesar