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
[Source] WHO. (2006). World Health Report 2006. WHO: Geneva.
� 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
:
Pre
-serv
ice
train
ing
Quality:
In-service train
ing
Pro
fessional d
ev’t
Recruitment
Deployment &distribution
Migration & retention
Accred
itation
Soci
al rec
ognitio
n
(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
[Source] WHO. (2006). World Health Report 2006. WHO: Geneva.
Accra
OuagadougouHanoi
Islamabad
San Salvador
and key HRH sensitization events
Cairo
Bangkok
Kampala
Abuja
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
MoL
Civil
society
MoF
Prof Ass’n
MoH
Private
Sector
MoE
National HRH committee
CCF
CC
FC
CF
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
Ac
cra
Ou
ag
ad
ou
go
u
Han
oi
San
Salv
ad
or
Isla
mab
ad
National HRH committee
Comprehensive costed HRH plan
2nd Global Forum
Strengthened Ab
uja
HRH as a complex “polyhedron”
Qua
ntity
:
Pre
-ser
vice
trai
ningQ
uality:
In-service training
Professional
dev’t
Recruitment
Deployment &distribution
Migration & retention
Accreditation
Soci
al rec
ogni
tion
(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
De
ve
lop
F
ina
nce
Implement
Mo
nito
r E
va
lua
te
Sta
ke
ho
lde
rs a
na
lys
is a
nd
id
en
tifi
ca
tio
n
Oth
er
HS
S c
oo
rdin
ati
on
me
ch
an
ism
s
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
21
14
43
0
5
10
15
20
25
Total Completed Under process Planned
Total Completed
Under process Planned
21
12
4 5
0
5
10
15
20
25
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
[Source] WHO. (2006). World Health Report 2006. WHO: Geneva.
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/
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