What are the workforce implications of UHC?
Briefing to MoHMETeheran, 15 September 2014
James Campbell, Director Health Workforce, WHO
Executive Director, Global Health Workforce Alliance
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Time to “rethink and improve”...
“The foundations for a strong and effective health workforce for the future are being corroded in front of our very eyes by failing to match today’s supply of professionals with the demands of tomorrow’s populations.
To prevent this happening, we must rethink and improve how we teach, train, deploy and pay health workers so that their impact can widen.”
Dr. Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation.
“Global health workforce shortage to reach 12.9 million in coming decades”http://www.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/
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HRH for UHC
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Overview
Campbell J, Dussault G, Buchan J, Pozo-Martin F, Guerra Arias M, Leone C, Siyam A, Cometto G.
A universal truth: no health without a workforce.
Forum Report, Third Global Forum on Human Resources for Health, Recife, Brazil. Geneva, Global Health Workforce Alliance and World Health Organization, 2013.
Campbell J, Dussault G, Buchan J, Pozo-Martin F, Guerra Arias M, Leone C, Siyam A, Cometto G. A universal truth: no health without a workforce. Global Health Workforce Alliance and World Health Organization, 2013.
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Human resources for health: global challenges, global opportunities
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Estimates of shortages and deficits
Global health workforce shortage to reach 12.9 million in coming decades
11 November 2013 | RECIFE, BRAZIL - The world will be short of 12.9 million healthcare workers by 2035; today, that figure stands at 7.2 million. A World Health Organization (WHO) report released today warns that the findings - if not addressed now - will have serious implications for the health of billions of people across all regions of the world.
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Different estimates of shortage and deficits
ILO – World Social Protection Report (2014)
The ILO estimates that at least 41.1 health workers per 10,000 population are necessary to provide services to all in need. The figure is based on calculations of median values of the density of health workers in countries where socio-economic conditions and health financing characteristics are conducive to universal coverage.
http://www.ilo.org/global/research/global-reports/world-social-security-report/2014/lang--en/index.htm
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The Recife Declaration and WHA67.24
Recife Political Declaration (Third Global Forum on HRH,
Brazil, November 2013)
"We as leaders are committed to attaining universal health coverage and recognize that we need an improved health workforce to achieve it. …We commit to addressing transnational issues and work towards strengthening health systems, including global HRH governance and mechanisms."
WHA Resolution 67.24 (World Health Assembly,
Geneva, May 2014)
"The Sixty-seventh World Health Assembly ENDORSES the call to action in the Recife Political Declaration; … REQUESTS the Director-General to develop and submit a new global strategy for human resources for health for consideration by the Sixty-ninth World Health Assembly."
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Towards a global HRH strategy: key objectives and principles
Impactful strategy
accelerating HRH action at
national, regional and global levels in the post-2015
period.
Make relevant to needs
of all countries.
Build on evidence and best practicesInclusive,
participatory and
transparent consultation
process
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2013 2014 2015Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb
Nov
201
3
Jan
2014
3rd Global Forum on HRH:Recife Political DeclarationGHWA Board:HRH Strategy development decision
WHO Executive Board 134:Recife Political Declaration on HRH (EB134/55)
Towards a Global Strategy on Human Resources for Health - OVERVIEW
May
201
4 67th World Health Assembly:Resolution on Recife Political Declaration on HRH gives WHO mandate to develop global HRH strategy
July
201
4
GHWA Board:Progress review ‘Global Consultation’ & emerging findings
24-2
9 Se
pt 2
014 UNGA
High-Level Meeting:Post-2015 develop-ment agenda
30 S
ept –
03
Oct
201
4
3rd Global Symposium on HSR:Cape Town – Global Consultation on HRH broadened
Jan
2014
Prince Mahidol Award Conference:Transformative education for health equity
Mar
201
4
GHWA: Formation of 8 “Thematic working groups” to collate HRH evidence‘Global Consultation on HRH’ begins
Global Consultation on HRH
GHWA Board:Adopts recommendations on global HRH strategy
AAAH Conference:Consultations on global HRH strategy27
-31
Oct
201
4
Feb
2015
GHWA synthesis paper reflecting outcome of Global ConsultationN
ov 2
014
– Ja
n 20
15
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2015 2016Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
Towards a Global Strategy on Human Resources for Health – OVERVIEW (continued)
May
201
6 69th World Health Assembly:Considers Global Strategy on HRH
UNGA High-Level Meeting:Post-2015 development agenda adopted
Jan
2015
Prince Mahidol Award Conference: global health post-2015
Sept
- O
ct 2
015 WHO
Regional Committee Meetings:Member States consultations at regional level on global HRH strategy
Sep
2015
Ongoing collation of evidence and consultation opportunities
GHWA Board:Adopts recommendations on global HRH strategyF
eb 2
014
Feb-
May
201
5 WHO global HRH strategy:Draft contents of WHO strategy on HRH developed (considering recommendations of GHWA consultation process)
Oct
201
5
Contents of global strategy on HRH adapted to reflect consultations of WHO Regional Committees and outcome of UNGA 2015
Jan
2016 WHO Executive
Board:Considers draft Global Strategy on HRH, review of effectiveness of WHO Code of Practice on International Recruitment Health Personnel, progress reports on HRH resolutions WHA64.7, WHA64.7, WHA66.23
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in support of UHC – WHR 2010
The basic messages:
1. Population coverage with needed health services
2. Coverage with financial protection
The emerging agenda….
“Effective Coverage” of the “needed” health services (R2H; burden; forecasts)
Coverage with financial protection – skills/capacity to manage/administer
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Health labour markets - AAAQ - UHC.
Sousa et al, Bulletin WHO. November 2013 (adapted from Vujicic & Zurn, 2006)
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Effective coverage
workforce is AVAILABLE?
workforce is ACCESSIBLE?
workforce is ACCEPTABLE?
workforce provides QUALITY CARE?
AVAILABILITY ACCESIBILITY ACCEPTABILITY
QUALITY
• A midwife is available in or close to the community
• As part of an integrated team of professionals, lay workers and community health services
• Woman attends
• A midwife is available
• As needed
• Financial protection ensures no barriers to access
• Woman attends
• A midwife is available
• As needed
• Providing respectful care
• Woman attends
• A midwife is available
• As needed
• Providing respectful care
• Competent and enabled to provide quality care.
CRUDE COVERAGE EFFECTIVE COVERAGE
Source: Campbell J. SoWMy 2014
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The health workforce implications?
Population
People-centred, integrated Services (AAAQ)
Financial protection
A
B
Where are you now?
Where do you want to be?
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The context in Iran?
Population
Financial protection
A
B
Where are you now?
Where do you want to be?
People-centred, integrated Services (AAAQ)
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Workforce intelligence
Country Briefs – Page 1 (2012) 150-word text, guiding the reader through key messages in the brief
1
Provides overview of ‘need’ for RMNH care across the continuum. #visits linked to WHO protocols/guidelines
2
Availability - who are the HCPs, what to they do, how much of the need do the cover at the moment.
3
Current status of education, regulation and association development/role.
4
Accessibility – financial perspective5
Accessibility – geographical perspective6
Country Briefs – Page 2 (to 2035)Projection of the need from 2012 to 20351
National agreed targets for maternal and newborn mortality and current status
2
Exits + entries = available staff through 2035. The actual projections
3
What if… a. start with less pregnancies because of better FP, then increase numbers of students, improve productivity and reduce attrition
4
Left – no additional effort – status quo scenarioRight – all the ‘what ifs’ implemented
5
Footnotes and country specific qualifications6