g. elzinga who, geneva 14 - 02 - 2005
DESCRIPTION
G. Elzinga WHO, Geneva 14 - 02 - 2005. Who cares?. Life Expectancy: Advancing and Slipping. Differences in health increase within countries and between countries. WHY CAN’T WE COPE?. HEALTH WORKFORCE PROBLEM. Joint Learning Initiative. Diagnosis (The Lancet, 27-11-2004). - PowerPoint PPT PresentationTRANSCRIPT
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G. ElzingaWHO, Geneva14 - 02 - 2005
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Who cares?
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Life Expectancy: Advancing and Slipping
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Differences in health
increase within countries
and between countries.
WHY CAN’T W
E COPE?
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HEALTH WORKFORCE PROBLEM
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Joint Learning Initiative
Diagnosis (The Lancet, 27-11-2004)
Global Health Workforce cannot
cope with global health crisis;
SSA hit hardest
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The Glue of the Health System
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migration
training
Sky full of HRH “challenges”
V&Hdilemma’s
productivity over-burdening
workconditions quality
distribution
number
honorarium
manage-ment
HIV/AIDS
statuscarrierperspective
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PROVIDING HEALTH IN POVERTY
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Program of
prevention and/or care
interventions to
controla
specific health-
problem.
V
Infrastructure of prevention - and care services to cope with the prevailing health problems.
H
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VH
V
HVertical-horizontal indeveloping countries
Vertical-horizontal indeveloped countries
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Program Macrostructure
MEIS
PC
Vintervention
strategymonitoring en
evaluation
preventionand/or care
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Differences between countries (polio)
MEIS
PC
MEIS
PC
MEIS
PC
General health services
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Differences between programspolio
MEIS
PC
TB
MEIS
PC
3x5
MEIS
PC
malaria
MEIS
PCGeneral health services
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Vertical programs: who is doing what?
Intervention Strategy
Monitoring/ Surveillance
Prevention/care
international
national
HRH required
district
facility
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HRH dilemma ?
V H
HRH synergy !
&
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RESEARCH CONTRIBUTIONS TO HEALTH WORKFORCE STRENGTHENING
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Health systems and workforces are ‘man-made’
Research outcomes depend more on time and place than those of biomedical research.
However, research is not second rate: Relevance: crucial to reach health outcomes and
cost contaiment Intellectually: methodology often quite
demanding because of complexities
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SPECIFIC
GENERIC
2 VALUABLE ‘RESEARCH’ LAYERS
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SPECIFIC
POLICYCYCLE
analysis
M&E planning
implementation
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LEARNING FROM RESEARCH
GENERIC
POLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&ePOLICYCYCLE
a
p
i.
m&ePOLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&e POLICYCYCLE
a
p
i.
m&e
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BY RELATINGDIFFERENCES TO
OUTCOMES
GENERIC
POLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&ePOLICYCYCLE
a
p
i.
m&ePOLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&e
POLICYCYCLE
a
p
i.
m&e POLICYCYCLE
a
p
i.
m&e
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socio-political contexthealth systemhealth workforceHRHTB/HIV
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socio-political context
health system
health workforce
HRHTB/HIV
ROLE OF HRHTB/HIV RESEARCH
supporter
facilitator
contributor
participator
stimulator
initiatorPriorities?
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PC
IS MESimplification• less time/patient• lower cadres
Time/Cost-effectiveness(of intervention(s) and system)• less time/patient• more work satisfaction
HIV/AIDS&TB
Optimisation(Integration; IT ?)• less time• higher quality
“INITIATOR” PRIORITIES
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socio-political context
health system
health workforce
HRHTB/HIV
ROLE OF HRHTB/HIV RESEARCH
initiator
participator
stimulator
contributor
facilitator
supporterPriorities?
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Policy truths
Economic growth cu
res povert
yHealth Care is a cost not a profit
Thus, keep health expenditure low!
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Social realitiesPoor populations havehigh disease burdens They therefore need
more health serviceswhile they can infact afford less.
Health belowa critical state tends
to deteriorateHIV/AIDS & TB/HIV
can push health below thatcritical state, causinglife expectancy to fall,
the labor force to falter, and social costs to sore!
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EXAMPLES OF “SUPPORTER” PRIORITIES
WHAT REALISTIC INTERVENTIONS CAN COUNTER
MIGRATION OF HEALTH WORKERS?
WHEN DOES HEALTH CARE CHANGE FROM COST TO INVESTMENT?
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Thank you
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Worker density by region
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socio-political context
health system
health workforce
HRHTB/HIV
ROLE OF HRHTB/HIV RESEARCH
initiator
participator
stimulator
contributor
facilitator
supporter
Priorities?
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Community Referral Centre
“ESSENTIAL PRIMARY CARE” FUNCTION
AVAILABLE 1 PER ?000ACCESSIBLE < .. HOURSAFFORDABLE < . . % INCOME
Tuberculosis
M&C health
Malaria
HIV-AIDS
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POLICYCYCLE
analysis
M&E planning
implement.
• Cost-effectiveness calculations of approach.
• Methodology to determine availability,
accessibility, affordability of EPF
• Controlled study of cost- and time
effectiveness of approach.
• Etc.
“PARTICIPATOR” PRIORITIES
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MDG’s countries
donors High level forum WHO
Worldbank NGO’s
UNDP Post JLI ILO
Technical agencies Foundations
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ILOPost JLI
Foundations
MDG’s countries
donors High level forum WHO
Worldbank NGO’s
UNDP
Technical agencies
THANK YOU
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ed. & tr.
community
global policies
population health
need supplyhealth workforce
h e a l t h s y s t e m
national policies
demand
HIV-AIDSMigration
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Een HRH dilemma ?
burden of disease is higher in
poor environments
V+ development requires adequate
general health services
H+