INCENTIVES TO SUPPORT HUMAN INCENTIVES TO SUPPORT HUMAN RESOURCES FOR HEALTH (HRH), RESOURCES FOR HEALTH (HRH), RETENTION, PRODUCTIVITY, AND RETENTION, PRODUCTIVITY, AND EQUITABLE DISTRIBUTIONEQUITABLE DISTRIBUTION

Lalitha Mendis, Indika Karunathilaka, and Lalitha Mendis, Indika Karunathilaka, and Hiranthi de SilvaHiranthi de Silva

AAAH Conference, Bangkok, October 28-31 AAAH Conference, Bangkok, October 28-31 20062006

Sri LankaSri Lanka Surface areaSurface area 62,7 million sq km 62,7 million sq km

KMKM PopulationPopulation 19.2M19.2M Health BudgetHealth Budget 3.8% GDP3.8% GDP Health IndicesHealth Indices

Life ExpectancyLife Expectancy 73 years 73 years Infant Mortality/1000 live births 11.2Infant Mortality/1000 live births 11.2 Maternal Mortality /10,000 live birthsMaternal Mortality /10,000 live births 1.91.9 Under 5 yr mortality/1000 live births 16.3Under 5 yr mortality/1000 live births 16.3

Health Work force Health Work force 100,000100,000

MAIN PROBLEMS RELATING TO HRHMAIN PROBLEMS RELATING TO HRH

Insufficient numbers in some categoriesInsufficient numbers in some categories MaldistributionMaldistribution MigrationMigration

InternationalInternational Rural to urbanRural to urban Public to private sectorPublic to private sector

Lack of clear health policyLack of clear health policy Lack of proper management information Lack of proper management information

systemsystem Lack of modern management systemLack of modern management system

As at 2006 & 2010 projectionAs at 2006 & 2010 projection

55.2 Drs per 100,000 population i.e. one Dr per 1811 55.2 Drs per 100,000 population i.e. one Dr per 1811 people.people.

(By 2010 it should increase to 90.5 Drs per 100,000 (By 2010 it should increase to 90.5 Drs per 100,000 i.e. I Dr per 1100 persons)i.e. I Dr per 1100 persons)

4.3 specialists per 100,000 population i.e. 4.3 specialists per 100,000 population i.e. One One Sp per 23,000Sp per 23,000 persons persons

(By 2010 we should have 10.8 sp per 100,000; (By 2010 we should have 10.8 sp per 100,000; i.e. 1 sp per 9000 persons)i.e. 1 sp per 9000 persons)

2.8 GPs per 100,000 population i.e. 2.8 GPs per 100,000 population i.e. GP per 35,000 GP per 35,000 persons.persons.

6.2 dentists per 100,000 pop. i.e. 1 dentist per 16,000 6.2 dentists per 100,000 pop. i.e. 1 dentist per 16,000 persons.persons.

DOCTORS PER 100,000 DOCTORS PER 100,000 POPULATIONPOPULATION

Drs per 100,000 55.2 Drs per 100,000 55.2 90.5 90.5

Sri lankaSri lanka

Global average Global average 170 / 100,000 170 / 100,000 populationpopulation

South Asian average South Asian average 40 +40 + Sri LankaSri Lanka 55.2 55.2 BangladeshBangladesh 2323 IndiaIndia 5151 NepalNepal 0505 PakistanPakistan 6666 MalaysiaMalaysia 67.267.2

Medical Laboratory

Technologists

Radiographers Physiotherapists ECG Recordists EEG Recordists

No. Rate No. Rate No. Rate No. Rate No. Rate

871 4.6 342 1.8 219 1.2 158 0.8 37 0.2

Rate per 100,000 population

Source : Annual Health Bulletin 2002 Medical Statistics Unit

Allied Health Professionals in SL, September 2002

NURSESNURSES

CadreCadre 36,000 36,000 Available 197000Available 197000 In Training 8000In Training 8000

ProvinceProvince

Non Non speciaspecia

lstlst Dr Dr /100,0/100,000 Pop00 Pop

SpecialistSpecialistDR/ DR/ 100,0100,0

00 00 poppop

Number of Number of GPsGPs

Population Population density density (persons (persons per sq. KM per sq. KM 2002)2002)

Rural & Rural & EstateEstate

Doctors per 100,000 Population

WesternWestern 51.451.4 77 441441

(79.6%)(79.6%)1,5151,515 68%68% 71.371.3

SouthernSouthern 3636 3.73.7 3232 427427 88.5%88.5% 43.843.8

Sabara’Sabara’ 29.429.4 3.23.2 1212 367367 34.834.8

CentralCentral 44..244..2 44 2525 437437 88.6%88.6% 52.452.4

N.WestN.West 32.132.1 2.52.5 3636

(6.5%)(6.5%)291291 95%95% 37.437.4

UvaUva 30..230..2 33 22 142142 92.5%92.5% 35.535.5

N.CentrN.Centr 3636 3.53.5 22 115115 95%95% 40.440.4

NorthNorth 3131 3.23.2 22 126126 90%90% 30.730.7

EastEast 24.524.5 2.32.3 22 154154 7979 30.530.5

Sri lankaSri lanka 38.538.5 4.34.3 554554 302302 ???? 55.255.2

Undergraduate Medical EducationUndergraduate Medical Education FreeFree 8 medical Schools8 medical Schools ? Impending glut of doctors? Impending glut of doctors

Postgraduate Medical Education (PGIM)Postgraduate Medical Education (PGIM)

Compulsory year of overseas TrainingCompulsory year of overseas Training

Both undergraduate and postgraduate medical Both undergraduate and postgraduate medical education by Ministry of Higher Educationeducation by Ministry of Higher Education

Loss of Postgraduate Trainees who Qualified MD/MS Loss of Postgraduate Trainees who Qualified MD/MS from 1993 to 2000from 1993 to 2000

Time Period Time Period 1993-19961993-1996 1997-20001997-2000

Number who Number who qualified with qualified with MD/MSMD/MS

302302 524524

Number who left Sri Number who left Sri Lanka after MD/MSLanka after MD/MS

3939 146146

Percentage Loss Percentage Loss 13%13% 28%28%

Highest Highest LossesLossesPsychiatryPsychiatry 33%33% 56%56%

Dental SurgeryDental Surgery 33%33% 50%50%

Anesthesiology Anesthesiology 26%26% 37%37%

Opthalmology Opthalmology 25%25% --

MedicineMedicine 28%28%

Microbiology Microbiology -- 29%29%

PaediatricsPaediatrics -- 28%28%

SurgerySurgery -- 34%34%

Training of Nurses and AHPTraining of Nurses and AHP By Ministry of HealthBy Ministry of Health

RecentlyRecently 4 universities have begun BSc 4 universities have begun BSc

coursescourses

What Non Financial Incentives are What Non Financial Incentives are possible to populate the provinces with possible to populate the provinces with

HCWs that they need HCWs that they need

Improve living conditions of housing, and Improve living conditions of housing, and accommodationaccommodation

Schooling for children by ensuring places for Schooling for children by ensuring places for children in closest & good urban schools (army has children in closest & good urban schools (army has this arrangement)this arrangement)

Provide car loans and housing loansProvide car loans and housing loans

Provide good working conditions that satisfy their Provide good working conditions that satisfy their professional conscious & good job satisfaction and professional conscious & good job satisfaction and enable them to use the skills that they have learnedenable them to use the skills that they have learned

Work out a credit and reward system for working in Work out a credit and reward system for working in difficult areasdifficult areas

What Non Financial Incentives are What Non Financial Incentives are possible to populate the provinces with possible to populate the provinces with

HCWs that they need HCWs that they need

Limit the period spent in difficult areas to a Limit the period spent in difficult areas to a minimumminimum

Offer the incentives of recruitment in services to Offer the incentives of recruitment in services to those in different areas as the understanding they those in different areas as the understanding they will serve in that area for a specific period of time will serve in that area for a specific period of time

The ministry could inspire more confidence in the The ministry could inspire more confidence in the system –that is worker friendly, efficient, non-system –that is worker friendly, efficient, non-political, fair and firm.political, fair and firm.

For this the ministry needs a good management For this the ministry needs a good management information system. For lack of this and due to information system. For lack of this and due to political manouvering some remain in urban political manouvering some remain in urban areas for long period of time. areas for long period of time.

INCREASING MOTIVATION AND INCREASING MOTIVATION AND PERFORMANCEPERFORMANCE

Performance based salary Performance based salary increments and promotionsincrements and promotions

Improve social prestige & imageImprove social prestige & image

Reward good workReward good work e.g. opportunities e.g. opportunities for post-basic training in country or for post-basic training in country or overseasoverseas

ADDRESSING THE HRH PROBLEMADDRESSING THE HRH PROBLEM

ROLE OF MINISTRY OF HEALTHROLE OF MINISTRY OF HEALTH Human Resource Unit in Ministry of Human Resource Unit in Ministry of

healthhealth Research the problemResearch the problem Evidence based solutionsEvidence based solutions Clear and transparent policiesClear and transparent policies

POSSIBLE ROLE OF WHO AND GHWAPOSSIBLE ROLE OF WHO AND GHWAAdvocacyAdvocacyFund ResearchFund Research

Thank youThank you