World Health Report 2006World Health Report 2006

Health workforce is importantHealth workforce is important

Health system : 3 MHealth system : 3 M ManMan**

MoneyMoney Material/TechnologyMaterial/Technology

Note * : ShortageNote * : Shortage

Health WorkersHealth Workers

Global health workforce’s situationGlobal health workforce’s situation

Amount : Amount : Shortage, Need-based sufficiencyShortage, Need-based sufficiency

Distribution : Distribution : Density, MigrationDensity, Migration

Diversity : Diversity : Gender/Tribe/AgeGender/Tribe/Age

Skill mixSkill mix Public-private mixPublic-private mix

Forces driving the workforce

Responding to urgent health needsResponding to urgent health needs

High priority services : MDGsHigh priority services : MDGs Burden of chronic diseases and Burden of chronic diseases and

injuriesinjuries Natural disasters and outbreaksNatural disasters and outbreaks Working in conflict and post Working in conflict and post

conflict environmentsconflict environments

Challenges:Challenges: MDGsMDGs Epidemics of in-service training Epidemics of in-service training Overburdened district staff Overburdened district staff Two tiers of salariesTwo tiers of salaries

Solutions:Solutions: Strategy 2.1 Scale up workforce planning Strategy 2.1 Scale up workforce planning Strategy 2.2 Capitalize on synergies across priority Strategy 2.2 Capitalize on synergies across priority

programmeprogramme Strategy 2.3 Simplify services and delegate appropriately Strategy 2.3 Simplify services and delegate appropriately Strategy 2.4 Secure the health and safety of health Strategy 2.4 Secure the health and safety of health

workersworkers

Challenges:Challenges: Preparing the workforce for the growing burden of Preparing the workforce for the growing burden of

chronic diseases and injuries chronic diseases and injuries New paradigms of care require a workforce New paradigms of care require a workforce

responseresponse

Solutions:Solutions: Strategy 2.5 Deploy towards a continuum of care Strategy 2.5 Deploy towards a continuum of care Strategy 2.6 Foster collaboration Strategy 2.6 Foster collaboration Strategy 2.7 Promote continuous learning for Strategy 2.7 Promote continuous learning for

patient safetypatient safety

Optimal mix of health services

Self-care

Informal community care

Health services through primary health care

Community

healthservices

Healthservices in

generalhospitals

Long-stayfacilities

andspecialistservices

Challenges:Challenges: Mobilizing for emergency needs: natural disasters and Mobilizing for emergency needs: natural disasters and

outbreaks outbreaks Preparedness plans can helpPreparedness plans can help

Solutions:Solutions: Strategy 2.8 Take a “command and control” approach Strategy 2.8 Take a “command and control” approach Strategy 2.9 Help remove sector boundaries Strategy 2.9 Help remove sector boundaries Strategy 2.10 Train appropriate health staff for emergency Strategy 2.10 Train appropriate health staff for emergency

response response Strategy 2.11 Develop an emergency deployment strategy for Strategy 2.11 Develop an emergency deployment strategy for

different kinds of health workers different kinds of health workers Strategy 2.12 Ensure adequate support for front-line workersStrategy 2.12 Ensure adequate support for front-line workers

Challenge:Challenge: Working in conflict and post-conflict environmentsWorking in conflict and post-conflict environments

Solutions:Solutions: Strategy 2.13 Obtain and maintain strategic information Strategy 2.13 Obtain and maintain strategic information Strategy 2.14 Invest in advanced planning and focused Strategy 2.14 Invest in advanced planning and focused

interventions interventions Strategy 2.15 Protect what works Strategy 2.15 Protect what works Strategy 2.16 Repair and prepare Strategy 2.16 Repair and prepare Strategy 2.17 Rehabilitate when stability beginsStrategy 2.17 Rehabilitate when stability begins

Preparing the health workforcePreparing the health workforce Working lifespan strategies

Getting the mix right: challenges to health workforce production

Pipeline to generate and recruit the health workforce

Functions of health educational institutions to generate the health

workforce

Relationship of education, labour and health services marketswith human resources

Making the most of Making the most of existing health workersexisting health workers

Human resource indicators to assesshealth workforce performance

Levers to influence the four dimensions

of health workforce performance

Exit routes from the health workforce

Managing exits from the workforceManaging exits from the workforce

MigrationMigration External migrationExternal migration

Source countrySource country Receiving countryReceiving country

Internal migrationInternal migration RetirementRetirement

External migration;External migration;

Source country strategiesSource country strategies

Strategy 5.1 Adjust training to need and Strategy 5.1 Adjust training to need and demands demands

Strategy 5.2 Improve local conditionsStrategy 5.2 Improve local conditions

External migration;External migration;Receiving country strategiesReceiving country strategies

Strategy 5.3 Ensure fair treatment of migrant Strategy 5.3 Ensure fair treatment of migrant workersworkers

Strategy 5.4 Adopt responsible recruitment Strategy 5.4 Adopt responsible recruitment policies policies

Strategy 5.5 Provide support to human Strategy 5.5 Provide support to human resources in source countriesresources in source countries

External migration;External migration;

International instruments International instruments

Strategy 5.6 Develop and implement tactics Strategy 5.6 Develop and implement tactics against violenceagainst violence

Strategy 5.7 Initiate and reinforce a safe work Strategy 5.7 Initiate and reinforce a safe work environmentenvironment

Internal migration;Internal migration;Challenge:Challenge: Change of occupation or work statusChange of occupation or work status

Solutions:Solutions: Choosing a reduced work weekChoosing a reduced work week Strategy 5.8 Accommodate workers’ needs Strategy 5.8 Accommodate workers’ needs

and expectationsand expectations

Internal migration;Internal migration;Challenge:Challenge: Health workers not employed in their fieldHealth workers not employed in their field

Solution:Solution: Strategy 5.9 Target health workers outside the Strategy 5.9 Target health workers outside the

health sectorhealth sector

Internal migration;Internal migration;Challenge:Challenge: Absentees and ghost workers Absentees and ghost workers

Solution:Solution: Strategy 5.10 Keep track of the workforceStrategy 5.10 Keep track of the workforce

Retirement;Retirement;Challenges: Challenges: Retirement rates and the risk of shortages Retirement rates and the risk of shortages Health workforce ageingHealth workforce ageing

Solution:Solution: Strategy 5.11 Develop the capacity and policy Strategy 5.11 Develop the capacity and policy

tools to manage retirementtools to manage retirement The need for knowledge transfer The need for knowledge transfer Strategy 5.12 Develop succession planningStrategy 5.12 Develop succession planning

Formulating Formulating national health workforce strategiesnational health workforce strategies

Building trust and managing expectations Fair and cooperative governing Strong leadership Strengthening strategic intelligence Investing in workforce institutions

Organizations influencing the behavior ofhealth workers and the health institutions

Professional organizations:Self regulations of entry

And market rules throughCodes of ethics, sanctions,

Training, role models

Institutional regulators:Administrative measures,

funding mechanisms,employment and contracts

managed by state,social health insuranceor similar institutions

The behaviorof health care institutions

and health workers

Civil society organizations:Protection of the interest of

citizens by: empowering users,functioning as watchdogs,

setting policy agenda

The country strategies

1. Build national strategies out of concrete action points that cover

management of entry, workforce and exit as well as: building or rebuilding trust; multi-stakeholder management of the regulatory environment; and

leadership capacities.

The country strategies

2. Pay attention to the process. The choices to be made may be difficult and controversial: it is essential to

ensure procedural fairness by being inclusive and transparent, but

with the courage to arbitrate when vested interests are taking over.

The country strategies

3. Strengthen strategic intelligence, focusing on: (i) understanding the extent and

nature of health workforce problems; (ii) evaluating what is being done and

determining what can be done; (iii) identifying the political drivers that led to

the current situation; (iv) understanding workers’ viewpoints and

anticipating their possible reactions to change.

The country strategies

4. Build the country’s health workforce institutional capacity, with a focus on regulation, leadership and strategic

information, including: (i) analysis and evaluation of microinnovations(ii) scenario building and planning for the future

Working together for healthWorking together for health, , within and across countrieswithin and across countries

Country LeadershipCountry Leadership

Global SodalityGlobal Sodality

Ten-year plan of action

Global stakeholder alliance