Challenges and Strategies: Public Health Education and Training of Human Resources

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Challenges and Strategies Public Health
Education and Training of Human Resources

• Dr Mubashar Sheikh
• Executive Director
• Global Health Workforce Alliance
• 12th World Congress on Public Health
• Istanbul, Turkey, 28 April 2009

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Millennium Development Goals at Midpoint

• This year mark half way point in the efforts to
  achieve the Millennium Development Goals (MDGs)
  by 2015.
• Assessment of the MDGs at midpoint presents a
  mixed picture, one of both significant progress
  and formidable challenges.
• There is considerable variation across regions
  and countries.
• While many developing countries are making
  impressive progress toward the MDGs, many others
  are falling behind.
• Assessment at the MDGs halfway point shows a
  clear, urgent need to accelerate progress and
  make it more inclusive.

Source MDG progress various internet sources
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Projected deaths by cause for high-, middle, and
low-income countries
Source World Health Statistics, WHO, 2008
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Public Health New Challenges

• Unequal growth, unequal outcomes
• Adapting to new realities
• A globalized, urbanized and ageing world
• Transformed relations between citizens,
  professionals and politicians
• Factors that undermine the health systems
  response
• Hospital-centrism
• Fragmentation
• Commercialization
• Epidemiological, socio-economic and demographic
  transitions
• Conflicts and emergencies

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Time Trend of Natural Disasters1975 - 2005
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Changing Values andRising Expectations

• Health services as a commodity
• Greater health equity and solidarity
• Care that puts people first
• Securing the health of communities
• Protection from emerging health problems
• Health governance and transparency
• Participation and coordination

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The heart of the response

• Health workers are the cornerstone and drivers of
  health systems

Health system performance
Adequate Health workforce
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Health Workers Availability Comparison of WHO
Regions
Source JLI 2004.
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Global Agenda

• To train, deploy and retain motivated,
  skilled and supported health workers (over 59
  million existing and 4.3 million additional
  required) who can deliver the appropriate,
  affordable and equitable packages of health
  services (including in emergencies)

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Responding to Public Health Challenges

• Traditional methods will not work (going beyond
  the bio-medical models)
• New approaches to produce
• Health leaders
• Advocates
• Negotiators
• Communicators
• Multi-tasked and multi-functional
• Representatives and oriented of local communities
• Team players consensus builders
• Responsive and accountable

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Life Span Approach toHealth Workforce
Lifespan approach need to be incorporated into
HRH policies, Education, training and management
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Strategies for Education and Training Health
Workforce
Task shifting
Based on projected needs, considering contexts
like equity, access, quality, programme
requirements and others
Existing workforce
Skill mix
Continuous develop.
Scaling up
New workforce
Multipurpose HW
Essential categories
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Actions Needed

• Success factors
• Political commitment and good governance
• Evidence and need based planning
• Enabling environment
• Policy actions
• Setting a clear vision with short, medium and
  long term actions for education and training by
  all stakeholders
• Developing community, competency and team based
  curricula along with training trainers,
  increasing qualifies faculty, reducing attrition
  of teaching staff and students and maximizing
  use of existing facilities
• 3. Allocating funds to pre-service education and
  to achieve balance between pre-service education
  and in-service training, and develop equipped
  infrastructure

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Actions Needed

• 4. Building south-south, south-north and
  public-private partnerships to
• Develop expertise and knowledge in public health,
  basic sciences and management
• Create centers of excellence
• Deliver innovative education and training based
  on BOD
• 5. Immediate priority to be given to a
  country-relevant expansion of education and
  training to increase community and mid-level
  health workers, alongside highly skilled staff
• 6. Agree and apply quality standards, appropriate
  regulatory framework and accreditation systems

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Role of Professionals Associations

• Active participation and support to governments
  (north and south).
• Multi-professional capacity development through
  national and international educational
  institutions.
• Developing national guidelines, training programs
  and regulatory framework for task shifting with
  Ministries of Health.
• Putting in place quality assurance mechanisms
  including accredited competency based training,
  licensing, supportive supervision and clinical
  mentoring.

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An Exciting and Challenging Time

• New tools, evidence and knowledge (SDH)
• Revitalization of PHC
• Expanded health architecture
• More political and financial commitments than
  ever
• Best practices and tangible progress in countries
• First Global Forum on Human Resources for Health

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New Opportunities and Initiatives
Political support
GHI/IHP
New tools guidelines
SDH
Public Private Partnerships
PHC
Kampala declaration AGA
Global Funds
GAVI
GHWA
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Iran Integration of Medical Education and
Health Services

• Increase in Medical Universities from 4 to 40
• Decentralization of health management system
• Increase in production of health workforce
• - Physicians from few thousand to 61,870,
  dentist to 13210, Pharmacist to 13900, and
  Nurses Midwifes 111107 (WHO-2006)
• Improvement in PHC coverage and health outcomes
• Promoted health research on PHC / Population
  Health Labs
• Improved referral system / technical support to
  PHC

Source Evaluation of Integration of Medical
Education and Health services, 2006
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Brazil Scaling-up Through PHC

• The strategy to reorganize primary health care
• Family health strategy (a group of health
  professionals based locally with a local
  community with approx. 4,000 individuals)
• Community health workers form a critical part of
  this strategy and are the bridge between the
  health professionals and the communities they
  serve
• More than 28,000 family health teams developed by
  now
• Of 5,564 municipalities, more than 90 have at
  least 1 family health team

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Pakistan National Program for Family Planning
and Primary Health Care

• Initiative by Government of Pakistan in 1994
• A new cadre of Community Health Workers (Lady
  Health Workers).
• in parallel with an expansion of other categories
  of health professionals
• Trained for 3 months, with in-service continuous
  education for 12 months
• One LHW for 200 households or 1000 population
• Establishing health houses one dedicated room
• By 2007, strength increased to 100,000

Health house in one room of LHWs home
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Ethiopia Health Extension Program

• 30,000 new Health Extension Workers (HEWs)
  trained
• Training of trainers with 700 faculty members
  trainers
• 5000 additional health officers will be trained
  by end 2009
• Cascade training approach
• Strong political leadership
• Cross-government cooperation and financial
  support
• Effective collaboration with development partners

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Public Health Movement in South-East Asia

• South-East Asia have less than 5 of the worlds
  schools of public health, but almost a third of
  the worlds population.
• The South-East Asia Public Health Initiative
  launched in 2004 with the aim of strengthening
  public health planning.
• BRAC University James P Grant School of Public
  Health aims to train a cadre of professionals to
  improve the health outcomes of populations in
  disadvantaged areas of the world.
• First batch of 25 students graduated in January
  2006.

• .In India, the newly created Public Health
  Foundation is mobilizing resources to establish
  five schools of public health spread across the
  country. The foundation reflects a publicprivate
  partnership. The programmes include
• structured, multidisciplinary educational
  programmes
• shorter and longer term training of health and
  allied professionals
• research on the prioritized health problems
• knowledge generation and knowledge translation.

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Global Health Workforce Alliance

• What is it?
• A partnership dedicated
• to identifying and implementing
• solutions to the health workforce
• Vision
• All people everywhere
• will have access to a skilled, motivated and
  supported health
• worker, within a robust health system.
• Mission
• To advocate and catalyze global and country
  actions to resolve the human resources for health
  crisis, to support the achievement of the
  health-related millennium development goals and
  health for all.

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First Global Forum on HRH, 2 7 March 2008,
Kampala, Uganda
Six fundamental and interconnected strategies to
address the global health workforce crisis

• Building coherent national and global leadership
• Ensuring capacity for an informed response based
  on evidence and joint learning
• Scaling up education and training
• Managing pressures of the international health
  workforce market and its impact on migration
• Retaining an effective, responsive and equitably
  distributed health workforce
• Securing additional and more productive
  investment in the health workforce

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Looking Forward

• New dynamics
• New expectations
• New thinking
• Clarifications