Lessons For Developing Winning GFProposals To Support Human ResourceStrengtheningLessons For Developing Winning GFProposals To Support Human ResourceStrengthening
The Health Systems Strengthening through the AAAHGlobal Fund Round 7 WorkshopThe Health Systems Strengthening through the AAAHGlobal Fund Round 7 Workshop
8-10 May 20078-10 May 2007
Anne Martin-Staple PhDAnne Martin-Staple PhD
President and Chief EconomistHealth Strategies International LLCPresident and Chief EconomistHealth Strategies International LLC
WHO, Global Health Atlas
Introduction
–Round 5: Malawi Supported resourceshortfall (US$65.4m) for Six-Year HREmergency Plan and HIV/AIDS HR Model
–Round 6: Zambia proposal to supportHealth Sector HR Planning and FinanceModel and Malaria Scale-up HR Model
Key points for winning proposalsKey points for winning proposals
WINNING THEME: GF should strengthenNOT weaken public and civil societyhealth sectorWINNING THEME: GF should strengthenNOT weaken public and civil societyhealth sector
1.Include health system strengthening1.Include health system strengthening
2.Technically sound and quantified2.Technically sound and quantified
3.Link HR activities to disease goals3.Link HR activities to disease goals
4.Provide comprehensive strategies4.Provide comprehensive strategies
5. Resource envelop, gaps and cost sharing5. Resource envelop, gaps and cost sharing
STEPS TO WINNING PROPOSALSSTEPS TO WINNING PROPOSALS
1.Assess health sector workforce shortfall1.Assess health sector workforce shortfall
2.Assess staffing requirements and shortfall for disease-specific interventions i.e. HIV/AIDS/ART, malaria2.Assess staffing requirements and shortfall for disease-specific interventions i.e. HIV/AIDS/ART, malaria
3.Analyzing labor market issues3.Analyzing labor market issues
4.Develop a mix of integrated, costed strategies to meetHR shortfall4.Develop a mix of integrated, costed strategies to meetHR shortfall
5.Mobilize political commitment and resources to meetHR targets5.Mobilize political commitment and resources to meetHR targets
6.Develop operational plans to implement recruitment,retention and training strategies6.Develop operational plans to implement recruitment,retention and training strategies
WHO, Global Health Atlas
STEP 1: Critical HR Shortfall
STEP 2: HR Crisis Threatensdisease-specific programsSTEP 2: HR Crisis Threatensdisease-specific programs
•Rapid expansion of programs (HIV/AIDS,EHP, TB, Malaria, ART) with noproportional expansion of workforce putscritical drain on health sectors•Rapid expansion of programs (HIV/AIDS,EHP, TB, Malaria, ART) with noproportional expansion of workforce putscritical drain on health sectors
•HR crisis threatens effective scale-up ofdisease specific programs especially inrural areas•HR crisis threatens effective scale-up ofdisease specific programs especially inrural areas
•HR crisis threaten sustainability ofprograms•HR crisis threaten sustainability ofprograms
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HIV/AIDS driving HR demand
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The 6-Year Plan Gap that tied theproposal to HIV/AIDS services
•Health Surveillance assistants (HSAs)(4200 including 1000 PWAs)
•Other cadres: doctors, nurses, COs,counselors
•Tutor career development
•Training institution support
Zambia: Ensuring malaria scale-upin context of overall MoH HR Goal:Zambia: Ensuring malaria scale-upin context of overall MoH HR Goal:
To determine the level of public sector and civil service HReffort required to carry out effective malaria scale-upand associated financial costs
•Develop a HR Finance Model with a mix of costedstrategies to meet MoH workforce targets in 4-years
•Develop malaria specific HR Finance Model to determinestaffing LOE and cost for scale-up
•Promote increased role of private sector
(e.g. CHAZ) and civil society for malaria
scale-up
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STEP 3: Analyzing Labor MarketIssues
1.Poor retention of existing staff
2.Inadequate trained labour supply
3.Inequitable staffing distribution
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Push Factors
•Poor pay and benefits
•Poor working conditions
•Delayed payment
•Lack of incentive schemes/career development
•Personal security
•Poor supervision and management
•Poor HR infrastructure
•Poor living conditions: housing
•High transport costs
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Pull Factor: Brain Drain
•To countries with greater financialrewards, improved working conditions,opportunities for further training
•To private sector
•NGO and research projects
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Inadequate Trained Labor Supply
•Training institutions have inadequateoutput
•Due to the lack of qualified healthworkers, recruitment outside of thecountry is required
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Inequitable distribution
•97% and 94% of COs and RNs in urbanareas
•High vacancies at under-served ruralareas
•10 districts without a MOH doctor
•4 districts have no doctor
•6 districts have nursing vacancies over70%
WHO, Global Health Atlas
STEP 4:Defining costed strategies for meetingHR targets
1.Determine HR shortfall and targets bycadre
2.Estimate the cost of mix of synergeticstrategies
3.Develop HR finance model
4.Examine finance implications:
5.Determine resource envelop
6.Estimate resource mobilisation targets
WHO, Global Health Atlas
Training
Institution
Cadre
CurrentEnrollment
RequiredCapacityExpansion
College of Medicine
Physicians
175
305
Kammuzu School ofNursing & CHA of Malawi
Nurses
1218
590
Malawi College of HelathSciences
Technicians
1048
452
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Training: Estimating the costs ofExpanding Institutional Capacity
–Capital costs for classrooms, dormitories, and labs
–Salary costs for newly hired tutors and staff
–Staff recruitment and training costs (overseas PhDprograms)
–Increase in operating costs as enrolment expands
$63 million estimated over 6 years
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OUTPUTS FROM BUILDINGTRAINING CAPACITY
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STEP 5: Finances Mobilized
Six-Year Emergency HR Programme
Total programme cost = US$272 million
•US$210M = Recruitment and retention
•US$62 M = Training Capacity
Donor financing – US$182M
Gap = US$90M
Requested = US$65.4M
WHO, Global Health Atlas
Staff retention improves
•“The number of resignation letters from nurses hasreduced from six per month to almost none”
•“Before the remuneration supplement in April, wewere having more than 120 nurses going to theUK,”….. Although they are working in harshconditions, we have seen the improvements in theirmorale.”
• Malawi Health Minister Hetherwick Ntaba , January2006
WHO, Global Health Atlas
Thank you
Dr. Anne Martin-Staple
President, Health Strategies International
(anne.staple@hsinternational)