Scaling up human resources for expanded ARV coverage

World Health Organization, Geneva

Identifying human resourcesinformation needs for ARTprogrammes

World Health Organization

Human Resources for Health

Department of Health Service Provision

Norbert Dreesch

World Health Organization, Geneva

There is a crisis in HR which stems from . . .

•…years of neglect of the significance of investingproperly in human resources development

•… lack of incentives in many countries to work in theservices (low pay, low working conditions, low morale)

•… sense of powerlessness amongst service staff inhigh-burden HIV/AIDS countries

•AGAINST THIS BACKGROUND: TREMENDOUS HRDEVELOPMENT NEEDS FOR ART

World Health Organization, Geneva

HR issues countries are struggling with - 1:

•HRH constraints to absorbing new resources andexpanding good practices

•Inadequate numbers and skills of providers affectquality of performance, ability to deliver services to thepoor and other disadvantaged populations

•Imbalances in the health workforce (geographic,gender, and other)

World Health Organization, Geneva

HR issues countries are struggling with - 2:

•Migration and retention of health workers

•Impacts of specific diseases and other risk factors forhealth care providers

•Weak congruency between education for health careproviders and achievement of coverage

•Lack of coordination between external donors' andcountries’ policies towards HRH development

World Health Organization, Geneva

•Currently no universally accepted classification of serviceproviders to whom distinct ART skills could be assigned

•Out-migration, low morale and poor retention capacity

•Difficulty to count the extent of FTE contributions by privateclinics, treatment NGOs, employers, research and public sectorin ART care flow

•Problems of accuracy of staff figures at aggregate levels, bothpublic and private

•Lack of HR development plans

HIV/AIDS specific HR issues countries are struggling with - 3:

Impact of HIV/AIDS on staffingImpact of HIV/AIDS on staffing

World Health Organization, Geneva

The challenges - 1:

•ART is a new, labour-intensive intervention

•Little to no knowledge about ART treatment systems

•Quality systems are needed

•Core treatment unit, tasks, FTEs, and skills trainingneeds have to be defined for different national settingsand conditions

•It is not yet clear to which extent and what level of staffclinical tasks can be transferred

World Health Organization, Geneva

The challenges - 2:

•Demand for ART is high, capacity to deliver is low:

–demand cumulative

–chronic care needs

•Success may create recipe for failure: increasingcoverage will need to be matched by increasednumbers of ART skilled staff

•But: some countries severely affected by staff lossesdue to HIV/AIDS

World Health Organization, Geneva

At facility level, we need to know - 1:

•The level of current staff types and their time utilization

•All leave and average morbidity and staff loss experience

•The baseline skills currently available amongst differentservice providers

•Additional FTE needs based on the national ART modeland coverage goals

•The training needs having to be achieved prior to scalingup

World Health Organization, Geneva

At facility level, we need to know - 2:

•The phasing pattern to insure skills, supplies, andequipment function in a quality care environment whengoing to scale

•The care flow best suited to available skills

•The optimal mix of task distributions:

–referral facilities

–staff in the care flow

•ART task distribution between service providers/communitymembers

World Health Organization, Geneva

At national/regional level we need to know or define - 1:

•The intended ART coverage goals for the next 5 years

•The current and future production of training institutions fordifferent types of service providers

•The responsiveness of education and training to changingneeds for different services

•Staff internal and external migration, geographicalimbalances of staff distribution within country

•The rate of attrition of service providers for the next yearsto come (as a result of age, disease (e.g. HIV/SARS),labour market dynamics, otherwise)

World Health Organization, Geneva

At national/regional level we need to know or define - 2:

•The impact of treating service staff with ARVs on staffproductivity and replacement needs

•Incentives and motivational factors to work in the healthservices, assessment of possibility to re-hire staff who leftthe service, retention strategies

•The capacity of existing personnel records systems toprovide accurate data on staff

•Administrative/personnel systems’ flexibility to reflect newskills mix in revised staff grading and remuneration systems

•Impact of existing constraints to public sector scale up dueto lending institution agreements

•Impact of international/regional recruitment policies

World Health Organization, Geneva

In conclusion, there are huge strategic information needs:

•Generic: more attention needed internationally tosupport identification of health systems/HRdevelopment needs for scaling up ART

•Specific to HIV in high-burden countries:

–impact on HR

–country-specific models

•Difficult to imagine how countries will be able to deliverquality ART if support is not given to identify theinformation necessary for HR planning.