G Elzinga WHO Geneva 14 02 2005 Who

G. Elzinga WHO, Geneva 14 - 02 - 2005

Who cares?

Life Expectancy: Advancing and Slipping

? E P Differences in health O E C W increase within countries T ’ N A C Y and between countries. H W

HEALTH WORKFORCE PROBLEM

Joint Learning Initiative Diagnosis (The Lancet, 27 -11 -2004) t o n n a c e c r o f k r o W ; s h i t l s i a r e c H h l t l a a e h l Glob a b o l g h t i t w s e e d p r o a c h t i SSA h

The Glue of the Health System

Sky full of HRH “challenges” distribution V&H dilemma’s work conditions HIV/AIDS quality honorarium training productivity management carrier perspective migration overburdening number status

PROVIDING HEALTH IN POVERTY

V H Program of prevention and/or care interventions to control a specific healthproblem. Infrastructure of prevention - and care services to cope with the prevailing health problems.

V Vertical-horizontal in developing countries H H V Vertical-horizontal in developed countries

Program Macrostructure V intervention strategy ME monitoring en evaluation IS PC prevention and/or care

Differences between countries (polio) IS ME PC PC General health services PC

polio IS Differences between programs ME TB IS 3 x 5 ME IS ME malaria IS ME PC PC General health services PC PC

Vertical programs: who is doing what? international Intervention Strategy Monitoring/ Surveillance national district Prevention/care facility HRH required

HRH dilemma ? V & H HRH synergy !

RESEARCH CONTRIBUTIONS TO HEALTH WORKFORCE STRENGTHENING

Health systems and workforces are ‘man-made’ § Research outcomes depend more on time and place than those of biomedical research. § However, research is not second rate: l l Relevance: crucial to reach health outcomes and cost contaiment Intellectually: methodology often quite demanding because of complexities

2 VALUABLE ‘RESEARCH’ LAYERS SPECIFIC GENERIC

SPECIFIC analysis M&E POLICY CYCLE implementation planning

GENERIC a a a POLICY a p p m&e a m&e p CYCLE POLICYi. p POLICY i. m&ei. a a CYCLE LEARNING FROM RESEARCH POLICY i. i. POLICY p m&e a a a CYCLE i. POLICY i. p p m&e CYCLE i. i. p p

GENERIC a a a POLICY a p p m&e a m&e p CYCLE POLICYi. p POLICY i. m&ei. a a CYCLE BY RELATING CYCLE DIFFERENCES TO OUTCOMES m&e POLICY i. i. POLICY m&e a a p a CYCLE i. POLICY i. p p m&e CYCLE i. i. p p

health workforce health system socio-political context HRHTB/HIV

ROLE OF HRHTB/HIV RESEARCH initiator HRHTB/HIV health workforce health system stimulator participator contributor facilitator socio-political context Priorities? supporter

“INITIATOR” PRIORITIES Optimisation Simplification • less time/patient • lower cadres IS ME HIV/AIDS & TB PC Time/Cost-effectiveness (of intervention(s) and system) • less time/patient • more work satisfaction (Integration; IT ? ) • less time • higher quality

ROLE OF HRHTB/HIV RESEARCH initiator HRHTB/HIV health workforce health system stimulator participator contributor facilitator socio-political context supporter Priorities?

y t r Policy truths e v He o p alt s h C ure c a hre t w is o r ac g c os i t m no Thus, noke t e p o h e a a c l t h expendit pr E ure loof w! it

Social realities Poor populations have high disease burdens They therefore need more health services while they can in fact afford less. Health below a critical state tends to deteriorate HIV/AIDS & TB/HIV can push health below that fall, critical state, causing life expectancy to the labor force to falter, and social costs to sore!

EXAMPLES OF “SUPPORTER” PRIORITIES WHEN DOES HEALTH CARE CHANGE FROM COST TO INVESTMENT? WHAT REALISTIC INTERVENTIONS CAN COUNTER MIGRATION OF HEALTH WORKERS?

Thank you

Worker density by region

ROLE OF HRHTB/HIV RESEARCH initiator HRHTB/HIV Priorities? health workforce health system stimulator participator contributor facilitator socio-political context supporter

“ESSENTIAL PRIMARY CARE” FUNCTION Malaria M&C health Community HIV-AIDS Referral Centre Tuberculosis AVAILABLE 1 PER ? 000 ACCESSIBLE <. . HOURS AFFORDABLE <. . % INCOME

“PARTICIPATOR” PRIORITIES • Cost-effectiveness calculations of approach. analysis • Methodology to determine availability, accessibility, affordability of EPF • Controlled study of cost- and time effectiveness of approach. M&E • Etc. POLICY CYCLE implement. planning

Technical agencies UNDP Foundations Post JLI Worldbank donors ILO NGO’s High level forum MDG’s countries WHO

Technical agencies UNDP Foundations Post JLI ILO THANK YOU Worldbank NGO’s donors High level forum MDG’s countries WHO

global policies national policies demand need health system health workforce population health community ed. & tr. supply HIV-AIDS Migration

Een HRH dilemma ? H+ V+ burden of disease is higher in poor environments development requires adequate general health services