HRH Strategic plan for Rwanda MOH 2006 2010

HRH Strategic plan for Rwanda MOH 2006 -2010 Presented by Dr Kathy Kantengwa

Document structure o o o 4 Main sections: Section 1 : states the purpose and uses of the plan, main issues and dimensions, and an overview of the health care system organization and structure; Section 2: Analysis of the current health workforce; Section 3: Training programs and training issues Section 4: Planned change for HRH. Also proposed logical framework and costing over 3 years.

Section 2: Current analysis of health workforce o o MOH hires approximately 62%[1] of the health workforce, and pays their salaries directly through the health district offices. 5840/7031 positions, 83% position filled 63% women, but mostly A 2 nurses 79% health personnel aged <40 years, and about one third of these will have reached the official age of retirement by year 2020. [1] Dr Dariya MUKAMUSONI & al : Human Resources inventory as of December 2005

Established posts filled and vacant December 2005

Recommended staffing norms Provider Type Recommended Daily Provider: Patient Ratio HEALTH CENTERS Recommended Daily Provider: Patient Ratio DISTRICT HOSPITALS Recommended Daily Provider: Patient Ratio REFERRAL HOSPITALS General 1: 40 1: 25 1: 30 Specialist Physician s - 5 per hospital (Ped, OB-GYN, Internist, Surgeon, Anesthesiologist) 1: 20 Medical Assistants 1: 40 Not applicable Nurses A 1 1: 40 1: 25 1: 20 Nurses A 2 1: 25 1: 20 1: 30 Nutritionists 1: 40 2 per hospital Social Workers 1: 40 10 per hospital Lab technician A 0 - - 2 per hospital Lab technician A 1 - 1: 40 1: 25 Lab technician A 2 1: 20 - Pharmacists A 0 - 1 for every 4 hospitals 2 per hospital Pharmacists A 1 - 1 per hospital 1: 50 Physician s

Average Monthly Salaries for Health Staff (basic salaries) Civil Service (MOH) Salary Average Salary at Agree Institutions Doctor 39, 200 66, 875 Nurse 23, 100 25, 000 Social Worker 23, 100 23, 000 Lab Technician 23, 100 23, 800 Aux. Staff 9, 900 13, 700 Nurses Aides 13, 500 13, 700 Average Salary paid by NGOs, Volunteer Organizations, Districts

Section 3: Training programs and issues o Basic professional training Types n n n n n A 0 General Medicine (NUR) A 0 Public health and health services management (SPH Butare) A 0 Pharmacy (NUR) A 0 Nursing , Bachelor in Nursing (KHI) A 0 Nurse Tutors/Educators (KHI) A 1 Nursing (MOE diploma course- KHI) A 1 Midwifery A 1 Psychiatric Nursing A 1 Radiographers A 1 Physiotherapy A 1 Environmental health science A 1 Ophtalmology assistants A 1 Anesthetics A 1 Dental technicians A 1 Lab Technicians A 2 Nursing (MOE-ESI certificate- Byumba, Kibungo, Rwamagana, Kabgayi and Nyagatare) A 2 Laboratory Technician (MOE certificate course- Gatagara, St Andre)

Training institutions o o o NUR/Faculty of Medicine and Pharmacie KHI (A 1 and A 0 health providers) Nursing schools A 2 Allied health professional A 2 SPH/NUR Public health (Masters and Ph. D) CEFOCK

Training issues o o Bonding system: need to review the conditions and operation of the bonding system Development of postgraduate training programs Pre-service training of nurses and other HP: Need for integrated curricula Up-dating and expansion of knowledge and skills of trainers in local training programs

HRD STRATEGIC PLAN 2006 -2010 Goal : To improve quality of health care Purpose: Focus investments to avail qualified Human Resources capable of implementing MOH policies Strategic axis for action: o Planning for Human Resources o Development of HR o Support system for HR

Link with HSSP o o All activities in the Human Resources Strategic Plan are reflected in HSSP National Targets by End of 2009: n n Increase from 30% to 50% the proportion of health facilities that meet the minimum staffing norms Decrease the doctor to population ratio from 1/50, 000 to 1/37, 000 Maintain the nurse to population ratio at 1/3900 Increase the percentage of midwives assigned to rural areas from 17% to 55%

5 Priority Programmes o o o Improve policy, regulation and planning of HRH, Improve management and performance Stabilise the labour market, Strengthen education, training and research Strengthen monitoring and evaluation of HRH.

Main activities (Link to PRSP) o Intense activity between 2005 -2007 (To develop HR management system; to create a conducive legal environment and develop performance evaluation system etc. . . ) o Recruitment and redeployment of personnel for central and decentralized levels to align with decentralization reform o From 2006, specific training schemes to support decentralization policy (Orientation meetings for new district health managers , short management courses for senior managers at the central level and District of health teams in budget control at the HC levels…. )

Main activities (cntd) o Currently working on better compensation packages (salaries increase, access to housing and vehicle loans…) o Scholarships programs continue, (Belgium, SA, East Africa, SPH Butare) and more to come o Bonding system to be established within training policy (serving a certain number of years)

HRH Strategic Framework and cost 060324. xls

What is next? o o Edit and Finalize the strategic plan document with specific results for each activity Agree on activities and budgets Specify basket funding management mechanisms Continue plan implementation (After retreat)

Thank you all for your attention

Strategic objectives 2006 -2010 S. Objective 1: Improve Policy, regulation and planning of HRH n n n Activity 1. 1 Develop a specific statute for Health professionals Activity 1. 2 Develop or update HRH policies (employment, management, etc. ) Activity 1. 3 Develop a training policy Activity 1. 4 Review laws to strengthen professional bodies Activity 1. 5 Establish accreditation system for health professionals and institutions

SO 2: Improve Management and performance n n Activity 2. 1 Design career paths for each category of health professionals Activity 2. 2 Assess workload staffing needs (study) Activity 2. 3 Update definitions of job descriptions for each category of health professionals Activity 2. 4 Recruit and redistribute health professionals in the public health sector to ensure geographical equity

SO 2: Improve Management and performance n n n Activity 2. 5 Assess training needs, develop a training plan and timeframe Activity 2. 6 Improve supervision, leadership and performance assessment (introduce and monitor performance indicators for HRH) Activity 2. 7 Develop mentoring scheme for young health professionals Activity 2. 8 Develop motivation strategies and schemes to improve performance of personnel Activity 2. 9 Update and disseminate management tools

SO 3: Stabilize labor market n n Activity 3. 1 Conduct a comprehensive human resources assessment of public and private sector health personnel Activity 3. 2 Develop appropriate compensation packages for HRH Activity 3. 3 Improve healthcare access to all health personnel and families (including for HIV/AIDS) Activity 3. 4 Improve working conditions for health personnel

SO 4: Strengthening Education, training and research n n n Activity 4. 1 Improve the development and implementation of continuous education training programs that address priority health areas Activity 4. 2 Support review of curricula for competence-based programs in preservice education Activity 4. 3 Develop a post-graduate and postbasic training plan and timeframe for health professionals

SO 4: Strengthening Education, training and research n n n Activity 4. 4 Develop funding mechanisms for post-graduate education of health professionals Activity 4. 5 Establish a health services, policy and management research center for coordinating and running research activities Activity 4. 6 Ensure use evidence-based mechanisms for health policy development

SO 5: Monitoring and evaluation o o o Activity 5. 1 Establish a monitoring system for performance indicators Activity 5. 2 Improve the health information system (HR/HIS) Activity 5. 3 regular review of the HRH plan

Financial resources

Constraints o o o Long procedures to get things done (relative delays) Need to strengthen the HR department More Financial resources to fill in identified gaps