Human Resources for Health in 2030 HRH 2030

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Human Resources for Health in 2030 (HRH 2030) Overview on Human Resources for Health

Human Resources for Health in 2030 (HRH 2030) Overview on Human Resources for Health in Jordan Al-Balqa Applied University / Faculty of Medicine April, 2018 Presenter: Dr. Raghad Hadidi HRH Governance Component Lead HRH 2030

OUTLINE Introduction HRH Challenges Country Response to HRH Challenges Human Resources for Health 2030

OUTLINE Introduction HRH Challenges Country Response to HRH Challenges Human Resources for Health 2030 (HRH 2030) National HRH Strategy in Jordan (NHRHS) National HRH Observatory (NHRHO) Annual HRH Report, 2016 2

Introduction Jordan is a middle income country with limited natural resources, and thus human

Introduction Jordan is a middle income country with limited natural resources, and thus human resources development has been made as one of the most valuable assets and strategic pillars of the country. The healthcare system in Jordan is evolving and has to continuously respond to the: Changing demographic, epidemiologic and risk profile of the population; The rising expectations of a more educated population; The fast growing private health sector; The rapid changes taking place in medical technology; The desire among the government to expand services and achieve universal health coverage (UHC) and sustainable developmental goals (SDGs). Accordingly, Jordan has been remarkably investing in HRH as a key element for scaling up health interventions to achieve global, regional and national goals. 3

Building Blocks of the Health System (WHO) 4

Building Blocks of the Health System (WHO) 4

A simple message: Health workers save lives! 5

A simple message: Health workers save lives! 5

HRH Challenges Governance, policy and partnership HRH management Absence of a national HRH strategy

HRH Challenges Governance, policy and partnership HRH management Absence of a national HRH strategy Inadequate generation of evidence-based HRH decisions Deficient endorsed national job descriptions Absence of a national board to license/relicense healthcare fields (La. Rocco, 2015) Lack of nursing and midwifery up to date database (Jordan Nursing Council, 2016) Lack of collaboration with other healthcare fields (Jordan Nursing Council, 2016) Adoption of the Civil Service Bureau performance appraisal system represents a change from current practices Pressure, particularly in the governorates, to hire more staff at the MOH because of the high unemployment rate in remote/underserved areas Lack of awareness and skills on the part of top management team and other managerial levels of the critical linkages between MOH strategic/operational planning and human resources planning Difficulty in attracting and retaining qualified health personnel Overemphasis on tenure and credentials over performance Weak performance management (unclear criteria, lack of transparency) system to inform career path and succession planning Weak linkages between the current performance appraisal system and incentives Risk that employees will focus on behaviors that are rewarded and neglect other work-related behaviors High stress and low job satisfaction (Hamaideh & Ammouri, 2011; Mrayyan, 2007; Nawafleh, 2014) in remote/underserved areas (Nawafleh, 2014) Workplace violence 6

HRH Challenges HRH education, production and development Interdependence of CPD with other HR policies

HRH Challenges HRH education, production and development Interdependence of CPD with other HR policies (e. g. , employee selection, career path planning, succession planning, and job analysis and description) Lack of requisite skills on the technical aspects of training and development for those who work at training and development directorate Lack of national CPD system linked with re-licensing Lack of funding for human resources development Weak capacity building and continuing education initiatives (Jordan Nursing Council, 2016) Educational lags in areas related to advanced healthcare skills such as newborn resuscitation and holistic nursing care (Kassab, Alnuaimi, Mohammad, Creedy, & Hamadneh, 2016; Shoqirat, 2015) Educational programs do not meet national, regional and international health needs and technological advancements Clinical training lags in quality and period Fragmented research and lack of research integration into clinical practice (Jordan Nursing Council, 2016) Lack of internship opportunities Limited provision of holistic care HRH planning Limited supply of specialties in the labor market as they take considerable time to develop Skill-mix, gender, and facility maldistribution of human resources across the country Weak linkages between the human resources planning system on one hand the performance management, reward, incentive, training, and development systems Shortage of midwives High turnover Weak effective HRH information system especially that of the private sector 7

Main HRH Challenges Absence of a national HRH strategy. Centralized HRH decisions in the

Main HRH Challenges Absence of a national HRH strategy. Centralized HRH decisions in the public sector. Brain drain of HRH. Variation of HRH wages and incentives between private and public sectors. In equitable distribution of health workforce among geographical areas, gender imbalance, skill mix and shortage of them in remote areas. Inefficient contribution of the HHC in the national education policy. Absence of continuous professional development system (CPD). Weak HRH information system. 8

Country Response to HRH Challenges 9

Country Response to HRH Challenges 9

Main Strategic plans, initiatives and projects emphasizing HRH issues National: National Agenda and its

Main Strategic plans, initiatives and projects emphasizing HRH issues National: National Agenda and its EDP Jordan 2025 and its EDP (2016 -2019) Governmental Action Plan A National Strategy for Human Resource Development (2016 -2025) National Health Strategy (2016 -2020) Health Sector Reform (2018 -2022) Health sector strategies: MOH, RMS, UHs Donors: WHO, USAID HRH 2030 Jordan Activity National Strategy for Nursing and Midwifery: A Road Map to 2025 10

Main Strategic plans, initiatives and projects emphasizing HRH issues Regional: Framework of Action for

Main Strategic plans, initiatives and projects emphasizing HRH issues Regional: Framework of Action for Health Workforce Development in the Eastern Mediterranean Region (2017 -2030) Frame work for action in strengthening Nursing and Midwifery in the Eastern Mediterranean Region (2015 - 2025) Regional HRH Observatory Global: Global strategic directions for strengthening nursing and midwifery (2016– 2020) HRH 2030 Program SDGs, UHC 11

Human Resources for Health in 2030 / Jordan The USAID Human Resources for Health

Human Resources for Health in 2030 / Jordan The USAID Human Resources for Health in 2030 program operating since 2016 to build the accessible, available, acceptable, and high-quality health workforce needed to improve health outcomes and advance universal health coverage. As HRH 2030’s first field-based activity, the Jordan project works to strengthen the health workforce for better health services. Objectives: 1. Improve human resources practices at the Ministry of Health. Strengthen human resources systems and staff capacity in order to efficiently and effectively motivate, retain, and distribute the workforce. 2. Improve health workforce competency. Train emerging health leaders and supervisors and support a national system for continuing professional development for health professionals. 3. Strengthen National Human Resources for Health Governance. Improve national HRH policies and strategic plans and improve HRH data for decision-making. 12

HRH 2030 Results Framework 13

HRH 2030 Results Framework 13

National HRH Strategy in Jordan 14

National HRH Strategy in Jordan 14

National HRH Strategy – Vision and Mission Vision To have adequate, competent, and responsive

National HRH Strategy – Vision and Mission Vision To have adequate, competent, and responsive health workforce to maximize the performance of the health system in Jordan towards UHC and SDGs. Mission To strengthen all functions of HRH (governance, policy, partnership, management, education, production, development, and planning) for better health services. 15

Methodology 16

Methodology 16

National workshop Priority Setting Policy Dialogue One to One interviews Frontline Health Worker at

National workshop Priority Setting Policy Dialogue One to One interviews Frontline Health Worker at Governorate Level 17

Particularity of the NHRHS Informed by evidence (local, regional and international) Followed an engaging

Particularity of the NHRHS Informed by evidence (local, regional and international) Followed an engaging process though out its development Linked the SDGs and UHC Linked to previous and ongoing strategies and plans (like the health sector reform strategy, the MOH strategy) Pragmatic aspect of implementation Will be monitored and evaluated on regular basis 18

National HRH Strategy Framework Strategic Pillars 3 1 4 2 19

National HRH Strategy Framework Strategic Pillars 3 1 4 2 19

Strategic Pillar 1: Strengthen governance structure, policies, and partnerships to strengthen HRH regulation, management,

Strategic Pillar 1: Strengthen governance structure, policies, and partnerships to strengthen HRH regulation, management, and monitoring 1. 1. Ensure alignment of existing laws/policies/ legislation to current needs and demands of community and providers 1. 2. Scale up HR component in healthcare accreditation systems to include standards on education, occupational health and safety, work-life balance, clinical governance, shared decision making, privileging and credentialing and violence prevention 1. 3. Develop or update legislated national scope of practice for physicians, registered nurses, midwives, pharmacists, dentists, and allied healthcare professionals that are aligned with required competencies 1. 4. Develop and implement interventions and policies to expand the scope of practice for areas where supply of healthcare professionals is low (as remote/underserved areas and primary healthcare centers) 1. 5. Establish policies to motivate and retain HR to work in remote/underserved areas 1. 6. Conduct mandatory examination for licensure of clinical healthcare professionals 1. 7. Strengthen partnerships in HRH among stakeholders 1. 8. Revise Civil Service by-law to align with HRH needs 1. 9. Develop and implement policies to address education and working abroad to align with the national needs

Strategic Pillar 2: Establish workforce planning based on current and emerging health service and

Strategic Pillar 2: Establish workforce planning based on current and emerging health service and community needs 2. 1 Update human resources registries to integrate up to date data sources and ensure timely access to data for evidence-informed decisions 2. 2 Ensure mechanisms to collect, report, analyze, and use reliable workforce data to inform HRH decision making 2. 3 Identify priority needs of the community and burden of disease by leveraging existing national surveys to forecast the human resources needs. 2. 4 Predict the human resources needs for the next five years at both the national and sub-national (governorate) levels based on priority HR needs and implement strategies to respond to these needs 2. 5 Attract and orient youth career choices to health programs and specialties with HRH shortage 2. 6 Reinforce gender balance in health institutions and within health professions 2. 7 Mobilize and secure adequate funding to improve the production, employment, and capacity building for all health professionals 21

Strategic Pillar 3: Enhance the competencies of the human resources for health based on

Strategic Pillar 3: Enhance the competencies of the human resources for health based on current and emerging health service needs 3. 1. Revise and unify current health profession educational strategies and tools based on the set of required profession competencies 3. 2. Establish inter-profession education in universities and institutions 3. 3. Develop re-licensure by-law and establish continuing professional development (CPD) system for health professionals 3. 4. Scale up bridging programs in health education 3. 5. Establish selection criteria for target admission of students before acceptance into health profession education 22

Strategic Pillar 4: Manage HRH with a purpose to attract, deploy, retain, and motivate

Strategic Pillar 4: Manage HRH with a purpose to attract, deploy, retain, and motivate health workforce in both public and private sectors and especially in remote/underserved areas 4. 1 Improve work environment for health workers 4. 2 Strengthen clinical governance through mentorship, clinical supervision, and preceptorship of healthcare workers 4. 3 Establish shared governance (shared decision making and accountability) in hospitals and primary healthcare centers 4. 4 Enhance job-person fit in all healthcare institutions and governmental positions 4. 5 Conduct performance evaluation based on competencies in a manner that reflects actual performance of HR and link to credentialing and privileging in institutions 4. 6 Provide financial and non-financial incentives to healthcare professionals based on performance evaluation 4. 7 Promote women in health leadership 4. 8 Develop and implement succession planning in the public sector 4. 9 Provide training to HR departments and health managers on HR related topics 4. 10 Ensure equitable distribution of health workforce throughout the country 23

Wrap Up Vision: To have adequate, Dashboard Monitoring & Evaluation Plan HRH National Briefin

Wrap Up Vision: To have adequate, Dashboard Monitoring & Evaluation Plan HRH National Briefin Strategy g Note HRH Implementatio n Plan competent, and responsive health workforce to maximize the performance of the health system in Jordan towards UHC and SDGs. Mission: To strengthen all functions of HRH (governance, policy, partnership, management, education, production, development, and planning) for better health services. 24

National HRH Observatory 25

National HRH Observatory 25

Establishment of the NHRHO Call for establishing regional & National observatories Latin America/Brazil: 1999

Establishment of the NHRHO Call for establishing regional & National observatories Latin America/Brazil: 1999 Africa: 2005 EMRO: 2006 Jordan: 2008 Need for HRH data & information for planning Global initiatives to manage the acute HRH shortage Emphasis on HRH issues 26

What and Why is the NHRHO - It is a cooperative initiative among relevant

What and Why is the NHRHO - It is a cooperative initiative among relevant stakeholders aimed at producing HRH information and knowledge. - On-going HRH system analysis via electronic updating and reporting - 24/7 Sleepless eye on HRH dynamics - The main purpose is to monitor trends in patterns of the health workforce distribution to provide reliable and instant data and information needed for evidence-based decision-making and policy development. 27

Objectives of NHRHO Establishing a national resource with reliable and up-to-date information pertaining to

Objectives of NHRHO Establishing a national resource with reliable and up-to-date information pertaining to major dynamics of the health workforce in Jordan. Establishing a national platform for effective and coherent coordination among stakeholders for policy dialogue. Promoting and using evidence based planning and decision making process regarding HRH issues. Installing monitoring and evaluation system to track progress overtime according to HRH related baseline and benchmark indicators. Strengthening the national capacities to produce well qualified and skilled health workforce staff. Sharing best lessons and experiences with regional and global HRH observatories. 28

Jordan Headways on the NHRHO Strong commitment to HRH evidence generation (National Agenda, NHS):

Jordan Headways on the NHRHO Strong commitment to HRH evidence generation (National Agenda, NHS): 2008 Institutional ownership (Hosting at the HHC, Appointment of focal point): 2008 Allocation of resources (Seed funds from WHO, biennium & fundraising GHWA): 2008 Poll survey: 2008 National stakeholders’ meeting: June, 2008 National platform for coordination: 2008 29

Jordan Headways on the NHRHO Develop observatory web site: 2009 www. hhc. gov. jo

Jordan Headways on the NHRHO Develop observatory web site: 2009 www. hhc. gov. jo Comprehensive mapping of HRH(HRH Country profile): 2010 Producing Annual HRH reports: 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016 Sharing experiences at national, regional and international levels. 30

Jordan Headways on the NHRHO Producing HRH materials (brochures, posters and policy briefs): 1.

Jordan Headways on the NHRHO Producing HRH materials (brochures, posters and policy briefs): 1. “HRH Jordan's Coordination and Facilitation Policy”: 2012 2. “Retention of MOH Physicians in remote areas of Jordan”: 2013 Conducting a survey on: "Distribution of private sector physicians in Amman Governorate”: 2013 Conducting a survey on: "Distribution of private sector dentists in Amman Governorate”: 2016 Conducting an assessment to the NHRHO with the support of HRH 2030, 2017 31

NHRHO Publications 32

NHRHO Publications 32

Annual HRH Report, 2016 33

Annual HRH Report, 2016 33

1. Aim and Design Aim of the report To serve as a tool for

1. Aim and Design Aim of the report To serve as a tool for providing a comprehensive picture of the health workforce situation in Jordan at both the national and sub-national levels in a comparable way to help monitoring HRH stock and trends, and so identify in-equitable geographical distribution of the health workforce in Jordan if any. Design of the study A cross-sectional point prevalence type of data collection method is adopted. 34

 2. Study population Dentists Physicians GPs, Residents, • Specialists GPs, Residents, Specialists •

2. Study population Dentists Physicians GPs, Residents, • Specialists GPs, Residents, Specialists • Nurses Pharmacists Registered nurses • Bachelor, Masters, PHD, Pharm • D Health Faculties’ students Enrolled & graduated • students Midwives midwives • 35

3. Study Variables Health workforce by sector Health workforce by Profession Health ﺍ workforce

3. Study Variables Health workforce by sector Health workforce by Profession Health ﺍ workforce by qualification Study Variable s Health workforce by specialty Health workforce by gender Health workforce by Geographical distribution 36

Mo. H ﺍ RMS Private UH NDC Centers Private ﺍ Private Clinics International &

Mo. H ﺍ RMS Private UH NDC Centers Private ﺍ Private Clinics International & NGOs Private Hospitals UNRWA KUKC Institutions & Councils NGOs Clinics HHC JMC JNC HPC JFDA Joint Procurement 4. Data Sources Components of Health Sector Public 37

5. Study tools Public Sector form Private sector form MOH central level form UHs

5. Study tools Public Sector form Private sector form MOH central level form UHs form RMS form Customized forms for each entity 38

6. Methodology of data collection Head of Employee Affaires Department Data Public sector FP

6. Methodology of data collection Head of Employee Affaires Department Data Public sector FP Health Director ates (14) Head of Health Profession & Institutions Licensing Private sector FP Central level (reports) Peripheral level (field) Focal point NHRHO secretariat /HHC 39

7. Data entry, cleaning, analysis & report writing & dissemination Data entry & collectio

7. Data entry, cleaning, analysis & report writing & dissemination Data entry & collectio verific n ation Data analysi s Indicators extraction presentation of findings in tables & graphs Sharing & discussing results with the National HRH Policy Forum Report writing Report dissem ination 40

Key findings of the HRH Annual Report, 2016 41

Key findings of the HRH Annual Report, 2016 41

Distribution of health workforce in the public sector by category, 2016 Cadre MOH Prince

Distribution of health workforce in the public sector by category, 2016 Cadre MOH Prince Hamzeh RMS JUH KAUH FDA JPD NCDE JNC JMC HHC Total Physicians Dentists Pharmacists Registered nurses Midwives 4697 339 1822 785 544 5 0 37 0 1 3 8233 799 6 460 41 22 0 0 0 1 1329 708 40 280 29 38 96 15 16 0 0 0 1222 5053 348 3810 488 764 4 1 24 4 0 0 10496 1469 0 304 8 16 0 0 0 1797 42

Health workforce in the Private Sector, 2016 Cadre Physicians Dentists Pharmacists Registered nurses Midwives

Health workforce in the Private Sector, 2016 Cadre Physicians Dentists Pharmacists Registered nurses Midwives King Hussein Foundation JAFPP KHCC 103 11 26 364 30 0 0 5 2 0 0 60 46 12 24 564 34 2 0 0 Private hospital & clinics UNRWA 5336 5435 13917 5045 315 Total 5840 5470 13979 5691 351 43

 Distribution of National Health Workforce by category in Jordan, 2016 Midwives 4% Physicians

Distribution of National Health Workforce by category in Jordan, 2016 Midwives 4% Physicians 26% Registerdc nurse [PERCENTAGE] Dentists 12% Pharmacists 28% 44

Distribution of National Health workforce by Sector, 2016 45

Distribution of National Health workforce by Sector, 2016 45

Ratio of physicians per 10000 population by governorate, 2016 46

Ratio of physicians per 10000 population by governorate, 2016 46

Ratio of dentists per 10000 population by governorate, 2016 47

Ratio of dentists per 10000 population by governorate, 2016 47

Ratio of Pharmacists per 10000 population by governorate, 2016 48

Ratio of Pharmacists per 10000 population by governorate, 2016 48

Ratio of Registered Nurses per 10000 population by governorate, 2016 49

Ratio of Registered Nurses per 10000 population by governorate, 2016 49

Ratio of Midwives per 10000 population by governorate, 2016 50

Ratio of Midwives per 10000 population by governorate, 2016 50

Graduates and Enrollees from Dentistry Faculties by gender, 2016 Graduates: 450 Enrollees : 2802

Graduates and Enrollees from Dentistry Faculties by gender, 2016 Graduates: 450 Enrollees : 2802 51

Recommendations 1. Improved HRH data production and utilization for decision making 2. Improve health

Recommendations 1. Improved HRH data production and utilization for decision making 2. Improve health workforce distribution all over the kingdom 3. Ensure adequate health workforce production to respond to growing population needs 52

Thank you! ! ﺷﻜﺮﺍ 53

Thank you! ! ﺷﻜﺮﺍ 53