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EFFECT OF HUMAN RESOURCES
CONSTRAINTS ON THE PROVISION OF
HEALTHCARE/SYSTEM
NAMAF 8TH ANNUAL CONFERENCE
“DRIVERS OF HEALTHCARE COSTS: ALTERNATIVE PERSPECTIVES
21 to 23 September 2014
Hilton hotel Windhoek
AGENDA
1. An Introduction to Health Systems
Resources
2. The Three areas of Health Systems
Resources
a.
b.
c.
Physical Capital
Consumables
Human Resources
3. Management of Resources
4. Health Systems Resources
and Global Health
AN INTRODUCTION TO HEALTH SYSTEMS RESOURCES
An Introduction to
Health Systems Resources
Training of People
Human Resources
Investments in
Buildings &
Equipment
Physical Capital
Capital Expenses
Total Financial
Resources
Patient Care
“Outcomes”
Labour Costs
Operational
Expenses
Maintenance
Other expenses
Consumables
What is a “Good” Healthcare System?
A good health system delivers
quality services to all people,
when and where they need
them.
What are Health Systems Resources?
Health systems resources
are the means that are
available to a healthcare
system for delivering
services to the population.
Why are Health Systems Resources Important?
To be effective and efficient,
health system resources must
be sufficient and appropriately
utilized and managed.
What are the different types of Health
Systems Resources?
• Healthcare systems resources can be
three areas:
• Physical capital
• Consumables
• Human resources
• These areas will be explored further now
divided into
HEALTH SYSTEM RESOURCES
Health system resources can be further broken down
into the following three areas:
• Physical Capital
• Consumables
• Human Resources
Physical Capital
Red Cross Children’s Hospital
Physical Capital
• Physical capital is composed of non-human healthcare
infrastructure, such as hospitals
and medical equipment.
• Hospitals and clinics
• Ambulances
• Furnishings, such as, beds and operating tables
• Infrastructure must both be purchased and maintained
• New physical capital results in high immediate costs
plus continued funding for maintenance, equipment,
and trained personnel.
Consumables
Consumables
• Consumables are disposable
resources that are used regularly in
the delivery of healthcare.
• Gloves
• Pharmaceuticals
• Syringes, sutures, etc.
• Consumables (particularly medications)
make up a significant percentage of
expenditures in the day-to-day
operation of a functioning healthcare
system.
Human Resources
Human Resources
Definition of Human Resources
Healthcare human resources refers to trained personnel
“responsible for public and individual health
interventions.”
•
•
•
•
•
Doctors (GP’s, Specialists etc)
Nurses (Community, ICU etc)
Allied Healthcare Professionals
Pharmacists
Interns and students
Healthcare Personnel
• In many low-resource settings(Namibia SA and
region), healthcare personnel shortages occur mainly
with doctors, and often with nurses.
• Allied Healthcare Professionals are healthcare workers
outside of dentistry, medicine and nursing. Examples
include:
• Physical and occupational therapists
• Physician assistants
• Technicians in many specialized areas
Healthcare Personnel
• A common healthcare professional in Developing countries
is the Community Health Worker. The CHW is a lay person
trained in basic health education, preventative care, and
simple medication treatment regimes.
• For example, educate patients how to
take ARV’s antiretroviral and check patients
in the community to ensure they are
properly taking medications.
• Need more CHW with NCD’s and the BOD’s
Summary
• Physical capital: non-human healthcare infrastructure.
• Consumables: disposable resources that are regularly
used in the delivery of healthcare.
• Issues with pharmaceuticals and essential medicines.
• Human resources: trained personnel responsible for
health interventions.
• In Developing countries, training allied healthcare professionals
and community health workers may decrease the workload of
strained doctors and nurses
MANAGEMENT OF RESOURCES
Goals of Appropriate Management
• The goal of resource management
is to optimally invest in each area
to avoid a mismatch of resources.
• A healthcare system will be the
most effective when all areas are
appropriately balanced.
Example of Mismanagement
• An imbalance between the availability of surgeons,
operating rooms, and the necessary tools of surgery
(i.e. drapes, drugs, instruments and gloves/ access to
electricity) will impact surgical productivity.
How do we manage Resources?
Systems try to optimize resources by:
• Accurately projecting the demand
for resources
• Designing systems which effectively
match the demand of resources with
the supply
• Complications is that Public and
Private sectors have different focuses
and requirements.
Management of Human Resources
• Most difficult by far is the management of human resources, often
abbreviated by HRH (human resources for health).
• A functional workforce requires a
sufficient number of appropriately
trained workers in a variety of
different roles.
• The management of human
resources must take into account
the training, retention, supply,
distribution, and utilization of
personnel.
• Remember the Public/Private mix
challenges
HRH Projections and Planning
• Workforce projections are
necessary to “determine the
most appropriate balance in
the mix, distribution and number
of health workers.” (Both Private
and Private sector)
• Based on baseline statistics, trends, policies, and other
variables, projections can be made of the health workers
required to meet the likely…
• health care needs of the population (Public/Private)
• demand for services by the population (Public/Private)
The Number of Health Care Workers
• Accurate projection of a society’s
future needs is imperative to
maintaining an effective and efficient
healthcare system
• After projecting the required number
of health workers, the input and
output variables must be considered to
ensure that the future workforce is
sufficient to meet the future needs of
the population – Public and Private
sectors – They have different needs
The Number of Health Care Workers
The total number of workers available is dictated by the:
• New additions (inflow)
• Annual new graduates
Inflow
• Immigration
• Active Supply
• Annual losses (outflow)
• Retirement (outflow)
• Emigration (outflow)
• Death (outflow)
Active Supply
Outflow
HEALTH SYSTEMS RESOURCES AND GLOBAL HEALTH - IMPACT
ON HRM
Health System Driving Forces
Health System Variables:
Financing
Technology
Consumer Demand
Health Needs of
Population:
Demographics
Health System
Environment
Labour and Education
Disease Burden
Political Climate
Epidemics
Globalization
Driving
Forces
The health system is influenced by various driving forces. These forces influence the workforce and may result in
various challenges.
Health System Challenges
Distribution: Internal
(urban vs. rural)
International
Migrations
Working Conditions:
Compensation
Non-financial
Incentives
Workplace Safety
Skill Mix:
Balance skills of healthcare
personnel
In Public/Private sectors
Workforce
Challenges
The health system is challenged by various factors. These challenges may inevitably decrease the quality of patient care,
particularly in low-income countries where resources are less prevalent.
Personnel Training
• Adequate training is essential for
effective healthcare
• Training methods used can affect
the number and quality of workers
available.
• Adequate training and professional
development opportunities may
decrease healthcare worker
migration, especially if workers are
trained nationally in local health
issues.
Challenges in Developing countries
• Management of Capital
Investments
• Affordability and Quality of
Pharmaceuticals
• Retention of Personnel (Brain
Drain)
• Personnel Production and
Distribution
Retention of Personnel (Brain Drain)
• It can be difficult for Developing countries to retain
personnel. This concept is known as brain drain.
• Brain drain is the recruitment of
healthcare workers from one
geographical region
(often Developing countries) to
another(Developed), thus further
destabilizing an often
overwhelmed healthcare system.
What causes “brain drain”?
Brain drain is influenced by many factors
• “Push” factors
• Poor working and living conditions, lack of
support/supplies, limited potential for advancement
and professional development, low salaries, physical
insecurity
• “Pull” factors
• Higher salaries, more opportunities for advancement,
better working and living conditions, greater security,
recruiting bonuses, better education for children
Strategies to halt Brain Drain
Strategies now in use attempt to
address both the “push” and
“pull” factors
• Internal policy changes (increase
supply, improve
working conditions, continuing
education and other incentives,
improved utilization of
skills/staff, incentives to encourage return).
• External policy changes, such as inter-country agreements. The
WHO has developed
Global Code of Practice on the International Recruitment of Health
Personnel.
History of HRH Production and Distribution
• Many Developing countries face challenges with healthcare
personnel production and distribution. Examples of
inequitable distribution:
• Concentration of personnel,
especially doctors, in urban centers.
• Inappropriate skill mix for the
prevailing health problems.
• Too many specialists, too few GP’s/
generalists.
• Private versus Public
• Training institutions based almost
entirely in urban centers.
A Case Study: Thailand
• History of inequitable healthcare
personnel distribution in Thailand:
• External brain drain (1960-1975): high demand for doctors
in the United States influenced 1500 Thai doctors to
emigrate.
• Compulsory rural contracts: medical graduates were
required to work for 3 years in rural public service.
• Internal brain drain (1988-1997): rapid growth in the
private healthcare sector caused many doctors to leave
rural public hospitals for private hospitals.
A Case Study: Thailand
• Strategies employed by government to combat
mal-distribution:
• Development of rural health infrastructure: ceased
urban hospital expansions and shifted funds to rural
health development.
• Educational strategies: implemented medical placements in rural
students’ hometowns to encourage returning after graduation.
• Education reform: redesigned curriculum and placed emphasis on
clinical competence, primary healthcare, and community medicine.
(Health needs of total population)
• Specialty training: introduced specialty training to reduce number of
Thai doctors emigrating for specialty training.
Summary
• There is a smaller margin of error in Developing
countries.
• In a high-resource setting (Developed Countries),
mismanagement of resources may result in waste
and inefficiency while
in a low-resource setting/ Developing countries
mismanagement exacerbates the shortage that
already exists
• Low-resource settings/ Developing countries may
struggle more with production and distribution of
healthcare personnel than high-resource settings/
Developed countries.
Summary of THE PROBLEM
Access to quality health care is severely constrained for
millions of people by deficits in the health workforce,
including:
• Too few health workers
• Poor distribution of the health workforce
• Mismatches between health needs and the composition
of the health workforce
• Insufficient skills tied to inadequate education and
training capacity
• Low retention and productivity
• Weak human resources management systems.
So how do we fix this PRO-ACTIVELY?
• Improve leadership and HR strategy
• Enhancing HR policy and planning, including HR management
and information systems
• Improving health workforce development, including pre-service
education, in-service training, and continuing professional
development
• Strengthening support to health workers to improve retention
and productivity – use technology to assist.
• Generating and disseminating knowledge to promote use of
evidence-based HR approaches.
THANK YOU.
QUESTIONS?
[email protected]
[email protected]
www.ldanamibia.com
www.lda.co.za
Cell: +264 81 832 7229
+27 82 468 5564
Office: +27 21 975 5409