Download Jack A. DeHovitz - SUNY Downstate Medical Center

Human Resources
for Health:
A Response
Georgian Health Care
2020: MEDEA 2011
February 1, 2011
Jack A. DeHovitz, MD, MPH
Director, New York International Training and
Research Program
Professor of Medicine
SUNY Downstate Medical Center
Physicians
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High levels of medical staffing even compared to
FSU
Only one medical faculty prior to 1991 (~700
students)
Four state and 69 private faculties IN 2004
(~15,000 students) decreasing to 34 in 2006
Responsive to demand but not need
Fragmentation of training, MoE responsible for
undergraduate, MoLHSA responsible for
postgraduate and CME
Flux between private and public employers
Source: WHO European Health for All Database (6)
Georgia Health System Performance Assessment 2009
Ratio of number of patients hospitalized annually per hospital full-timeequivalent doctor working in hospitals, Georgia and selected countries,
2007
Source: WHO European Health for All Database (6)
Georgia Health System Performance Assessment 2009
Source: National Centre for Disease Control
Georgia Health System Performance Assessment 2009
Challenges in Nursing
Workforce
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Nurse training focuses on technical
skills rather than theoretical and
critical thinking
Historically two paths-technical
education and medical students
No national licensing, specialization
or continuing education
No national registry
Nursing competencies
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Only allowed to obtain vital signs and
distribute medications
Do not do patient assessments
Do not engage in nursing care plans
No health education
No knowledge of evidence based
practice
Source: National Centre for Disease Control
Georgia Health System Performance Assessment 2009
Nurses per 100 000 population in Georgia and other selected countries
from 1990 to latest available year
Source: Who Regional Office for Europe 2009
Georgia Health System Review
Nursing Supply
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21,000 Physicians and 19,000 nurses
Ratio=0.9 nurses: physicians
Greece and China: 0.7
Bangladesh: 1.0
US: 4
Positive Trends in Nursing
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Law recently passed (December, 2010) to
allow for the development of a baccalaureate
nursing program
Emory University funded by USAID to initiate
program beginning in Fall, 2012
Georgian Nurses Association has increasing
presence and has a plan to initiate a nursing
registry
Demand will be created by anticipated opening
of over 40 new hospitals and clinics.
Public Health Workforce
Challenges
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Elements remain of Russian Sanitarian (“Sanepid”) model
Achievements included high immunization
rates and communicable disease control
Numerator focused assessment-case countingcurrent staff have little or no competence in
designing and conducting epidemiologic
studies
Following independence =>Decentralization
Subsequent rise in STI’s, substance use, CV
disease and smoking
Decline in its share of total allocation for
Role of Public Health System
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Policy makers and managers must
use analyzed data to make informed
public health decisions.
Accurate data is necessary in order to
make these decisions
Comparison of infant, under-five and maternal mortality rates reported by
National Centre for Disease Control (routine health information source)
and two population-based surveys, 2000-2004.
Source: National Centre for Disease Control; Women’s Reproductive Health Survey (9); Multiple Indicator Cluster Survey (7)
Georgia Health System Performance Assessment 2009
Public expenditures on outpatient care, inpatient care and public health
and prevention services as % of total public health expenditures, 2001 –
2007.
Source: National Health Accounts
Georgia Health System Performance Assessment 2009
Public Health Workforce
Challenges
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Until last month, not one staff member at
NCDC had a Master’s degree in Public Health
While US and others have made serious
investment in public health training most
return to work for NGOs
Challenges in intersectoral collaboration
Unequal distribution of public health workers
with lack of professional staffing in rural
centers and overstaffing in urban centers*
Poor coordination between district level public
health programs and health facilities
*Djibuti et al. Human resources for health challenges of public health system reform in Georgia;
Human Resources for Health 2008
Positive trends in public health
workforce
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MPH programs being
developed in Georgia with
assistance of US and
European institutions
New public health law passed
in 2007 which defines
MoLHSA role
Effective functioning of
Country Coordinating
Mechanism (CCM) to fight
HIV/TB/Malaria
Recent appointment of US
trained specialists to direct
NCDC
Documented improvement in
immunization delivery
Substantial and ongoing
support for epidemiology and
laboratory training by USG
Issues for discussion
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How do we move beyond ad hoc planning?
Who will take responsibility for addressing
the nexus between training and provision
of services?
How do we revitalize and evolve public
health services?
How do we integrate the alphabet soup of
international partners into rational health
planning?
How do we balance decentralization and
centralization?
Stakeholders to consider including
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Government at National and Regional
level
Sectors: Education, health, finance
Under and postgraduate education
Training organizations
Employers of health workers
Representatives of healthworkers
Representatives of users
Donor community
Parliament
With thanks to:
SUNY Downstate Medical Center (Brooklyn, NY)
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David Odegaard, MPH
Dana Turner
Susan Holman, RN, MS
University at Albany School of Public Health
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Louise-Anne McNutt, PhD
New York State Department of Health (Albany, NY)
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Dale Morse, MD, MS
Emory University (Atlanta, GA
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Carlos del Rio, MD
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Henry Blumberg, MD
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J.L. Wold, PhD, RN
Georgian National Centers for Disease Control
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Maia Butsashvili, MD, MS
Infectious Diseases, AIDS and Clinical Immunology Research Center
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Tengiz Tsertsvadze, MD, Ph.D.