HRH Planning & Management in the Caribbean Region

1. HRH Planning & Management in the Caribbean Region

2. Outline of Presentation • Goal of HRH Planning • Scope and Components of the HRH Planning Process • Highlights of the Caribbean Comparison Report • Approach to HRH Capacity Development • HRH Roadmap: Priorities for Action

3. Goal of HRH Planning “To achieve and maintain an optimal and stable supply and distribution of appropriately trained, deployed, supported and motivated health workforce, with the capacity to respond to current and future population health care needs in a way that maximizes efficiency and effectiveness while being affordable and sustainable…”

4. The History of HRH Planning

5. HRH Planning Context

6. Sustainable Health System Reform Health Delivery CHANGE MANAGEMENT

7. Sustainable Health Workforce Development HRH Planning Management \ Policy / Education Finance / Partnership L Leadership

8. Workforce Development

9. Affordable Healthcare

10. Health System Outcomes

11. Health Expenditure & Outcomes Ranking (3) (1) (2) (4) (5) (3) (1) (2) (4) (5) (4) (2) (4) (2) (2) (2) (3) (1) (3) (5) (5) (3) (3) (1) (1) (5) (5) (4) (4) (1)

12. Equity in Healthcare Delivery

13. Equity for Healthcare Workers

14. Health System Cost Drivers

15. Technology Management

16. Application of Technology

17. Telemedicine

18. Primary Health Care Teams

19. HRH Task Shifting

20. Competency-Based Deployment

21. HRH Forecasting

22. HRH Forecasting

23. Recruitment & Retention

24. HRH Management & Development

25. Governance in Healthcare

26. Knowledge Translation & Exchange

27. Non-Communicable Diseases NCD’s Injuries CD’s

28. Non-Communicable Diseases Lifestyle Risk FactorsPolicy Response • - Primary Health Care • - Public Health • - Health Promotion/Disease Prevention • - Health Education • - Community Health Support • WHAT ARE THE IMPLICATIONS FOR • HUMAN RESOURCES FOR HEALTH • PLANNING ?

29. Health Outcomes

30. HRH Reform ISSUES: Supply Demand Production Training Recruitment Retention Distribution Access Deployment Health/Safety Productivity Migration Management Payment Sustainability

31. Review of HRH in the Caribbean Historical Trends • Only Dominica, Trinidad & Tobago and St. Lucia up in MD supply in last decade • Others record a decline in physician numbers, the greatest in Jamaica • Jamaica and Guyana greatest decline in RN numbers • Jamaica and Grenada the highest health worker emigration • Regional out-migration of 81% RNs and 53% MDs • 78% employed in the public sector • Specialists 17% of Dominica’s MD stock; 85% in Anguilla • Trinidad & Tobago recruiting 450 RNs and 119 Medical Specialists • Guyana 300 vacancies, 25% to 50% vacancy rates • Possible surplus of health workers in Guyana in less than five years

32. Review of HRH in the Caribbean Regional Goals • 8 of 11 countries achieve the minimum target of 25 per 10,000 population • Jamaica and Belize 25% of goal; Montserrat & Barbados 3.3 times minimum target • Only Belize and Grenada were 40 percent of MDs PHC physicians • 5 of 9 countries achieved 90% of required PHC competencies & team coverage • One RN for every MD achieved by all countries; Montserrat & Barbados 8.3 to 1 • All countries had an HRH Unit, but the majority were one-person operations • 80% of population growth occurring in urban areas • Four countries reached target regarding staff inter-cultural competencies • Jamaica, Dominica & St. Lucia reported upgrading staff skills and competencies • Only four countries recruited PHC workers locally • Only Barbados & Jamaica had adopted recruitment codes of practice • No countries had achieved self-sufficiency in HRH

33. Review of HRH in the Caribbean Regional Goals • 29% of health workers were in precarious, unprotected positions • Six countries had worker health and safety practices in place • Four countries had managers with appropriate competencies • All countries had labor dispute mechanisms; 67% essential services legislation • Six countries provided some inter-disciplinary training, the highest in Jamaica (73%) • Only Jamaica & Barbados recruited students from under-serviced areas • Only Barbados, Jamaica & Guyana have nursing attrition rates less than 20% • Six countries have reached the target regarding health program accreditation Conclusions • About HALF the Regional Goals are well underway • Continuing support needed for data development, HRH planning capacity, ongoing skills development and workforce management and retention.

34. HRH Action Framework

35. HRH CAPACITY DEVELOPMENT & SUSTAINABILITY GOAL : Optimal, Productive, Accessible, Responsive, Motivated & Stable Workforce MoH LINKAGES ENABLERS CORE FUNCTIONS Leadership Management Education/Training Curriculum Communications KTE Leg/Regulation Programs/Policies Stds/Guidelines Partnerships Finance/Incentives Data Development Trend Monitoring Research & Analysis Supply & Distribution Needs Identification Cost-Benefit/Impact Strategic Planning Forecasting Evaluation Primary Health Care Public Health Health Promotion RHA’s Finance Health Institutions Mental Health Health & Safety Health Information CNO / MOH Research & Planning FACILITATION PARTICIPATION COORDINATION COLLABORATION PLANNING DEVELOPMENT IMPLEMENTATION EVALUATION MODIFICATION

36. Health Workforce Productivity Outcomes Capacity Development Workforce Optimization Workplace Support Education & Training Workforce Culture, Communications & Expectations Supply & Mix Models of Care Matching Competencies to Requirements Provider Roles & Deployment Mix, Numbers & Distribution Occupational Health & Safety Personnel Management Practices Innovation & Support Stability of Workforce Efficiency in health services delivery Effectiveness of Patient Care, Health Outcomes & Population Health

37. Roadmap: Priorities for ActionGovernance • HRH Database Development • HRH Policy Inventory • HRH Policy Brief Development • (Online) Observatory Development • Processes to Update & Disseminate Information • Hiring Guidelines stipulating Public Health competencies • MoH to draft new supporting HRH policies

38. HRH Roadmap: Priorities for ActionEducation & Training • Build capacity & competencies to meet challenges of NCD’s • Caribbean Learning Network courses in planning, evaluation and management • CLN courses in online in-service training to work in inter-professional teams • Enroll HR Managers in online HRH Management courses • Health staff will upgrade competencies as required • CLN will begin process of course accreditation • Ongoing commitment to staff training & capacity building • Improved working conditions through better staff preparation