Human Resource for Health, UHC and Private Sector

Harnessing and Aligning the Private Sector

for Universal Health Coverage
Presented at Prince Mahidol Awards Ceremony Week
Paul Lalvani
Dean and Director
Empower School of Health
New Delhi, India
26 January, 2016

WHO HR4H vision 2020:

Universal coverage for access to quality health services,

particularly for the most vulnerable and excluded groups, with
improved patient and community health outcomes, through a
balanced distribution and efficient skill mix of a multi-professional,
motivated workforce able to prevent and manage a full range of
conditions and empower people and communities to manage their
own health needs as fully as possible

Classification of Health Professionals

Health Professionals
Generalist medical practitioners
Specialist medical practitioners
Nursing professional
Midwifery professional
Traditional and complementary
medicine professionals
Paramedical practitioner
Dentist
Pharmacist
Environmental and occupational
health and hygiene professionals
Physiotherapist
Dieticians and nutritionists
Audiologists and speech
therapists
Optometrists and ophthalmic
opticians

Health Associate
Professionals

Personal Care Workers in

Health Services

Health Management and

Support Personnel

Medical imaging and therapeutic

equipment technicians
Medical and pathology laboratory
technicians
Pharmaceutical technicians and
assistants
Medical and dental prosthetic
technicians
Nursing associate professionals
Midwifery associate professionals
Traditional and complementary
medicine associate professionals
Dental assistants and therapists
Medical records and health
information technicians
Community health workers
Dispensing optician
Physiotherapy technicians and
assistant
Medical assistant
Environmental and occupational
health inspectors and associates
Ambulance worker
Health associate professionals
not elsewhere classified

Health care assistant

Home-based personal care
worker
Personal care workers in health
services not elsewhere classified

Health service manager

Health management personnel
not elsewhere classified
Life science professionals
Social work and counselling
professional
Non-health professionals not
elsewhere classified
Life science technicians
Medical secretaries
Non-health technicians and
associate professionals not
elsewhere classified
Clerical support workers
Service and sales workers
Trades worker
Plant and machine operators and
assemblers
Elementary occupations

Source: WHO Health Workers Classification

International Standard Classification of Occupations (ISCO, 2008 revision)

Challenges in HR for Health

Large variation of health workforce Asia Pacific Region

Psychiatrists

Pharmaceutical
Personnel

Dentistry
personnel

Physicians

Nursing and
midwifery
personnel

Density of health workforce (per 10 000 population)

WHO region
African Region
Region of the Americas
South-East Asia Region
European Region
Eastern Mediterranean Region
Western Pacific Region

2.6

12

0.5

0.9

<0.05

20.8

45.8

6.9

6.7

0.5

5.9

15.3

3.8

<0.05

33.1
11.4
15.3

80.5
16.1
25.1

5
1.9

5.1
6.1
4.5

1.1
0.1
0.2

0.3
1.2

5.8
2.7

0.5
4.2
3.1
8.4
4.3

<0.05
0.1
0.2
1
0.3

Income group
Low income
Lower middle income
Upper middle income
High income
Global

2.4
7.8
15.5
29.4
14.1

5.4
17.8
25.3
86.9
29.2

Source: World Health Statistics, 2014

6

Health Systems

Psychiatrists

Pharmaceutical
Personnel

Dentistry
personnel

Physicians

Nursing and
midwifery
personnel

Density of health workforce (per 10 000 population)

WHO region
African Region
Region of the Americas
South-East Asia Region
European Region
Eastern Mediterranean Region
Western Pacific Region

2.6

12

0.5

0.9

<0.05

20.8

45.8

6.9

6.7

0.5

5.9

15.3

3.8

<0.05

33.1
11.4
15.3

80.5
16.1
25.1

5
1.9

5.1
6.1
4.5

1.1
0.1
0.2

0.3
1.2

5.8
2.7

0.5
4.2
3.1
8.4
4.3

<0.05
0.1
0.2
1
0.3

Income group
Low income
Lower middle income
Upper middle income
High income
Global

2.4
7.8
15.5
29.4
14.1

5.4
17.8
25.3
86.9
29.2

Source: World Health Statistics, 2014

7

Health Systems

Psychiatrists

Pharmaceutical
Personnel

Dentistry
personnel

Physicians

Nursing and
midwifery
personnel

Density of health workforce (per 10 000 population)

WHO region
African Region
Region of the Americas
South-East Asia Region
European Region
Eastern Mediterranean Region
Western Pacific Region

2.6

12

0.5

0.9

<0.05

20.8

45.8

6.9

6.7

0.5

5.9

15.3

3.8

<0.05

33.1
11.4
15.3

80.5
16.1
25.1

5
1.9

5.1
6.1
4.5

1.1
0.1
0.2

0.3
1.2

5.8
2.7

0.5
4.2
3.1
8.4
4.3

<0.05
0.1
0.2
1
0.3

Income group
Low income
Lower middle income
Upper middle income
High income
Global

2.4
7.8
15.5
29.4
14.1

5.4
17.8
25.3
86.9
29.2

Source: World Health Statistics, 2014

8

Examples of Imbalance in the Health Sector

Urban - Rural Imbalance:

Cambodia, 85% of the population reside in rural areas, yet only 13% of
government health professionals work there

In Nepal, only 20% of rural physician posts are filled, compared with
96% in urban areas
Health Professional Imbalance

Greater numbers of physicians than nurses or midwives were registered

in Bangladesh, India, Mongolia and Myanmar
Global average is twice as many nurses/midwives relative to physicians

Source: Health in Asia Pacific Chap 11.

9

Challenges faced by HR in health (In the Asia Pacific Region)

CRITICAL GAPS AND CHALLENGES

1.
2.
3.
4.
5.
6.
7.
8.

Cross-sectoral planning and policy alignment

Health sector financing and governance
HRH databases, information management systems and strategic plans
Workforce shortages and maldistribution
Implementation of HRH plans
Education and training
Informal health workers
Research, analysis, monitoring and evaluation

All these depend on good personnel management, appropriate career

structures, effective staff supervision and development, presence of adequate
support and good working conditions.

Source: Health in Asia Pacific Chap 11.

WHO HRH Action Framework

10

Cross-sectoral planning and policy alignment

Health workforce planning and policy alignment across sectors,

including health, education, finance and labour, are currently lacking in
many countries.

More attention must be spent on facilitating policy dialogue and joint

decision-making across sectors with multiple stakeholders, including
all relevant ministries, the publicprivate service delivery sector,
professional associations, nongovernmental and faith-based
organizations, consumers and communities, and technical and
donor partners.

Source: Health in Asia Pacific Chap 11.

WHO HRH Action Framework

11

Health sector financing and governance

HRH policies, plans and interventions call for strong political
commitment and sustained financial investments to support workforce
scaling up in areas of greatest need, i.e. employment costs and preservice education

Little has been done to increase health sector funding even though
the consequences of inadequate investment are widely recognized.
As such, many countries are struggling to improve the recruitment,
deployment, retention and performance of the health workforce.

Source: Health in Asia Pacific Chap 11.

WHO HRH Action Framework

12

HRH databases, information management systems and

strategic plans
In most lesser-resourced countries, databases and other data sources,
as well as HRH information management systems (IMS), even if they
exist, do not provide policy-makers and planners with the necessary
minimum data sets to enable full workforce analyses by gender, age,
location (rural or urban), ethnicity and expertise.

Governments have not completely or consistently identified health

service priorities, or delineated the functions and staffing norms for
different facilities or services, further limiting the effectiveness of
workforce planning efforts.

Source: Health in Asia Pacific Chap 11.

WHO HRH Action Framework

13

Workforce shortages and maldistribution

Seriousness of the problems varies from country to country
Overall, the Region has insufficient numbers of essential groups of
health personnel, including: qualified tutors/faculty for education and
training; mental health personnel; community-based nurses and
midwives and selected categories of medical specialists
Adequately trained health facility and equipment engineers and
maintenance personnel; and, in the Pacific islands, local, low-cost
prosthetic makers.
All countries also have workforce distribution inequities with most
health workers found in urban areas, leaving rural areas
underserved.

Source: Health in Asia Pacific Chap 11.

WHO HRH Action Framework

14

Implementation of HRH plans

Many countries have HRH plans in place to address workforce issues,

but the main challenge is in implementation

Even if HRH priorities are clearly delineated, there may still be inadequate
strategic action planning and budgetary support to adequately address
urgent HRH needs.
Disconnects still exist between health services and educational and
workforce planning, contributing to inefficiencies and misalignment in
training, deployment and uptake into the workforce.

Source: Health in Asia Pacific Chap 11.

WHO HRH Action Framework

15

Education and training

The standards and quality of education and training of health
professionals remain below par in many countries
In many countries, there is no formal, credible system for educating
allied health workers
Too many different kinds of professionals, too many people need to
be educated and trained

In many lesser-resourced countries, the health workforce is illprepared to effectively respond to rapidly changing, complex health
systems, population health challenges, and the growing burden of
noncommunicable diseases
Faculty in lesser-resourced countries typically lack clinical expertise
as well as formal preparation in education, teaching and learning

Source: Health in Asia Pacific Chap 11.

WHO HRH Action Framework

16

Informal health workers

The HRH challenges of the formal workforce apply to the informal
workforce to an even greater extent, as many informal health
workers do not receive salaries or supervision, and are operating
below the radar
If not managed or educated, or brought into the formal health
system, they can create more harm than good

Insufficient comparative and analytical data exist regarding their

education, deployment, utilization, retention and effectiveness in the
region
Informal health workers have multiple titles and varying types and
depth of training, studies and experience have shown that they can
play important roles in child survival, maternal health and
management of infectious diseases
Source: Health in Asia Pacific Chap 11.
WHO HRH Action Framework

17

Research, analysis, monitoring and evaluation

There is growing amount of analysis and research being undertaken
throughout the region, which can inform policy development and
planning
More is needed to capture the unique characteristics of each
country and its health workforce
.
Research has been directed at better understanding the workforce
situation, and the underlying causes of particular problems.
There has been little investigation of the impact of interventions
taken to resolve problems; however, in many countries, not enough
time has passed for such impacts to be felt, and resources for
monitoring or independent analysis are limited

Source: Health in Asia Pacific Chap 11.

WHO HRH Action Framework

18

Public-Private Partnerships for HR4H

19

Workforce Development Model

Demand
driven skills in
Health Sector

Improved
Workforce

Education
and Training

Public/ Private
Partnership

According to USAID early private sector engagement is an essential component to youth

employment programs as well as a critical contributor to programme sustainability
Source: Public-Private Partnerships: lessons learned (USAID/Jordan, January 2009)
Oxford Policy Management

20

Case Study: NSDC, India

21

National Skills Development Corp., India

Launched by the Finance Minister "...There is a compelling need to launch a world-class skill
development programme in a mission mode that will address the challenge of imparting the
skills required by a growing economy. Both the structure and the leadership of the mission must
be such that the programme can be scaled up quickly to cover the whole country."

Mission:
Upgrade skills to international standards through significant industry involvement and
develop necessary frameworks for standards, curriculum and quality assurance
Enhance, support and coordinate private sector initiatives for skill development through
appropriate Public-Private Partnership (PPP) models; strive for significant operational and
financial involvement from the private sector
Play the role of a "market-maker" by bringing financing, particularly in sectors where market
mechanisms are ineffective or missing
Prioritize initiatives that can have a multiplier or catalytic effect as opposed to one-off
impact.
Source: NSDC
22

NSDC Case Study: Overview

NSDC is a not-for-profit company set up by the Ministry of Finance,. It has an
equity base of Rs. 10 crore, of which the Government of India holds for 49%,
while the private sector has the balance 51%.

A large part of its efforts are directed at skill development programmed in the unorganized
sector
NSDC is actively promoting the involvement of employers through the establishment of
Sector Skills Councils, and providing seed money to develop occupational standards and
competence-based curricula.
The differentiated focus for the 21 sectors under NSDCs purview and its understanding of
their viability will make every sector attractive to private investment.

Source: NSDC
Oxford Policy Management

23

Healthcare Sector Skill Council (HSSC)

Healthcare Sector Skill Council is a unique Initiative of Confederation of Indian
Industry (CII), National Skills Development Corporation (NSDC) and Leading
Healthcare Industry Leaders, representing both public and private sector.
Objective: facilitating skilling of 4.8 million workforce in the Allied
Healthcare and Paramedics over the next 10 years

Source: HSSC
24

HSSC Role in Developing Vocational Education

in India for Allied Healthcare and Paramedics

Development of
National
Occupational
Standards

Development
of Appropriate
Courses &
Curriculum

Accreditation
& Affiliation of
Training Institutes

Assessment &
Certification for
Trainees

Establishment of a
Vibrant LabourMarket Information
System & Placement
Support

Academy of
Excellence A
World-class
Simulation
Centre

Source: HSSC
25

Case Study: UNAIDS, Empower

26

Case Study: UNAIDS and implementation by Empower School of Health

(ongoing)
Objective:
Develop and approach and establish a platform for scaleable assessment
of HR capacity
Professional focus:
Health Procurement and Supply chain
Where:
Philippines, Pakistan and Indonesia
Horizontal and vertical programs (HIV, TB, Malaria and RCH)
Centre and the provinces
Approach:
Self assessment online tool, takes about 1 hour to complete and includes about
100 questions

27

HR Competency Assessment

Funders and Partners

Use any platform to conduct assessment

Educational
Qualifications

Work
Experience

Soft Skills

Domain
Competency

Personal HR Profile

28

Competency Finding (78 staff)

DOMAIN

29

Measuring Competency Level Performance

Storage & Distribution - Competency Level Performance
10%

13%

15%
31%
41%

62%

44%

57%
Good performance
36%

Average performance
Poor performance

67%

41%
28%

30%

23%
3%

Practice storage,
Supply commodities to Manage transport for Manage disposal of Manage re-packing of
warehousing and
facilities
commodities
products (e.g, expired,
products
inventory
damaged, redundant
management standard
products)
procedures

30

Analyse Competency Performance Results

Training
Received

Actual
Performance

Work Experience

Self Assessment
Competency
Performance
Analysis

31

Report product use / consumption

Properly use medical products according to

international / national regulations

Dispense or provide commodities to patients / users

Competency-wise Assessment

Provide information and advice to the product user /

patient

Manage transport for commodities

Manage re-packing of products

Supply commodities to facilities

Manage disposal of products (e.g, expired, damaged,

redundant products)

Practice storage, warehousing and inventory

management standard procedures

Manage import and export of products

Manage procurement costs and budget

Ensure quality of products

Manage contract, risk and quality

Build and maintain supplier relationships

Manage tendering processes and supplier agreements

Forecast and quantify product needs

Supply planning

Define the specifications and quality of the product

Select the appropriate product

Findings across 19 competency areas

Work Experience

Training Received

Competency Performance

Self Assessment

Good

Average

Weak

32

Report product use / consumption

Properly use medical products according to

international / national regulations

Competency-wise Assessment

Dispense or provide commodities to patients / users

Provide information and advice to the product user /

patient

Manage transport for commodities

Manage re-packing of products

Supply commodities to facilities

Manage disposal of products (e.g, expired, damaged,

redundant products)

Practice storage, warehousing and inventory

management standard procedures

Manage import and export of products

Manage procurement costs and budget

Ensure quality of products

Manage contract, risk and quality

Build and maintain supplier relationships

Manage tendering processes and supplier agreements

Forecast and quantify product needs

Supply planning

Define the specifications and quality of the product

Select the appropriate product

Self Assessment for each Competency

Self Assessment

Good

Average

Weak

33

Report product use / consumption

Work Experience

Properly use medical products according to

international / national regulations

Dispense or provide commodities to patients / users

Provide information and advice to the product user /

patient

Competency-wise Assessment

Manage transport for commodities

Manage re-packing of products

Supply commodities to facilities

Manage disposal of products (e.g, expired, damaged,

redundant products)

Practice storage, warehousing and inventory

management standard procedures

Manage import and export of products

Manage procurement costs and budget

Ensure quality of products

Manage contract, risk and quality

Build and maintain supplier relationships

Manage tendering processes and supplier agreements

Forecast and quantify product needs

Supply planning

Define the specifications and quality of the product

Select the appropriate product

Work Experience at Competency Level

Self Assessment

Good

Average

Weak

34

Report product use / consumption

Work Experience

Properly use medical products according to

international / national regulations

Dispense or provide commodities to patients / users

Provide information and advice to the product user /

patient

Competency-wise Assessment

Manage transport for commodities

Manage re-packing of products

Supply commodities to facilities

Manage disposal of products (e.g, expired, damaged,

redundant products)

Practice storage, warehousing and inventory

management standard procedures

Manage import and export of products

Manage procurement costs and budget

Ensure quality of products

Manage contract, risk and quality

Build and maintain supplier relationships

Manage tendering processes and supplier agreements

Forecast and quantify product needs

Supply planning

Define the specifications and quality of the product

Select the appropriate product

Training received at each Competency Level

Training Received

Self Assessment

Good

Average

Weak

35

Report product use / consumption

Properly use medical products according to

international / national regulations

Dispense or provide commodities to patients / users

Competency-wise Assessment

Provide information and advice to the product user /

patient

Manage transport for commodities

Manage re-packing of products

Supply commodities to facilities

Manage disposal of products (e.g, expired, damaged,

redundant products)

Practice storage, warehousing and inventory

management standard procedures

Manage import and export of products

Manage procurement costs and budget

Ensure quality of products

Manage contract, risk and quality

Build and maintain supplier relationships

Manage tendering processes and supplier agreements

Forecast and quantify product needs

Supply planning

Define the specifications and quality of the product

Select the appropriate product

Overall Findings
Work Experience

Training Received

Competency Performance

Self Assessment

Good

Average

Weak

36

Report product use / consumption

Properly use medical products according to

international / national regulations

Dispense or provide commodities to patients / users

Competency-wise Assessment

Provide information and advice to the product user /

patient

Manage transport for commodities

Manage re-packing of products

Supply commodities to facilities

Manage disposal of products (e.g, expired, damaged,

redundant products)

Practice storage, warehousing and inventory

management standard procedures

Manage import and export of products

Manage procurement costs and budget

Ensure quality of products

Manage contract, risk and quality

Build and maintain supplier relationships

Manage tendering processes and supplier agreements

Forecast and quantify product needs

Supply planning

Define the specifications and quality of the product

Select the appropriate product

Competency Performance (answering technical questions)

Competency Performance

Good

Average

Weak

37

Design Your Own Modular Course

Module 1: Product
Selection

Module 2:
Quantification

Module 3: Procurement

Module 4: Inventory
Management

Module 5: Quality
Assurance

Module 6: Rational Use

of Drugs

38

Customized UNDP PSM course (freely available)

39

Conclusions

HR in health is fraught with numerouse challenges

Lots of science to help us find the solutions, but more research needs to be done
Many governments are working on this and have developed HR4H plans
Many leading organizations working on thisWHO, ADB, World Bank, ILO,
Academia
Private sector is getting engaged and collaborating with public sector and NGOs
Technology is acting as a game changer
Funds are available to help reform the sector

40

Thank you
About Empower School of Health
Vision: Saving lives by promoting universal access to quality-assured medicines
Our area of expertise is in Access to Medicines including procurement, supply chain,
pharmaceutical management, regulatory and quality-assurance. Empower focuses on education,
training, technical assistance and research.

Empower School of Health works across 30 countries in Africa and Asia

Government

Government

Government

of Pakistan

of Indonesia

of Philippines

Ministry of Commerce,
India

EMPOWER PARTNERS, FUNDERS AND CLIENTS

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