Outcomes are the end results of the correct process of patient care and of the timely availability of the necessary inputs .Favorable outcomes can be affected by factors not under the direct control of the health worker such as cultural factors, housing, diet, environment, genetics, all not a process action of the health worker. It is therefore more effective to improve the health care delivery process continuously and to make sure that the most critical inputs are available.
Yes, money and drugs are needed, but these inputs demand an effective workforce for it is people, not just vaccines, drugs, who prevent disease and administer cures. Workers are active-not passive-agents of change often commanding two-thirds of health budgets gluing together the many parts of the health systems to spearhead the production of health.
A strong and vibrant health system is impossible without health workers who are the ultimate resource of health systems.
The critical input to be considered in this write up is the human resource in health and suggestions on how to manage them effectively and concisely.
The human agency drive towards sustainable healthcare is dependent on building a high performance health system which is largely reliant on a vibrant/effective workforce represented in health by the health workers who unfortunately are inputs.
The vertical programs such as HIV/AIDS(increase workload ,exposure to infection, stress to morale),out-migration(brain drain) and inadequate investments(underinvestment in human resources) in health due to mass poverty, disparity in economic growth in low/middle income countries and political instability threaten the fundamental functions of the health systems through shortage of health workers.
Sparse distribution of health workers have threatened development in all spheres of life necessitating cooperative action among all countries.
Generally, there is global shortage of health workers and all countries have geographic imbalances in their workforce requiring strategic investing in and management of their health workforce.
SKILL IMBALANCES: Create huge inefficiencies requiring health plans directed towards population-based public health that closely reflect the needs of the population essentially through deploying auxiliary and community health workers.
MALDISTRIBUTION & MIGRATION: In form of intra-migration-urban migration of health workers and international migration-across nations probably due to economic and/or work environment related reasons.
POOR WORK ENVIRONMENT: To encourage, maintain and sustain “Best Practices”, human and physical infrastructures have to be upgraded through financial and non-financial incentives to retain and motivate health workers.
WEAK KNOWLEDGE BASE: Restricts ability to efficiently attain desired goals due to fundamental defects in planning, program management, policy development and appropriate data management.
The proposed workforce strategy to overcome the crisis and achieve a high performance workforce must be country-oriented, community driven and backed by international reinforcement. The strategy should have the tendency to promote community engagement in recruiting, retaining ,training and accounting for worker performance.
All the strategy have five key dimensions viz;
- Engage leaders and stakeholders in country or community of origin
- Plan human investments
- Manage for performance
- Develop enabling policies
- Potential for capacity building
Workforce development require a multisectoral approach with the health and education sectors required to be responsible for the management of the workforce to achieve the following strategies:
Coverage: Promote worker skill mix and outreach to vulnerable population
Motivation: Promote adequate remuneration and improved work environment.
Competence: Educating for appropriate attitudes and skills, continuous education, entrepreneurship and motivation all oriented towards capacity building.
International reinforcement will combat negative health consequences due to cross-border flows and improve management of transnational flows by retaining talent in sending countries and educational self sufficiency in destination countries. Enhancement of educational investments in source countries and accelerated appropriate reverse flow of workers from better-endowed to deficit countries is also done through international reinforcement.
Strategies must focus on bridging the knowledge-action gap, promoting the sharing of information, and strengthening the knowledge base of all countries while inculcating a research culture and promotion of intermingling of innovation among countries.
Development Assistance is also a critical area in overcoming the global workforce shortage by devoting a large chunk to human resource development with improve donor coordination and policy coherence to harmonize and sustain the workforce improvement efforts.
Due to the timeliness of new opportunities in global health, all actors are to direct their efforts to a three part agenda viz;
- Strengthening sustainable health systems: Development of a national workforce strategic plan to guide enhanced investments in human resources through education ,deployment, training, retraining and retention aimed to ensure access of every family to a motivated, skilled and supported health worker in their community.
- Mobilizing to combat health emergencies : Delegation of core health functions to well trained community based auxiliary workers in crisis countries as well as build a strong Primary Health Care system for sustainability.
- Building Knowledge base: Through building virtual and operational networks to support country based and country led actions, infusion of a culture of science based knowledge in human resources for health particularly in strengthening national data, information and analyses; and research in human resources for health tailored towards ensuring “Best Practices”.
The implementation of this agenda requires acting ,learning ,adjusting and growing while the national governments and international agencies will be saddled with the responsibility of collaborative planning and constant feedback.
1.Lincoln chen.2004(Human resources: overcoming the crisis)
2.Willy De Geyndt.1995(Managing the quality of healthcare in developing countries)