AAAH Newsletter
by the AAAH Secretariat @ IHPP Thailand

AAAH Newsletter

Volume 1, Issue No. 3, May – August 2007

Click to Download the Full Newsletter in PDF Version (960 Kb)

In this Issue

AAAH 2nd Annual Conference, Beijing

The 2nd Annual AAAH Conference will be organized on 12-14 October, 2007 in Beijing. Check out the call for case studies to be presented there.

Country Progress & Regional Movements

Read what and how Vietnam, Sri Lanka , and Myanmar have been working to address the health workforce issues in their countries.

AAAH Announced 5 Priority countries

the AAAH will focus its effort in the five countries in the first 2 years. Who are they?

Securing Funds from Global Fund and GAVI

Both GF and GAVi provide funding support for health system strengthening including health workforce development

Report from the AAAH GF HSS Workshop

AAAH organized a workshop to support 6 countries to integrate health system strengthening actions into their application to Global Fund round 7

News and Technical HRH Updates

Read latest global and regional news related to health workforce and look at latest list of technical development and publications, and the web version of the HRH Action Framework

Upcoming Events

See the list of upcoming health workforce related events

Mark your calendar:12 - 14 October 2007

The 2nd Annual AAAH Conference, Beijing

The Second AAAH Conference will be organized on 12-14 October, 2007 in Beijing, China. It will be co-hosted by the Health Human Resources Development Center of Ministry of Health, P.R.China (HHRDC) and the AAAH. The theme of this year will be on “Health Workforce for Rural Health and Primary Care”. All 15 AAAH member countries, representatives from other countries in the region, international organizations and regional health workforce alliances and platforms are invited to attend.

The goal of the Conference is to provide a platform for the alliance members and global partners to closely work together to formulate strategies to strengthen country capacity in the management and development of HRH for rural health and primary health care.

Conference Objectives

The Conference has four specific objectives:

1.To follow up on HRH activities in member countries at the regional and global level after the 1^st conference held in 2006, and to review the progress the countries have made in reaching the objectives established in “The AAAH Workplan 2007-2008”.

2.To identify the challenges and constraints facing the development and management of rural HRH and community health workers in the Asia-Pacific region, and to understand to which extent those barriers could inhibit the regional progress toward the goal of “equity health for all” and MDGs.

3.To share frameworks, tools and experience on the development and implementation of national rural HRH strategic plans as well as the achievements in promoting and supporting the community health workers in the primary health care system in the member countries and others.

4.To share experience generated from WHO and other international agencies, platforms or alliance (eg. Global Health Workforce Alliance, GHWA) on assisting the countries to accelerate the development of rural HRH and the building of primary health care system.

Registration and Financial Support

If you are interested in participating in the 2nd AAAH Conference in Beijing, please contact the AAAH Secretariat at secretariat@aaahrh.org for additional information and registration form. With support from the Global Health Workforce Alliance and the World Health Organization (SEARO and WPRO), limited amount of financial support for travel and local expenses will be available to selected participants with priority given to those who prepare case studies to be presented at the Conference. Please check the Call for Case Studies on page 3 for more information on the submission process.

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New HRH Technical Articles

More information about these recently released or published technical documents are available on the AAAH Website. Please do not hesitate to contact the AAAH Secretariat (secretariat@aaahrh.org) with your questions or requests.

Regularly check our Website at http://www.aaahrh.org/articles.php for latest update on recent HRH development.

• Knowledge and Practice of Unqualified and Semi-Qualified Allopathic Providers in Rural Bangladesh: Implications for the HRH Problem

• Nurses' Experiences of Recruitment and Migration from Developing Countries: A Phenomenological Approach

• Impact of an In-built Monitoring System on Family Planning Performance in Rural Bangladesh

• Postoperative Outcome of Caesarean Sections and Other Major Emergency Obstetric Surgery by Clinical Officers and Medical Officers in Malawi

• HIV and Infant Feeding Counseling: Challenges Faced by Nurse-Counselors in Northern Tanzania

• More Non-Physician Clinicians will Boost African Healthcare Workforce

• Lung Health Programme in Nepal

• What's Wrong with Doctors? A Review of a New Book on How Doctors Think

• Approach to Classifying Human Resources Constraints to Attaining Health-related Millennium Development Goals

• Establishing Human Resource Systems for Health During Post Conflict

• International Mobility of Health Professionals: Brain Drain or Brain Exchange?

• Training competent and effective Primary Health Care Workers to fill a void in the outer islands health service delivery of the Marshall Islands of Micronesia

• Health Sector Reforms and Human Resources for Health in Uganda and Bangladesh: Mechanisms of Effect

• Management of Expatriate Medical Assistance in Mozambique

• A Canadian Report on Ethical Recruitment of Health Professionals

• Improving Quality of Clinical Care: Incentives for Health Care Workers

• Collection and Analysis of Human Resources for Health (HRH) Strategic Plans

• Retention Strategies for Nursing: a Profile of Four Countries

• Treat, Train Retain: the AIDS and Health Workforce Plan

• Human Resources for Health Challenges in Dealing with HIV/AIDS in Sub-Saharan Africa

• Development of an Extended Analytical Framework for Needs Based Health Human Resources Planning

• The College of Medicine in the Republic of Malawi: Towards Sustainable Staff Development

• The Training and Expectations of Medical Students in Mozambique

• How Labour Intensive is a Doctor-Based Delivery Model for Antiretroviral Treatment (ART)? Evidence from an Observational Study in Siem Reap,Cambodia

• ILO Multilateral Framework on Labour Migration

• The Ethical Recruitment of Internationally Educated Health Professionals: Lessons from Abroad and Options for Canada

• Learning for Performance: a Guide and Toolkit for Health Worker Training and Education Programs

• Health Workers and Vaccination Coverage in Developing Countries: an Econometric Analysis

• Global Pharmacy Workforce and Migration Report : a Call for Action

• Transition to Skilled Birth Attendance: Is There a Future Role for Trained Traditional Birth Attendants?

• Lessons from Maternal Care in Bangladesh

• Social Franchising of TB Care Through Private GPs in Myanmar

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The 2nd AAAH Annual Conference

12 to 14 October 2007, Beijing, China

Call for Case Studies on

Health Workforce for Rural & Primary Health

The Asia-Pacific Action Alliance on Human Resource for Health (AAAH) with support from the Global Health Workforce Alliance and the World Health Organization will organize its second annual conference in October 2007 under the theme “health workforce for rural health and primary health care”. The conference will be in Beijing, China and will involve AAAH members and global experts

To prepare for the Beijing Conference, the AAAH is calling for case studies related to the Conference theme. It must be drawn on actual experience in a country or a region.

The suggested topic of the case studies could be one of the following (non-exclusive):

1. Skill mix of rural health workers

2. Financing the production and maintenance of rural health workers

3. Incentives for rural health workers

4. Public Sector Reform and rural health workers

5. Decentralization and rural health workers

6. Globalization and its implication on rural health

7. Private health services and its implication on rural health workers

8. Community Health workers, past, present, and future

9. Essential research and information on rural health workers

10. Innovative education for rural health workers

Each case study should not exceed 5000 words with an abstract of less than 600 words.

The report should include the following sections:

1. The background

2. The conceptual framework

3. The story of the case or cases

4. The lessons learnt

5. Proposal for regional or global actions.

The deadline for submission is 31 August 2007. The case will then be reviewed by the Conference’s technical committee. Authors of selected case studies will be invited to present their cases at the Beijing Conference with financial support for all relevant travel costs and local expenses. All contributors will be informed of the decision by 15 September 2007.

For more information on this call for proposal and for the submission of the case study please contact:

The AAAH Secretariat

IHPP-Thailand, Sataranasuk 6 Road,

Nonthaburi 11000, Thailand

Email: secretariat@aaahrh.org

Tel: +66 2 5902370

Fax: +66-2-5902385

Act Fast! Deadline Approaching!

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The AAAH Priority Countries

AppleMark

Following a call for application to be AAAH Priority Countries, eight AAAH members have applied with proposals on the area of HRH work they would like to conduct to strengthen health workforce strategy and system in the country.

The Steering Committee had a difficult time selecting the program. Five of the 8 applicants have been selected. They are: Fiji, Myanmar, Nepal, Papua New Guinea, and Sri Lanka. In addition, Vietnam has been chosen by the Global Health Workforce Alliance (GHWA) as one of the 8 GHWA’s Pathfinder Countries. The AAAH will therefore work with GHWA and the World Health Organization in supporting Vietnam as well.

Read more about current and planned health workforce activities in 2 of the 5 AAAH Priority Countries, Sri Lanka (p.4) and Myanmar (p.5), in this Newsletter. We will bring you health workforce info from the other 3 countries in the next AAAH newsletter.

Country Update

Nine Ongoing Major HRH activities in Vietnam

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Update from Vietnam:

by Nguyen Huong

Manpower and Organization of Vietnam Ministry of Health & The AAAH Focal Point For Vietnam

1) Health sector in Vietnam is on the reform process. We are setting up policy/regulation to delegate the authorities to the local facilities to manage human resource (recruitment, retain, training, promotion, etc.)

2) Review HR in health system, including preventive, medical care system. However, it just focus on public sector .

3) Strengthening preventive system, including HR in preventive system, especially improve capacity for health workers those working in HIV/AIDS, emergence of aviation flu.

4) Working with others sectors to develop labour norm for health facilities

5) Review and revise the policies related to salary and allowance for health workers

6) Develop criteria/standard for promotion

7) Improve capacity for health worker in some disadvantage areas, like Mekong river, Northwest, and Taynguyen areas.

8) Conduct some research related to HR

9) Other routine activities.

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Human Resource Development: a key component in the Sri Lankan Health Master Plan

by Dr. Sarath Samarage,

Deputy Director General of Health Services (Planning), Ministry of Healthcare & Nutrition, Sri Lanka & The AAAH Focal Point for Sri Lanka

Sri Lanka pays special emphasis on HRD in the Health Master Plan. A key strategy is to improve human resources for health development and management.

The Health Master Plan of Sri Lanka launched early this year builds upon many months of dialogue and discussions with all relevant stakeholders and health related sectors including National and Provincial Ministries of Health, Private Health Sector and consumers. It gives direction to translate policy to tangible and practical measures that deliver results. It has been designed for the next ten year period from 2007.

The Health Master Plan (HMP) aims to build on the successes and experiences of the past, and address the challenges of today and tomorrow, based on recognition that Sri Lanka is facing a health transition. These challenges include: changing demographic and disease patterns, limited resources, increased demand and expectations by the public, the need for equity and the development of a management ethos that ensures good governance and value for money in delivering quality services.

The HMP is carefully designed to support Sri Lanka's overall economic and social goals. It aims to facilitate equity through ease of access to health services, improve productivity and ensure that resources allocated to health result in a healthier population that is able to contribute to the economic and social well-being of the country. This is to be achieved by responding to the people's needs and working in partnership to ensure access to comprehensive, high-quality, equitable, cost-effective and sustainable health services. The overarching aim of improving health status and reducing inequalities will be achieved by the five strategies, namely:

A. To ensure the delivery of comprehensive health services which reduce the disease burden and promote health;

B. To empower communities (including households) towards more active participation in maintaining their health;

C. To improve human resources for health development and management;

D. To improve health financing, resource allocation and utilisation; and

E. To strengthen stewardship and management functions of the health system.

Sri Lanka pays special emphasis on HRD in the HMP. A key strategy is to improve human resources for health development and management. Despite the increasing numbers of specific categories of Human Resources in the health sector, the past years have witnessed many problems and challenges. One of the recurrent constraints for improving the effectiveness of human resource policy and planning in the health sector is the lack of a comprehensive human resource strategy and lack of coordination among all units concerned in Ministry of Healthcare and Nutrition and Ministry of Education.

The current major problems are the absence of a realistic approved cadre, imbalance in the recruitment and production of different categories of staff, inequity in spatial deployment and the disparity between expected job performance and training, due to the quality of training.

At present there are some disparities in the requirements and supply of several categories of health personnel, particularly nurses and paramedical personnel. Shortages of certain specialist categories cause inefficiency and ineffectiveness in the public and private delivery systems. On the other hand, the growing number of doctors will have serious cost and quality implications. These doctors may not be fully absorbed into the state health system, as the commitment to do so is only until 2010. Even if increasing numbers of doctors move into the private sector, a surplus of doctors practicing privately will cause an increase in supply-driven health consumption levels in urban areas.

There is also a significant imbalance existing in the distribution of human resource for health (HRH) among districts. Specifically, the number of health personnel in the Northern Province is extremely low while districts such as Colombo, Kandy and Galle have a significantly higher concentration. The insufficient quality and competency of health staff too has been identified as a challenge. Lack of technical competency and absence of positive humane attitudes have affected the responsiveness of the services.

In relation to human resource recruitment, all categories of state sector staff are appointed by a Public Service Commission or similar provincial bodies. Other ancillary workers are appointed by the Ministry of Healthcare and Nutrition (MoH) or Provincial Ministries. The challenge is to introduce an improved system of management geared to appraise the performance of individuals and institutions against their defined roles. This will require an improvement in the working conditions of staff, a fair and transparent system for promotion, reward, discipline and training and continuous professional development. It will also require revised terms and conditions of employment that will generate different incentives for staff who are more responsive to clients' needs. Appropriate conflict resolution procedures need to be introduced as well

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Current Health Workforce and HRH Policy in Myanmar: The Way forward

by Dr. Hla Hla Aye

Director, International Health Division, Ministry of Public Health, Myanmar

Myanmar is divided administratively and geographically into 14 states and divisions, which are again sub-divided into 63 districts. One District Health Department oversees 3-7 townships under its jurisdiction, and there are a total of 325 townships, 13,762 village tracts and 65,235 villages in the whole country.

The basic structure of the national health care system lies at the township levels as 70% of the total population resides in the rural areas which constitutes a large part of townships all over the country. The majority of health workforce covering the whole country lies mostly in these townships where there are both urban and rural settings.

National Health Workforce Policy

A comprehensive national health workforce policy document has not been developed as yet. However, in the past the Public Service Department had appointed the staffing of medical doctors and similar official posts in the health sector. At present, the Ministry of Health takes responsibility for recruitment, training and deployment of health workforce and some of the policies applicable in staffing of all government officers.

Till date, there is very little attention and documentation on the contributions of the the private sector health workforce which contribute partly towards the health care of the people. In the national health plans matters relating to registration, regulation, training, continuing education, deployment and service activities of personnel in the non-government sector has not been taken into account in the official annual reports.

In Myanmar, the National Health Policy was developed with the initiation and guidance of the National Health Committee in 1993. The National Health Policy has placed the Health for All Goal as a prime objective using Primary Health Care approach. The National Health Policy states the following points which are generally considered as health workforce policy:

• To follow the guidelines of the population policy formulated in the country.

• To produce sufficient as well as efficient human resources for health locally in the context of broad frame work of long term health development plan.

Human Resources for Health

The Department of Medical Science is responsible for the production of all categories of health personnel with the aim to strengthen the development of human resources for health and equip them with advanced technologies to deliver health care to the people. Under the Department of Medical Science there are 4 medical universities, 2 dental universities, 2 nursing universities, 2 universities of medical technology, 2 universities of pharmacy, 1 university of community health, 43 nursing and midwifery training schools all over the country.

Health Workforce	2005
Total No. of Doctors - Public - Co-operative & Private	18,725 6,564 12,161
Dental Surgeon - Public - Co-operative & Private	1,870 620 1,250
Nurses	19,922
Dental Nurses	162
Health Assistants	1,771
Lady Health Visitors	2,908
Midwives	16.699
Traditional Practitioners	889
From Health in Myanmar 2006

The types of health personnel produced are doctors, dental surgeons, nurses (including specialty nurses), radiographers, medical lab technicians, physiotherapists, pharmacists, dental technicians, and basic health workers such as health assistants, public health supervisors grade I and II, lady health visitors and midwives who are the corner stone for the implementation of rural health development programme.

The Department of Traditional Medicine is also training Traditional Medical Practitioners by establishing one institute and one university each for Traditional Medicine, in Mandalay.

From the above institutions human resource for health have been developed and the present health workforce situation of Myanmar is shown in the Table here.

Current Challenges

WHO Regional Consultation on Health Workforce held in Bali,18-20 December 2006, identified the following programs to be affected by health workforce related issues. They are National HIV/AIDS program, Maternal and Child health program, Immunization program, Malaria and TB control program.

It has also been high lighted that the current health workforce related issues and challenges are lack of complete health workforce data and information, shortage of competent trainers for different categories of health workforce, maldistribution of health workforce leading to skill-mix imbalance, ineffective health work force management.

Major Initiatives to be taken to overcome HWF related issues for Myanmar - The following areas of need were identified as priority to be developed.

• Development of a national strategic plan for HWF,

• Development of HWF information system,

• Development of accreditation systems for for all training institutions.

• Development of a systematic continuing education program

• Introduction of effective Township Health System with proper HWF management policies in place.

Conclusion

Having identified the needs and challenges related to HWF and the major initiatives to be taken, with concerted efforts of all partners and support from AAAH, Myanmar will be able to have a comprehensive HWF plan and develop appropriate mix of HWF capacity according to the nation's health needs.

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HRH Action Framework

Designed to assist governments and health managers to develop and implement strategies to achieve an effective and sustainable health workforce, the HRH Action Framework diagram includes six clickable Action Fields (HR Management Systems, Leadership, Partnership, Finance, Education and Policy) and four clickable Phases (Situational Analysis, Planning, Implementation and Monitoring & Evaluation).

Now Available on the Web

http://www.capacityproject.org/framework

Disclaimer: The HRH Action Framework website has been developed as an initiative of the Global Health Workforce Alliance (GHWA) and represents a collaborative effort between

the U.S. Agency for International Development (USAID) and the World Health Organization (WHO). The Capacity Project is the website administrator.

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Using funds from the Global Fund and GAVI for HRH and

Health System Strengthening

One role of the AAAH is to support its members in identifying resources to strengthen their health workforce system. The Global Fund and the GAVI Alliance are two global funders who support HRH in the context of health system strengthening (HSS). The AAAH organized a workshop to help countries integrate HSS into the GF application in its Round 7 (see next page) and will consider organizing similar workshop for future GAVI and GF rounds if there are enough interests.

In this newsletter, we provide some basic information on how the Global Fund and the GAVI Alliance could be one source of funding for health workforce strengthening activities in your countries.

Using the Global Fund’s Application to Improve Health Workforce Situation in Your Country

Weak health systems can be a major obstacle to the scale up of prevention and treatment activities to reduce the burden of HIV/AIDS, tuberculosis and malaria. The Global Fund therefore allows health system strengthening activities to be included in the application.

Health workforce mobilization, payment and management are considered one area of major health system obstacles. In the previosu rounds, a number of countries such as Malawi, Rwanda, or Cambodia, have successfully applied to the Global Fund to get support for health system actions that also strengthen health workforce.

The Global Fund’s application round is annually and the deadline for 2007 just passed. Since the application process could take a long time, we recommend that you start early and coordinate with your country’s GF country coordinating mechanism (CCM) earliest. Check the Global Fund website for more information. http://www.theglobalfund.org.

Strengthen Health Workforce System through the GAVI Alliance Health System Strengthening Funds

GAVI encourages countries to use its GAVI HSS funding to target the “bottlenecks” or barriers in the health system that impede progress in improving the provision of and demand for immunisation. Health workforce is one of the three main priority areas of GAVI HSS and health workforce mobilization, distribution and motivation are identified as necessary to overcome health system barriers in GAVI-eligible countries. Sample areas of investment in health workforce as proposed by GAVI include:

• Innovative approaches to the allocation and motivation of existing human resources

• Pay for performance and other incentive-schemes

• Skills transfer training and regulation

• Quality assurance and accreditation of workers

There are many rounds of HSS application for GAVI. The next deadline for proposal submission is on 5 October 2007. For more information, please check its website

http://www.gavialliance.org/support/what/hss/index.php

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GF Workshop Scores: The Results from the Workshop on Integrating Health System Strengthening into GF Round 7 Application

The AAAH organized a workshop to support member countries in the integration of Health System Strengthening actions into the Global Fund Round 7 Applications. Thirty participants from 6 countries attended. Here are the results from 21 evaluation forms we received back . . .

On a scale from 1 to 5: 1 = Very poor; 2 = Poor; 3 = Fair; 4 = Good; 5 = Very Good

Workshop Support got 4+

Expert Sessions got scores between 3.8 to 4.4

19 of 21 (90%) will recommend this workshop to others

18 of 18 want similar workshop for GAVI HSS

17 of 21 (85%) would like support on application’s mock review

If you believe this kind of Workshop will be useful for your work in the country and would like to participate, please send a not

4.19

4.14

4.10

e to let us know with any request or comments that you may have to secretariat@aaahrh.org or fax number +66-2-590-2385. We always appreciate your advice!

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Latest HRH News on the AAAH Website

Read these news articles from the AAAH Website (http://www.aaahrh.org/news.php)

•Call for Abstract to the Geneva Forum 2008 on Health Systems and the Global Health Workforce

•First Announcement International Conference/ New Frontiers in Primary Health Care: Role of Nursing and Other Professions

•OECD says doctor Migration has Limited Impact on Health Care in Poor Countries

•Presentations from the Workshop on Human Resources For Health And Migration now available

• The International Conference on Primary Health Care in Chiang Mai, Thailand

• Beijing AAAH Conference in October 2007

• WHO and HRH Journals Call for Papers on Human Resources

• New MSF Report on Health Worker Shortages Threatening Scale-Up of ART

• Materials from AAAH Workshop on GFATM Round 7 HSS Available

• American Samoa Plans to Hire Nurses from the Philippines

• ASEAN Economic Ministers Sign Mutual Recognition Arrangement on Nursing Services

• World Bank's New Strategy for Health, Nutrition, and Population Draws Praises and Doubts

• EU Announces its Programme of Action on HRH

• Call for Papers: "Towards a Scaling-Up of Training and Education for Health Workers" - Special Joint Issue

• Call for Your Inputs on Health System Challenges and Promising Health System Strategies

• Presentations from International Health Workforce Conference Now Available

• WHO Director General Urges Countries to Train Enough Health Workers

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AAAH Calendar:

July

30-31: GFATM-WHO Consultation on Health Systems Strengthening, Geneva

September

13-14: GHWA Board Meeting

October

3-5: WHO-SEARO Workshop on Community Health Workers

11 AAAH Steering Committee Meeting

12-14: The 2nd AAAH Annual Conference, Beijing

November

TBC: AAAH Workshop on HRH Planning & Management, Manila

March 2008

First Global Health Workforce Alliance Forum, Kampala Uganda

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