Transforming the Health Workforce in Support of Universal Health Coverage

88 Pages·2015·3.02 MB·English

Transforming the Health Workforce in
Support of Universal Health Coverage :
A gloab l toolkit for evaluating health
ow rkforce eud cation
rd
eR port of the 3 eM eting
3–1 uJ l y 4102
Transforming the Health Workforce in
Support of Universal Health Coverage :
A gloab l toolkit for evaluating health
ow rkforce eud cation
rd
eR port of the 3 eM eting
3–1 uJ l y 4102
© World Health Organization 2014
All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int)
or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
(tel.: [phone]; fax: [phone]; e-mail:
A global toolkit for evaluating health workforce education I
Contents
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Day 1: proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Opening session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Presentations on Day 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Day 2: proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Group work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Discussion following group work on the ‘big rock’ items. . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Discussion following looking at the indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Day 3: proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Criteria for selection of countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Discussions following this presentation about countries included: . . . . . . . . . . . . . . . . . . 18
Discussion following Paul Worley’s presentation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Discussion following groupwork on the Handbook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Annex 1: Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Annex 2: List of participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Annex 3: WHA resolution 66.23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Annex 4: Countries that signed up to Resolution WHA66.23 . . . . . . . . . . . . . . . . . . . . . . . 35
Annex 5: Recife Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Annex 6: Recife HRH Commitment Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Annex 7: Presentations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
II Transforming the Health Workforce in Support of Universal Health Coverage:
Executive Summary
This three day meeting focused on reaching agreement on which questions and indicators best ft
the requirements of a global assessment toolkit, using the program logic model.
Addressing the degree to which the quantity, quality, skills mix and distribution of the health workforce
(HWF) is appropriate and aligned to a country’s health context, burden of disease and health system
is a global imperative. It is essential that the HWF is equipped with disciplinary knowledge, technical
skills, profession-specifc and generic competencies and attributes to ensure the centrality of patients
and the population in the pursuit of equitable access to quality universal health coverage (UHC).
The literature has several examples that examine HWF education in the context of the needs of the
population, social accountability and equity, including but not limited to: the World Health Report 2006:
Working Together for Health; the Social Accountability Framework for Evaluation (SAFE) of Health
Systems 2007; the WHO Global Health Workforce Alliance 2008: Scaling Up Saving Lives; the Lancet
Commission 2010: Health Professionals for a New Century: Transforming Education to Strengthen
Health Systems in an Interdependent World; the World Federation for Medical Education 2012: Basic
Medical Education WFME Global Standards for Quality Improvement; the WHO Guidelines 2013:
Transforming and Scaling up Health Professionals’ Education and Training; the Training for Health
Equity Network (THENet) Evaluation Framework; and the WHO-UNESCO-FIP Education Initiative
Needs-Based Education Model.
Evaluation of the outcomes of HWF education is complex. While the ultimate outcome is the health
of the community the health worker serves, there are many variables that preclude analysis of direct
relationships. The importance of developing reliable and valid evaluation tools, with continuous
monitoring and evaluation of progress towards pre-determined HWF education goals is thus
imperative.
Several reports from a diverse set of stakeholders ranging from the World Bank and the World Health
Organisation (WHO) to especially constituted international Commissions, global forums and in-country
health and education-related national plans speak to current HWF challenges, including but not
limited to the quantity, quality, distribution, cost-effectiveness, and relevance of the HWF as well as the
multi-stakeholder, trans-ministerial and educational institution leadership required to address them.
Despite these, the investment in the development of a capable, motivated and supported HWF
remains low, there is a mismatch between supply and demand exacerbated by sub-optimal
policy and regulatory frameworks as well as uncoordinated planning and budgeting at national,
regional and international levels (WHO, 2006; http://www.who.int/workforcealliance/forum/2013/
recife_declaration_13nov.pdf). Severe shortages across all cadres, marked maldistribution, gender
imbalances and poor working environments between and within countries have reached crisis
proportions with developing countries and remote and rural areas particularly disadvantaged as a
result of emigration to developed countries and concentration in urban areas respectively (Crisp &
A global toolkit for evaluating health workforce education III
Chen, 2014 & WHO, 2010). There is a shortage of some 4.3 million physicians, nurses and midwives
globally, approximately 57 low income countries have an insuffcient health workforce to meet minimum
needs, and several countries do not have medical schools, but are instead reliant on international
graduates, thereby circumventing the WHO Global Code of Practice on the International Recruitment
of Health Personnel (WHO, 2010 & WHO, 2006).
Program Logic Model
The program logic model was considered along with all of the indicators that had been discussed in
December 2013 and in May 2014. The indicators were reviewed and added to which resulted in a total
number of 747 suggested items. These were further reviewed and crystallized into 9 key indicators.
Three major country level “traffc light” indicators were proposed based on the submitted key areas
for inclusion and a total of 9 key indicators aimed at institutions, professional organizations etc., who
are responsible for educating, training, accrediting courses and regulating the health workforce were
identifed.
The 9 key indicators were developed from WHA Resolution 66.23, the guidelines document on
Transforming and Scaling Up Health Professional Education and Training, the Recife Declaration,
policy briefs that accompanied the guidelines and other inputs from the group, with some adaptation
to cater for important groups wider than health professionals.
A global toolkit for evaluating health workforce education 1
1. Introduction
The purpose of this third meeting of the Technical Working Group on Health Workforce Education
Assessment Tools was to reach agreement on which questions and indicators best ft the requirements
of a global assessment tool, using the program logic model. The draft protocol and handbook to
accompany the tool, as well as a review of countries to begin phase 1 of the implementation, was
also to be discussed and an approach agreed upon. The focus of the indicators is to be guided by
the WHA Resolution 66.23 where Member States urged the WHO Secretariat:
„ To develop a standard protocol and tool for assessment, which may be adapted to country context;
„ To support Member States as appropriate in using the protocol to conduct comprehensive
assessments of the current situation in health workforce education
„ To provide technical support to Member States in formulating and implementing evidence-based
policies and strategies in order to strengthen and transform their health workforce education
„ To consult regionally in order to review the country assessment fndings and submit a report
providing clear conclusions and recommendations, through the Executive Board, for consideration
by the Seventieth World Health Assembly.
The Technical Working Group on Health Workforce Education Assessment Tools met on 1–3 July
2014 in order to agree on the following 6 objectives :
1. To have a shared understanding of the consolidated program logic models.
2. To reach agreement on a fnal set of indicators for each of the Paired Domains.
3. To reach agreement on the questions for each of the Paired Domains.
4. To reach agreement on a draft Protocol and Handbook to accompany the tool.
5. To reach agreement on an outline of the pilot testing process.
6. To reach agreement on which countries to pilot the tool in frst.
Twenty six Technical Working Group members, six non members, eighteen observers, fve WHO staff
members and one faciliator, participated in the meeting.
2 Transforming the Health Workforce in Support of Universal Health Coverage:
Day 1: proceedings
The meeting began with a welcome from Dr Erica Wheeler, on behalf of WHO.
Opening session
Professor Francisco George, Director General of the Portuguese NHS
Professor George began the opening session by stating that Portugal had achieved many health
goals over the past 30 years. These are mainly in maternal and child health but also include all types
of health care. The Portuguese national health system is doing well, despite the economic crisis in
Portugal. In addition, the Portuguese national health plan until 2020 has recently been approved and
was launched by the WHO Regional Director, Suzanne Jacob.
Professor João Lobo Antunes, Emeritus Professor, Faculty of Medicine, University of Lisbon,
Council of State Member.
Professor Antunes, began by informing the group that he had been closely following this work. For
him, education is not just a vocation but is his passion. He stressed the importance of the contribution
of a health workforce to achieving a modernised health system in Portugal for the 21st Century. He
mentioned that medicine had become more and more complex with the health workforce no longer
dependent solely on doctors and nurses but rather a myriad of health workers. The emphasis of what
it means to be healthy has changed. The goals of healthcare are much broader.
Health professionals today come from a variety of different backgrounds and there is a belief that
those who are destined to work together should be reared together. All health professions have a
common future. However new medicines and new health care demand new solutions. The complexity
of health professionals’ roles is increasing and technology has driven medicine beyond its traditional
area of concern and beyond its original defnition. There is an increasing range of health professionals
and health workers with an increasing range of skills, new work relationships, partnerships and
relationships with the public. Change is necessary and long held beliefs cannot be a stumbling block.
Health workers face moral challenges, new conditions, and a new approach to medical education is
needed. Education needs to be transformative as young health workers will experience huge change
in the next 25 years. The example of Portugal was cited where a new contract is being developed
between medicine and the state and citizens to promote health literacy, personal health information
and person centred models of care. Health education will inevitably need to change to achieve this.
Competence and inter-disciplinary education is critical in meeting the challenges facing health workers.