Consultation on maximizing synergies between health systems and global health initiatives through work on building and sustaining health workforce development World Health Organization, Regional Office for the Americas. 525-23 rd Street, N.W., Washington 20037 Room B, 2 nd floor, 17-18 March 2009 Current efforts Ethiopia to fast track the implementation of policy decision to build HRH Abebe Asmelash, Director, HRD Federal Ministry of Health of Ethiopia Dr. Wuleta Lemma Deputy Director Center for Global Health Equity, CD Ethiopia Program Tulane University
Outline of the Presentation General Background Present situation of HRH in Ethiopia Measures so far taken to tackle the problem Achievements so far Way forward 2
General Background A. Country Profile Geographical Location:- Eastern part of Africa Population:- More than 73 million Administration:- Decentralized Federal system B. Health services Health policy :- Focuses mainly on prevention, promotion, and basic curative and rehab.services (70-80% preventable health prob.) HSDPII 3
HRH Situation in Ethiopia A. Low HRH density compared to other African countries ( physician and nurse to pop. Ratio) Physcian density (per 10,000 pop) Nurse density (per 10,000 pop) Burundi 0.05 0.1 Rwanda 0.19 2.1 Liberia 0.23 0.58 Mozambique 0.24 2.05 Chad 0.25 1.5 Ethiopia 0.3 2.05 Niger 0.33 2.31 Centrafrique 0.35 0.88 Gambia 0.35 1.25 Burkina Faso 0.4 2.6 Tanzania 0.41 8.52 Mali 0.44 1.26 Uganda 0.47 0.56 Angola 0.5 11.4 Eritrea 0.51 2.1 Togo 0.56 1.67 Zimbabwe 0.57 5.41 Congo (R.D) 0.68 4.41 Lesotho 0.7 3.3 Zambia 0.7 11.3 Comores 0.74 3.41 Cameroon 0.74 3.67 Physcian density (per 10,000 pop) Nurse density (per 10,000 pop) Madagascar 0.87 1.88 Sierra Leone 0.88 9.07 Côte d'ivoire 0.9 3.12 Ghana 0.9 6.4 Benin 1 2 Senegal 1 5 Guinea 1.3 5.57 Mauritania 1.38 6.24 Kenya 1.41 10.8 Swaziland 1.51 4 Guinea Bissau 1.66 10.93 Cape - Verde 1.71 5.58 Equatorial Guinea 2.46 3.95 South Africa 2.51 14 Congo 2.51 18.51 Nigeria 2.69 6.62 Botswana 2.87 24.1 Namibia 2.91 16.58 Sao Tome & Principe 4.67 12.74 Mauritius 8.5 23.3 Algeria 8.5 30 Seychelles 13.2 46.75
Low HRH Density Prof. Category Number Population Density/1000 Doctors 1,805 0.02 Doctors and HO 2,957 0.04 Nurses 18146 0.23 Midwives 1012 0.01 HEW 17653 0.22 Total 39,768 0.24 WHO Recommendation 2.3
HRH Situation in Ethiopia cont B. Unequal distribution b/n urban and rural 12.00 10.00 8.00 6.00 4.00 Physicians Health officers Nurses Health assistants 2.00 0.00 Amhara Oromia Somali Afar SNNPR Tigray Benishangul Gambella Addis Ababa Dire Dawa Hareri
HRH Situation in Ethiopia cont C. High attrition of highly skilled staff D. Inadequate professional mix E. Inadequate skills F. Poor Retention mechanism G. Weak HR management H. Low production of highly skilled professionals
Measures so far taken A. New initiatives launched since 2005 1. Health Extension Program (HEP) - Innovative Strategy Institutionally linking facility based healthcare to community based health care - Focuses on Key areas» Major Communicable Diseases: HIV/AIDS, Malaria, TB prevention & control package» Family Health Care Package» Hygiene & Environmental Health Package» Health Education/IEC/BCC
Measures so far taken cont 2. Accelerated Health officers Training Program ( AHOTP)» is FMOH initiated training program to produce 5000 HOs [minimum]» Program Duration: 5 years [2006 in 2010]» Types of Trainees: both post basic & generic» Training Institutions: 5 universities and 21 affiliated training hospitals Duration of training : 3 years for both PB and Gen.
Measures so far taken cont Why Health Officers? Only few in the Health System Are expected to cover the gap of physicians Gaps in training vs needs [only about 400 HOs graduate/year before AHOTP was initiated] Ideal to expand basic health services & to meet MDGs [expensive to train physicians]
Measures so far taken cont 3. Surgical Emergency and Obstetrics Training (Masters program) - is FMOH initiated training progra to produce 1000 Msc Emergency Surgical officers - Program Duration: 5 years [2009 in 2014] - Types of Trainees: Health officers who served for a minimumu 2 yrs in public sector - Training Institutions: 5 universities and 20 affiliated training hospitals - Duration of training : 3 years
Measures so far taken cont 4. Medical Education A High Level task force chaired by FMOH and MOE established A TWG on Medical education established Strategy for four year Innovative Medical Education being explored target by 2014/15 (8000); 2020 (21,864) Intake of medical students has been increased from 200/Yr in previous years to 1500 in 2008
Measures so far taken cont B. Human Resource Development Strategy 2020 is being developed Guide to Strategic Planning for HRH - Evidence based to extent possible - Focus on system needed for HRH» Financing» Education» Management» Policy and Legal Issue - Focus on how best to achieve health system objectives
CONTEXT SUSTAINABILITY QUALITY HEALTH COVERAGE
HRH Strategy and its targets Desired Outcome Equitable, Efficient and cost effective service delivered at all levels of health delivery accessed by all citizens Relevant and competent health professionals produced. Efficient access of information to users (Costumers and Decision makers) Improved HRH planning and management in the health system The public will be protected from unqualified and unethical health practitioners Objectives To produce a comprehensive HRH strategic plan by 2009 To train 8000 medical doctors and other Health professionals, and by 2014 using innovative Health Science training To standardize staffing pattern for all level of health service by 2009/10 To reduce unfilled posts by 95 % based on the minimum staffing standard at all levels by 2015 To certify and licensee all health professionals by 2010 To develop and deploy national HRIS by 2010 To reduce attrition of high skilled health professionals To develop HRH legal framework
Measures so far taken cont D. Retention Mechanism - Increase in salary 60-70% - Government sponsored Education opportunity for those who provide service in the public sector for a minimum 2 years - Special non-financial incentives for those who are willing to go to hard to reach area (lap top) - enforcement of mandatory service - Each is expected to give mandatory service for the years when the graduate was being under training
Achievements so far A. Health Extension Program - more than 24,500 health extension workers are trained and deployed to their respective communities and 6792 are under training - this is more the target set 30000 HEW/5 years - 886208 selected families have graduated as model families and 133876 are being trained, - national latrine coverage increased from 32% in 2007 to 54% in 2008. - encouraging achievements towards the MDG are being seen
Achievements so far cont B. Human Resource Development Strategy 2020 - the study is nearly completed - this strategy helps the sector to get required staff with the right skill at the right time and at an affordable reasonable cost - the strategy also proposes different types incentives packages (both financial and nonfinancial) that will help to retain professionals in the public sector
Achievements so far cont C. Retention Mechanism - The government was able to deploy and retain all graduates of 2008 - this a great achievement when it is compared with that of 2006 and 2007 which was 15-20% retention rate - this is a good experience that other countries with similar problems could share from Ethiopia
Achievements so far cont D. Accelerated Health Officers Training Program (AHOTP) - 2289 Health Officers are graduated and deployed - 4563 Health officers are under training - these graduates are covering some of the gaps seen both in the clinical service and district office management - these graduates are also a pool for the new initiated training program, surgical emergency and obstetrics care training
Achievements so far cont E. Surgical emergency and Obstetrics Training (Masters program) - started in 3 universities - 53 HO are under training
Achievements so far cont
Way Forward To increase annual intake of high skilled professionals specially physicians to >2500 To initiate 4 year medical education training which is different from the conventional 6 years medical training, to produce more medical doctors in a shorter time To further strengthen and sustain the existing retention mechanism
Acknowledgment Federal Ministry of Health Ethiopia Federal Ministry of Education CDC Ethiopia/PEPFAR Ethiopia WB WHO Other partners
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