Pacific Islands Primary Care Association (PIPCA) Workforce Development: Strengthening the Safety Net AAPCHO 20 th Anniversary Conference March 10, 2008 Washington DC
PIPCA MISSION To promote and support quality Pacific Islands primary health care for all member islands.
PIPCA MEMBERS Ebeye Community Health Center, Republic of the Marshall Islands Northern & Southern Regional Community Health Centers, Guam Palau Community Health Center, Republic of Palau Pohnpei Community Health Center, Pohnpei, FSM Tafuna Family Health Center, American Samoa Wa`ab Community Health Center, Yap American Pacific Nursing Leaders Council Northern Pacific Environmental Health Association Pacific Basin Dental Association Pacific Basin Medical Association Pacific Islands Health Officers Association Pacific Substance Abuse and Mental Health Collaborating Council
Workforce Development is one of the top Health Priorities for the six USassociated Pacific Island Ministries/Departments of Health Many thanks to the Pacific Island Health Officers Association (PIHOA) for the basis of this presentation
Top Priority: PIHOA Action Plan Workforce development Buy why? Isn t this Workforce Investment and not Health? Workforce development is cross-sector, collaborative effort Current mismatch between health, labor, and education Health workforce development dictated by health priorities Health needs to do its part ALSO...
... IT S OUR BIGGEST PROBLEM Shortages in nursing, allied health, dental nursing, laboratory technician, radiology technician, pharmacy technician Shortages of trained public health professionals proficient in health systems management (data, planning, quality assurance, etc..) Pipeline: Too few qualify (math, science, English) Too few graduate (academic demands, family needs) Too few return (competition abroad, low salaries) Bridging programs: Many existing staff are undertrained and underprepared Most allied health workers have been trained on-the-job by more senior workers who were also trained on-the-job Need for more in-country training
KEY CONCEPT #1: It s not just about doctors and nurses What are Human Resources for Health? Most people think clinicians: doctors and nurses. BUT: The WHO World Health Report (April 2006) Human Resources for Health defines health workers to be all people engaged in ACTIONS whose primary intent is to enhance health. This includes:
KEY CONCEPT #1: It s not just about doctors and nurses Health service providers: Professional: doctors, nurses, midwives, mid-levels Associates: technicians Paraprofessionals: Community Health Workers, Dental Nurses Other community: traditional practitioners BUT ALSO....
KEY CONCEPT #1: It s not just about doctors and nurses Health service management and support workers Public Health Managers, Program Coordinators Accountants, Fiscal Managers, Procurement Specialists Support staff: clerical, drivers, couriers Craft and trade workers: maintenance, biomedical techs
So what is being done? Must address multiple points in the pipeline simultaneously; for example: Advocate for elementary and secondary math, science, English Bridging programs Appropriate (in-country) health professional training / education Licensing / certification / continuing education / civil service pay scales Can t just start with preschool and then wait 22 years for a doctor to pop out
So what is being done? Short-term Mid-term Long-Term
So what is being done? Short-term PIHOA grants to professional associations for continuing education: medicine, dentistry, nursing.
So what is being done? Mid-term 1. In-country public health training program 2. FSM Nursing School 3. Regional dental paraprofessional training program 4. Quality Assurance and licensing systems
So what is being done? Long-Term HRH action planning in six USAPI Partnership with education sector, including elementary, secondary, and higher education (Example: Area Health Education Center, Health Careers Opportunities Program)
In-Country Public Health Training - big priority biggest health problem is disorganization Geared to real life work situations/need in USAPI: Environmental health Health services management Health promotion, Epidemiology and surveillance Nutrition and dietetics Research and evidence based practice Palau identified $100,000 in Federal funds for planning and startup Academic coordinator recently contracted and began curriculum development in COM-FSM Initially to be rolled out to PCC and COM-FSM; expand to other sites according to interest Designed by Pacificans, based on decades of USAPI experience No sustaining funds yet (AHEC? USAPI? CDC?).
FSM Nursing School FSM is only USAPI without nurse training program FSM arguable most in need: significant shortages; existing nurses under-trained Piloted in Yap State: Senior nurses trained as nurse educators Training occurs in context of health system Tremendous boost to morale Creates buzz / interest in education among other nurses QA program important component Concept paper/proposal and budget developed by Yap and COM-FSM Discussing de-centralized program: All four states. Palau provided $48,000 for COM-FSM to advance nursing and PH projects PIHOA providing $25,000 to help with startup (training senior nurses) Need substantially more for year one (!!) No stable funding yet: AHEC? Need FSM Government financial support. Significant HRSA interest.
Regional Dental Paraprofessional Training Program PIHOA endorsed, PBDA wrote planning grant, PIHOA found funding ($23,000) Focus on cost-effective dental nurses and technicians; basic primary oral health care: cleaning, fillings, extraction, education In-region training program, at a USAPI public health department Outstationed faculty from health professional school Regional advisory committee, develop curriculum, MOA s Startup 1/09 No sustaining funds yet. WE RE LOOKING!
A few lesson s learned in HRH: Emphasize in-country training. Usually lower costs Minimize outmigration / competition Minimize disruption of services Has collateral benefits (class auditors, the buzz ) Fuse health services and education Every hospital and clinic becomes a teaching hospital, partnered with a community college. Learning becomes part of the culture of work
A few lesson s learned in HRH: Develop quality assurance programs that reinforce learning Work environment must support what is learned, or what s the point? QA is the soil in which the seeds of education take root QA prerequisite for in-country training programs Partner with local colleges at every opportunity Help build local education infrastructure Steer away from parachute/silo training; work with funders to fund cross-cutting competencies; academize training Work closely with the PI Jurisdictions (e.g. UH MCH, PITCA)
Thank you. Clifford Chang, MPH, CHES Executive Director Pacific Islands Primary Care Association 345 Queen Street Suite 601 Honolulu, HI 96813-4715 Ph: 808-536-8442 ext. 221 Fax: 808-5240347 Email: <cchang@pacificislandspca.org