"Transforming and Scaling up Health Professional Education and Training" Global Policy Recommendations 2012 IAPAE 5 th Annual Conference, University of Witswatersrand, Joh burg, South Africa 1,6-18 September, 2012 Dr Erica Wheeler, Human Resources for Health, Department for Health Systems, Policies and Workforce
Purpose of the Presentation 1. To describe the context in which the policy recommendations are being developed. 2. To explain the objectives, scope and recommendations of the guidelines. 3. To define what transforming and scaling up education entails and describe the areas recommended for interventions.
Context: WHO response 2006 Rapid scaling up of health workforce production (WHA59.23) Strengthening Nursing and Midwifery (WHA59.27) 2009 Primary health care, including health system strengthening (WHA62.12) 2010 WHO Global Code of Practice on the International Recruitment of Health Personnel (WHA63.16) 2011 Strengthening the health workforce (WHA64.6) Strengthening nursing and midwifery (WHA64.7)
Global Paradigm Shifts and Health Professional Policy Changes High Level Task Force on Innovative Financing for Health Systems published its report in 2009. In 2009 the FDI World Dental Association established the Global Caries Initiative (GCI). Work on Health Professionals in the 21 st century began in 2009 and report published in 2010. United Nations (UN) High Level meeting on Control and Prevention of NCDs held in New York (September 2011)
Context: A time for change The 21st century has seen an increased focus on disease prevention and primary care with a patient-centered approach at the core of health care delivery. However, these changes need to be complemented and reflected in alterations in health professional education and training. The mismatch between the health needs of the population and education curricula necessitates that 21st century reforms replace outdated curricula and teaching methods with a socially accountable approach. Education systems for health professionals require reform through needs-based comprehensive curriculum design and innovative teaching methods, as part of a competency-based approach.
Innovations along the education pipeline Source: The World Health Report 2006 Working together for health
Health Worker Education and Health System Strengthening
Factors Driving Change What we all have in common, is a desire to respond effectively to changing population health needs. A recognition that business as usual does not work and will not address the shortage of health workers at the country level. We need strong health systems in order to deliver effective, sustainable health care, particularly primary health care.
So More health professionals, but not more of the same. We need to produce a new generation of health professionals. Globally competent, but locally relevant. The process of reform requires a broad coalition of committed partners and a multi-sectoral approach between education, health systems and labor market to fit the realities of health service delivery. A global social movement guided by strong technical instruments has to be nurtured to transform education to produce professionals fit for the 21 st century.
Transforming and scaling up the education and training of health professionals recommendations: what is it? A series of policy recommendations and guidelines that addresses the quantity, quality and relevance of health professionals and contributes to improving population health outcomes.
"Quantity"
"Quality"
"Relevance": health system Most of the population accesses care at the primary level. Tertiary Secondary Primary Pakistan 2007 data
Density of medical schools by region (2008 estimate)
Actors in the reforms
The guidelines and policy options Governance and planning Regulatory frameworks Education and training institutions Financing and sustainability Planning, implementation and evaluation
Recommendations: Transforming and Scaling Up Health Professional Education and Training All recommendations relate to improving the quantity, quality and relevance of health workers Political commitment and leadership is needed to transform and scale-up health professional education. (Good Practice) Formal collaboration and shared accountability between the Ministry of Health, the Ministry of Education, and other related ministries (e.g. finance, labour, public service), at national and/or sub-national level, in the education and training of health professionals. (Good Practice) Developing a national health professional education and training plan to produce and retain graduates, which is developed in consultation with all stakeholders, informed by the needs and absorptive capacity of the labour market, and aligned with national human resources for health plans and national health plans. (Good practice)
Recommendations: Transforming and Scaling Up Health Professional Education and Training cont d Strengthening of the national human resources for health information system (HRIS) to include multi-sectoral data elements that support the situation analysis, monitoring and evaluation of the production, recruitment and retention of health professionals. (Good Practice) Creating or strengthening of national or sub-national institutions, capacities or mechanisms to support the implementation of the reform and scale-up plan (e.g. legislation, policies, procedures). (Good Practice) Innovative expansion of faculty, through the recruitment of community based clinicians and health workers as educators versus no such expansion. The effectiveness of continuous development programmes for faculty and teaching staff, including current health workers, which update and develop teaching skills (e.g. curriculum development and instructional design), in both undergraduate and postgraduate programs.
Recommendations: Transforming and Scaling Up Health Professional Education and Training cont d Adaptation of curricula to needs through the definition of core competencies and their incorporation into core curricula, in both undergraduate and postgraduate programs. Inter-professional (IPE) in both undergraduate and postgraduate programmes. Simulation methods in the education of health professionals in high income countries. Direct entry of graduates from relevant undergraduate, postgraduate or other educational programmes into professional studies. Introduction/improving accreditation of health professional education. Use of regulation to ensure the quality and relevance of health professional practice.
Recommendations: Transforming and Scaling Up Health Professional Education and Training cont d Streamlined educational pathways, or ladder programmes, for the advancement of practicing health professionals, in both undergraduate and postgraduate programmes. Continuing professional development (CPD) and in-service training of health professionals, which reflects reforms in education to address evolving population health needs, and increase the coverage of services, with the engagement and active participation of education and training institutions in its design and execution. Links to clinical rotations in remote and rural areas, CPD and specialization, scholarships in return for practice. (Increasing access to health workers in remote and rural areas through improved retention).
2013: Expansion of the guidelines To date WHO has not covered cadres such as clinical Associates, but this is changing. Given the paradigm shift which is occurring among health professionals globally to address population health needs, WHO is seeking to cover other cadres of health workers through its normative and standard setting mandate. Discourse is already changing from MDGs to SDGs and this has implications for health service delivery and the attendant providers. 21
Next Steps 1. Better understanding of the cadres to be included and existing practice. 2. Identifying networks, individual experts with whom to have a dialogue to identify priority areas for global guidance. 3. Set up discussions to map out the way forward. 22
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