Strategy 5.3 Ensure fair treatment of migrant workers Strategy 5. 4 Adopt responsible recruitment policies 103 Strategy 5.5 Provide support to human resources in source countries 104 Intemational instruments Occupational risks to health workers 105 Strategy 5.6 Develop and implement tactics against violence 6 other risks Strategy 5.7 Initiate and reinforce a safe work environment lllness and death from hiviaids Change of occupation or work status Choosing a reduced work week Strategy 5.8 Accommodate workers' needs and expectations 107 Health workers not employed in their field Strategy 5.9 Target health workers outside the health sector Absentees and ghost workers Strategy 5.10 Keep track of the workforce 109 Retirement rates and the risk of shortages 109 Health workforce ageing Strategy 5 11 Develop the capacity and policy tools to manage retirement 111 The need for knowledge transfer 111 Strategy 5.12 Develop succession planning Conclusion Chapter 6 Formulating national health workforce strategies 119 Building trust and managing expectations Strategy 6. 1 Design and implement a workforce strategy that fosters trust Fair and cooperative governing 121 Self-regulation Muddling through"and command-and-control Watchdogs and advocates A model for effective governance Strategy 6.2 Ensure cooperative governance of national workforce policies 124 Strong leadership Strengthening strategic intelligence Strategy 6. 3 Obtain better intelligence on the health workforce in national situations Extent and nature of the national workforce problem Action taken and further options 126 National politics around the health workforce Reactions of health workers and their employers vesting in workforce institutions Learning from microinnovations Scenario building and planning
vi Strategy 5.3 Ensure fair treatment of migrant workers 103 Strategy 5.4 Adopt responsible recruitment policies 103 Strategy 5.5 Provide support to human resources in source countries 104 International instruments 104 Occupational risks to health workers 105 Violence 105 Strategy 5.6 Develop and implement tactics against violence 106 Other risks 106 Strategy 5.7 Initiate and reinforce a safe work environment 107 Illness and death from HIV/AIDS 107 Change of occupation or work status 107 Choosing a reduced work week 107 Strategy 5.8 Accommodate workers’ needs and expectations 107 Health workers not employed in their field 108 Strategy 5.9 Target health workers outside the health sector 108 Absentees and ghost workers 108 Strategy 5.10 Keep track of the workforce 109 Retirement 109 Retirement rates and the risk of shortages 109 Health workforce ageing 110 Strategy 5.11 Develop the capacity and policy tools to manage retirement 111 The need for knowledge transfer 111 Strategy 5.12 Develop succession planning 111 Conclusion 112 Chapter 6 Formulating national health workforce strategies 119 Building trust and managing expectations 120 Strategy 6.1 Design and implement a workforce strategy that fosters trust 120 Fair and cooperative governing 121 Self-regulation 121 “Muddling through” and command-and-control 122 Watchdogs and advocates 123 A model for effective governance 123 Strategy 6.2 Ensure cooperative governance of national workforce policies 124 Strong leadership 125 Strengthening strategic intelligence 126 Strategy 6.3 Obtain better intelligence on the health workforce in national situations 126 Extent and nature of the national workforce problem 126 Action taken and further options 126 National politics around the health workforce 126 Reactions of health workers and their employers 127 Investing in workforce institutions 127 Learning from microinnovations 128 Scenario building and planning 129 Conclusion 129
Chapter 7 Working together, within and across countries 135 A firm foundation for information 36 Generation and management of knowledge Pooling of expertise 141 Striking cooperative agreements Responding to the health workforce crisis An extraordinary global response is needed 144 14 Towards more worker-friendly practices 144 The imperative of sufficient, sustained financing 145 global guideline for financi Moving forward together 14 48 Plan of action Joint steps to the future Statistical Annex Explanatory notes Annex Table 3 186 Fiqures-0verview Health workers save lives! Forces driving the workforce Countries with a critical shortage of health service providers XVIl Working lifespan strategies Global stakeholder alliance Figures- Chapt Figure 1.1 Distribution of women in health service professions, by WHO region Distribution of health workers by level of health expenditure and burden of disease, by WHO region Rural-urban distribution of health service providers 9
vii Chapter 7 Working together, within and across countries 135 Catalysing knowledge and learning 135 A firm foundation for information 136 Generation and management of knowledge 139 Pooling of expertise 141 Striking cooperative agreements 143 Responding to the health workforce crisis 143 An extraordinary global response is needed 144 Coalitions around emergency plans 144 Towards more worker-friendly practices 144 The imperative of sufficient, sustained financing 145 A global guideline for financing 146 Moving forward together 147 National leadership 148 Global solidarity 149 Plan of action 150 Joint steps to the future 151 Statistical Annex Explanatory notes 155 Annex Table 1 168 Annex Table 2 178 Annex Table 3 186 Annex Table 4 190 Index 201 Figures – Overview Figure 1 Health workers save lives! xvi Figure 2 Forces driving the workforce xvii Figure 3 Countries with a critical shortage of health service providers (doctors, nurses and midwives) xviii Figure 4 Working lifespan strategies xxi Figure 5 Global stakeholder alliance xxvi Figures – Chapters Figure 1.1 Distribution of women in health service professions, by WHO region 6 Figure 1.2 Distribution of health workers by level of health expenditure and burden of disease, by WHO region 9 Figure 1.3 Rural–urban distribution of health service providers 9
Figure 1.4 Population density of health care professionals required to ensure skilled attendance at births 11 Figure 1.5 Countries with a critical shortage of health service providers (doctors, nurses and midwives) From massive deprivation to marginal exclusion: moving up the coverage ladder Figure 2.2 Optimal mix of mental health services Figure 2.3 Global distribution of psychiatrists Getting the mix right: challenges to health workforce production gure 3.2 Pipeline to generate and recruit the health workforce Figure 3.3 Relationship of education, labour and health services markets with human resources Projected time to recuperate student investments in education colombia. 2000 Figure 4.1 Patients' perception of respectful treatment at health facilities in 19 countries Levers to influence the four dimensions of health workforce performance 7 Figure 5.1 Exit routes from the health workforce Figure 5.2 Health workers' reasons to migrate in four African countries (Cameroon, South Africa, Uganda and Zimbabwe) Figure 5.3 Occupations at risk of violence, Sweden gure 5. 4 Ageing nurses in the United States of America 110 Figure 5.5 Age distribution of doctors Figure 6.1 Organizations influencing the behaviour of health workers and the health institution 124 Figure 7.1 Health information system(HIS) performance Figure 7.2 Immunization coverage and density of health workers 139 Figure 7.3 Country priorities for health systems strengthening 145 Figure 7. 4 Global stakeholder alliance
viii Figure 1.4 Population density of health care professionals required to ensure skilled attendance at births 11 Figure 1.5 Countries with a critical shortage of health service providers (doctors, nurses and midwives) 12 Figure 2.1 From massive deprivation to marginal exclusion: moving up the coverage ladder 20 Figure 2.2 Optimal mix of mental health services 26 Figure 2.3 Global distribution of psychiatrists 27 Figure 3.1 Getting the mix right: challenges to health workforce production 42 Figure 3.2 Pipeline to generate and recruit the health workforce 42 Figure 3.3 Relationship of education, labour and health services markets with human resources 56 Figure 3.4 Projected time to recuperate student investments in education, Colombia, 2000 57 Figure 4.1 Patients’ perception of respectful treatment at health facilities in 19 countries 69 Figure 4.2 Levers to influence the four dimensions of health workforce performance 71 Figure 5.1 Exit routes from the health workforce 98 Figure 5.2 Health workers’ reasons to migrate in four African countries (Cameroon, South Africa, Uganda and Zimbabwe) 99 Figure 5.3 Occupations at risk of violence, Sweden 105 Figure 5.4 Ageing nurses in the United States of America 110 Figure 5.5 Age distribution of doctors 111 Figure 6.1 Organizations influencing the behaviour of health workers and the health institutions 124 Figure 7.1 Health information system (HIS) performance 136 Figure 7.2 Immunization coverage and density of health workers 139 Figure 7.3 Country priorities for health systems strengthening 145 Figure 7.4 Global stakeholder alliance 151
Boxes-Chapters B0x1.1 B0x1.2 The invisible backbone of the health system management and support workers B0X1.3 Where are the health workers? Service Availability Mapping B0x2.1 Health workers and the Millennium Development Goals e An emergency programme for human resources in malawi Task shifting in the health care workforce Core competencies for long-term patient care B0x2.5 Patient safety B0x2.6 Responding to infectious disease outbreaks-SARS Thailand's response to epidemics and disasters Protecting health systems and biomedical practice during conflicts 36 B0x3.1 Is the future of academic medicine in jeopardy? The public health movement in South-East Asia regional initiatives and new schools B0x3.3 Rapid growth in private education of health professionals B0X3.4 Practice-based teaching problem-based learning, and patient-focused practice all go togeth B0X3.5 Faculty development programmes: training trainers in B0x3.6 From in-service to pre-service training Integrated Management of Childhood Ilness(IMCi) B0X3.7 Regionalization of training for health professionals: University of the South Pacific and the University of the West Indies The evidence base to enhance performance of health educational institutions B0X3.9 Pakistan's Lady Health Workers election and development of new cadres
ix Boxes – Chapters Box 1.1 Classifying health workers 3 Box 1.2 The invisible backbone of the health system: management and support workers 4 Box 1.3 Where are the health workers? Service Availability Mapping 10 Box 2.1 Health workers and the Millennium Development Goals 21 Box 2.2 An emergency programme for human resources in Malawi 22 Box 2.3 Task shifting in the health care workforce 24 Box 2.4 Core competencies for long-term patient care 25 Box 2.5 Patient safety 28 Box 2.6 Responding to infectious disease outbreaks – SARS 29 Box 2.7 Thailand’s response to epidemics and disasters 31 Box 2.8 Protecting health systems and biomedical practice during conflicts 36 Box 3.1 Is the future of academic medicine in jeopardy? 43 Box 3.2 The public health movement in South-East Asia: regional initiatives and new schools 45 Box 3.3 Rapid growth in private education of health professionals 46 Box 3.4 Practice-based teaching, problem-based learning, and patient-focused practice all go together 49 Box 3.5 Faculty development programmes: training trainers in professional health education 50 Box 3.6 From in-service to pre-service training: Integrated Management of Childhood Illness (IMCI) 51 Box 3.7 Regionalization of training for health professionals: University of the South Pacific and the University of the West Indies 53 Box 3.8 The evidence base to enhance performance of health educational institutions 55 Box 3.9 Pakistan’s Lady Health Workers: selection and development of new cadres 59
B0X4.1 Infant mortality and health worker density, Viet Nam B0x4.2 Differences in performance of male and female health service providers B0x43 Job-related challenges to improving health worker performance B0x4.4 Differences in salaries between countries, professions, sectors and sexes 76 Box 4 Incentives to enhance health workers' performance B0x4.6 Using modern communication technology to improve data, services and productivity B0X4.7 What sort of training works best? B0x4.8 Quality assurance, supervision and monitoring in Ugand 0X4.9 Changing tasks and therefore skill needs B0x4.10 The importance of management and leadership B0x5.1 Turning brain drain into brain gain-the Philippines BoX 5.2 Recruitment agencies and migration B0x5.3 Bilateral agreement between South Africa and the United Kingdom 104 Strategies in action: examples of exit management B0x5.5 Measures for a safe work environment hIvaids BOX 6.1 Self-regulation opportunities 122 B0x6.2 Human resources for health observatories in latin america B0x7.1 Seeking a common technical framework for human resources for health: a public good useful to all countrie 137 B0x72 Research priorities related to community health workers B0x73 Tools for health workforce assessment and development 141 B0x7.4 Technical skills for human resource policy-making 142
Box 4.1 Infant mortality and health worker density, Viet Nam 68 Box 4.2 Differences in performance of male and female health service providers 70 Box 4.3 Job-related challenges to improving health worker performance 74 Box 4.4 Differences in salaries between countries, professions, sectors and sexes 76 Box 4.5 Incentives to enhance health workers’ performance 78 Box 4.6 Using modern communication technology to improve data, services and productivity 80 Box 4.7 What sort of training works best? 82 Box 4.8 Quality assurance, supervision and monitoring in Uganda 83 Box 4.9 Changing tasks and therefore skill needs 84 Box 4.10 The importance of management and leadership 85 Box 5.1 Turning brain drain into brain gain – the Philippines 101 Box 5.2 Recruitment agencies and migration 102 Box 5.3 Bilateral agreement between South Africa and the United Kingdom 104 Box 5.4 Strategies in action: examples of exit management 106 Box 5.5 Measures for a safe work environment: HIV/AIDS 108 Box 6.1 Self-regulation opportunities 122 Box 6.2 Human resources for health observatories in Latin America 128 Box 7.1 Seeking a common technical framework for human resources for health: a public good useful to all countries? 137 Box 7.2 Research priorities related to community health workers 140 Box 7.3 Tools for health workforce assessment and development 141 Box 7.4 Technical skills for human resource policy-making 142