1 World Health Organization, Geneva Identifying human resources information needs for ART programmes World Health Organization Human Resources for Health Department of Health Service Provision Norbert Dreesch

2 World Health Organization, Geneva There is a crisis in HR which stems from... …years of neglect of the significance of investing properly in human resources development … lack of incentives in many countries to work in the services (low pay, low working conditions, low morale) … sense of powerlessness amongst service staff in high-burden HIV/AIDS countries AGAINST THIS BACKGROUND: TREMENDOUS HR DEVELOPMENT NEEDS FOR ART

3 World Health Organization, Geneva HR issues countries are struggling with - 1: HRH constraints to absorbing new resources and expanding good practices Inadequate numbers and skills of providers affect quality of performance, ability to deliver services to the poor and other disadvantaged populations Imbalances in the health workforce (geographic, gender, and other)

4 World Health Organization, Geneva HR issues countries are struggling with - 2: Migration and retention of health workers Impacts of specific diseases and other risk factors for health care providers Weak congruency between education for health care providers and achievement of coverage Lack of coordination between external donors' and countries’ policies towards HRH development

5 World Health Organization, Geneva Currently no universally accepted classification of service providers to whom distinct ART skills could be assigned Out-migration, low morale and poor retention capacity Difficulty to count the extent of FTE contributions by private clinics, treatment NGOs, employers, research and public sector in ART care flow Problems of accuracy of staff figures at aggregate levels, both public and private Lack of HR development plans HIV/AIDS specific HR issues countries are struggling with - 3: Impact of HIV/AIDS on staffing

6 World Health Organization, Geneva The challenges - 1: ART is a new, labour-intensive intervention Little to no knowledge about ART treatment systems Quality systems are needed Core treatment unit, tasks, FTEs, and skills training needs have to be defined for different national settings and conditions It is not yet clear to which extent and what level of staff clinical tasks can be transferred

7 World Health Organization, Geneva The challenges - 2: Demand for ART is high, capacity to deliver is low: –demand cumulative –chronic care needs Success may create recipe for failure: increasing coverage will need to be matched by increased numbers of ART skilled staff But: some countries severely affected by staff losses due to HIV/AIDS

8 World Health Organization, Geneva At facility level, we need to know - 1: The level of current staff types and their time utilization All leave and average morbidity and staff loss experience The baseline skills currently available amongst different service providers Additional FTE needs based on the national ART model and coverage goals The training needs having to be achieved prior to scaling up

9 World Health Organization, Geneva At facility level, we need to know - 2: The phasing pattern to insure skills, supplies, and equipment function in a quality care environment when going to scale The care flow best suited to available skills The optimal mix of task distributions: –referral facilities –staff in the care flow ART task distribution between service providers/community members

10 World Health Organization, Geneva At national/regional level we need to know or define - 1: The intended ART coverage goals for the next 5 years The current and future production of training institutions for different types of service providers The responsiveness of education and training to changing needs for different services Staff internal and external migration, geographical imbalances of staff distribution within country The rate of attrition of service providers for the next years to come (as a result of age, disease (e.g. HIV/SARS), labour market dynamics, otherwise)

11 World Health Organization, Geneva At national/regional level we need to know or define - 2: The impact of treating service staff with ARVs on staff productivity and replacement needs Incentives and motivational factors to work in the health services, assessment of possibility to re-hire staff who left the service, retention strategies The capacity of existing personnel records systems to provide accurate data on staff Administrative/personnel systems’ flexibility to reflect new skills mix in revised staff grading and remuneration systems Impact of existing constraints to public sector scale up due to lending institution agreements Impact of international/regional recruitment policies

12 World Health Organization, Geneva In conclusion, there are huge strategic information needs: Generic: more attention needed internationally to support identification of health systems/HR development needs for scaling up ART Specific to HIV in high-burden countries: –impact on HR –country-specific models Difficult to imagine how countries will be able to deliver quality ART if support is not given to identify the information necessary for HR planning.