1. G. Elzinga WHO, Geneva 14 - 02 - 2005

2. Who cares?

3. Life Expectancy: Advancing and Slipping

4. Differences in health increase within countries and between countries. WHY CAN’T WE COPE?

5. HEALTH WORKFORCE PROBLEM

7. Joint Learning Initiative Diagnosis (The Lancet, 27-11-2004) Global Health Workforce cannot cope with global health crisis; SSA hit hardest

8. The Glue of the Health System

9. migrationtraining Sky full of HRH “challenges” V&H dilemma’s productivity over- burdening work conditions qualitydistributionnumberhonorarium manage- ment HIV/AIDSstatus carrier perspective

10. PROVIDING HEALTH IN POVERTY

11. Program of prevention and/or care interventions to control a specific health- problem. V Infrastructure of prevention - and care services to cope with the prevailing health problems. H

12. V H V H Vertical-horizontal in developing countries Vertical-horizontal in developed countries

13. Program Macrostructure MEIS PC V intervention strategy monitoring en evaluation prevention and/or care

14. Differences between countries (polio ) MEIS PC MEIS PC MEIS PC General health services

15. Differences between programs polio MEIS PC TB MEIS PC 3x5 MEIS PC malaria MEIS PC General health services

16. Vertical programs: who is doing what? Intervention Strategy Monitoring/ Surveillance Prevention/care international national HRH required district facility

17. HRH dilemma ? VH HRH synergy ! &

18. RESEARCH CONTRIBUTIONS TO HEALTH WORKFORCE STRENGTHENING

19. Health systems and workforces are ‘man-made’ §Research outcomes depend more on time and place than those of biomedical research. §However, research is not second rate: l Relevance: crucial to reach health outcomes and cost contaiment l Intellectually: methodology often quite demanding because of complexities

20. SPECIFIC GENERIC 2 VALUABLE ‘RESEARCH’ LAYERS

21. SPECIFIC POLICY CYCLE analysis M&E planning implementation

22. LEARNING FROM RESEARCH GENERIC POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e

23. BY RELATING DIFFERENCES TO OUTCOMES GENERIC POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e POLICY CYCLE a p i. m&e

24. socio-political context health system health workforce HRH TB/HIV

25. socio-political context health system health workforce HRH TB/HIV ROLE OF HRH TB/HIV RESEARCH supporter facilitator contributor participator stimulator initiator Priorities?

26. PC ISME Simplification less time/patient lower cadres Time/Cost-effectiveness (of intervention(s) and system) less time/patient more work satisfaction HIV/AIDS & TB Optimisation (Integration; IT ?) less time higher quality “INITIATOR” PRIORITIES

27. socio-political context health system health workforce HRH TB/HIV ROLE OF HRH TB/HIV RESEARCH initiator participator stimulator contributor facilitator supporter Priorities?

28. Policy truths Economic growth cures poverty Health Care is a cost not a profit Thus, keep health expenditure low!

29. Social realities Poor populations have high disease burdens They therefore need more health services while they can in fact afford less. Health below a critical state tends to deteriorate HIV/AIDS & TB/HIV can push health below that critical state, causing life expectancy to fall, the labor force to falter, and social costs to sore!

30. EXAMPLES OF “SUPPORTER” PRIORITIES WHAT REALISTIC INTERVENTIONS CAN COUNTER MIGRATION OF HEALTH WORKERS? WHEN DOES HEALTH CARE CHANGE FROM COST TO INVESTMENT?

31. Thank you

32. Worker density by region

33. socio-political context health system health workforce HRH TB/HIV ROLE OF HRH TB/HIV RESEARCH initiator participator stimulator contributor facilitator supporter Priorities?

34. CommunityReferral Centre “ESSENTIAL PRIMARY CARE” FUNCTION AVAILABLE 1 PER ?000 ACCESSIBLE <.. HOURS AFFORDABLE <.. % INCOME Tuberculosis M&C health Malaria HIV-AIDS

35. POLICY CYCLE analysis M&E planning implement. Cost-effectiveness calculations of approach. Methodology to determine availability, accessibility, affordability of EPF Controlled study of cost- and time effectiveness of approach. Etc. “PARTICIPATOR” PRIORITIES

36. MDG’scountries donorsHigh level forumWHO WorldbankNGO’s UNDPPost JLIILO Technical agenciesFoundations

37. ILOPost JLI Foundations MDG’scountries donorsHigh level forumWHO WorldbankNGO’s UNDP Technical agencies THANK YOU

38. ed. & tr. community global policies population health need supply health workforce h e a l t h s y s t e m national policies demand HIV-AIDS Migration

39. Een HRH dilemma ? burden of disease is higher in poor environments V+ development requires adequate general health services H+