HRH in the Diaspora to Support the Health Sector in Sierra Leone Dr JF Aguilera, IOM RO Dakar April 1st, 2014

Background SL has one of the highest MMR and U5MR in the world, although improving since 2000 (DHS, 2008) – Maternal mortality: 857/100,000 LB (1,800 in 2000) – U5 mortality: 140/1,000 LB (286 in 2000) HRH densities (WHO, 2010) – Nurses/Midwives: 0.17/1,000 – Physicians: 0.02/1,000  WHO threshold to deliver essential maternal and child health care: 2.3/1,000

HRH Gaps in SL (Source: National Health Sector SP 2010–15)

HRH Issues and Challenges in SL Low production of HRH – Insufficient number of institutions (1 med school, 10 nursing schools) – Poorly equipped training institutions with inadequate tutors – No medical post-graduate training in SL (in planning) Poor retention of HRH – High attrition rate – Poor conditions of service – Low motivation, especially to work in remote areas – Inadequate accommodation for key facility staff at all levels Weak HR planning and management – Lack of reliable HRH information systems – Delay in recruitment of staff – Absence of structured career pathway for most cadres

Overview of IOM Intervention on HRH in Sierra Leone Mapping of HRH in the Diaspora in US/Canada, UK and Germany Mapping of needs in health-care and training institutions Development of a Diaspora Engagement Strategy

HRH in the Diaspora US/CanadaUKGermany Diaspora estimates US 34,161 (East coast++) Canada 2,950 (BC, Ontario, Alberta++) 23,1182,479 HRH Diaspora estimates 115 MD, 696 N/MW % in London >50% nurses/midwives 76 Scattered across 23 MD, 7N/MW; # Respondents to the survey 94 East coast++, Canada % from London 32 Scattered across Respondents characteristics 38% N/MW, 17% MD Half in private sector; Most in non-prof associations 50% N/MW, 15% MD; 71% perm contract; 31% in prof associations 60% MD, 20% N/MW Most perm contract; Most in prof associations Anticipated Deployment Most interested in training (33%) and service delivery (33%) <1 month: 22% 1-6: 40% >12 months: 26% 90% ST (<3 m); 10% LG Citizenship 80% bi-nationals60% bi-nationals

HRH training and Healthcare Delivery Needs 17 HRH training institutions surveyed – All the training institutions seriously lack teaching/learning materials (books, computers, internet access), logistic for clinical placement of students – Insufficient staffing for tutorship (quantitative and qualitative) – Plan to provide facilities for home based postgraduate training in the various health disciplines through the establishment of a Sierra College of Health Specialties and promotion of international partnerships 30 HFs surveyed – There is an acute shortage of trained and qualified health HRH (e.g. pediatricians, gyn/obst, surgeons) exacerbated by unequal staff distribution – Low moral, mostly due to largely insufficient incentive (salary, top-ups, career paths) to retain qualified staff, especially in the provinces – All of the HFs surveyed provide back-up for training institutions (clinical practice, lecturers)

Perspectives for Diaspora Engagement in SL Endorsement of the newly developed DES by the ODA – Political leadership at the highest level – Recognition that diaspora engagement is a tool to contribute to improve HRH for training and healthcare delivery 4 axes were identified: – Establishment of a coordinating mechanism to improve needs assessing, planning and management – Establishment of effective communication mechanisms to promote the DES, identify diaspora skills and facilitate deployment – Sustainable recruitment of 150 HRH Diaspora to be placed (ST, LT, virtual) in prioritized areas health care delivery and training institutions by 2018 Obstacles to be overcome (cost, mistrust, logistical issues, maintenance of Diaspora database, updated HRH needs, …) – Support to the development of a policy and legal framework to enhance engagement of HRH in the diaspora Inclusion of diaspora engagement component in the National Health Sector SP