Making HRH the Centerpiece of Program Management and Improving Productivity The Ethiopia Experience Meeting the FP Demand to Achieve MDGs: Vision 2015

Total number of available human resource for health during HSDP I, II, and III HR CategoryEnd HSDP-I (2001/02) End HSDP-II (2004/05) HSDP-III (2008/09) Total No Ratio to Population All Physicians 1,8881,9962,2181:34,986 Specialists :62,783 General Practitioners 1,2361,2211,0171:76302 Public Health Officers ,7601:20,638 Nurses BSc and Diploma (except Midwifes) 11,97614,27015,8521:4,895 Midwifes 8621,274,13531:57,345 Health Extension Workers -2,73731,8311:2,437

HRH Framework HRH Strategy developed – to improve the quality of training and HR management – HR Directorate established It is an all-inclusive strategy – Flooding and retention – Training – Remuneration and condition of work – Incentives – Workforce planning – HR 2020 – Management and other issues related to HRH development.

HRH Strategic Approach- Flooding Expansion of Training – Universities from 2 to 22 (medical schools increased from 3 to 10) – 23 Public Midwifery Schools – Private Health training colleges including 2 medical schools – Annual medical students enrollment increased from 250 to 1400 – Accelerated Training of Health Officers-5000 – Training of Non-Physician clinicians – 33,000 HEWs and 3,200 Supervisors

HRH Strategic Approach- Retention Career Development Creating enabling environment Incentives – Monetary Point rating system Anniversary Scheme Better remuneration compared to other civil servants – Non-Monetary Accommodation Recognition

Retention of HEWs- Career Development Masters and PhD level training on Health Extension Work Health Extension Professionals (HEW training + BSc training) Level-IV Health Extension Practitioners (HEW training + 2 years distance Learning coupled with practical attachment) to be enrolled in April 2010 Level-III HEWs (High School + 1 year Training at TVET center ) - 33,000 trained and deployed

HEWs In-Service Training New Skills Training – Implanon Insertion – Clean and Safe Delivery – Community Case Management of Pneumonia Integrated Refresher Training

Level of Care Hospital Health center Health Posts Household Type of FP methods Health Care Providers Doctors HOs & Nurses HEWsVCHWs TASK SHIFTING

CPR 4% 7% 15%

%

Lessons learned Access and utilization of Family Planning increased by bringing services closer to the community Task shifting has facilitated the above and encourages and motivates providers/HEWs Model families create peer/ client to client influence, particularly in the use of LAFP Promotion of voluntary community health workers to support HEWs encourages volunteerism HRH strategy encourages the provision of integrated PHC services at all levels

Challenges Delay in implementing comprehensive HRH strategy High turnover and shortage of staff at all levels particularly high level health professionals The new HEP supervisory structure needs more support Uneven distribution of mid and high level professionals Urban vs rural, Public vs private Weak HR information system Information Gap between supplier(MOE) and consumer( MOH)

Way Forward Mobilize resources to implement the Compressive HRH strategy Use the opportunity of having training institutions graduate the needed cadres with key competencies Strengthen the supervisory structure of the HEP Establish HR management information system Strengthen coordination between MOH and MOE