1. International Health Policy Program -Thailand 1 Financing Health Workforces Viroj Tangcharoensathien International Health Policy Program Ministry of Public Health Thailand AAAH Conference, October 2006

2. International Health Policy Program -Thailand 2 Outline Background – Current situation of HR at global and regional – Challenges and opportunities Financing the whole ranges of HR cycle – Public private and ROW sources of finance Recommendations – Comprehensive views, not only HR as all inter- connected

3. International Health Policy Program -Thailand 3 Background Common HR problems in Asia Pacific region – Shortage and mal-distribution (public-private, urban-rural) – Skill mix Low performance, non-responsive, high absenteeism Root causes of problem – Inadequate national policy and strategies Coordination between production and utilization of HR Limited evidence and information, data is very scarce Especially on financing human resource Under researched areas and limited understanding – Globalization and privatization Major threats to all size of countries, domestic and international migration of HR – Limited fiscal spaces Reliance heavily on OOP

4. International Health Policy Program -Thailand 4 Opportunities in the Region WPR and SEAR Regional Committee endorsement – Regional strategies on HR and actions plans Country increasing capacity and commitment – Intersectoral dialogues Regional Global networks – AAAH – GHWA Development partners commitments

5. International Health Policy Program -Thailand 5 How much was spent on health workers? Source: WHR2006

6. International Health Policy Program -Thailand 6 HR shortage: a chronic problem Source: WHR2006 Huge resource needs to fill up the critical shortage: production and employment of HR in the context of continued international brain drain

7. International Health Policy Program -Thailand 7 Country with critical shortage of HR Source: JLI

8. International Health Policy Program -Thailand 8 Global inequity in health workers distribution Source: WHR2006

9. International Health Policy Program -Thailand 9 Skill substitution: doctor vs. nurse in PHC Source: WHR2006

10. International Health Policy Program -Thailand 10 Whole range of financing HR Full range of HR : – Planning [cycle of situation analysis, prioritization, planning, M&E] and HR management – Production of HR – Employment – Maintenance Financing source – Public – Private household – Donor Health service provision – Public – Private

11. International Health Policy Program -Thailand 11 HR and financing matrix See word files and discussions

12. International Health Policy Program -Thailand 12 Recommendations 1. Constitutional rights of the citizen to equal access to Healthcare, Education, Employment opportunity, etc. through – The promulgation/ amendment /reform of the constitutions – Pro-poor ideology in social policy agenda setting, policy formulation and effective implementation

13. International Health Policy Program -Thailand 13 Recommendations 2. Invest more in health (± education) of the population, through – Increase budget to GDP ratio (± larger GDP size) + ensure better allocation to health, education and other social sectors – Mobilize external resources + donor harmonization and ensure donor sustainability in health OECD DAC to accelerate to achieve 0.7% GDP on ODA. – Investment in public health infrastructure in rural areas and ensure the functioning of ‘close to client’ services, district and sub-district level PHC services Strengthening PHC in providing quality care, Ensure adequate staffing with a good skill mix

14. International Health Policy Program -Thailand 14 Recommendations 3. Ensure equity by introducing health protection to the poor (targeting) and strong government determinations towards gradual extension to achieve universality, through – Pro-poor budget allocations and risk equalization mechanisms – Minimize the proportion of OOP in financing healthcare [to prevent catastrophic expenditure and impoverishment] General tax (plus donor) financed scheme to subsidize the poor, Risk pooling voluntary schemes such as CBHI + government subsidies to the poor members in CBHI, The residual informal sector can either apply SHI (but face difficulties in premium collections and enforcement), or covered by publicly subsidised mandatory health insurance scheme. – Benefit package: comprehensive, with minimum financial barriers, special focus on prevention and health promotion

15. International Health Policy Program -Thailand 15 Recommendations 4. Better health gains from the limited health resources available, through – Ensure ‘allocative efficiency’ through the application of cost effective interventions [see evidence in DCP2 in the design of benefit packages] – Invest more in public health functions of health systems, especially diseases surveillance and primary prevention of major risk factors of the population – Establish or reform the provider payment methods that send strong signal towards Efficiency, Rational use of health resources Long term cost containment

16. International Health Policy Program -Thailand 16 Recommendations 5. A functioning and responsive primary health care services, through – Evidence based HRH policy and interventions to address in specific Address pushing forces Address pulling forces The ethical codes on international recruitment The national code of local recruitment Reciprocity compensation funds for both national and international flows – Regulatory framework and effective relationship of the private provider sector, Towards public health goals, Bring private sector on board, through e.g. contractual arrangement – Careful implementation of Decentralization to safeguard the PHC and public health functions

17. International Health Policy Program -Thailand 17 Recommendations 6. Evidence base for agenda setting, policy formulation, implementation and M&E – Institutionalization of national capacity to generate, analysis and translate evidence into policy – Publicity of these evidences to the public and policy stakeholders, civil society

18. International Health Policy Program -Thailand 18 Acknowledgments – GHWA and country partners in AP region – European Commission – Rockefeller Foundation – WHO – MOPH