Partners' Forum 2010: From Pledges to Action
constituency Health Care Professionals
Sunday 14 November - 11:30 - 15:00
Dr André Lalonde, SOGC and Ms Bridget Lynch, International Confederation of Midwives
Between 12 and 14 November 2010, over 100 health care professionals gathered during the PMNCH Partner's forum to discuss and agree on priorities for the implementation of health care professional association commitments to the United Nations Secretary General's Global Strategy for Women's and Children's Health. Discussions during these sessions, in addition to providing guidance on priority areas of focus for those associations that have committed also made recommendations to all associations present of some issues that need to be tackled in order to improve quantity and quality of human resources in countries.
Understanding the workforce and its environment
The need for an adequate understanding of the health force in numeric and distribution terms is key. Participants highlighted that better information on how health care professionals are distributed at national and sub-national levels and on service needs was key in highlighting where the actual gaps are and in identifying adequate remedies. Participants therefore suggested that the PMNCH undertake a global assessment of health worker coverage and service needs in the high burden countries. Relatedly PMNCH has been asked to support the scale up of the intervention of a limited (10-15) number of interventions in a few countries and to define MNCH core competencies that can be adapted and adopted at country level.
Defining more health for the money in regards to the health workforce. National definitions of more health for money whether it be for example, increased service provision or provision of better quality services; and a better understanding of what kind of environment is conducive for its achievement, will dictate the priorities for the health workforce in that setting.
Linking training to field needs. Pre-service education both medical and nursing needs to be aligned with required skills at primary health care level. Better task / profile / competency definition is required to ensure that graduating nurses posted to rural areas for instance have conducted a deliveries - which in some instances is not the case.
Understanding the needs, options and defining local solutions. Providing quality services requires in resource constrained settings will require making use of existing resources. Though task shifting/sharing is not to be seen as a permanent low cost solution to shortages in staff it can be a way to improving and using existing cadres to provide services in the community. Outreach services are a necessity in settings with poor access to and use of service centers. As such programmes like the Pakistan Lady Health Worker or the Indian Asha are crucial to the provision of basic care. It is crucial however that these community workers be linked to the health system so that they have support and referral systems and can more easily be retrained and absorbed into the formal system as time progresses. Task shifting/sharing, with strong support systems and continuing education and certification can help resolve immediate shortages.
Participants suggested that PMNCH set up a knowledge system that includes a compilation of human resources best practices as well as a blog or space for exchange and communication. PMNCH and international health care professional organizations were also asked to devise a system of accreditation or certification of professionals who have completed certain courses at the national level to ensure full use of all available human resources.
Defining and improving key motivational factors for better workforce performance. Human resources for health are in short stock in most countries in the world, a survey of the reasons why the health industry attracts less jobs is required and interventions to remedy this by positioning the health workforce as a high value and highly recognized workforce. Among others, participants encouraged the use of media and television and other more traditional mediums such as awards and prizes to increase the recognition of health care professionals and increase incentives and consequently motivation. These initiatives of course would need to be complemented by salary, support, supervision and career incentives.
A common thread throughout these knowledge initiatives should be the integration of the private sector as an important delivery system.
Building the capacity of health care professionals
Providing better quality services will require continuing education of health professionals. Localized training programs that happen at the point of delivery, refresher courses for signal functions, and improved support and supervision in service centers will be key to improving quality of services. Health care professional training should also include leadership and management training as well as respect for service seekers and ethics (i.e. profiteering).
A strong emphasis was placed on the role of health workers in quality data collection- notably birth and death registration and audits. HCPAs are encouraged to develop a culture of monitoring and to work with the government to improve data collection system quality and ensure comparability across regions and to advocate the importance of data collection to health care professionals.
Organizational capacity of health care professional associations needs to be built to increase institutional memory so that initiatives do not disappear when leadership changes. Additionally health care professional associations need particular assistance in grant seeking / proposal writing, workplan development, intra and inter association communication, advocacy and policy making, research and publication and data collection and analysis.
International health care professional associations were asked to continue building the organizational capacity of their national associations.
Increasing collaborative efforts
Building the capacity of health care professionals and their associations and increased contribution of these professionals to policy making and advocacy among others will require cross sectoral and cross constituency collaboration. UN agencies in countries should be encouraged to support capacity building of health care professional associations while Ministries of Health should be encouraged to systematically involve health care professionals in policy making and monitoring initiatives. Health care professionals should also collaborate with the media, parliamentarians and NGOs in advocacy for increased investment by stakeholders and improved performance by health care professionals and in ensuring accountability and performance by all actors.
Health care professional associations were also encouraged to collaborate across professional bodies to increase the impact of their initiatives. For instance FIGO passed a resolution that midwives have prescriptive authority for uterotonics. FIP is defining a policy document on the role of pharmacists as an auxiliary workforce for MNCH. Examples of the PMNCH health care professional workshop were given through which the creation of a consortium in India across professional HCPA groups that has increased collaboration and the development of MDG 4 and 5 programs in conjunction with UNICEF, Population Council, directorate of health services. The consortium began with neonatologists, paediatricians and obstetrician/gynaecologists, expanding to include midwives and nurses. FOGSI has changed its approach from single year initiatives that change with the president to a five year focus on maternal mortality.
Participants agreed to inform their counterparts in country on the commitments made to the Global Strategy and on the content of the Global Strategy. They also agreed include other professional associations in their assembly meetings to develop and cement a culture of collaboration. Participants asked PMNCH and international organizations to support this cross association exchange at the regional level by facilitating the addition of half days at regional congresses for short multi-stakeholder sessions on MNCH related issues focused on specific topics that could be actioned.
Use of innovative technologies
Building the capacity of human resources that are already inadequate in quantity needs to be done in such a way that it disrupts the ability of the health care providers to provide services as little as possible. Participants congratulated the training initiatives that are conducted by development partners but asked that these be done in more cost effective ways in terms of financial and human capital costs. Participants recommended increasing the number of distance learning courses and web based exchanges, noting that certain incentives such as for instance certificates upon completion of tests, would be required to make these useful.
Participants also encouraged the use of information and communication technologies to support health care professionals and facilitate their communication with patients. They encouraged using telephone and SMS to communicate health information to patients, remind patients of appointments and respond to patients who are unable to make it to the health center on short notice. They also encouraged the use of ITC for data collection and management, the use of PDAs to record and communicate patient status and commodity related information.