Historically, HRH development in Paraguay was not given high political priority, resulting in an inadequate availability and composition of the health workforce, particularly health workers required for essential health services. Although there are 22.5 health workers per 10,000 population nationally, inequitable geographic distribution of health workers due to lack of infrastructure and incentives to work in rural areas has resulted in 70% of health workers concentrated in the area around Asunción where 30% of the population lives.
An inequitable composition also has resulted in a density of 2 physicians for every nurse (Política Nacional de Recursos Humanos en Salud 2008-2013; Taller de Planes…2010).
Other HRH challenges include: health worker migration to neighboring countries due to poor working conditions and precarious employment contracts; absence of research in HRH; health care training that inadequately meets the needs of career development and of the new primary health care system; and weak regulation and control of professional practice and quality control of graduates from private sector institutions (Taller de Planes de Recursos Humanos para la Atención Primaria de Salud y sus relaciones con Finanzas, Trabajo y Educación; Documento Paraguay, 2010; Paraguay: Building a National Health Sector Career Structure, 2011).
Decentralization and a policy of universal comprehensive health care were instituted in 2008 as primary strategies for the new national health plan, which included HRH as one of the central pillars of the health system. As such, a general policy for HRH was included within the National Health Policy, which listed 6 strategic actions for the development of HRH. From these 6, the following 5 were accomplished:
- Creation of a National Strategic Directorate for Human Resources for Health-DNERHS
- Creation of an HRH registry. Although this registry has not yet been created, a new Health Information System was created that ties directly into the DNERHS
- Creation of new regulations for the health professions in the area of quality control
- Creation of a Bureau of Labor Management in Health which has succeeded in addressing some of the past issues relating to HRH contracts and remuneration
- Creation of a National Human Resources for Health Observatory.
Current projects include: strengthening the National Institute of Health with the objective of increasing research in health, and creating a Continuous Education Plan for the education and training of health workers. The Continuous Education Plan is being created with the consensus of public and private universities and is integrated within the policy of the primary health care system.
COUNTRY COORDINATION AND FACILITATION (CCF) IN PARAGUAY:
Paraguay has completed Phases 1-3 of the CCF process and is currently involved in Phases 4 and 5: Mobilization of Resources for HRH Interventions, and Implementation and Monitoring of the HRH Plan.
The following stakeholder groups have been represented in CCF workshops: training/educational institutions, trade unions, professional councils, civil society representatives and NGOs, private sector, the Ministries of Health, Finance, Education, and Labor, and members of Congress. Recent CCF activities include: HRH forums on development of a Health Sector Career Law with authorities from the Ministries of Health and Finance, as well as with representatives from health sector trade unions and professional organizations; and completion of a feasibility study of a National Health Sector Career.
HEALTH WORKFORCE DATA
- Observatorio Regional de Recursos Humanos de Salud
- El Observatorio Paraguayo de Recursos Humanos en Salud
HUMAN RESOURCES FOR HEALTH PLAN
- A version of the "Política Nacional de Recursos Humanos en Salud 2008-2013. Dirección Nacional Estratégica de Recursos Humanos en Salud-MSPBS, 2009" can be found here: "Políticas Públicas para la Calidad de Vida y Salud con Equidad 2008-2013"
- Taller de Planes de Recursos Humanos para la Atención Primaria de Salud y sus relaciones con Finanzas, Trabajo y Educación; Documento Paraguay (2010)
HEALTH SECTOR STRATEGIES / PLANS
COUNTRY CASE STUDIES AND OTHER DOCUMENTS
Paraguay: Building a National Health Sector Career Structure
- Paraguay Health Service Delivery in Paraguay: A Review of Quality of Care and Policies on Human Resources and User Fees (2006)
- Política Nacional de Salud Indígena (2012)
- Plan Nacional de Promoción de la Calidad de Vida y Salud con Equidad de la Adolescencia 2010-2015
- Plan Nacional de Promoción de la Calidad de Vida y Salud con Equidad de la Niñez 2010-2015
- Plan Nacional de Salud Sexual y Reproductiva: Paraguay 2009-2013
- SIECS: Propuesta para el sistema de información en salud (2009)