Developing multiple, integrated strategies to address Ethiopia’s Human Resources for Health needs
Author: Federal Ministry of Health (FMoH)
The Human Resources for Health (HRH) situational assessment in Ethiopia, conducted in 2007, identified low health workforce density, poor distribution, weak HRH management and absence of effective HRH regulatory framework as the major HRH challenges.
Acknowledging the current inadequacies in the HRH situation in Ethiopia, the Government of Ethiopia has piloted and implemented several initiatives. These include HRH strategic plan development, scale-up of HRH training and education, health workforce retention measures, and development of a legal framework and Human Resources Information System (HRIS).
- The Government has developed a twelve-year comprehensive HRH Strategic Plan (2009-2020), which details the HRH planning, management, education, training and skill development and legal framework. The plan, which also presents information on the budget requirements is the first of its kind for Ethiopia and has been developed through the involvement of relevant stakeholders, health development partners and international consultants.
- The Health Extension Programme (HEP) was introduce in 2002/03 with a fundamental philosophy that if the right health knowledge and skill is transferred, households can share the responsibility for producing and maintaining their own health. Locally recruited female Community health workers, called Health Extension Workers (HEWs), are an integral component of this programme.
- The Government has launched the Accelerated Health Officer Training Programme (AHTOP). This consists of several concomitant strategies, including increasing enrollment through regular and post-basic training programs as well as using hospitals and their staff for teaching and clinical practice.
- Recognizing the acute shortage of medical doctors in the country, the Government decided to scale-up the pre-service medical education in the country. The Federal Ministry of Health (FMoH) decided to transform existing hospitals into institutes for higher education.
- The Government has also taken practical steps in designing and implementation of retention mechanisms. These include constructive dialogue with new medical graduates, mandatory fixed-term public service, financial and non-financial incentive mechanisms to increase the provision of primary health care services in the underserved areas. A two-week pre-deployment training has also been provided in the last two years for new graduates to enhance their understanding of the health sector and the overall health situation of the country.
- After several consultations with relevant stakeholders and partners a web-based HRIS application, which has management and licensing component, has been developed, tested and implemented. It includes a web-based recruitment system.
Main outcomes against each of the project components are listed below:
- The Government has surpassed the target set for the training and deployment of HEW. The rural HEP, with necessary adjustments, has been expanded to urban settings in six regions in 2010.
- The FMoH, in collaboration with the Federal Ministry of Education (FMoE) and development partners, has been successful in increasing the number of health officers to meet the human resource requirements of the Primary Health Care Units (PHCU) through the AHOTP. At the end of the planning period the Government has successfully enrolled a total of 5,430 students.
- The expansion of medical education has significantly boosted the annual enrollment rate of medical students to more than 1,000
- The pre-deployment training is considered one of the most successful strategies as it has resulted in the retention of over 95% of the new medical graduates.
- Currently, the HRIS has been implemented as a pilot programme. This software is expected to be implemented at all Regional Health Bureaus by the end of 2011.
Reforming HRH systems and practices require a combination of strategies that address varied, but often inter-connected issues. The experience of Ethiopia shows how reforming HRH requires a combination of both long-term and strategic decisions, as well as specific immediate/ short-term measures.