Human Resources for Health Goal To increase efficiency, quality and - PDF document

4/13/2010 Human Resources for Health in Belize A Status Report on the HRH Core Data Set and Regional Baseline Indicators Projects October 20, 2009 Human Resources for Health Goal To increase efficiency, quality and equity of the health services delivered, through a well-trained, well- compensated, and well –distributed workforce that has the capacity to meet the needs of presented and that is committed to the mission enough to be motivated to give the very best. - PAHO/WHO 1

4/13/2010 Human Resources for Health Planning Objective To equip governments with the information and tools they require to determine and to achieve the health workforce required to meet the health needs of the population, both now and in the future. Context and Rationale Regional • Toronto Call to Action - 2005 • Health Agenda for the Americas - 2008-2015 • Twenty Regional Goals for HRH – 2007 • Task Force of the Regional Network of Observatories for HRH, Baseline Values 2

4/13/2010 Context and Rationale Belize • Government of Belize Health Sector Reform Program (2007-2011) • Belize National Health Insurance Scheme • Belize Health Information System • HRH Reform including - improving HRH distribution - managing migration - developing an HRH data base - HRH monitoring & evaluation guidelines - strengthening MoH HRH planning capacity Project Objectives HRH Core Data Set • Complete the collection and analysis and report on the Core Data Set project launched in 2008 • Identify HRH stocks, education, management and regulation • Highlighting major concerns & issues HRH Baseline Goals • Undertake a status report of Belize in relation to the twenty baseline goals and indicators • Identify priority actions and strategies to support HRH 3

4/13/2010 Human Resources for Health Data Role • Describe current and past trends • Identify implications and emerging issues • Estimate opportunity costs • Determine priorities for action • Guide policy and program development • Monitor changes and impact of policy initiatives • Determine contingency plans and actions • Support system sustainability and accountability Human Resources for Health Data Ongoing Challenges • Infrastructure development and maintenance costs • Time-lag in implementation and changing technology • Lack of common data standards, definitions and format • Confidentiality, lack of unique identifiers and data regulation • Current data is limited & incompatible with other data sets • New health programs often require new data systems • New data lacks historical context for planning & evaluation • Limited capacity to cross-link HRH data to planning, research, evaluation and health outcomes • Analytical capacity and knowledge transfer often limited 4

4/13/2010 Project Team Internal • PAHO/WHO Belize • Belize Ministry of Health (PAPU) • University of Belize External • PAHO/WHO Washington, D.C. • Cameron Health Strategies Group Approach • Introductory Team Meeting, June, 2009 • Reviewed Regional Handbook for Monitoring Regional Goals • Identified data required and sources available • Began update of 2008 survey of MoH personnel data • Identified top 10 most relevant data fields • Meetings with MoH staff, University, KHMH, clinics and Health Regions re HRH public & private data collection & availability • Surveyed MoH staff on HRH policy and regulatory issues • Collected all graduate data from the Faculty of Nursing, Allied Health and Social Work at the University of Belize, 2000-2009 • Cross-compared employment and graduate data • Examined Belize’s HRH status in relation to 20 Regional Goals • Developed a strategy to address HRH issues identified 5

4/13/2010 HRH Data Fields Total Health Care Professionals in MoH, Hospitals, Clinics & Regions, Public & Private by - • Name • District (Urban/Rural) • Gender • Age • Ethnicity and Language • Profession and Employment Post • Terms of Employment • Start Date of Current Employment University of Belize Graduate Data Total Health Program Graduates by – • Year (2000 to 2009) • Gender • Ethnicity and Language • Type of Degree Granted • Training Program • District and City (on application) • Certificate Passes (Nurses) • Scholarship recipients • Plus total student applicants, accepted and admissions by program, year and district 6

4/13/2010 Health Workforce in Belize Historical Belize 40 th place in HRH density in the Region of the Americas in the • 1990’s; 29 th place by year 2000 In 2005, 3 rd lowest density of physicians in Region but in 9 th place • overall in the supply of nurses • Belize research minimum population density target of 25 per 10,000 (WHO) in 2005, but has fallen recently • 38,000 physicians, nurses and midwives needed in Region • 4.3 million health care workers needed world wide (WHO) • Population growth nearing 4 percent annually, 6 percent in Cayo and Belize Districts Health Workforce in Belize Current ( July 2009) • 2,283 employed in health industry, including 1279 health care providers • Women outnumber men 2.2 to 1 • Young workforce: 25 percent in 30’s, 4.5 percent over 55 years • 30 nationalities and ethic groups represented, Mestizo and Creole represent 61 percent of total • Physicians: 181 GPs and 64 specialists, HRH density per 10,000 population of 7.6 • Registered nurses: outnumber doctors 1.3 to 1 with a HRH density of 10.2 • Only 38 percent of positions are “established”, 23 percent filled by volunteers or unestablished positions. 7

4/13/2010 Health Workforce in Belize Current ( July 2009) • 80 percent of health care providers work in public sector • 52 percent of Belizeans and 13.6 percent of health care providers live in rural areas • Only about half the health graduates from University of Belize between 2003 and 2007 are employed in Belize health system • Of those working, 80 percent return to their home Districts • Overall employment attrition low – workers in their current jobs and average of 9.5 years University of Belize Health Graduates 2000-2009 • Application rates doubled over the past decade • Acceptance rates are high; registration rates low • 7000 applicants and 528 graduates over past decade • Orange Walk and Corozal Districts and Mestizo and Mayan ethnic groups not well represented • Health program completion rates for those entering programs between 2001 and 2005 was 34 percent • 52 percent of population is rural; only 21 percent of graduates were from rural areas 8

4/13/2010 University of Belize Health Graduates 2000-2009 • About 82 percent of nursing graduates elect to write the exam • Only 50 percent of nurses pass certification exam in any one year; 68 percent pass after an average of 1.6 attempts • About 50 percent of students receive scholarships, the greatest per capita numbers from Cayo and Stann Creek Districts • Belize density per 10,000 population of physicians, nurses and midwives is about 18.5; well below the target of 25. • Net gain of 32 required annually to meet target by 2015; plus 26 more to accommodate population growth • Output from all health programs at UB has only been 53 annually, with nursing and midwives totalling only 14 Implications and Next Steps • Increase enrolments in health programs at University of Belize • Increase uptake of applicants who have been accepted to train • Recruit more students from rural areas and ethnic populations • Expand the number and range of scholarships across training programs and Districts • Reduce student attrition from health training programs • Enhance graduate retention rates • Improve graduate certification exam pass rates • Significantly augment the number of employment opportunities for health professional graduates • Increase the proportion of established employment positions 9

4/13/2010 Regional HRH Baseline Goals Challenge One Build long-range policies and plans to adapt workforce to changing health system Goal 1: Regional HRH density target – 25 per 10,000 Belize result – 18.5 per 10,000 population Goal 2: Regional target – PHC MDs 40% of total MDs Belize result – PHC MDs are 75% of total Goal 3: Regional target - PHC teams with broad skills Belize result - 79 % achieved, but under staffed Goal 4: Regional target - Ratio of RNs to MDs 1 to 1 Belize result – Ratio of RNs to MDs 1.3 to 1 Goal 5: Regional target - Establish HRH Planning Unit Belize result – 54 percent achieved Challenge One – Goals 1 to 5 10

4/13/2010 Regional HRH Baseline Goals Challenge Two Achieve an equitable distribution of the health workforce according to the health needs of the population Goal 6: Regional target – Reduce U/R gap by 50% by 2015 Belize result – Urban/Rural split currently 21 to 1 Goal 7: Regional target – 70% PHC team have right skills Belize result – 34% (half) target has been achieved Goal 8: Regional target – 70% of staff to upgrade skills Belize result – No established requirement Goal 9: Regional target – 30% recruited from home areas Belize result – District recruitment rate is 40.5% Challenge Two - Goals 6 to 9 11