2nd AAAH Conference, Beijing, China Guideline for Regional HRH Country Strategic Planning Philippine...

2nd AAAH Conference, Beijing, China

Guideline for Guideline for Regional HRH Regional HRH

Country Strategic Country Strategic PlanningPlanning

Philippine Consultant TeamPhilippine Consultant Team


Philippine Consultant TeamPhilippine Consultant TeamF. Marilyn E. LorenzoF. Marilyn E. Lorenzo

Kenneth RonquilloKenneth Ronquillo Co- project team leadersCo- project team leaders

Dr. Rodel NodoraDr. Rodel Nodora

Prof. Esmeralda SilvaProf. Esmeralda Silva

Co- ConsultantsCo- Consultants


Presentation OutlinePresentation Outline

• Process of Development of Regional Process of Development of Regional Guideline for Country Strategic Guideline for Country Strategic PlanningPlanning

• Situational Analysis ResultsSituational Analysis Results• Draft Regional GuidelineDraft Regional Guideline• Next StepsNext Steps


Process of Process of Development of Development of

Regional Guideline Regional Guideline for Country Strategic for Country Strategic

PlanningPlanning


Development of Regional Development of Regional Guideline for Country Guideline for Country

Strategic PlanningStrategic Planning– Review HRH situation in AAAH member Review HRH situation in AAAH member

countries and the existence of national HRH countries and the existence of national HRH strategies or master plans in these strategies or master plans in these countries countries

– Literature review – Peruse existing Literature review – Peruse existing guidelines on national health workforce guidelines on national health workforce strategy developmentstrategy development

– Drafting regional guideline that can be used Drafting regional guideline that can be used as reference for AAAH member countriesas reference for AAAH member countries

– Consultation with AAAH member countries Consultation with AAAH member countries through teleconferencethrough teleconference

– Finalize draft guidelinesFinalize draft guidelines


Situational AnalysisSituational Analysis

• Main objective was to review HRH Main objective was to review HRH Situation in AAAH member countries Situation in AAAH member countries and determine the existence of and determine the existence of national HRH strategies or master-national HRH strategies or master-plans within countriesplans within countries

• Requested focal points to assist team Requested focal points to assist team in accomplishing five sets of in accomplishing five sets of worksheetsworksheets


WORKSHEETS DEVELOPED WORKSHEETS DEVELOPED FOR THE PROJECTFOR THE PROJECT

SELECTED SOCIO-DEMOGRAPHIC SELECTED SOCIO-DEMOGRAPHIC ANDHEALTH PROFILESANDHEALTH PROFILES

– TOTAL POPULATION– POPULATION GROWTH RATE, 1980-2006– UNEMPLOYMENT AND UNDEREMPLOYMENT

NUMBER AND RATES: 2000-2006– INFANT, UNDER-5 & MATERNAL MORTALITY

RATES : 2000-2006– NUMBER OF REGISTERED DEATHS AND CRUDE

DEATH RATES : 2000-2006



• SUPPLY SIDESUPPLY SIDE– NUMBER AND DENSITY OF HEALTH WORKERS TO POPULATION

• By Priority Professions• 2000-2007

– NUMBER OF HEALTH WORKERS IN GOVERNMENT SERVICE• By Priority Professions• 2000-2007

– NUMBER OF REGISTERED PROFESSIONALS• By Priority Professions including Community Volunteer Health

Workers• 1980-2007

– NUMBER OF SCHOOLS AND NUMBER OF FIRST YEAR ENROLLEES• By Priority Professions• 1999-2007

– NUMBER OF NUMBER OF GRADUATES• By Priority Professions• 2000-2007



• DEMAND SIDEDEMAND SIDE– DEMAND FOR HEALTH WORKERS IN ALL NATIONAL DEMAND FOR HEALTH WORKERS IN ALL NATIONAL

GOVERNMENT AGENCIES ( PRIVATE) , INCLUDING THE GOVERNMENT AGENCIES ( PRIVATE) , INCLUDING THE MINISTRY OF HEALTHMINISTRY OF HEALTH

– NUMBER OF HEALTH PROFESSIONALS WHO LEFT THE NUMBER OF HEALTH PROFESSIONALS WHO LEFT THE COUNTRY TO WORK ABROADCOUNTRY TO WORK ABROAD

– AVERAGE MONTHLY SALARIES OF HEALTH AVERAGE MONTHLY SALARIES OF HEALTH PROFESSIONALS IN THE GOVERNMENT AND PRIVATE PROFESSIONALS IN THE GOVERNMENT AND PRIVATE SECTORS (IN US$)SECTORS (IN US$)

– MONTHLY SALARY OF MIGRANT HEALTH PROFESSIONS MONTHLY SALARY OF MIGRANT HEALTH PROFESSIONS IN TOP 5 DESTINATION COUNTRIES (IN US$)IN TOP 5 DESTINATION COUNTRIES (IN US$)

– ATTRITION RATE FOR PRIORITY HEALTH PROFESSIONS: ATTRITION RATE FOR PRIORITY HEALTH PROFESSIONS: 2000-20072000-2007

– NUMBER OF HEALTH FACILITIES AND BEDS IN THE NUMBER OF HEALTH FACILITIES AND BEDS IN THE GOVERNMENT AND PRIVATE SECTORSGOVERNMENT AND PRIVATE SECTORS

– STANDARD REQUIREMENT FOR HUMAN RESOURCESSTANDARD REQUIREMENT FOR HUMAN RESOURCES



• HUMAN RESOURCE SYSTEMSHUMAN RESOURCE SYSTEMS– HRH FRAMEWORK– HUMAN RESOURCE PLAN– JOB RELATED RECRUITMENT AND SELECTION– TRAINING AND DEVELOPMENT NEEDS ANALYSIS– HUMAN RESOURCE FOR HEALTH INFORMATION

SYSTEM– PERFORMANCE MANAGEMENT SYSTEM– INDIVIDUAL CAREER PLANNING– CAREER PATHING/ CHARTING– SUCCESSION PLANNING– RETENTION PLANNING– COMPENSATION AND BENEFITS– LABOR RELATIONS


Summary of Responses to 1 Summary of Responses to 1 HR System, by countryHR System, by country

LEGENDC: CompleteI: Incomplete


Country-specific Responses Country-specific Responses to HR System worksheetsto HR System worksheets


Results of the Results of the Situational AnalysisSituational Analysis


Situational Analysis Situational Analysis ResultsResults

• Country definitions of many HRH elements Country definitions of many HRH elements were not the samewere not the same– definitions of health workers i.e. what constitute definitions of health workers i.e. what constitute

the group of physicians, nurses, community health the group of physicians, nurses, community health workers and other HRH classifications workers and other HRH classifications

– some countries expressed their HRH needs in some countries expressed their HRH needs in terms of FTEs required while others specified terms of FTEs required while others specified their requirements in absolute numbers their requirements in absolute numbers

– Understanding of HRH plans is varied ; some think Understanding of HRH plans is varied ; some think of HRH planning as merely workforce projections of HRH planning as merely workforce projections while others include in their plans the while others include in their plans the establishment of systemsestablishment of systems



• Unclear framework models: some frameworks Unclear framework models: some frameworks were workforce forecasting models and not were workforce forecasting models and not planning frameworks; planning frameworks;

• A number of country plans were not systems A number of country plans were not systems based i.e. there was no mention of HRH based i.e. there was no mention of HRH systems set up except for recruitment and systems set up except for recruitment and training and development systems. training and development systems.

• Consultant team believes Consultant team believes HRH systems HRH systems developmentdevelopment need to be basis of optimal need to be basis of optimal utilization and development of HRH to ensure utilization and development of HRH to ensure the quantity and quality of HRH in any the quantity and quality of HRH in any country. country.



Poor Quality of data on HRH, Poor Quality of data on HRH, • Available information seems to still be Available information seems to still be

incomplete, and non-standardizedincomplete, and non-standardized• Current HRH information available Current HRH information available

identified health workers either to be identified health workers either to be providing care only in private or public providing care only in private or public sectors, rather than in both sectors, rather than in both

• There is a need for standardized, uniform There is a need for standardized, uniform information available within the region information available within the region for comparability and forecasting for comparability and forecasting purposes.purposes.


Situation Analysis Situation Analysis ResultsResults

•Only Thailand, China , Papua Only Thailand, China , Papua New Guinea and the New Guinea and the Philippines have formal HRH Philippines have formal HRH plans but plans are all plans but plans are all different : Some plans are different : Some plans are mere workforce projectionsmere workforce projections

•Not all plans have systems Not all plans have systems developed and implementeddeveloped and implemented



•Critical systems are planning, Critical systems are planning, training, recruitment and training, recruitment and performance management, performance management, compensation and benefits. compensation and benefits. Most country focal points are Most country focal points are aware of the systems. The aware of the systems. The levels of country development levels of country development cannot be discerned.cannot be discerned.



There is a need for the There is a need for the guidelines to develop guidelines to develop common definitions, create common definitions, create uniform understanding of uniform understanding of HRH systems and planning, HRH systems and planning, advance standard advance standard formulation at country levels formulation at country levels and develop HRH systems.and develop HRH systems.


Draft Guidelines for Draft Guidelines for Developing Country Developing Country HRH Master PlansHRH Master Plans


1. Accomplish a situational 1. Accomplish a situational AnalysisAnalysis

• External Environment AnalysisExternal Environment Analysis– Labor and Employment environment Labor and Employment environment – Socio-economic contextSocio-economic context– Political situationPolitical situation

• Internal EnvironmentInternal Environment– Health sector systems assessmentHealth sector systems assessment– Levels of Classification for HRH Levels of Classification for HRH

systemssystems


2. Decide on Goals of the 2. Decide on Goals of the Master PlanMaster Plan

• GoalsGoals– Recommend the adoption of work of Recommend the adoption of work of

Hornby and Ozcan for Malawi (Hornby Hornby and Ozcan for Malawi (Hornby and Ozcan,2003). and Ozcan,2003).

– Designed to ensure that each country’s Designed to ensure that each country’s health services have effective and well-health services have effective and well-motivated workforce and are motivated workforce and are appropriately managed. appropriately managed.


2. Decide on Goals of the 2. Decide on Goals of the Master PlanMaster Plan

Health Services should have: Health Services should have: 1.1. The right number of people,The right number of people,2.2. The right category,The right category,3.3. In the right place,In the right place,4.4. At the right time,At the right time,5.5. With the right skills,With the right skills,6.6. With the right motivation and attitudes,With the right motivation and attitudes,7.7. At the right cost,At the right cost,8.8. Doing the right work, Doing the right work, 9.9. Under the right work conditions. Under the right work conditions.


2. Identify Objectives of 2. Identify Objectives of the Master Planthe Master Plan

Suggested broad objectives:Suggested broad objectives:1.1. Specify the direction of country HR Specify the direction of country HR

development in three planning frames: short development in three planning frames: short term (5 years), medium term ( next 10 years) term (5 years), medium term ( next 10 years) and long term ( next 10 years)and long term ( next 10 years)

2.2. Determine HRH development objectives, key Determine HRH development objectives, key strategies, activities and evaluation indicators strategies, activities and evaluation indicators for the above mentioned time framesfor the above mentioned time frames

3.3. Identify short term, medium term and long- Identify short term, medium term and long- term actions, including policy and program term actions, including policy and program actions that are needed to proceed to actions that are needed to proceed to medium term and long termmedium term and long term


3. Decide on a Planning 3. Decide on a Planning FrameworkFramework

• Overarching vision/mission/goals Overarching vision/mission/goals • Strategies and mandates of the health Strategies and mandates of the health

sectorsector• Ensure that all aspects of HRH Ensure that all aspects of HRH

development from production and development from production and planning, utilization, placement and planning, utilization, placement and development are given the necessary development are given the necessary attention.attention.

• Identify planning frames, assumptions, and Identify planning frames, assumptions, and context of plans context of plans



• Recommend the adoption of a modified Recommend the adoption of a modified version of the WHO Framework for version of the WHO Framework for sustainable HRH Development (WHO-sustainable HRH Development (WHO-Dayrit, 2006)Dayrit, 2006)

• Framework contains common technical Framework contains common technical framework for human resources to help framework for human resources to help national governments and national national governments and national planners understand the myriad and planners understand the myriad and complex problems of human resources complex problems of human resources for health – and find feasible solutions. for health – and find feasible solutions.



1.1. define key dimensions of technical define key dimensions of technical competencies needed to develop and competencies needed to develop and implement a strategy for human resources; implement a strategy for human resources;

2.2. help inform the growing number of groups help inform the growing number of groups interested in the health workforce and interested in the health workforce and prevent the simplistic and limited views on prevent the simplistic and limited views on what is involved; and what is involved; and

3.3. provide a common reference point for all provide a common reference point for all health workforce stakeholders and save health workforce stakeholders and save policy-makers, implementers, donors, the policy-makers, implementers, donors, the academe, and others the effort to “reinvent academe, and others the effort to “reinvent the wheel” (WHO-Dayrit, 2006).the wheel” (WHO-Dayrit, 2006).


BETTER HEALTH OUTCOMES

SERVICESEquity

EffectivenessEfficiency

Quality

ANALYSIS

EVALUATION

IMPLEMENTATION

POLICY

FINANCEHUMAN RESOURCE

MANAGEMENTSYSTEMS

OTHER HEALTH SYSTEMS

COMPONENTS

COUNTRY SPECIFIC

CONTEXTS

PLANNING

LEADERSHIP

EDUCATIONPARTNERSHIP

WHO Framework (2006)WHO Framework (2006)


c

ANALYSIS

IMPLEMENTATION

HEALTH SERVICES CHARACTERISTICSEquity Effectiveness Efficiency Quality Accessibility AcceptabilityAppropriateness

BETTER HEALTH OUTCOMES

OTHER HEALTH SYSTEM COMPONENTS &

IMPLICATIONS ON HRDFinancial ManagementQuality Management SystemStrategic Management SystemOrganizational Information SystemAudit and Risk Management System

COUNTRY SPECIFIC CONTEXT

(Issues,Culture and Behavior)

HEALTH SECTOR PERFORMANCE IMPROVEMENT & HRDQuality of staff Mix of staff cadres Number of staffStaff distributed Staff productivity Education & TrainingHR Management


4. Identify Key Issues that 4. Identify Key Issues that needs to be addressed by needs to be addressed by

Master Plan Master Plan • Results of the situational analysis to Results of the situational analysis to

identify key issues identify key issues • Utilize decision making models i.e. Utilize decision making models i.e.

decision treedecision tree

problem trees problem trees • Utilize Algorithms Utilize Algorithms • Problem Tree and Core Problems : Problem Tree and Core Problems :

Philippine Example Philippine Example


3. Lack of Operations Research to rationalize HR standards

National HHRD Plan of 1994 not implemented

1. No integrated policies on HHR

2. Weak HRH info system to support other HR systems (e.g. health facilities, HRH stock and needs)

Functions of organizations with HR roles are not integrated

(DOH, PRC. CHED, DBM, POEA, DOLE, DILG, TESDA, Private Hospitals)

Inadequate HRH Management Systems

Inadequacy in budgeted items for health human resource in government and private facilities at the provincial and municipal levels

10 Inadequacy in Budgeted Items for HRHresource in government and private facilities at the provincial and municipal levels

HR Standards outdated or inappropriate

No rational basis for opening of health science schools

Variable cost of health sciences education

Proliferation of substandard schools (e.g. nursing schools)

Inequitable distribution of health professionals

Other health professionals going into nursing

Increased Migration of Health professionals

Lack of integrated HRH systems in general: Information system, HRH development, compensation/ benefits/ incentives, production, regulation, deployment/ placement, utilization, monitoring/ evaluation, policy and standard development, HRH planning

Poor Working Conditions; Limited Career Progression Opportunities; Unfavorable terns of employment

Compensation: Low; Large gap exists between salaries of government and private based health workers

Lack of system for local recruitment and deployment

Low

Productivity of Health

Professional Dissatisfaction

12. Weak Health System

Salaries of resident doctors and nurses pale in comparison to professionals in other sectors

Inappropriate or outdated skill and skill mix

Low Quality

HR Standards outdated or inappropriate

7. No rational basis for opening of health science schools

9. Variable cost of health sciences education

8. Proliferation of substandard schools (e.g. nursing schools)

11. Inequitable distribution of health professionals

5. Other health professionals going into nursing

Increased Migration of Health professionals

Lack of integrated HRH systems in general: Information system, HRH development, compensation/ benefits/ incentives, production, regulation, deployment/ placement, utilization, monitoring/ evaluation, policy and standard development, HRH planning

6.Poor Working Conditions; Limited Career Progression Opportunities; Unfavorable terns of employment

4. Compensation: Low; Large gap exists between salaries of government and private based health workers

Lack of system for local recruitment and deployment

Low

Productivity of Health

Professional Dissatisfaction Salaries of resident doctors and nurses pale in comparison to professionals in other sectors

Inappropriate or outdated skill and skill mix

Low Quality


5. Identify Key Result 5. Identify Key Result Areas of the PlanAreas of the Plan

• Key result areas are focused on key Key result areas are focused on key issues that have been identifiedissues that have been identified

• Need to be measurableNeed to be measurable• Will include workforce projectionsWill include workforce projections• Will require projection models Will require projection models • Philippines used simple workforce Philippines used simple workforce

projection model commissioned by projection model commissioned by WPROWPRO


6. Craft effective and 6. Craft effective and appropriate strategiesappropriate strategies

• Strategies have to be planned for Strategies have to be planned for different phases:different phases:– Short term – Most detailed with clear Short term – Most detailed with clear

indicatorsindicators– Medium term- Directional plan based on Medium term- Directional plan based on

accomplishment of short term objectivesaccomplishment of short term objectives– Long term- Directional planLong term- Directional plan

• Strategies include systems Strategies include systems developmentdevelopment


7. Accomplish Operational 7. Accomplish Operational PlanPlan

• Log Frame AnalysisLog Frame Analysis– Verifiable IndicatorsVerifiable Indicators– Identification of risks and assumptionsIdentification of risks and assumptions– Identification of key activities, tasks and Identification of key activities, tasks and

responsible personsresponsible persons– Timelines Timelines – BudgetBudget


LOGICAL FRAMEWORK(Purpose 2.2 – To implement retention schemes in all facilities in the health sector)

Program: Retention Program Team:

NO. NARRATIVE SUMMARY (Outputs)

OBJECTIVELY VERIFIABLE INDICATORS

(OVI)

MEANS OF VERIFICATION (MOV)

IMPORTANT ASSUMPTIONS/RISKS

1.Best practices and feasibility of retention schemes explored with government, pilot ILHZ stakeholders and private health facilities, DOH) regarding the following:Facilities developmentHRH Functions

o Job designo Job pricingo Rewards systemo Career

progressiono Training and

Development

Consultation sessions conductedDocumentation of the session and analysis of the data done

Implementing organization secretariat (DOH-HHRDB) documentation

Results of process evaluation of 6 HRH functions available.Participation of stakeholders from 27 pilot ILHZs, government and private health facilities, LGU

1.Implementation of retention schemes

Hospital based retention program and activities implemented

LGU based retention program and activities implemented

Hospital Retention Program planLGU Retention Program plan

Consensus on retention schemesParticipation of government, private and LGU health facility stakeholders


8. Identify Key Policies and 8. Identify Key Policies and Programs to support Programs to support

Master PlanMaster Plan • There are key policies that need to There are key policies that need to

be reviewed, updated be reviewed, updated • New policies that need to be New policies that need to be

institutedinstituted• Programs that need to be prioritized, Programs that need to be prioritized,

emphasized or designed emphasized or designed


9. Craft Monitoring and 9. Craft Monitoring and Evaluation SchemeEvaluation Scheme

• Monitoring and Evaluation to start in Monitoring and Evaluation to start in short term short term

• Drive the refinement of the Master Drive the refinement of the Master PlanPlan

• Based on HRH information system Based on HRH information system establishedestablished

• Review and revise Master Plan over Review and revise Master Plan over periods of timeperiods of time


10.Plan for Annual Plan 10.Plan for Annual Plan Review and ReplanningReview and Replanning

• Annual Strategic Planning Review Annual Strategic Planning Review to evaluate accomplishments and re to evaluate accomplishments and re align plans, activities and tasks for align plans, activities and tasks for given yeargiven year

• Detailed annual planning and Detailed annual planning and readjustment of strategic directionsreadjustment of strategic directions


Summary of Guideline Summary of Guideline StepsSteps

1.1. Do situational AnalysisDo situational Analysis2.2. Decide on Goals of the Master Plan Decide on Goals of the Master Plan 3.3. Decide on a Planning FrameworkDecide on a Planning Framework4.4. Identify Key Issues that needs to be addressed Identify Key Issues that needs to be addressed

by master-planby master-plan5. Identify Key Result Areas of the Plan5. Identify Key Result Areas of the Plan6. Craft effective and appropriate strategies6. Craft effective and appropriate strategies7. Accomplish Operational Plan7. Accomplish Operational Plan8. Identify Key Policies and Programs to support 8. Identify Key Policies and Programs to support

plan plan 9. Craft Monitoring and Evaluation Scheme9. Craft Monitoring and Evaluation Scheme10. Plan for Annual Plan Review10. Plan for Annual Plan Review


Next StepsNext Steps

• Organize a country team Organize a country team - The team should - The team should be multidisciplinary and inter-sectoral be multidisciplinary and inter-sectoral

– Staff from the Human Resource Department within Staff from the Human Resource Department within the Department/Ministry of Health and other key the Department/Ministry of Health and other key stakeholdersstakeholders

– Other agencies such as education, finance, planning Other agencies such as education, finance, planning as well as professional regulatory bodies, as well as professional regulatory bodies, professional organizations, academe, and professional organizations, academe, and development partners. development partners.

– Team leader - someone that can provide immediate Team leader - someone that can provide immediate guidance on issues at hand and has a network among guidance on issues at hand and has a network among various departments/ministries and other relevant various departments/ministries and other relevant agencies. agencies.

2nd AAAH Conference, Beijing, China 44

The Philippine HRH The Philippine HRH Implementing Implementing OrganizationOrganization

Support & coordinating

agencies

Planning, Resource Mgmt,

Coordination , Champion

DOHBLHD,

HHRDB,,IMS, HPDPB, BIHC, BHFS, NCFHD

Partners Proposed Implementers

of the Plan

DOF NGOs

FundingPHIC/

International Donors like

WHO

CSCNEDA

Data source:LGU’s

DTI

DILGRetention, Compensa-

tion & Career Dev’t

DBM, PHA & LGUs

ProductionAcademe & Accredited

Professional Organizations

RegulationPRC,

Professional Regulatory

Boards, CHED, TESDA & PHIC

DomesticDeployment

DOLE & League of

Municipalities and Cities

Int’l Deployment

POEA, DFA & OWWA



• Ensure adoption of HRH Master Ensure adoption of HRH Master Plan by government as the official Plan by government as the official HRH development strategyHRH development strategy

• Ensure buy-in by various Ensure buy-in by various stakeholders in HRH developmentstakeholders in HRH development



• Commit roles and responsibilitiesCommit roles and responsibilities ––terms of reference clear and well terms of reference clear and well understood by everyone. A work plan understood by everyone. A work plan should be developed to include specific should be developed to include specific tasks and assignments, timelines, budgets, tasks and assignments, timelines, budgets, and responsible persons. and responsible persons.

• Hold discussions with key informants Hold discussions with key informants - - Interviews, meetings, focus group Interviews, meetings, focus group discussions and other approaches for discussions and other approaches for further information should be done to further information should be done to validate existing strategies,programsvalidate existing strategies,programs


MABUHAY!MABUHAY!Xie Xie!Xie Xie!

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