Human Resources for Health is one of the areas that has received arguably the most attention in terms of debate and discussion in terms of trying to improve the performance of the health sector and therefore improved health outcomes.
The symposium panel on Human Resources for Health was a power-house of expertise; including Dr. Peter Ogwal of the World Bank; Prof. Pius Okong who is the Chairman of the Health Service Commission; Dr. Pius Achanga of the Uganda National Council for Higher Education; Prof. Charles Hongoro from Human Sciences Research Council and Dr. Paul Onek, the outgoing District Health Officer Gulu.
Dr. Peter Ogwal who is a Health Economist argued that the key issue in health workforce effectiveness is not numbers but the crisis is from the general human resources issues. “This should be the foundation for sorting it out. Need to plug gaps and vacancies and then absenteeism. Is it funded positions that are not staffed?”, he asked
The issue of bureaucratic complexities in recruitment at the district level where structures are not in place yet some that have the structures are simply not recruiting. “Some staff are recruited but not supervised, not appreciated, paid poorly and they just absent themselves. The main task is to pay attention to the human resource planning and management”, he emphasised.
The question that was asked is who should be recruiting health workers in a system of fragmented sub-systems and policies!
The issue of task shifting which is quite topical in many Low and Middle Income Countries was a big part of the debate. Dr. Ogwal contends that the approach should be to first of all, thinking through why the country needs task shifting and what tasks need to be shifted.
Prof. Pius Okong made the meeting know that at the district level, a good number of members of the District Service Commissions are retired teachers and they find handling health workforce issues a nightmare. This may complicate proper planning for the implementation of universal health coverage.
A touchy issues; export and immigration of health workers. Prof Okong is firm on this one. “Immigration of health workers is inevitable; the truth is that government could explore how to export labour without hurting the system. There is a WHO Code that guides member countries on how to export health workers without hurting their own systems”. He was requested to widely disseminate this Code especially in policy circles for informed decision making.
From the Uganda National Council for Higher Education, Dr. Pius Achanga posed a question that was also the focus of discussion on Day 1: Who is good enough to be admitted to a health sciences degree programme? Is it one with excellent grades or one with not so good grades but with the requisite motivation to work? What about letting people work their way through the system from diploma level to the required degree level?
On task shifting and how or even whether it should be done, and what tasks are shifted to who, Prof. Charles Hongoro used the case of early initiation of ART in some countries where with increasing demand, lower cadres were trained and skilled to provide the services. Eventually the programmes moved from largely doctor-centred to other cadres. He was fast to add though that effective task shifting goes with additional training and close supervision.
Speaking from a level of on-ground experience Dr. Paul Onek, outgoing DHO Hulu district shared his experience with task shifting. He noted that several declarations have been made but the performance is still poor on the part of Uganda. For the Abuja Declaration he pointed out the score card is very poor. Basing on this and the current skewed distribution of the health workforce biased towards urban settings, he wondered whether universal health coverage is not too big a venture.
“Are we going to succeed? Distribution of health workers is skewed towards urban centres leaving lower levels with Nursing assistants and health information assistants. When you consider staffing norms; 50% of the numbers given are those who do not deliver health services which complicates the hope for achieving UHC. Health Centre II is the closest to the community but has only one nurse, one midwife and one health assistant to serve 5,000-10,000 population. Is that realistic?”, he asked.
Staffing is poor, supervision is poor and resources not there, unless there is a real shift to look at PHC the dream about UHC is just that.
Recruitment and retention of the necessary and right cadre of nurses is a major challenge and task shifting has to be around for much longer to counter this problem.