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EthiopiaHealth Profile and HRH CrisisEthiopia ranks 170 out of 177 in the in the 2006 Human Development Index (HDI). In terms of Health Nutrition and Population outcomes, despite some minor improvements between 2000 and 2005, life expectancy and infant mortality rates are still some of the lowest in the world, at 42.5 and 110.4 respectively. Despite increased efforts to scale up intervention and investment, the government and donors alike have recognized that HNP outcomes are unlikely to improve further without an adequately developed and equitably distributed health workforce.
Addressing HRH Country-led action, with global responsibility and collective solidarity to sustainably address the health worker problem in Ethiopia is crucial. The WB HRH program is complementing Government activity, Donor activity, and NGO activity to address the crisis. The following activities are organized and funded by the Banks HRH program, and are currently ongoing or have been completed. Activities are centered around 1) obtaining baseline information on HRH 2) developing strategy, policy, and programs on HRH, 3) implementing strategy, policy and programs on HRH. Baseline Information and AnalysisStudy on Health worker motivation: The health sector in Ethiopia is suffering from mal-distribution of health workers in favor of urban areas, a migration of workers to the private sector, low levels of motivation and performance in the public sector, and a lack of support supervision. To address these problems, more insights are needed into the individual behavior, choices and preferences of health workers. The survey is to cover a sample of health workers in Addis Ababa, and the regions of Southern Nations and Tigray, and to gather information on individual behavior, choices and preferences of health workers. The study is led by William G Jack. Cohort Study (first wave): final year nursing and medical students: The study aims to build a base line for a cohort survey with future health workers (see overview of second wave cohort study below); the survey that was conducted (in 2003) and interviewed 219 final year clinical nursing students and 90 medical students in 11 schools in Ethiopia. Second, the survey aspires to provide insights on the supply side aspect of human resources in the health sector. This is crucial information in the design of comprehensive policies and strategies on HRH. The study provides information using the collected data by evaluating social-economic and demographic characteristics of final year clinical nursing students and medical students and determines what influences their decisions and motivates students to become health workers, as well as different aspects of professional training, and student expectations, perceptions and concerns for the future. The study was lead by Pieter Serneels, Magnus Lindelow, Jose Garcia Montalvo, and Abigail Barr. Cohort Study (second wave): graduated nurses and doctors in their current place of residence and work: This study largely follows on from the first wave of the cohort study, and is concerned with understanding the motivation, behavior, and labor market choices of health workers. It seeks to provide valuable descriptive and analytical information that can contribute to the policy dialogue, especially within the context of program implementation and the PRSC preparation, and serve as inputs in the design of more effective human resource strategies. The study is premised on the notion that health workers are not passive actors in the health system, but rather make choices about where, when, and how to work on the basis of personal characteristics and circumstances, as well as the institutional and organizational environment in which they operate. As part of the second wave, nurses and doctors will be re-interviewed in their current place of residence and work. This will help to address a number of important questions about how young health workers make their career choices, and about how their perceptions, motivation, skills, and behavior change in response to their professional experience. Pieter Serneels, Magnus Lindelow, Aklilu Kidanu are leading the study. Study on Wage ceilings:This study focuses on health workers’ wage ceilings and the process determining the budgeted wage bill for health workers, contracting arrangements, and external funding of health worker salary and remuneration. As discussed above, such information is important both for designing policies and programs to manage outflows as well as for increasing the productivity of the existing stock of health workers. This proposed study will collect, analyze, and map out information on wage bill conditionalities and the process determining the budgeted health worker wage bill, public sector contracting arrangements, and donor funding of salaries. This process will identify problems and help “make the case” and pave the road for investments to improve health workforce performance and adequately manage and deal with outflows. Marko Vujicic is leading the study with general guidance from the Africa Health Workforce Team. Mapping bottlenecks to scaling up health worker production. This study plans to assess quantitatively and qualitatively the current capacity of production of qualified health workers in Ethiopia (doctors, nurses, dentists, pharmacists, technicians, and allied providers), and the factors which influence it. The proposed work will look at the following dimensions of the production of health workers: policy environment, the regulation and functioning of training institutions, planning practices (i.e how many health workers can be employed in the public and private sectors), actual health worker training programs and locations, educational institution infrastructure, actual student population, quality of training, outputs (graduation rate, course development rate etc), and institutional ownership and funding (public and private), etc. The study will make recommendations on what the bottlenecks to increased production are and what are the most cost-effective investments to make to rapidly increase production of health workers. The study is lead by Gaston Sorgho and Aly B. Sy, under the overall direction of the Africa Health Workforce Team. HRH Situation Analysis in Ethiopia (2007): The Government of Ethiopia is committed to providing its population with quality health services. The Ethiopian health delivery system is characterized by shortage, inadequate distribution and lack of necessary skill - mix in its human resources for health. There are not enough health workers; they do not have the right skills and support networks; they are often not in the right place; they are overstretched and overstressed. In addition, HIV/AIDS as new and uniquely vicious peril to this workforce has emerged recently and is threatening the health workforce across various dimensions. It increases the workload and skill demands on health workers as health facilities are being overwhelmed by AIDS patients, in the context of scale up interventions of the newly introduced antiretroviral treatment. This paper broadly lists and analyzes the latest HRH situation in Ethiopia, as part of a comprehensive approach to HRH policy development and strategic plan for its implementation. The paper is lead by Maurice Bucagu. Obtaining accurate information on the stock, profiles and distribution (SPD) of health workers in Ethiopia. In light of the growing government agenda on Human Resources for Health, and the recognition that accurate and up-to-date information on health worker SPD is crucial for HRH policy and program development and monitoring, this study seeks to conduct a detailed analysis of the existing data examining a) the extent to which this data can be used to paint a comprehensive picture on health workers in Ethiopia (by conducting a deep analysis of the data and computing all indicators of relevance), b) the extent to which any derived information can be considered accurate (paying particular attention to the sufficiency, quality and timeliness of data collected, and thus the data collection methodology, associated tools and data entry, and c) provide key recommendations on how a future initiative to collect, enter and analyze health worker data can improve the comprehensiveness and accuracy of any data provided (including key recommendations on how to improve the institutionalized mechanisms to collect, enter and analyze health worker data in Ethiopia). Lead by Christopher Herbst. Expected to be completed in June, 2007. Study on Health worker motivation: The health sector in Ethiopia is suffering from mal-distribution of health workers in favor of urban areas, a migration of workers to the private sector, low levels of motivation and performance in the public sector, and a lack of support supervision. To address these problems, more insights are needed into the individual behavior, choices and preferences of health workers. The survey is to cover a sample of health workers in Addis Ababa, and the regions of Southern Nations and Tigray, and to gather information on individual behavior, choices and preferences of health workers. The study is led by William G Jack. Development of National Strategic Plans, Policies and ProgramsHuman Resources for Health, Business Process Re-Engineering. The Federal Ministry of Health requested that the World Bank and other members of the technical working group on HRH produce a paper revisiting and redesigning HRH along the Business Process Reengineering (BPR) principles. The goal of HRH BPR is to rethink and reshape the production and administration of a more balanced health workforce, with support of state of the art health information technology to realize universal coverage of health services. The report discussed the objectives of the HRH BPR (for the period 2008-2015) as well as key methods and actions for achieving these. These objectives are: (i) To promote public health careers and educational opportunities in schools (ii) To devise selective recruitment system for entry into health field. (iii) To strengthen the education regulatory framework for improved curricula and recruitment criteria in the pre-service health training programs. (iv) To scale up production of selected categories of health professionals with new skills and implement wide scale task shifting to the existing health cadres. (v) To provide a comprehensive policy and strategy guide for HRH development process and to enable effective and efficient implementation of the designs.(vi) To ensure improved HRH management and performance (vii) To stabilize HRH labor market. Maurice Bucagu led the process. Detailed concept note for HRH strategic Plan development in Ethiopia: The Government of Ethiopia asked the Bank to produce a detailed concept note outlining the development of a Human Resources for Health strategic plan. A detailed concept note was produced to facilitate and jump start the development of a well thought governing strategy to coordinate and guide human resources development (HRD) activities in Ethiopia. As requested by the government, the concept note focuses in great part on the contribution and application of the principles of Business Process Re-engineering (BPR) – see above. Maurice Bucagu developed the concept note. Implementing Policy and ProgramsHRH Supply, Requirement Projection and Financial Resource Requirement: Ethiopia has undertaken a health sector MDG need assessment, and based on this assessment the country has developed a national HSDP III document. One of the major factors for the achievement of these targets is the presence of an adequate number and skill mix of HRH. Thus, there is an urgent need to assess the requirements and supply of HRH for scale up of health services. This study was undertaken with the objective of determining the human resource supply and requirement for scaling up health service in Ethiopia under different scenarios of scale up. The study has also looked at the additional cost related to salary adjustment and recurrent cost related to salary, benefit and duty allowance of HRH for maintaining the minimum staffing standard as well as scale up of health services. By circulating this report to relevant stakeholders and partners, the study will also help in indicating areas which need further discussion and study. The Study was requested by the Federal Ministry of Health in Ethiopia, and carried out in partnership with other development partners, including JHEPIGO, WHO and Italia Cooperation. Dieter Gijsbrechts, World Bank, together with various other DP’s led the study. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
