Different perspectives

Innovations and new products: enthusiasm and hope
Health systems, human resources: anguish and crisis

Derek Yack
World Health Report 2006
Working together for Health
Figure 2

STRATEGIC CHARACTER OF HUMAN RESOURCES
Figure 3

Global Initiatives
Creation of Global Health Workforce Alliance (NORAD, CIDA, SIDA, Gates)
Global Fund for AIDS, Tb and Malaria, GAVI
Networks of Observatories in HRH (AFRO, EMRO, SEARO-WPRO)

In the region of  The Americas
In 2000, over 163 million persons lived in areas where the human resource density was lower than the minimum target of 25 per 10 000 pop. Regarding the 6 countries with lowest human resource density, roughly 23 000 physicians and nurses are required to increase the present ratio of 8,3 per 10 000 to the intermediate point with the minimal target of 25.

The availability of physicians in urban areas is 8-10 times higher than in rural areas.
The ratio of nurses to physicians in North America is 3:1, but this ratio is reversed in Latin America.
In 2004, sixty four national strikes caused the interruption of public health services in Latin America.
Approximately, three quarters of countries and territories in the region have had a net loss due to migration of human resources in healthcare.
Haiti, with the lowest ratio of physicians per inhabitants in The Americas, shows a medical migration rate that is 12 times higher than that of Cuba and one of the highest rations worldwide.
The gap between countries with high density and low density of human resources in healthcare continue opening.


Five Common Challenges

To define and to implement long-term human resource policies, based on reliable information and linked to general health policies.

To locate the right persons in the right places to eliminate inequities in the availability of healthcare staff.

To control domestic and external migration of health professionals in order to prevent shortages that will affect the most neglected populations.

To make healthcare workers to commit themselves to the mission of rendering quality service to the whole population.
To jointly work with Health Universities, Schools and Services so that the formation of new professionals and technicians be suitable for meeting the health requirements of the population.

7th Regional Meeting of Observatories of Human Resources, Lima, November 2006.

From the law to the collective action
Thirty one countries in The Americas, five African countries
 Main idea: action plans 2006-2015
Identification of strategic objectives
Formulation of changing indicators
Design of monitoring mechanism


Technical cooperation hubs
Plans of action 2006-2015    TOR platform…….Health systems
PHC
EPHF

Implementation of policies in HRH
Development of plans and policies
Information/research (Observatories)
Leadership in HRH
Strengthening of HRH lines
PHC teams
PHC competencies
Multi-professional formation
Inter-culturality
Health sciences education and unattended/marginal populations   “scaling up”

3. Workforce in public health / EPHF
Characterization of EPHF
Competencies in PH, SI
Leadership

Development of medium-term “initiatives”
Principle: alignment of interests/ domestic capacities in health care and outside cooperation, in a multi-country effort, by using the Toronto Action Appeal as a common platform.

•    Brazil: TC41 CIRHUS, Andean countries

•    Canada: Health Canada and CIDA

•    Cuba: Virtual Campus of Public Health (VCPH)




Virtual Campus of Public Health

MISSION

To develop the capacities of institutions and the individual competencies through interaction and e-learning for continuous improvement of performance of public health practice, on the basis of a management model that functions in a cooperative and de-centralized way, with the participation of formative institutions, service centres and the associations of technicians and professionals that make up the health workforce in the countries of The Americas region.

PRINCIPLES
Creation of a collective space owned by the countries of the region, which represents a global public asset operating as a shared source and universal access.

Setting up of an open management model working in a decentralized way for the cooperative construction of e-learning methods and tools on the basis of evidence and the best practice in public healthcare.

Encouragement of solidarity with those countries and populations in the geopolitical environments with the greatest social and public health needs.

Fostering the processes of quality, relevance, evaluation and control of processes, resources and services aimed at the continuing formation of public healthcare workforce.

Strengthening of continuing education programs in Public Health.

Support of local capacities development in formative process by promoting the adoption and development of tools, methodologies and technologies for e-learning.

Structuring based on technical/financial sustainability criteria and on universal access.

Encouragement to processes that reduce digital gaps, paying special attention to gender and intercultural approaches.

Use and utilization of technological innovations under international practices of Free Software, including developments that may be offered under free or onerous licences according to fair, equitable and non-discriminatory criteria.

Agreed strategic model
Participation rules and operating guidelines
Architecture under implementation: a) Automatic and interoperable portal – Web per node, b) Moodle course platform; c) Repository, and d) Fora  5 Nodes under implementation: 1) PAHO 2) Bra 3) Chi 4) Cub and 5) Spain
5 Nodes in preparation:  1) Peru 2) Col 3) Arg 4) Kor 5) English-speaking Caribbean and 6) CIESS

VCPH : potentialities and challenges

Force of integration/articulation at many levels
Serious institutional decision; pressure for development of an educational policy at institutional level (decision-making methodology).
Opening of new alliances and possibilities for action.
Setting of quality normative and referent
Purpose, governance, PAHO leadership and “•strategic offer” of the campus.
Reaching a “critical mass” of active partners and  density of learning resources.
Co-ordination, growth and mobilization of resources, inter-regional working prospects (EPHF course).