WPRO IRIS - The Health Workforce...workforce planning, health workforce training and some aspects of workforce management in thirteen Pacific Island countries. In August-September

The Health Workforce South Pacific Island Nations

Arie Rotem and John Dewdney

with the suppon of

J. Rodgers, S. Wolfgramm and A. Drori

A Study Sponsored Uy the

World Health Organization Western Pacific Regional Office Manila, Philippines

"HO/WPRO LrnRlllft tlmnillJ. Pll.i~

The Health Workforce South Pacific Island Nations

Arie Rotem and John Dewdney

with the suppon of

J. Rodgers, S. Wolfgramm and A. Drori

A Study Sponsored Uy the

World Health Organization Western Pacific Regional Office Manila, Philippines

"HO/WPRO LrnRlllft tlmnillJ. Pll.i~

The views expressed in this publication are those of the authors and do not necessarily reflect the decisions or the stated policy of the World Health Organization.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country. territory. city or area or of its authorities or concerning the delineation of its frontiers or boundaries.

Copyright of this material remains with the University of New South Wales. Its reproduction. whether in part or in full. for study and research purposes is permitted. provided that the source is acknowledged.

Printed and distributed by the University of New South Wales on behalf of the WHO Regional Training Centre for Health Development

ALL RIGHTS RESERVED

ISBN 0 7334 0176 7

I·; " " " ~

The University of New South Wales August 1991

The views expressed in this publication are those of the authors and do not necessarily reflect the decisions or the stated policy of the World Health Organization.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country. territory. city or area or of its authorities or concerning the delineation of its frontiers or boundaries.

Copyright of this material remains with the University of New South Wales. Its reproduction. whether in part or in full. for study and research purposes is permitted. provided that the source is acknowledged.

Printed and distributed by the University of New South Wales on behalf of the WHO Regional Training Centre for Health Development

ALL RIGHTS RESERVED

ISBN 0 7334 0176 7

I·; " " " ~

The University of New South Wales August 1991

CONTENTS

Page

Acknowledgemen1li. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ii

List of Abbreviations/Acronyms Used in Text. . . . . . . . . . . . . . . . . . . . . .. iv

PART I

1. Introduction.......................................... 1 1.1 Population and health personnel. . . . . . . . . . . . . . . . . . . . . . . . . .. 2

2. The Current Status of Health Workforce Planning in Pacific Island Countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4 2.1 National development plans, health plans and health workforce plans. . .. 4 2.2 National health plans and health workforce plans. . . . . . . . . . . . . . . .. 4 2.3 Integration and direction of health worldorce planning. . . . . . . . . . . . . 6 2.4 Health workforce plan preparation. . . . . . . . . . . . . . . . . . . . . . . .. 7 2.5 Sources of health worldorce planning data. . . . . . . . . . . . . . . . . . . .. 8 2.6 Formal arrangements for sharing health workforce

information with other agencies. . . . . . . . . . . . . . . . . . . . . . . . . .. 10 2.7 Present planning capacity of health authorities. . . . . . . . . . . . . . . . .. 10 2.8 Health workforce planning methods. . . . . . . . . . . . . . . . . . . . . . .. 12 2.9 Projected increases in the health workforce 1989-1995 . . . . . . . . . . . " 12 2.10 The composition of the health worldorce. . . . . . . . . . . . . . . . . . . .. 14 2.11 Health worldorce distribution. . . . . . . . . . . . . . . . . . . . . . . . . . .. 17 2.12 Health workforce - age distribution. . . . . . . . . . . . . . . . . . . . . . . .. 18

3. Health Workforce Training and Development. . . . . . . . . . . . . . . . . . . .. 20 3.1 Policies and plans for health personnel training and development. . . . . .. 20 3.2 Linkage of educational planning to national health plans. . . . . . . . . . .. 21 3.3 Responsibility for educational planning. . . . . . . . . . . . . . . . . . . . .. 22 3.4 Local formal training programs. . . . . . . . . . . . . . . . . . . . . . . . . .. 23 3.5 Local in-service training activities. . . . . . . . . . . . . . . . . . . . . . . .. 25 3.6 Problems associated with local training programs. . . . . . . . . . . . . . .. 25 3.7 Overcoming local training problems. . . . . . . . . . . . . . . . . . . . . . .. 26 3.8 Utilization of major regional or overseas training programs. . . . . . . . . .. 29 3.9 Fellowships - the "needs" list. . . . . . . . . . . . . . . . . . . . . . . . . . .. 31 3.10 Fellowships and scholarships - awarding procedures. . . . . . . . . . . . . .. 31 3.11 Difficulties in obtaining suitable candidates for overseas fellowships. . . .. 33 3.12 Liaison between service providers and training personnel in

the development and conduct of training programs. . . . . . . . . . . . . . .. 33

CONTENTS

Page

Acknowledgemen1li. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ii

List of Abbreviations/Acronyms Used in Text. . . . . . . . . . . . . . . . . . . . . .. iv

PART I

1. Introduction.......................................... 1 1.1 Population and health personnel. . . . . . . . . . . . . . . . . . . . . . . . . .. 2

2. The Current Status of Health Workforce Planning in Pacific Island Countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4 2.1 National development plans, health plans and health workforce plans. . .. 4 2.2 National health plans and health workforce plans. . . . . . . . . . . . . . . .. 4 2.3 Integration and direction of health worldorce planning. . . . . . . . . . . . . 6 2.4 Health workforce plan preparation. . . . . . . . . . . . . . . . . . . . . . . .. 7 2.5 Sources of health worldorce planning data. . . . . . . . . . . . . . . . . . . .. 8 2.6 Formal arrangements for sharing health workforce

information with other agencies. . . . . . . . . . . . . . . . . . . . . . . . . .. 10 2.7 Present planning capacity of health authorities. . . . . . . . . . . . . . . . .. 10 2.8 Health workforce planning methods. . . . . . . . . . . . . . . . . . . . . . .. 12 2.9 Projected increases in the health workforce 1989-1995 . . . . . . . . . . . " 12 2.10 The composition of the health worldorce. . . . . . . . . . . . . . . . . . . .. 14 2.11 Health worldorce distribution. . . . . . . . . . . . . . . . . . . . . . . . . . .. 17 2.12 Health workforce - age distribution. . . . . . . . . . . . . . . . . . . . . . . .. 18

3. Health Workforce Training and Development. . . . . . . . . . . . . . . . . . . .. 20 3.1 Policies and plans for health personnel training and development. . . . . .. 20 3.2 Linkage of educational planning to national health plans. . . . . . . . . . .. 21 3.3 Responsibility for educational planning. . . . . . . . . . . . . . . . . . . . .. 22 3.4 Local formal training programs. . . . . . . . . . . . . . . . . . . . . . . . . .. 23 3.5 Local in-service training activities. . . . . . . . . . . . . . . . . . . . . . . .. 25 3.6 Problems associated with local training programs. . . . . . . . . . . . . . .. 25 3.7 Overcoming local training problems. . . . . . . . . . . . . . . . . . . . . . .. 26 3.8 Utilization of major regional or overseas training programs. . . . . . . . . .. 29 3.9 Fellowships - the "needs" list. . . . . . . . . . . . . . . . . . . . . . . . . . .. 31 3.10 Fellowships and scholarships - awarding procedures. . . . . . . . . . . . . .. 31 3.11 Difficulties in obtaining suitable candidates for overseas fellowships. . . .. 33 3.12 Liaison between service providers and training personnel in

the development and conduct of training programs. . . . . . . . . . . . . . .. 33

4. Workforce Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 35 4.1 Difficulties in health personnel management. . . . . . . . . . . . . . . . . .. 35 4.2 Job descriptions and their review. . . . . . . . . . . . . . . . . . . . . . . . .. 35 4.3 Staff incentive schemes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 36 4.4 Written guidelines for routine personnel management. . . . . . . . . . . . .. 37 4.5 Workforce management and woMorce planning. . . . . . . . . . . . . . . .. 38

S. Suggestions for Action. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 40 5.1 An action agenda and information exchange. . . . . . . . . . . . . . . . . .. 40 5.2 Development of health woMorce planning capacity. . . . . . . . . . . . . .. 40 5.3 Health workforce planning and operational research. . . . . . . . . . . . . .. 44 5.4 Resolutions of the WHO 1990 Conference. . . . . . . . . . . . . . . . . . .. 45

PART II

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 46

The Health Workforce Profiles of Pacific Island Nations Commonwealth of the Northern Mariana Islands. . . . . . . . . . . . . . . . . . . .. 47 Cook Islands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 60 Federated States of Micronesia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 74 Fiji. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 86 Kiribati. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 100 Papua New Guinea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 113 Republic of Guam ....................................... 125 Republic of Palau. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 139 Solomon Islands ........................................ 151 Tonga .............................................. 165 Vanuatu ............................................. 181 Western Samoa ......................................... 195

Concluding Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

4. Workforce Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 35 4.1 Difficulties in health personnel management. . . . . . . . . . . . . . . . . .. 35 4.2 Job descriptions and their review. . . . . . . . . . . . . . . . . . . . . . . . .. 35 4.3 Staff incentive schemes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 36 4.4 Written guidelines for routine personnel management. . . . . . . . . . . . .. 37 4.5 Workforce management and woMorce planning. . . . . . . . . . . . . . . .. 38

S. Suggestions for Action. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 40 5.1 An action agenda and information exchange. . . . . . . . . . . . . . . . . .. 40 5.2 Development of health woMorce planning capacity. . . . . . . . . . . . . .. 40 5.3 Health workforce planning and operational research. . . . . . . . . . . . . .. 44 5.4 Resolutions of the WHO 1990 Conference. . . . . . . . . . . . . . . . . . .. 45

PART II

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 46

The Health Workforce Profiles of Pacific Island Nations Commonwealth of the Northern Mariana Islands. . . . . . . . . . . . . . . . . . . .. 47 Cook Islands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 60 Federated States of Micronesia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 74 Fiji. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 86 Kiribati. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 100 Papua New Guinea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 113 Republic of Guam ....................................... 125 Republic of Palau. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 139 Solomon Islands ........................................ 151 Tonga .............................................. 165 Vanuatu ............................................. 181 Western Samoa ......................................... 195

Concluding Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

ACKNOWLEDGEMENTS

'This survey was commissioned by the Western Pacific Regional Office of the W orId Health Organisation. The sustained interest and support of Dr. A. Romualdez Jr. is gratefully acknowledged. The study could not have been completed without the cooperation of health authorities and their planning officers to whom we are most grateful.

An early version of the survey protocol used in this study was developed in a workshop sponsored by the Commonwealth Secretariat. The help of Mr. Busby Kautoke of Tonga who helped to facilitate that workshop and Professor K. Thairu from the Commonwealth Secretariat, London, is acknowledged with much appreciation.

Arie Rotem John Dewdney

ACKNOWLEDGEMENTS

'This survey was commissioned by the Western Pacific Regional Office of the W orId Health Organisation. The sustained interest and support of Dr. A. Romualdez Jr. is gratefully acknowledged. The study could not have been completed without the cooperation of health authorities and their planning officers to whom we are most grateful.

An early version of the survey protocol used in this study was developed in a workshop sponsored by the Commonwealth Secretariat. The help of Mr. Busby Kautoke of Tonga who helped to facilitate that workshop and Professor K. Thairu from the Commonwealth Secretariat, London, is acknowledged with much appreciation.

Arie Rotem John Dewdney

EXECUTIVE SUMMARY

1bis survey, sponsored by WPROIWHO, reviews the current status of health workforce planning, health workforce training and some aspects of workforce management in thirteen Pacific Island countries.

In August-September 1990, surveyors collected information from the Cook Islands, the Federated States of Micronesia, Fiji, the Republic of Palau, the Solomon Islands, Tonga, Vanuatu and Western Samoa. Information was supplied by the central health authorities of the Commonwealth of the Northern Mariana Islands, Guam, Kiribati, New Zealand and Papua New Guinea in response to a postal questionnaire.

Health Workforce Planning

While most of the countries surveyed had a national development and/or national health plans, few had included a comprehensive indicative or prescriptive health workforce plan. Although general capability in health policy formulation and broad health planning is present in most central health authorities, competence in workforce planning is limited. Limitations arise from lack of formally trained planning personnel and from problems in accessing and processing appropriate, accurate and up-to-date data. In countries having decentralised health service administrative arrangements, these problems are magnified. From the incomplete data reported, it is apparent that attention should be given to: (1) projection of the workforce requirements; (2) the present composition and mix of the health workforce; (3) possibilities for personnel substitution and role extension; (4) the distribution of personnel in relation to workload; (5) the implications of the aging of the present workforce. It is also evident that at present very little operational research related to workforce planning is undertaken.

Training

In some countries, training intakes are not clearly related to future staffing requirements. Widespread concern over shortages of competent instructors and some reported shortcomings in present curricula point to the need for cooperation in the development of curricula and teachingllearning materials. While the strengthening of in-country training programs and resources is necessary, it is inevitable that most of the countries surveyed will continue to rely on out-of-country training of medical and dental officers, pharmacists and other highly specialised allied health personnel and clinical support staff (such as laboratory scientists and bio-medical engineers). Difficulty in attracting adequately educated and well motivated school leavers to enter pre-service training and shortages of appropriately qualified staff to pursue further professional studies were reported in most countries.

ii

EXECUTIVE SUMMARY

1bis survey, sponsored by WPROIWHO, reviews the current status of health workforce planning, health workforce training and some aspects of workforce management in thirteen Pacific Island countries.

In August-September 1990, surveyors collected information from the Cook Islands, the Federated States of Micronesia, Fiji, the Republic of Palau, the Solomon Islands, Tonga, Vanuatu and Western Samoa. Information was supplied by the central health authorities of the Commonwealth of the Northern Mariana Islands, Guam, Kiribati, New Zealand and Papua New Guinea in response to a postal questionnaire.

Health Workforce Planning

While most of the countries surveyed had a national development and/or national health plans, few had included a comprehensive indicative or prescriptive health workforce plan. Although general capability in health policy formulation and broad health planning is present in most central health authorities, competence in workforce planning is limited. Limitations arise from lack of formally trained planning personnel and from problems in accessing and processing appropriate, accurate and up-to-date data. In countries having decentralised health service administrative arrangements, these problems are magnified. From the incomplete data reported, it is apparent that attention should be given to: (1) projection of the workforce requirements; (2) the present composition and mix of the health workforce; (3) possibilities for personnel substitution and role extension; (4) the distribution of personnel in relation to workload; (5) the implications of the aging of the present workforce. It is also evident that at present very little operational research related to workforce planning is undertaken.

Training

In some countries, training intakes are not clearly related to future staffing requirements. Widespread concern over shortages of competent instructors and some reported shortcomings in present curricula point to the need for cooperation in the development of curricula and teachingllearning materials. While the strengthening of in-country training programs and resources is necessary, it is inevitable that most of the countries surveyed will continue to rely on out-of-country training of medical and dental officers, pharmacists and other highly specialised allied health personnel and clinical support staff (such as laboratory scientists and bio-medical engineers). Difficulty in attracting adequately educated and well motivated school leavers to enter pre-service training and shortages of appropriately qualified staff to pursue further professional studies were reported in most countries.

ii

Management of Human Resources

Inadequate numbers of staff, lack of appropriate knowledge and skills and low productivity were widely reported as major health workforce management problems. A wide range of incentives was identified, but their effectiveness in motivating staff is reportedly limited. Although the majority of the responding authorities had sets of job descriptions and written guidelines for certain personnel management processes, many of these were not regularly reviewed and up-dated.

The recommendations and suggested action plan included in this report focus on the improvement of health workforce planning. The establishment of a health workforce information exchange and mutual support network linking WHO with interested Pacific Basin countries is proposed, together with training of planning personnel in the installation and use of a workforce information and planning system.

Following the WHO conference on workforce planning in which the findings of this study were considered, a number of resolutions were adopted. These are included in the final section of this report.

iii

Management of Human Resources

Inadequate numbers of staff, lack of appropriate knowledge and skills and low productivity were widely reported as major health workforce management problems. A wide range of incentives was identified, but their effectiveness in motivating staff is reportedly limited. Although the majority of the responding authorities had sets of job descriptions and written guidelines for certain personnel management processes, many of these were not regularly reviewed and up-dated.

The recommendations and suggested action plan included in this report focus on the improvement of health workforce planning. The establishment of a health workforce information exchange and mutual support network linking WHO with interested Pacific Basin countries is proposed, together with training of planning personnel in the installation and use of a workforce information and planning system.

Following the WHO conference on workforce planning in which the findings of this study were considered, a number of resolutions were adopted. These are included in the final section of this report.

iii

LIST OF ABBREVIATIONS/ACRONYMS USED IN TEXT

(Alphabetical Order)

CNMI

CPMEB

DA

DG

DOA

DOH

FSM

HO

HPC

HRS

ISN

MA

MHFP

MHMS

MOE

MOH

NHP

PHC

PNG

PSB

PSC

RN

SDC

SHRDO

SMC

STUDIS

T&SC

WHO

Commonwealth of the Northern Mariana Islands

Central Programming Monitoring and Evaluation Board

Development Agency

Director General

Department of Administration

Department of Health

Federal States of Micronesia

Health Officer

Health Planning Committee

Human Resource System

Indicators of Staffing Need

Medical Assistant

Ministry of Health and Family Planning

Ministry of Health and Medical Services

Ministry of Education

Ministry of Health

National Health Plan

Primary Health Care

Papua New Guinea

Public Service Board

Public Service Commission

Registered Nurse

Staff Development Committee

Senior Human Resources Development Officer

Senior Management Committee

Student Information System

Training and Scholarship Committee

World Health Organization

iv , I

LIST OF ABBREVIATIONS/ACRONYMS USED IN TEXT

(Alphabetical Order)

CNMI

CPMEB

DA

DG

DOA

DOH

FSM

HO

HPC

HRS

ISN

MA

MHFP

MHMS

MOE

MOH

NHP

PHC

PNG

PSB

PSC

RN

SDC

SHRDO

SMC

STUDIS

T&SC

WHO

Commonwealth of the Northern Mariana Islands

Central Programming Monitoring and Evaluation Board

Development Agency

Director General

Department of Administration

Department of Health

Federal States of Micronesia

Health Officer

Health Planning Committee

Human Resource System

Indicators of Staffing Need

Medical Assistant

Ministry of Health and Family Planning

Ministry of Health and Medical Services

Ministry of Education

Ministry of Health

National Health Plan

Primary Health Care

Papua New Guinea

Public Service Board

Public Service Commission

Registered Nurse

Staff Development Committee

Senior Human Resources Development Officer

Senior Management Committee

Student Information System

Training and Scholarship Committee

World Health Organization

iv , I

PART I PART I

1. INTRODUCTION

The WHO Seminar on Manpower Development Opportunities in the Pacific, (November, 1989), recommended necessary improvements in the collection, analysis and sharing of information related to human resources in Pacific Island nations. The Western Pacific Regional Office, WHO was asked to promote these improvements as a matter of priority.

This survey, sponsored by the Western Pacific Regional Office, WHO, reviews the current status of health workforce planning, health workforce training and development and some aspects of personnel management in Pacific Island countries. The report was reviewed at the WHO Conference on Health Workforce Plan Development, which convened in Manila, in November 1990.

Much of the information reviewed here was collected in the course of an interview survey conducted during August-September, 1990. The countries visited were:-

Cook Islands Federated States of Micronesia (FSM) Fiji Palau Solomon Islands Tonga Vanuatu and Western Samoa

Material was also obtained in response to a postal questionnaire from Australia, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Kiribati, New Zealand and Papua New Guinea. Published reports and other material from international agencies and other sources were also reviewed in preparing this report. Some of the commentary reflects the authors' personal knowledge of health services in the Pacific countries.

The scale and complexity of the health care systems in Australia and New Zealand are very different from those in other South Pacific countries. Accordingly, only occasional reference is made in the text to material from these two countries.

The report includes a summary of findings concerning planning practices and capabilities, current availability and utilization of health workforce, training of health personnel and aspects of personnel management.

The first part of the report concludes with suggestions for the development of health workforce capability in Pacific Island countries and the resolutions of the 1990 WHO Conference on Workforce Planning.

1. INTRODUCTION

The WHO Seminar on Manpower Development Opportunities in the Pacific, (November, 1989), recommended necessary improvements in the collection, analysis and sharing of information related to human resources in Pacific Island nations. The Western Pacific Regional Office, WHO was asked to promote these improvements as a matter of priority.

This survey, sponsored by the Western Pacific Regional Office, WHO, reviews the current status of health workforce planning, health workforce training and development and some aspects of personnel management in Pacific Island countries. The report was reviewed at the WHO Conference on Health Workforce Plan Development, which convened in Manila, in November 1990.

Much of the information reviewed here was collected in the course of an interview survey conducted during August-September, 1990. The countries visited were:-

Cook Islands Federated States of Micronesia (FSM) Fiji Palau Solomon Islands Tonga Vanuatu and Western Samoa

Material was also obtained in response to a postal questionnaire from Australia, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Kiribati, New Zealand and Papua New Guinea. Published reports and other material from international agencies and other sources were also reviewed in preparing this report. Some of the commentary reflects the authors' personal knowledge of health services in the Pacific countries.

The scale and complexity of the health care systems in Australia and New Zealand are very different from those in other South Pacific countries. Accordingly, only occasional reference is made in the text to material from these two countries.

The report includes a summary of findings concerning planning practices and capabilities, current availability and utilization of health workforce, training of health personnel and aspects of personnel management.

The first part of the report concludes with suggestions for the development of health workforce capability in Pacific Island countries and the resolutions of the 1990 WHO Conference on Workforce Planning.

The Health Workforce

The emerging profile of twelve partICIpating Pacific Island countries is included in the second part of this report.

1.1 Population and health personnel

To provide perspective on the relative size of populations to be served by health personnel in the countries included in this report, Table 1.1 gives for each country an approximation of the size of its population and the reported number of its health personnel within the categories included in the survey questionnaire. The last column in the table gives for each country a recent estimate of life expectancy at birth. This information provides a reminder that populations with similar survival expectancies may have markedly different ratios of population to health personnel.

As with virtually all the statistical tables in this report, the figures in Table 1.1 should be regarded as indicative rather than exact, reflecting the near universal problem of obtaining up-to-date, accurate and comparable data from a number of different sources.

2


The emerging profile of twelve partICIpating Pacific Island countries is included in the second part of this report.

1.1 Population and health personnel

To provide perspective on the relative size of populations to be served by health personnel in the countries included in this report, Table 1.1 gives for each country an approximation of the size of its population and the reported number of its health personnel within the categories included in the survey questionnaire. The last column in the table gives for each country a recent estimate of life expectancy at birth. This information provides a reminder that populations with similar survival expectancies may have markedly different ratios of population to health personnel.

As with virtually all the statistical tables in this report, the figures in Table 1.1 should be regarded as indicative rather than exact, reflecting the near universal problem of obtaining up-to-date, accurate and comparable data from a number of different sources.

2

lntroducoon

Table 1.1 Population, reported number of health service personnel and life expectancy, selected Pacific Basin countries c. 1989.

Country Population Number of Population per Life expectancy estimate health workers health worker at birth

(approx) • (approx) (years)

Australia 16,500,000 300,000 55 75

CNMI 38,000 237 160 50

Cook Islands 17,200 182 94 66

FSM 96,000 633 152 N/A

Fiji 727,000 2,354 309 63

Guam 132,700 1,064 125 73

Kiribati 66,000 280 236 53

New Zealand 3,300,000 63,500 50 74

Palau 14,000 140 100 66

PNG 3,661,000 9,404 389 50

Solomon Island 316,700 824 384 60

Tonga 97,300 372 262 63

Vanuatu 142,600 528 270 60

Western Samoa 158,000 409 387 64

* Represents only the numbers for the categories reported and do not necessarily reflect the total health workforce. In some of the countries, the total number of health workers would be greater than the figure in this table.

3

lntroducoon

Table 1.1 Population, reported number of health service personnel and life expectancy, selected Pacific Basin countries c. 1989.

Country Population Number of Population per Life expectancy estimate health workers health worker at birth

(approx) • (approx) (years)

Australia 16,500,000 300,000 55 75

CNMI 38,000 237 160 50

Cook Islands 17,200 182 94 66

FSM 96,000 633 152 N/A

Fiji 727,000 2,354 309 63

Guam 132,700 1,064 125 73

Kiribati 66,000 280 236 53

New Zealand 3,300,000 63,500 50 74

Palau 14,000 140 100 66

PNG 3,661,000 9,404 389 50

Solomon Island 316,700 824 384 60

Tonga 97,300 372 262 63

Vanuatu 142,600 528 270 60

Western Samoa 158,000 409 387 64

* Represents only the numbers for the categories reported and do not necessarily reflect the total health workforce. In some of the countries, the total number of health workers would be greater than the figure in this table.

3


2. THE CURRENT STATUS OF HEALTH WORKFORCE PLANNING IN PACIFIC ISLAND COUNTRIES

2.1 National development plans and national health plans

Table 2.1 shows which countries covered in this review reported having current national development plans. These plans, usually compiled by the national ministry responsible for economic planning, and spanning a period of five years, are directed towards both economic development and social advancement in such fields as education, health and welfare.

The health and health care content of national development plans includes rather broad statements of health policy directions. It may include some indicative planning material, or may provide some prescriptions for health project implementation and workforce development.

National development plans generally are not sufficiently specific to serve as a detailed guide to action in all aspects of health care delivery. As Table 2.1 indicates, several countries have produced national health plans as separate documents which extend and elaborate the health material contained in national development plans.

2.2 National health plans and health workforce plans

Among the contents of national health plans, whether presented as part of national development plans or as separate documents, are statements regarding (a) policy, strategies and targets relating to changes in morbidity and mortality; (b) changes in service structure, activities and coverage; (c) programs of facility construction, modification and equipment and (d) the funding of health services and staffing. Matters pertaining to health personnel development ranges from rather general statements of policy to extensive tabulation of workforce projections. targets and detailed prescription for pre-service and in-service training outputs.

4


2. THE CURRENT STATUS OF HEALTH WORKFORCE PLANNING IN PACIFIC ISLAND COUNTRIES

2.1 National development plans and national health plans

Table 2.1 shows which countries covered in this review reported having current national development plans. These plans, usually compiled by the national ministry responsible for economic planning, and spanning a period of five years, are directed towards both economic development and social advancement in such fields as education, health and welfare.

The health and health care content of national development plans includes rather broad statements of health policy directions. It may include some indicative planning material, or may provide some prescriptions for health project implementation and workforce development.

National development plans generally are not sufficiently specific to serve as a detailed guide to action in all aspects of health care delivery. As Table 2.1 indicates, several countries have produced national health plans as separate documents which extend and elaborate the health material contained in national development plans.

2.2 National health plans and health workforce plans

Among the contents of national health plans, whether presented as part of national development plans or as separate documents, are statements regarding (a) policy, strategies and targets relating to changes in morbidity and mortality; (b) changes in service structure, activities and coverage; (c) programs of facility construction, modification and equipment and (d) the funding of health services and staffing. Matters pertaining to health personnel development ranges from rather general statements of policy to extensive tabulation of workforce projections. targets and detailed prescription for pre-service and in-service training outputs.

4

The Current Slillus Of Health Workforce Planning In PacifIC Island Countries

Table 2.1 National development plans and national health plans, selected Pacific Basin countries, 199ft

Countries

Australia

Cook Islands

FSM

Fiji

Guam

Kiribati

Palau

Papua New Guinea

Solomon Islands

Tonga

Vanuatu

Western Samoa

National Development Plan

No

Yes

** No

*** *** *** Yes

Yes

Yes

Yes

Yes

* ** ***

Compilation of individual state health plans Compilation of individual state development plans Information not recorded

National Health Plan as separate document

No

No

* No

Now out of date

Yes

No

Yes

Yes

No

No

No

Stressing the long term implications that may arise from short term decisions on manpower. the PNG Natiorud Health Plan 1986-1990 includes desired staffmg levels for all major cadres up to the year 2000 and sets out in detail the training input and output that will be necessary to meet those levels.

The Ministry of Health and Medical Services, Solomon Islands. has produced. in addition to the workforce section of the national health plan, a comprehensive and detailed document, Human Health Resources Development, covering workforce development and training policy, manpower projections and training programs for all categories of health personnel and support staff for the period 1989/90 to 1994. The Medical Manpower Plan 1986-1995 of the Ministry of Health. Tonga, sets target figures for medical staffing.

The Department of Public Health. in the Mariana Islands. (CNMI). is currently in the process of preparing a health workforce plan. The New Zealand Health Department aims to develop a health workforce plan in the near future with the intention of strengthening regional planning and national coordination.

5

The Current Slillus Of Health Workforce Planning In PacifIC Island Countries

Table 2.1 National development plans and national health plans, selected Pacific Basin countries, 199ft

Countries

Australia

Cook Islands

FSM

Fiji

Guam

Kiribati

Palau

Papua New Guinea

Solomon Islands

Tonga

Vanuatu

Western Samoa

National Development Plan

No

Yes

** No

*** *** *** Yes

Yes

Yes

Yes

Yes

* ** ***

Compilation of individual state health plans Compilation of individual state development plans Information not recorded

National Health Plan as separate document

No

No

* No

Now out of date

Yes

No

Yes

Yes

No

No

No

Stressing the long term implications that may arise from short term decisions on manpower. the PNG Natiorud Health Plan 1986-1990 includes desired staffmg levels for all major cadres up to the year 2000 and sets out in detail the training input and output that will be necessary to meet those levels.

The Ministry of Health and Medical Services, Solomon Islands. has produced. in addition to the workforce section of the national health plan, a comprehensive and detailed document, Human Health Resources Development, covering workforce development and training policy, manpower projections and training programs for all categories of health personnel and support staff for the period 1989/90 to 1994. The Medical Manpower Plan 1986-1995 of the Ministry of Health. Tonga, sets target figures for medical staffing.

The Department of Public Health. in the Mariana Islands. (CNMI). is currently in the process of preparing a health workforce plan. The New Zealand Health Department aims to develop a health workforce plan in the near future with the intention of strengthening regional planning and national coordination.

5


2.3 Integration and direction of health workforce planning

Some workforce planning activities are carried out at many points within any health service or health personnel training system. The adoption of guiding principles and national plans to provide a framework within which the activities take place is the role of a group of high level decision-makers within each central health authority. The bodies listed in Table 2.2 were identified as having this leadership role.

Table 2.2 Principal decision making bodies, health workforce planning, selected Pacific Basin countries, 1990

Country Principal decision making body

CNMI Not identified

Cook Islands Director of Health and Division Heads, MOH

FSM Not identified

Fiji Staff Board - Pennanent Secretary and Directors, MOH

Guam No one central body

Kiribati Central Programming, Monitoring and Evaluation Board.

Palau Not identified

Papua New Guinea

Solomon Islands

Tonga

Vanuatu

Western Samoa

Pennanent Secretary and Directors, DOH

Staff Board - Pennanent Secretary, Under Secretaries and Directors, MHMS

National Health Development Committee, MOH

Meeting of inter-sectoral committees - SDC, SMC, T&SC,HPC.*

Director of Health and Division Heads, MOH

* SOC-Staff Development Committee, SMC-Senior Management Committee, T&SCTraining and Scholarship Committee, HPC - Health Planning Committee.

Although the central health authorities playa major role in health workforce planning, training and the management of health personnel, their role is subject to a number of constraints. Public service authorities and finance ministries regulate some aspects of workforce employment and management. Public service authorities are also usually involved in the

6


2.3 Integration and direction of health workforce planning

Some workforce planning activities are carried out at many points within any health service or health personnel training system. The adoption of guiding principles and national plans to provide a framework within which the activities take place is the role of a group of high level decision-makers within each central health authority. The bodies listed in Table 2.2 were identified as having this leadership role.

Table 2.2 Principal decision making bodies, health workforce planning, selected Pacific Basin countries, 1990

Country Principal decision making body

CNMI Not identified

Cook Islands Director of Health and Division Heads, MOH

FSM Not identified

Fiji Staff Board - Pennanent Secretary and Directors, MOH

Guam No one central body

Kiribati Central Programming, Monitoring and Evaluation Board.

Palau Not identified

Papua New Guinea

Solomon Islands

Tonga

Vanuatu

Western Samoa

Pennanent Secretary and Directors, DOH

Staff Board - Pennanent Secretary, Under Secretaries and Directors, MHMS

National Health Development Committee, MOH

Meeting of inter-sectoral committees - SDC, SMC, T&SC,HPC.*

Director of Health and Division Heads, MOH

* SOC-Staff Development Committee, SMC-Senior Management Committee, T&SCTraining and Scholarship Committee, HPC - Health Planning Committee.

Although the central health authorities playa major role in health workforce planning, training and the management of health personnel, their role is subject to a number of constraints. Public service authorities and finance ministries regulate some aspects of workforce employment and management. Public service authorities are also usually involved in the

6

The Current StIlIUs Of Heallh Workforce Planning In Pacific Island Countries

granting of fellowships for further training of government employees. Education ministries are often concerned with pre-service education of some categories of health personnel.

In countries where health service administration is decentralised with regional authorities exercising considerable autonomy, as in FSM, Papua New Guinea and the Solomon Islands, there may be very considerable limitations upon the degree to which the central health authority can influence or control decisions regarding workforce planning, development and management.

The role of central health authorities is further limited by the degree to which they are able to influence and control the activities of health personnel working outside government services and by powers vested in quasi-governmental authorities such as professional Registration Boards. The influence of the private practitioner sector on health service development is evident in Australia and New Zealand, and is becoming increasingly evident in Fiji and Papua New Guinea.

2.4 Health workforce plan preparation

In countries having a national health plan there is a central body or administrative unit which brings together the information required for the formulation of the national health plan, including its workforce content. Where the health workforce is small the 'unit' may be simply one or two officials whose duties include this responsibility.

Table 2.3 lists the units within central health authorities identified as having responsibility for preparing the national health plan and/or health workforce plans.

7

The Current StIlIUs Of Heallh Workforce Planning In Pacific Island Countries

granting of fellowships for further training of government employees. Education ministries are often concerned with pre-service education of some categories of health personnel.

In countries where health service administration is decentralised with regional authorities exercising considerable autonomy, as in FSM, Papua New Guinea and the Solomon Islands, there may be very considerable limitations upon the degree to which the central health authority can influence or control decisions regarding workforce planning, development and management.

The role of central health authorities is further limited by the degree to which they are able to influence and control the activities of health personnel working outside government services and by powers vested in quasi-governmental authorities such as professional Registration Boards. The influence of the private practitioner sector on health service development is evident in Australia and New Zealand, and is becoming increasingly evident in Fiji and Papua New Guinea.

2.4 Health workforce plan preparation

In countries having a national health plan there is a central body or administrative unit which brings together the information required for the formulation of the national health plan, including its workforce content. Where the health workforce is small the 'unit' may be simply one or two officials whose duties include this responsibility.

Table 2.3 lists the units within central health authorities identified as having responsibility for preparing the national health plan and/or health workforce plans.

7


Table 2.3 Central health and health workforce planning units, selected Pacific Basin countries, 1990.

Country Central Planning Unit

CNMI Commonwealth Health Planning and Development Agency.

Cook Islands No designated unit

FSM Planning and Manpower Section. Department of Human Resources.

Guam No designated unit.

Fiji No designated unit.

Kiribati General Programming. Monitoring and Evaluation Board. BHS.

Papua New Guinea Policy and Planning Division. DOH.

Solomon Islands Health Planning Unit. MHMS.

Tonga Health Planning and Information Division. MOH.

Vanuatu Principal Administrative Officer and Health Planner. MOH.

Western Samoa Health Planning and Information Unit, MOH.

2.5 Sources of health workforce planning data

In all the countries reviewed, most of the data required for health workforce planning at national, regional, institutional and individual level is presently· recorded. Indeed, much of the data required for workforce planning is also required for managing the day to day operations of the health service, for personnel management, for the conduct of training programs, for budgeting and financial control, and for facility and other types of planning.

Unfortunately, the information is usually scattered through the records in offices of a number of agencies and their component units, and is not routinely collated into a readily accessible and usable fOnD.

Material relating to government health personnel is mainly located within the national health authority although not necessarily held or continuously

8


Table 2.3 Central health and health workforce planning units, selected Pacific Basin countries, 1990.

Country Central Planning Unit

CNMI Commonwealth Health Planning and Development Agency.

Cook Islands No designated unit

FSM Planning and Manpower Section. Department of Human Resources.

Guam No designated unit.

Fiji No designated unit.

Kiribati General Programming. Monitoring and Evaluation Board. BHS.

Papua New Guinea Policy and Planning Division. DOH.

Solomon Islands Health Planning Unit. MHMS.

Tonga Health Planning and Information Division. MOH.

Vanuatu Principal Administrative Officer and Health Planner. MOH.

Western Samoa Health Planning and Information Unit, MOH.

2.5 Sources of health workforce planning data

In all the countries reviewed, most of the data required for health workforce planning at national, regional, institutional and individual level is presently· recorded. Indeed, much of the data required for workforce planning is also required for managing the day to day operations of the health service, for personnel management, for the conduct of training programs, for budgeting and financial control, and for facility and other types of planning.

Unfortunately, the information is usually scattered through the records in offices of a number of agencies and their component units, and is not routinely collated into a readily accessible and usable fOnD.

Material relating to government health personnel is mainly located within the national health authority although not necessarily held or continuously

8

The Current StIltus Of HealJh Workforce Planning In PacifIC Island Countries

updated in the central office. Other relevant planning data is held in the offices of public service and education authorities, the national demographic bureau, the finance ministry and perhaps in the offices of ministries having special planning responsibility, which may include departments of the President or Prime Minister, a ministry for internal or provincial affairs, a national economic planning ministry or national manpower planning authority.

It is apparent that the more decentralised the system of government and its health service administration, the more scattered and inaccessible is the data required for its national health planning. Also, the larger the nongovernment sector within the health field, the more difficult is it to obtain needed information.

The central office of the Department of Health (DOH), PNG, faces to a marked degree the problem of collecting workforce planning data relating to a relatively large workforce and an extensive training program within a decentra1ised system of government administration and a large non-government health service sector. Recognising the desirability of bringing together and providing access to workforce information, the PNG Department of Manpower Planning has embarked on an ambitious project aimed at providing an integrated government pay-roll, personnel and establishment system. This personnel management information system, which has been named Human Resource System (HRS), is designed to facilitate better planning, budgeting and control of manpower resources within the whole of the PNG Public Service. The HRS holds in summary:-

personnel information position information position occupancy information department structures and staff ceilings (plus staff on strength) institution information code tables pay-roll information

Government departments are to be linked to the central processing unit housed at the National Computer Centre. The first point of entry for personnel and establishment information is the staff office within each department.

The successful implementation of this HRS project should greatly facilitate the planning activities of the central office of the DOH which currently has difficulty in collecting data from the provincial health authorities. Although church organisations operate a significant part of the health care system and other non-government providers are growing in number, it is not proposed to integrate them into the HRS.

To facilitate management of its training programs the PNG Department of Health set up in 1987 a computer-based Student Information System, STUDIS. This enables monitoring of student flows through all departmental and departmentally supervised training establishments and the monitoring of student characteristics such as province of origin and sponsorship. As yet the system does not provide information on the destination of graduates from training institutions. Information generated by STUDIS has obvious application both in the planning of training and in workforce planning.

9

The Current StIltus Of HealJh Workforce Planning In PacifIC Island Countries

updated in the central office. Other relevant planning data is held in the offices of public service and education authorities, the national demographic bureau, the finance ministry and perhaps in the offices of ministries having special planning responsibility, which may include departments of the President or Prime Minister, a ministry for internal or provincial affairs, a national economic planning ministry or national manpower planning authority.

It is apparent that the more decentralised the system of government and its health service administration, the more scattered and inaccessible is the data required for its national health planning. Also, the larger the nongovernment sector within the health field, the more difficult is it to obtain needed information.

The central office of the Department of Health (DOH), PNG, faces to a marked degree the problem of collecting workforce planning data relating to a relatively large workforce and an extensive training program within a decentra1ised system of government administration and a large non-government health service sector. Recognising the desirability of bringing together and providing access to workforce information, the PNG Department of Manpower Planning has embarked on an ambitious project aimed at providing an integrated government pay-roll, personnel and establishment system. This personnel management information system, which has been named Human Resource System (HRS), is designed to facilitate better planning, budgeting and control of manpower resources within the whole of the PNG Public Service. The HRS holds in summary:-

personnel information position information position occupancy information department structures and staff ceilings (plus staff on strength) institution information code tables pay-roll information

Government departments are to be linked to the central processing unit housed at the National Computer Centre. The first point of entry for personnel and establishment information is the staff office within each department.

The successful implementation of this HRS project should greatly facilitate the planning activities of the central office of the DOH which currently has difficulty in collecting data from the provincial health authorities. Although church organisations operate a significant part of the health care system and other non-government providers are growing in number, it is not proposed to integrate them into the HRS.

To facilitate management of its training programs the PNG Department of Health set up in 1987 a computer-based Student Information System, STUDIS. This enables monitoring of student flows through all departmental and departmentally supervised training establishments and the monitoring of student characteristics such as province of origin and sponsorship. As yet the system does not provide information on the destination of graduates from training institutions. Information generated by STUDIS has obvious application both in the planning of training and in workforce planning.

9

TM Heallh Workforce

2.6 Formal arrangements for sharing health workforce information with other agencies

Sharing of information concerning workforce commonly occurs between the central health authority and the public service authorities. Information most frequently Shared relates to establishment of staff and its posting and to allocation of fellowships for out-of-country training.

Only one respondent mentioned formal linkage of the central health authorities with the authority responsible for preparing the national budget, although some interaction must occur in all countries.

2.7 Present planning capacity of health authorities

The survey collected opinions as to the current capability of health authorities regarding several components of health planning and related activities. The recording of "present" or "not present" in questionnaires poses problems of interpretation and comparison because "present" covers a very wide range of capability, and "not present" was used by some respondents to indicate the opinion that although some capability is present, it is of a low level.

With these reservations, Table 2.4 may be read as indicating that some planning and planning related capability exists in most of the respondent countries. The data suggests that capability within the group of countries is strongest in broad health planning, in project planning and appraisal and in health statistics. There is, however, a need for further development and strengthening of capabilities in these areas, as well as in health workforce planning, health information systems and computer operation.

Only a small number of personnel within a health authority are directly concerned with the drafting and preparation of health policy and health plans, including workforce plans and training programs. Consequently the loss of even one competent officer may very severely reduce planning capability. Also, with the devolution of planning functions from a central authority to a number of state, provincial or other regional authorities, there is likely to be a serious deficit of planning capability in these authorities. Both these problems have been experienced by some countries in the Pacific Basin.

In the countries with decentralised health service administration there may be planning capability within the national office but less or none at the state, provincial or regional levels. Therefore in assessing need for training in planning and support· by way of data processing facilities, it will be necessary to extend enquiry beyond the national office level. For example

10

TM Heallh Workforce

2.6 Formal arrangements for sharing health workforce information with other agencies

Sharing of information concerning workforce commonly occurs between the central health authority and the public service authorities. Information most frequently Shared relates to establishment of staff and its posting and to allocation of fellowships for out-of-country training.

Only one respondent mentioned formal linkage of the central health authorities with the authority responsible for preparing the national budget, although some interaction must occur in all countries.

2.7 Present planning capacity of health authorities

The survey collected opinions as to the current capability of health authorities regarding several components of health planning and related activities. The recording of "present" or "not present" in questionnaires poses problems of interpretation and comparison because "present" covers a very wide range of capability, and "not present" was used by some respondents to indicate the opinion that although some capability is present, it is of a low level.

With these reservations, Table 2.4 may be read as indicating that some planning and planning related capability exists in most of the respondent countries. The data suggests that capability within the group of countries is strongest in broad health planning, in project planning and appraisal and in health statistics. There is, however, a need for further development and strengthening of capabilities in these areas, as well as in health workforce planning, health information systems and computer operation.

Only a small number of personnel within a health authority are directly concerned with the drafting and preparation of health policy and health plans, including workforce plans and training programs. Consequently the loss of even one competent officer may very severely reduce planning capability. Also, with the devolution of planning functions from a central authority to a number of state, provincial or other regional authorities, there is likely to be a serious deficit of planning capability in these authorities. Both these problems have been experienced by some countries in the Pacific Basin.

In the countries with decentralised health service administration there may be planning capability within the national office but less or none at the state, provincial or regional levels. Therefore in assessing need for training in planning and support· by way of data processing facilities, it will be necessary to extend enquiry beyond the national office level. For example

10

The Current Status OJ Healih Workforce Planning In PacifIC Island Countries

in Papua New Guinea anyone of the twenty provinces is comparable in size to one or more of the other Pacific Island countries covered in this review and has its own planning responsibilities.

Table 2.4 Capability in planning and planning related activities, selected Pacific Basin countries, 1990 (n=l1)

Capability present Capability not present

Specific planning capability

- Health planning 8 3

- Workforce planning 7 4

- Project planning and appraisal 8 3

- Education program planning 5 6

Planning related activities

- Health information system 7 4

- Health statistics 9 2

- Computer operation 7 4

- Health systems research 3 8

Data from CNMI, Cook Is., FSM, Fiji, Guam, Kiribati, Papua New Guinea, Solomon Is., Tonga, Vanuatu, Western Samoa.

In two areas - planning of educational programs and health systems research - more limited capability was reported. Regarding educational program planning this may have been regarded by some respondents as referring to curriculum development rather than planning in terms of student intake, allowance for student attrition, and relating graduate output to service needs and similar matters. The problem of curriculum development is mentioned in Chapter 3 of this report. The reported lack of health system research capability is not surprising since HSR is poorly developed in most countries throughout the world.

11

The Current Status OJ Healih Workforce Planning In PacifIC Island Countries

in Papua New Guinea anyone of the twenty provinces is comparable in size to one or more of the other Pacific Island countries covered in this review and has its own planning responsibilities.

Table 2.4 Capability in planning and planning related activities, selected Pacific Basin countries, 1990 (n=l1)

Capability present Capability not present

Specific planning capability

- Health planning 8 3

- Workforce planning 7 4

- Project planning and appraisal 8 3

- Education program planning 5 6

Planning related activities

- Health information system 7 4

- Health statistics 9 2

- Computer operation 7 4

- Health systems research 3 8

Data from CNMI, Cook Is., FSM, Fiji, Guam, Kiribati, Papua New Guinea, Solomon Is., Tonga, Vanuatu, Western Samoa.

In two areas - planning of educational programs and health systems research - more limited capability was reported. Regarding educational program planning this may have been regarded by some respondents as referring to curriculum development rather than planning in terms of student intake, allowance for student attrition, and relating graduate output to service needs and similar matters. The problem of curriculum development is mentioned in Chapter 3 of this report. The reported lack of health system research capability is not surprising since HSR is poorly developed in most countries throughout the world.

11


2.8 Health workforce planning methods

All survey respondents mentioned consultation and committee deliberation as part of the planning process. From Papua New Guinea it was reported that an incremental approach to planning has been adopted. Regarding quantitative techniques, a service target method of calculating health personnel requirements has been used in CNMI. Tonga has employed a health demands method.

The manpower chapters in the PNG National Health Plan 1986-1990 and the Health Human Resources Development document from the MHMS, Solomon Islands, provide information on the methods employed in preparing the detailed tabulations they contain. These include the use of experience-derived recruitment and attrition rates, linking increases in establishment to population growth, the judicious use of staff:population and staff:workload ratios, and estimates by experienced officers of realistic rates at which appropriately trained personnel may be placed in currently understaffed or new services.

In Papua New Guinea a comprehensive set of Indicators of Staffing Need (ISN) has been developed to assist in calculating the number of staff required to provide an acceptable standard of service at a given rate of service utilization. These workerproductivity standards are currently being used in national budget negotiations aimed at increasing the allocation of resources to poorer provinces. The method is also potentially useful as a tool in addressing the very considerable inequities in health resource distribution within provinces.

Other respondents produced "projected" numbers of health personnel in some major categories for 1995, but the basis on which the figures were arrived at was not recorded. Nor was it clear whether these projected figures related to demand or supply of personnel, or to established, funded or filled posts. This lack of clarity highlights the need for very careful attention to the definitions of inputs to any Pacific regional health workforce data bank.

2.9 Projected increases in the health workforce 1989-1995

As mentioned above respondents in seven countries reported projections of numbers for some categories of health personnel. Projections to 1995 for virtually all cadres were reported from CNMI, FSM, Kiribati, and to 1994 from the Solomon Islands. Projections for some categories were reported from the Cook Islands, Tonga and Western Samoa. Projections for all major cadres in Papua New Guinea up to the year 2000 were published in the PNG National Health Plan, 1986-1990.

The projected percentage increase in total health personnel in each of the five countries for which information on virtually all cadres was reported is shown in Table 2.5

12


2.8 Health workforce planning methods

All survey respondents mentioned consultation and committee deliberation as part of the planning process. From Papua New Guinea it was reported that an incremental approach to planning has been adopted. Regarding quantitative techniques, a service target method of calculating health personnel requirements has been used in CNMI. Tonga has employed a health demands method.

The manpower chapters in the PNG National Health Plan 1986-1990 and the Health Human Resources Development document from the MHMS, Solomon Islands, provide information on the methods employed in preparing the detailed tabulations they contain. These include the use of experience-derived recruitment and attrition rates, linking increases in establishment to population growth, the judicious use of staff:population and staff:workload ratios, and estimates by experienced officers of realistic rates at which appropriately trained personnel may be placed in currently understaffed or new services.

In Papua New Guinea a comprehensive set of Indicators of Staffing Need (ISN) has been developed to assist in calculating the number of staff required to provide an acceptable standard of service at a given rate of service utilization. These workerproductivity standards are currently being used in national budget negotiations aimed at increasing the allocation of resources to poorer provinces. The method is also potentially useful as a tool in addressing the very considerable inequities in health resource distribution within provinces.

Other respondents produced "projected" numbers of health personnel in some major categories for 1995, but the basis on which the figures were arrived at was not recorded. Nor was it clear whether these projected figures related to demand or supply of personnel, or to established, funded or filled posts. This lack of clarity highlights the need for very careful attention to the definitions of inputs to any Pacific regional health workforce data bank.

2.9 Projected increases in the health workforce 1989-1995

As mentioned above respondents in seven countries reported projections of numbers for some categories of health personnel. Projections to 1995 for virtually all cadres were reported from CNMI, FSM, Kiribati, and to 1994 from the Solomon Islands. Projections for some categories were reported from the Cook Islands, Tonga and Western Samoa. Projections for all major cadres in Papua New Guinea up to the year 2000 were published in the PNG National Health Plan, 1986-1990.

The projected percentage increase in total health personnel in each of the five countries for which information on virtually all cadres was reported is shown in Table 2.5

12

The Current Status Of Health Workforce Planning In PacifIC IslmuI Countries

Table 2.5 Projected growth of health workforce, selected Pacific Basin countries, 1989 to 1995.

Country

CNMI

FSM

Kiribati

PNG

Solomon Islands

Projected percentage increase

+112

+35

+31

+19

+19 (1989-94)

Approximate annual growth rate

+13

+5

+5

+3

+3

It is noteworthy that in the two countries where workforce plans are most fully documented, PNG and Solomon Islands, the rate of increase projected is relatively low. Indeed in Papua New Guinea it was estimated in 1986 that, despite the projected growth in the total numbers of health personnel, in no cadre would there be an improvement in the population per staff ratio by the year 2000.

Table 2.6 summarises the projected changes in personnel numbers from 1989 to 1995 as reported in the survey. The table does not include projections from Papua New Guinea or Fiji. The figures from PNG are relatively so large (although the projected growth rate is not very great) that they would mask projected changes in the smaller countries. Projections were not obtained from Fiji. In view of the overall incompleteness of the data and the small number of countries reporting on some categories of personnel the table must be interpreted with caution. The overall projected growth as reported represents an increase of nearly 50 percent in the total number of health personnel, that is an annual growth rate of some six percent per year - a rate much above the population growth rate of any reporting country. Their annual population growth rates range from 0.6 to 3.5 per cent per year. Assessing the likelihood of the projected workforce increases occurring in any particular country calls for analysis beyond the scope of this report.

13

The Current Status Of Health Workforce Planning In PacifIC IslmuI Countries

Table 2.5 Projected growth of health workforce, selected Pacific Basin countries, 1989 to 1995.

Country

CNMI

FSM

Kiribati

PNG

Solomon Islands

Projected percentage increase

+112

+35

+31

+19

+19 (1989-94)

Approximate annual growth rate

+13

+5

+5

+3

+3

It is noteworthy that in the two countries where workforce plans are most fully documented, PNG and Solomon Islands, the rate of increase projected is relatively low. Indeed in Papua New Guinea it was estimated in 1986 that, despite the projected growth in the total numbers of health personnel, in no cadre would there be an improvement in the population per staff ratio by the year 2000.

Table 2.6 summarises the projected changes in personnel numbers from 1989 to 1995 as reported in the survey. The table does not include projections from Papua New Guinea or Fiji. The figures from PNG are relatively so large (although the projected growth rate is not very great) that they would mask projected changes in the smaller countries. Projections were not obtained from Fiji. In view of the overall incompleteness of the data and the small number of countries reporting on some categories of personnel the table must be interpreted with caution. The overall projected growth as reported represents an increase of nearly 50 percent in the total number of health personnel, that is an annual growth rate of some six percent per year - a rate much above the population growth rate of any reporting country. Their annual population growth rates range from 0.6 to 3.5 per cent per year. Assessing the likelihood of the projected workforce increases occurring in any particular country calls for analysis beyond the scope of this report.

13


2.10 The composition of the health workforce

The factors which may influence the composition of a country's health workforce include:

policies and personal preferences pursued by high level decision makers, both past and present

the funds available to finance health care

the relative cost of practitioners at different levels within the same field e.g. nurse v. nurse aide emoluments

the degree to which expatriates have been replaced by local personnel

the power of particular interest groups to influence staffing and training policies

the degree to which policies espoused by international development assistance agencies affect national policies

the scope for national staff to obtain employment in other countries

the availability of school leavers with sufficient educational attainment and interest to complete training at a particular level

the expectations and preferences of the population regarding the qualifications of those from whom health care is sought.

14


2.10 The composition of the health workforce

The factors which may influence the composition of a country's health workforce include:

policies and personal preferences pursued by high level decision makers, both past and present

the funds available to finance health care

the relative cost of practitioners at different levels within the same field e.g. nurse v. nurse aide emoluments

the degree to which expatriates have been replaced by local personnel

the power of particular interest groups to influence staffing and training policies

the degree to which policies espoused by international development assistance agencies affect national policies

the scope for national staff to obtain employment in other countries

the availability of school leavers with sufficient educational attainment and interest to complete training at a particular level

the expectations and preferences of the population regarding the qualifications of those from whom health care is sought.

14

The Current Swtus Of HealJh Workforce Planning In PacifIC Island Countries

Table 2.6 Projected increase in health workforce, major categories of personnel, selected Pacific Basin countries, 1989·1995

Number of Number of personnel

Category of respondent Projected Increase Health Worker countries 1989 1995 increase percent

General Medical Practitioner 6 171 227 56 33 Specialist/Consultant 4 31 72 41 132 Health Officer 2 28 36 8 29 Health Extension Officer 2 6 10 4 67 Medical Assistant 2 35 49 14 40

Dentist 6 31 51 20 65 Dental Therapist 4 22 39 17 77

Dental Assistant 3 35 48 13 37 Dental Technician 4 18 22 4 22 Dental Nurse 2 2 13 11 550 Nursing Sister/Regis. Nurse 5 781 1105 324 42 Nurse Midwife 3 52 73 21 40

Public Health Nursel Community Nurse 4 195 273 78 40

Nurse Aide 2 80 113 33 41 Medical Technologist 3 11 24 13 118 Lab Technician 4 55 79 24 44

Radiographer 4 39 61 22 56 Anaesthetic Tech} Assistant 2 8 12 4 50 Pharmacist 5 47 67 20 43 Dispensary Assistant 3 128 163 35 27 Nutritionist 3 5 12 7 140 Dietitian 3 4 11 7 175 Health Educator 7 35 74 39 111 Health Inspector 6 82 141 59 72

Sanitarian 3 52 65 13 25 Physiotherapist 2 12 18 6 50 Health Statistician 3 13 21 8 62 Computer Operator 3 20 53 33 165 Health Administrator 5 28 39 11 39 Medical Engineer 3 7 16 9 129

Totals 2033 2987 954 47%

Data from CNMI, Cook Islands, FSM, Kiribati, Solomon Islands, Tonga, Western Samoa.

15

The Current Swtus Of HealJh Workforce Planning In PacifIC Island Countries

Table 2.6 Projected increase in health workforce, major categories of personnel, selected Pacific Basin countries, 1989·1995

Number of Number of personnel

Category of respondent Projected Increase Health Worker countries 1989 1995 increase percent

General Medical Practitioner 6 171 227 56 33 Specialist/Consultant 4 31 72 41 132 Health Officer 2 28 36 8 29 Health Extension Officer 2 6 10 4 67 Medical Assistant 2 35 49 14 40

Dentist 6 31 51 20 65 Dental Therapist 4 22 39 17 77

Dental Assistant 3 35 48 13 37 Dental Technician 4 18 22 4 22 Dental Nurse 2 2 13 11 550 Nursing Sister/Regis. Nurse 5 781 1105 324 42 Nurse Midwife 3 52 73 21 40

Public Health Nursel Community Nurse 4 195 273 78 40

Nurse Aide 2 80 113 33 41 Medical Technologist 3 11 24 13 118 Lab Technician 4 55 79 24 44

Radiographer 4 39 61 22 56 Anaesthetic Tech} Assistant 2 8 12 4 50 Pharmacist 5 47 67 20 43 Dispensary Assistant 3 128 163 35 27 Nutritionist 3 5 12 7 140 Dietitian 3 4 11 7 175 Health Educator 7 35 74 39 111 Health Inspector 6 82 141 59 72

Sanitarian 3 52 65 13 25 Physiotherapist 2 12 18 6 50 Health Statistician 3 13 21 8 62 Computer Operator 3 20 53 33 165 Health Administrator 5 28 39 11 39 Medical Engineer 3 7 16 9 129

Totals 2033 2987 954 47%

Data from CNMI, Cook Islands, FSM, Kiribati, Solomon Islands, Tonga, Western Samoa.

15


The interplay of some of these factors can be seen in anyone Pacific Island country. The outcome of the interplay is demonstrated in the very considerable difference between countries in the mix of personnel constituting their health workforce.

The diversity of mix is apparent in Table 2.7 where the make-up of three occupational groups - medical, dental and nursing is presented as ratios calculated from data supplied by respondents in the countries surveyed. The ratio of medical to nursing personnel is also shown.

In Table 2.7 the medical group ratio compares the reported number of general practitioners and specialists with the number of personnel reported under the designations of medical assistant, physicians assistant, health extension officer, health officer and. in the case of Vanuatu. nurse practitioners. Within the nursing group the number of professional nurses -reported as registered nurses, nursing sisters, nurse supervisors, nurse midwifes. public health and community nurses - is compared with the number of nurse aides. For dental personnel the number of dental officers is compared with the number of dental therapists or dental assistants.

Because the way staff categories and their roles are defined differs from country to country comparisons between ratios should be approached with caution. Also the demarcation between categories of personnel in terms of work actually performed may be very "fuzzy". For example the work of an experienced nurse or. in some cases, a nurse aide may be virtually the same as that of a medical assistant; a medical assistant in a hospital may be doing virtually the same work as a medical officer. But despite the acknowledged limitations of the available data. it is clear that significant differences in workforce mix do exist between the countries surveyed.

The necessity for or desirability of making alterations in any present mix must be determined in the light of the particular circumstances of the country concerned. It is unlikely that the optimal mix will be arrived at by simply applying ratios borrowed from another country's health service.

16


The interplay of some of these factors can be seen in anyone Pacific Island country. The outcome of the interplay is demonstrated in the very considerable difference between countries in the mix of personnel constituting their health workforce.

The diversity of mix is apparent in Table 2.7 where the make-up of three occupational groups - medical, dental and nursing is presented as ratios calculated from data supplied by respondents in the countries surveyed. The ratio of medical to nursing personnel is also shown.

In Table 2.7 the medical group ratio compares the reported number of general practitioners and specialists with the number of personnel reported under the designations of medical assistant, physicians assistant, health extension officer, health officer and. in the case of Vanuatu. nurse practitioners. Within the nursing group the number of professional nurses -reported as registered nurses, nursing sisters, nurse supervisors, nurse midwifes. public health and community nurses - is compared with the number of nurse aides. For dental personnel the number of dental officers is compared with the number of dental therapists or dental assistants.

Because the way staff categories and their roles are defined differs from country to country comparisons between ratios should be approached with caution. Also the demarcation between categories of personnel in terms of work actually performed may be very "fuzzy". For example the work of an experienced nurse or. in some cases, a nurse aide may be virtually the same as that of a medical assistant; a medical assistant in a hospital may be doing virtually the same work as a medical officer. But despite the acknowledged limitations of the available data. it is clear that significant differences in workforce mix do exist between the countries surveyed.

The necessity for or desirability of making alterations in any present mix must be determined in the light of the particular circumstances of the country concerned. It is unlikely that the optimal mix will be arrived at by simply applying ratios borrowed from another country's health service.

16

The Current Status Of Health WorkJorce Planning In PacifIC Island Countries

Table 2.7 Comparison of the medical, nursing and dental workforce mix in selected Pacific Basin countries, 1990.

RATIOS

Country Medical:Nursing Medical Group Nursing Group Dental Grou, personnel Dr:MA*l RN:NA*2 DO:DThlDA 3

CNMI 1:7.6 19:1 8:1 1:5

Cook Islands 1:3 NoMA's 2:1 1:2.6

FSM 1:5.2 1.2:1 2.5:1 1:4.5

Fiji 1:5.7 3.3:1 NoNA's 1:3.7

Guam 1:2.4 10.9:1 3.8:1 1:3

Kiribati 1:11.8 1:2 N/A 1:8

Palau 1:4.9 5.5:1 3.3:1 1:3.7

Papua New Guinea 1:5.8 1.3:1 1.7:1 1:15.7

Solomon Islands 1:8.7 NoMA's NtA 1:3

Tonga 1:4.2 2.2:1 NoNA's 1:1.2

Vanuatu 1:17.4 2.6:1 6.8:1 1:2

Western Samoa 1:6.6 NoMA's 2.7:1 1:2.6

Notes: Nt A - Not Available

* 1 Dr - general medical practltloners and specialists; MA - medical assistants, physicians assistants, health extension officers and health officers.

*2 RN - registered nurses, nursing supervisors, nurse-midwives, public health and community nurses; NA - nurse aides.

*3 00 - dental officers; DlbIDA - dental therapists, dental assistants.

2.11 Health workforce distribution

The achievement of an appropriate distribution of the health workforce among the population to be served is generally regarded as one of the aims of health planning. What is to be considered "appropriate" for a particular population is a matter to be determined by those responsible for the formulation of health policy.

The detailed country profiles presented in the second part of this report include the approximate percentage allocation of health personnel between main hospitals, district hospitals, health centres and health clinics. Not surprisingly, the great majority of staff in almost all categories are reported

17

The Current Status Of Health WorkJorce Planning In PacifIC Island Countries

Table 2.7 Comparison of the medical, nursing and dental workforce mix in selected Pacific Basin countries, 1990.

RATIOS

Country Medical:Nursing Medical Group Nursing Group Dental Grou, personnel Dr:MA*l RN:NA*2 DO:DThlDA 3

CNMI 1:7.6 19:1 8:1 1:5

Cook Islands 1:3 NoMA's 2:1 1:2.6

FSM 1:5.2 1.2:1 2.5:1 1:4.5

Fiji 1:5.7 3.3:1 NoNA's 1:3.7

Guam 1:2.4 10.9:1 3.8:1 1:3

Kiribati 1:11.8 1:2 N/A 1:8

Palau 1:4.9 5.5:1 3.3:1 1:3.7

Papua New Guinea 1:5.8 1.3:1 1.7:1 1:15.7

Solomon Islands 1:8.7 NoMA's NtA 1:3

Tonga 1:4.2 2.2:1 NoNA's 1:1.2

Vanuatu 1:17.4 2.6:1 6.8:1 1:2

Western Samoa 1:6.6 NoMA's 2.7:1 1:2.6

Notes: Nt A - Not Available

* 1 Dr - general medical practltloners and specialists; MA - medical assistants, physicians assistants, health extension officers and health officers.

*2 RN - registered nurses, nursing supervisors, nurse-midwives, public health and community nurses; NA - nurse aides.

*3 00 - dental officers; DlbIDA - dental therapists, dental assistants.

2.11 Health workforce distribution

The achievement of an appropriate distribution of the health workforce among the population to be served is generally regarded as one of the aims of health planning. What is to be considered "appropriate" for a particular population is a matter to be determined by those responsible for the formulation of health policy.

The detailed country profiles presented in the second part of this report include the approximate percentage allocation of health personnel between main hospitals, district hospitals, health centres and health clinics. Not surprisingly, the great majority of staff in almost all categories are reported

17

The Heallh Workforce

as based at either the main or district hospital. The categories of staff most frequently reported as based in health centres are medical assistants (however designated), nursing personnel, health inspectors or sanitarians, and dental staff. The only staff reported as based in health clinics are nursing personnel and, in the few reports where they are mentioned at all, community health workers.

From the data collected in this survey it is not possible to assess the proportions of the workforce engaged on primary or higher levels of care, on "preventative" or "curative" activities, on intramural or out-reach services. Nor is it possible to assess from the limited data whether there is an "appropriate" allocation of personnel resources between or within urban and rural populations.

Undoubtedly urban/rural ineqUlues as indicated by simple personnel population ratios do exist in these as in all countries. The use of Indicators of Staffing Need (ISN) in Papua New Guinea has demonstrated marked inequities in the distribution of health personnel in relation to actual work load both between provinces and within provinces. The use of the ISN approach in other Pacific Basin countries would certainly reveal other inequities in personnel to workload allocation. But the extent to which the present distribution of health personnel within countries represents consciously formulated policy, the impact of apparent inequities in workforce distribution on community health and how they are to be redressed if this is thought desirable are matters for further inquiry in the countries concerned. At the present time the capacity to undertake these inquiries in the countries surveyed is limited.

2.12 Health workforce - age distribution

Health personnel age data was obtained from nine countries. There are of course differences in the age distribution from country to country.

For the group of reporting countries, as shown in Table 2.10, some 60 per cent of the current workforce is in the 40 or less years age group. Twelve per cent of currently employed health workers are over the age of 55 years, more than half of this elderly group being more than 60 years of age. With public service retiring ages of 55 or 60 years a significant number of those now in employment have passed or are close to retirement age.

It is not clear from the data collected in this survey how far present training programs are geared to provide the needed replacements for these elderly personnel. The relatively small proportion of the workforce reported in the 21-25 years age group suggests that pre-service training intakes in recent years may have been insufficient to provide for future workforce attrition in the age groups below retiring age, for the replacement of personnel due to

18


as based at either the main or district hospital. The categories of staff most frequently reported as based in health centres are medical assistants (however designated), nursing personnel, health inspectors or sanitarians, and dental staff. The only staff reported as based in health clinics are nursing personnel and, in the few reports where they are mentioned at all, community health workers.

From the data collected in this survey it is not possible to assess the proportions of the workforce engaged on primary or higher levels of care, on "preventative" or "curative" activities, on intramural or out-reach services. Nor is it possible to assess from the limited data whether there is an "appropriate" allocation of personnel resources between or within urban and rural populations.

Undoubtedly urban/rural ineqUlues as indicated by simple personnel population ratios do exist in these as in all countries. The use of Indicators of Staffing Need (ISN) in Papua New Guinea has demonstrated marked inequities in the distribution of health personnel in relation to actual work load both between provinces and within provinces. The use of the ISN approach in other Pacific Basin countries would certainly reveal other inequities in personnel to workload allocation. But the extent to which the present distribution of health personnel within countries represents consciously formulated policy, the impact of apparent inequities in workforce distribution on community health and how they are to be redressed if this is thought desirable are matters for further inquiry in the countries concerned. At the present time the capacity to undertake these inquiries in the countries surveyed is limited.

2.12 Health workforce - age distribution

Health personnel age data was obtained from nine countries. There are of course differences in the age distribution from country to country.

For the group of reporting countries, as shown in Table 2.10, some 60 per cent of the current workforce is in the 40 or less years age group. Twelve per cent of currently employed health workers are over the age of 55 years, more than half of this elderly group being more than 60 years of age. With public service retiring ages of 55 or 60 years a significant number of those now in employment have passed or are close to retirement age.

It is not clear from the data collected in this survey how far present training programs are geared to provide the needed replacements for these elderly personnel. The relatively small proportion of the workforce reported in the 21-25 years age group suggests that pre-service training intakes in recent years may have been insufficient to provide for future workforce attrition in the age groups below retiring age, for the replacement of personnel due to

18

The Cu"ent Status OJ Healih Workforce Planning In PacifIC Island Countries

leave the service when retirement age is reached, and replacement of those now past retirement age.

The aging of the present workforce underlines the need for health workforce planning which links training programs to present and future service staffing needs.

Table 2.10 Age distribution of health workforce, selected Pacific Basin countries, 1990.

Age Group Number Percent

21 - 25 512 8.3

26 - 30 1,169 19.0

31 - 35 785 12.7

36 -40 1,229 20.0

41 -45 785 12.7

46 - 50 533 8.7

51- 55 437 7.1

56 - 60 326 5.3

61 - 65 270 4.4

66+ 109 1.8

Totals 6,155 100.0

Data from CNMI, Cook Islands, FSM, Fiji, Guam, Kiribati, Solomon Islands,

Tonga, Western Samoa.

19

The Cu"ent Status OJ Healih Workforce Planning In PacifIC Island Countries

leave the service when retirement age is reached, and replacement of those now past retirement age.

The aging of the present workforce underlines the need for health workforce planning which links training programs to present and future service staffing needs.

Table 2.10 Age distribution of health workforce, selected Pacific Basin countries, 1990.

Age Group Number Percent

21 - 25 512 8.3

26 - 30 1,169 19.0

31 - 35 785 12.7

36 -40 1,229 20.0

41 -45 785 12.7

46 - 50 533 8.7

51- 55 437 7.1

56 - 60 326 5.3

61 - 65 270 4.4

66+ 109 1.8

Totals 6,155 100.0

Data from CNMI, Cook Islands, FSM, Fiji, Guam, Kiribati, Solomon Islands,

Tonga, Western Samoa.

19


3. HEALTH WORKFORCE TRAINING AND DEVELOPMENT

3.1 Policies and plans for health personnel training and development

In several of the countries surveyed health workforce training and staff development policies and plans are included in national development plans and national health plans - for example, Cook Islands, Papua-New Guinea, Solomon Islands, Tonga and Western Samoa. (Table 3.1) The statements range from broad intentions to strengthen the health workforce and perhaps replace expatriate staff to detailed formulation of policy and plans for the training and development of each major category of health personnel as in the Papua New Guinea National Health Plan 1986-1990. The Solomon Islands Ministry of Health and Medical Services has documented in detail its plans for personnel training and staff development in the previously mentioned Health Human Resources Development - Health Training Policy, Manpower Projections and Training Programs, 1989190-1994. This statement was prepared in accordance with the government's overall manpower policy.

Where there is no national development or national health plan, the training and development of health personnel may be guided by in-house policies of the central health authority. Training and development policies and plans, although not formally documented by central authorities, may be reflected in actual training programs as in Fiji.

Among the federal systems, each state in the FSM pursues its own health personnel training and development program. In Papua New Guinea the central health authority sets national policy but implementation depends very considerably on the cooperation of the provincial authorities. Health staff development in the provinces is subject to the direction of Provincial Staff Development Committees which regulate all staff development activities throughout the provincial government services.

20


3. HEALTH WORKFORCE TRAINING AND DEVELOPMENT

3.1 Policies and plans for health personnel training and development

In several of the countries surveyed health workforce training and staff development policies and plans are included in national development plans and national health plans - for example, Cook Islands, Papua-New Guinea, Solomon Islands, Tonga and Western Samoa. (Table 3.1) The statements range from broad intentions to strengthen the health workforce and perhaps replace expatriate staff to detailed formulation of policy and plans for the training and development of each major category of health personnel as in the Papua New Guinea National Health Plan 1986-1990. The Solomon Islands Ministry of Health and Medical Services has documented in detail its plans for personnel training and staff development in the previously mentioned Health Human Resources Development - Health Training Policy, Manpower Projections and Training Programs, 1989190-1994. This statement was prepared in accordance with the government's overall manpower policy.

Where there is no national development or national health plan, the training and development of health personnel may be guided by in-house policies of the central health authority. Training and development policies and plans, although not formally documented by central authorities, may be reflected in actual training programs as in Fiji.

Among the federal systems, each state in the FSM pursues its own health personnel training and development program. In Papua New Guinea the central health authority sets national policy but implementation depends very considerably on the cooperation of the provincial authorities. Health staff development in the provinces is subject to the direction of Provincial Staff Development Committees which regulate all staff development activities throughout the provincial government services.

20

Health Workforce Training AIul Development

Table 3.1 National policies and plans for health personnel training and development, selected Pacific Basin countries, 1990.

Country National policies and plam for health personnel training development

CMNI Policies and plans not formally stated

Cook Islands Policies stated in National Development Plan 1988-1992

FSM Some in-house policies for some aspects of training

Guam Policies and plans not formally stated

Fiji Policies and plans reflected in training programs at Fiji Schools of Medicine and Nursing

Kiribati Policies and plans not formally stated

PNG Detailed policies and plans in national health plans

Solomon Islands

Tonga

Vanuatu

Western Samoa

Overall government manpower policy and detailed MHMS personnel training and development plan 1990-1994

Policy stated in 5th and 6th Five Year National Development Plans

Policies and plans not formally stated but policy directed to development ofPHC' capability

Policies and strategies in 6th National Development Plan

3.2. Linkage of educational planning to national health plans

If appropriately trained personnel are to be available to staff health services in accordance with a national health plan there must of necessity be close linkage between the national plan and educational planning. In two countries a close linkage was evident - Papua New Guinea and Solomon Islands.

Both Papua New Guinea and Solomon Islands have comprehensive and detailed national health plans published as documents separate from their national development plans. In Papua New Guinea the National Health Plan 1986-1990 contains detailed plans for staffing the health services and for the training of each category of health personnel. The Human Health Resources Development Plan of the Solomon Islands MHMS is an extension of the national health plan.

* PHC - Primary health care

21

Health Workforce Training AIul Development

Table 3.1 National policies and plans for health personnel training and development, selected Pacific Basin countries, 1990.

Country National policies and plam for health personnel training development

CMNI Policies and plans not formally stated

Cook Islands Policies stated in National Development Plan 1988-1992

FSM Some in-house policies for some aspects of training

Guam Policies and plans not formally stated

Fiji Policies and plans reflected in training programs at Fiji Schools of Medicine and Nursing

Kiribati Policies and plans not formally stated

PNG Detailed policies and plans in national health plans

Solomon Islands

Tonga

Vanuatu

Western Samoa

Overall government manpower policy and detailed MHMS personnel training and development plan 1990-1994

Policy stated in 5th and 6th Five Year National Development Plans

Policies and plans not formally stated but policy directed to development ofPHC' capability

Policies and strategies in 6th National Development Plan

3.2. Linkage of educational planning to national health plans

If appropriately trained personnel are to be available to staff health services in accordance with a national health plan there must of necessity be close linkage between the national plan and educational planning. In two countries a close linkage was evident - Papua New Guinea and Solomon Islands.

Both Papua New Guinea and Solomon Islands have comprehensive and detailed national health plans published as documents separate from their national development plans. In Papua New Guinea the National Health Plan 1986-1990 contains detailed plans for staffing the health services and for the training of each category of health personnel. The Human Health Resources Development Plan of the Solomon Islands MHMS is an extension of the national health plan.

* PHC - Primary health care

21


Other countries having plans for the operation and development of their health services reported either that links between those plans and plans for the training of health personnel were weak:, or that training decisions were made on a more or less ad-hoc basis having regard to the year-by-year availability of funds from budgetary or other sources.

3.3 Responsibility for educational planning

Respondents in four countries nominated a specific unit within the central health authority responsible for planning health personnel education. Another four identified a committee or working group having this responsibility (Table 3.2).

Table 3.2 Responsibility for educational planning, selected Pacific Basin countries, 1990.

Country Responsible body

CMNI No designated unit.

Cook Islands Overall educational planning - Manpower Development Unit, PSC; liasing with WHO on training needs; DG and Executive Committee of MOH involved in decision making.

FSM Administrator of each State Health Department.

Fiji Each section within MOH is responsible in collaboration with the Fiji Schools of Medicine and Nursing.

Guam Department of Administration (DOA) responsible for overall education planning for government line agencies. Each government and private agency responsible for planning and implementing their own specific programs.

Kiribati Education and Training Committee and Central Planning, Monitoring and Evaluation Board, Ministry of Health and Family Planning.

Palau Chief, Health Manpower Division, BHS.

PNG Training Division, DOH, and provincial authorities.

Solomon Islands

Tonga

Vanuatu

Western Samoa

Health Planning Unit, MHMS.

National Health Development Committee of MOH, Scholarship Advisory Committee of MOE for allocation of overseas scholarships.

Director of Health, Planning Officer and Principal Nursing Officer, MOH.

Director General of Health with heads of divisions. Manpower Unit, PSC, coordinates allocation of government scholarships.

22


Other countries having plans for the operation and development of their health services reported either that links between those plans and plans for the training of health personnel were weak:, or that training decisions were made on a more or less ad-hoc basis having regard to the year-by-year availability of funds from budgetary or other sources.

3.3 Responsibility for educational planning

Respondents in four countries nominated a specific unit within the central health authority responsible for planning health personnel education. Another four identified a committee or working group having this responsibility (Table 3.2).

Table 3.2 Responsibility for educational planning, selected Pacific Basin countries, 1990.

Country Responsible body

CMNI No designated unit.

Cook Islands Overall educational planning - Manpower Development Unit, PSC; liasing with WHO on training needs; DG and Executive Committee of MOH involved in decision making.

FSM Administrator of each State Health Department.

Fiji Each section within MOH is responsible in collaboration with the Fiji Schools of Medicine and Nursing.

Guam Department of Administration (DOA) responsible for overall education planning for government line agencies. Each government and private agency responsible for planning and implementing their own specific programs.

Kiribati Education and Training Committee and Central Planning, Monitoring and Evaluation Board, Ministry of Health and Family Planning.

Palau Chief, Health Manpower Division, BHS.

PNG Training Division, DOH, and provincial authorities.

Solomon Islands

Tonga

Vanuatu

Western Samoa

Health Planning Unit, MHMS.

National Health Development Committee of MOH, Scholarship Advisory Committee of MOE for allocation of overseas scholarships.

Director of Health, Planning Officer and Principal Nursing Officer, MOH.

Director General of Health with heads of divisions. Manpower Unit, PSC, coordinates allocation of government scholarships.

22

Health Workforce Training And Development

3.4 Local formal training programs

Fonnal in-country training of health personnel is conducted in

Institutions under the direct control of government health authorities e.g. government schools of nursing, and the PNG Colleges of Allied Health Sciences.

Schools conducted by church organisations with government subsidy and supervision by the health authority e.g. Atoifi and Helena Goldie Schools of Nursing, Solomon Islands and church schools of nursing in PNG.

Tertiary education establishments having links with health authorities e.g. the Fiji School of Medicine, Medical School of the University of Papua New Guinea, Solomon Islands College of Higher Education.

Although the reporting of formal in-country training summarised in Table 3.3 is known to be incomplete and inexact in a number of respects, the table provides a reasonably comprehensive overview of the capacity for preservice training of most categories of health personnel.

The small intakes into courses other than those conducted in Fiji and Papua New Guinea suggest the scope for and desirability of adopting a modular approach to curriculum development and the use of standard teachingllearning materials. These measures would facilitate training of trainers, maximise the effecti veness of limited in-country teaching resources and provide a means for region-wide improvements in training competence and in the subsequent work performance of course graduates. This type of collaboration would require the establishment of a network linking those responsible for training in the participant countries and a centre which could act a clearing house for the exchange of information and distribution of materials, and perhaps provide the focal point for training of trainers and similar inter-country activities.

23


3.4 Local formal training programs

Fonnal in-country training of health personnel is conducted in

Institutions under the direct control of government health authorities e.g. government schools of nursing, and the PNG Colleges of Allied Health Sciences.

Schools conducted by church organisations with government subsidy and supervision by the health authority e.g. Atoifi and Helena Goldie Schools of Nursing, Solomon Islands and church schools of nursing in PNG.

Tertiary education establishments having links with health authorities e.g. the Fiji School of Medicine, Medical School of the University of Papua New Guinea, Solomon Islands College of Higher Education.

Although the reporting of formal in-country training summarised in Table 3.3 is known to be incomplete and inexact in a number of respects, the table provides a reasonably comprehensive overview of the capacity for preservice training of most categories of health personnel.

The small intakes into courses other than those conducted in Fiji and Papua New Guinea suggest the scope for and desirability of adopting a modular approach to curriculum development and the use of standard teachingllearning materials. These measures would facilitate training of trainers, maximise the effecti veness of limited in-country teaching resources and provide a means for region-wide improvements in training competence and in the subsequent work performance of course graduates. This type of collaboration would require the establishment of a network linking those responsible for training in the participant countries and a centre which could act a clearing house for the exchange of information and distribution of materials, and perhaps provide the focal point for training of trainers and similar inter-country activities.

23

Table 3.3 Entrants to local formal training programmes in selected Pacific Basin countries, 1990.

Name of training programme Cook FSM Fiji Guam K'bati Palau PNG S'mon Tonga Van'to West Total Is. Is. Samoa

Medicine 25 30 18 73 HEOIHOfMA 5 15 60 10 90 Basic Nursing 12 120 28 15 227 30 38 22 41 533 Nurse Midwife 25 8 8 12 53 Community N urselPublic Nurse 20 5 10 10 45 Nurse Practitioner 8 10 18 Community Health Worker 430 430

~ Dental Therapist 6 8 14 Dental Nurse 15 15 Chairs ide Assistant 7 7 Pharmacist 5 6 11 Health Inspector 8 31 35 5 10 89 Physiotherapy 3 3 Nutrition 4 4 Lab Technician 19 6 25 Radiographer 12 6 18 Health Education 14 6 20 Finance 3 3 Ward Management 30 30 Microscopist 10 10

Table 3.3 Entrants to local formal training programmes in selected Pacific Basin countries, 1990.

Name of training programme Cook FSM Fiji Guam K'bati Palau PNG S'mon Tonga Van'to West Total Is. Is. Samoa

Medicine 25 30 18 73 HEOIHOfMA 5 15 60 10 90 Basic Nursing 12 120 28 15 227 30 38 22 41 533 Nurse Midwife 25 8 8 12 53 Community N urselPublic Nurse 20 5 10 10 45 Nurse Practitioner 8 10 18 Community Health Worker 430 430 Dental Therapist 6 8 14 Dental Nurse 15 15 Chairs ide Assistant 7 7 Pharmacist 5 6 11 Health Inspector 8 31 35 5 10 89 Physiotherapy 3 3 Nutrition 4 4 Lab Technician 19 6 25 Radiographer 12 6 18 Health Education 14 6 20 Finance 3 3 Ward Management 30 30 Microscopist 10 10

Health Workforce Training Ami Development

3.5 Local in-service training activities

The fonnal pre-service and post-basic training programs are augmented by a very wide range of in-service training activities. These include conferences, seminars, workshops, short courses, and distance education programs. Much of this activity is led by staff within the health authorities but use is also made of training opportunities provided by other bodies such as training in management conducted by public service training staff.

Structured in-service training programs including distance learning courses are conducted by provincial health authorities in PNG. Trainers have been trained and teachingnearning materials prepared, printed and distributed by the National Training Support Unit (recently renamed as the Health Curriculum and Media Centre). Sharing of the experience gained in developing these programs and others in Pacific Basin countries could be mediated through the establishment of the network and centre discussed in section 3.4 above.

3.6 Problems associated with local training programs

3.6.1 Teaching personnel

Respondents in all countries reported shortages of adequately trained teaching personnel. Where senior staff are used as teachers this may disrupt their other work and leads to inadequately prepared teaching material. Having to employ expatriate teaching staff is expensive and, due to frequent changes of expatriate staff, training programs may be interrupted or curtailed.

3.6.2 Recruitment into pre-service training programs

Reported problems relating to recruitment into pre-service training programs were the low educational level of school leavers and shortage of applicants for training places. Reasons advanced for the shortage of applicants were lack of interest in entering upon a health career or concern as to future prospects and career paths within the health service.

From Fiji it was reported that there was no shortage of candidates for entry to medical or nursing training.

25

Health Workforce Training Ami Development

3.5 Local in-service training activities

The fonnal pre-service and post-basic training programs are augmented by a very wide range of in-service training activities. These include conferences, seminars, workshops, short courses, and distance education programs. Much of this activity is led by staff within the health authorities but use is also made of training opportunities provided by other bodies such as training in management conducted by public service training staff.

Structured in-service training programs including distance learning courses are conducted by provincial health authorities in PNG. Trainers have been trained and teachingnearning materials prepared, printed and distributed by the National Training Support Unit (recently renamed as the Health Curriculum and Media Centre). Sharing of the experience gained in developing these programs and others in Pacific Basin countries could be mediated through the establishment of the network and centre discussed in section 3.4 above.

3.6 Problems associated with local training programs

3.6.1 Teaching personnel

Respondents in all countries reported shortages of adequately trained teaching personnel. Where senior staff are used as teachers this may disrupt their other work and leads to inadequately prepared teaching material. Having to employ expatriate teaching staff is expensive and, due to frequent changes of expatriate staff, training programs may be interrupted or curtailed.

3.6.2 Recruitment into pre-service training programs

Reported problems relating to recruitment into pre-service training programs were the low educational level of school leavers and shortage of applicants for training places. Reasons advanced for the shortage of applicants were lack of interest in entering upon a health career or concern as to future prospects and career paths within the health service.

From Fiji it was reported that there was no shortage of candidates for entry to medical or nursing training.

25


3.6.3 C;:urricula and curriculum development

Two respondents drew attention to out-dated curricula and stated that skills in curriculum review and development were lacking.

3.6.4 Funds, stationery, materials, equipment andjacilities

Most respondents mentioned funding problems and shortages of teachingnearning materials and supplies, teaching aids and equipment.

3.6.5 Other problems

Other problems associated with local training programs included transport and communication difficulties in rural areas; interference with service activities when staff attend training courses; problems in coordinating inservice training activities and ordering training priorities; difficulty in providing adequate clinical experience during training; courses not attracting an ethnic composition consistent with population mix.

3.7 Overcoming local training problems

Suggestions for overcoming local training problems included both proposals for local activities and expressions of need for technical and other forms of assistance. The most common suggestions relate to the training of trainers and training coordinators, curriculum development, overseas training of national staff and provision of expatriate resource personnel to provide incountry assistance with training. Specific suggestions are shown in Table 3.4 on a country-by-country basis.

26


3.6.3 C;:urricula and curriculum development

Two respondents drew attention to out-dated curricula and stated that skills in curriculum review and development were lacking.

3.6.4 Funds, stationery, materials, equipment andjacilities

Most respondents mentioned funding problems and shortages of teachingnearning materials and supplies, teaching aids and equipment.

3.6.5 Other problems

Other problems associated with local training programs included transport and communication difficulties in rural areas; interference with service activities when staff attend training courses; problems in coordinating inservice training activities and ordering training priorities; difficulty in providing adequate clinical experience during training; courses not attracting an ethnic composition consistent with population mix.

3.7 Overcoming local training problems

Suggestions for overcoming local training problems included both proposals for local activities and expressions of need for technical and other forms of assistance. The most common suggestions relate to the training of trainers and training coordinators, curriculum development, overseas training of national staff and provision of expatriate resource personnel to provide incountry assistance with training. Specific suggestions are shown in Table 3.4 on a country-by-country basis.

26

HealJh Workforce Training And Del'elopment

Table 3.4 Suggestions for overcoming local training problems, selected Pacific Basin countries 1990.

Local activities suggested by respondents

Cook Islands

Give greater attention to selection of trainers and trainees.

FSM

Give greater emphasis to education and educational evaluation.

Fiji

Activate in-service training program.

Guam

Upgrade High School English and mathematics levels of entrants to pre-service training courses. Provide pre-nursing orientation programs to facilitate acculturation to college and to College of Nursing. Advisers for nursing students on one to one basis. Improve recruitment process and student retention rates. Intensive on-island and off-island recruitment of nurses to meet current crisis.

Kiribati

Recruit Public Health Nursing Tutor. Increase doctor involvement in medical assistant training.

Assistance required

Training local personnel in implementation and evaluation of training programs.

Exposure of educators to international experience and overseas training.

Training workshops with expatriate resource personnel. Training of staff in new teaching methods. Up-dating training programs. Augmenting library resources. Overseas fellowships in nursing education. Use of telecommunications and TV for training rural area staff. Provision of transport, fuel etc for rural staff training program.

Training of senior staff for higher qualifications in public health and clinical work e.g. overseas clinical attachments, MPH etc.

27

HealJh Workforce Training And Del'elopment

Table 3.4 Suggestions for overcoming local training problems, selected Pacific Basin countries 1990.


Cook Islands

Give greater attention to selection of trainers and trainees.

FSM

Give greater emphasis to education and educational evaluation.

Fiji

Activate in-service training program.

Guam

Upgrade High School English and mathematics levels of entrants to pre-service training courses. Provide pre-nursing orientation programs to facilitate acculturation to college and to College of Nursing. Advisers for nursing students on one to one basis. Improve recruitment process and student retention rates. Intensive on-island and off-island recruitment of nurses to meet current crisis.

Kiribati

Recruit Public Health Nursing Tutor. Increase doctor involvement in medical assistant training.

Assistance required

Training local personnel in implementation and evaluation of training programs.

Exposure of educators to international experience and overseas training.

Training workshops with expatriate resource personnel. Training of staff in new teaching methods. Up-dating training programs. Augmenting library resources. Overseas fellowships in nursing education. Use of telecommunications and TV for training rural area staff. Provision of transport, fuel etc for rural staff training program.

Training of senior staff for higher qualifications in public health and clinical work e.g. overseas clinical attachments, MPH etc.

27


Table 3.4 (Continued)


Solomon Islands

Ensure appropriate allocation of funds for training facilities, equipment, facility sites. Establish regular liaison and consultation with public service and fmance authorities on the required and affordable level of health workforce. Secure commitment from public service authority for armual increments to ensure ongoing training and employment. Develop closer coordination between training institutions and service providers.

Tonga

Elaborate existing manpower policies into a plan for effective implementation. Give preliminary training to program coordinators/teachers before taking up new role. Increase support for training from central administration. Develop system of monitoring and evaluating training programs and their impact on the health care system.

Vanuatu

Identify training priorities. Develop coordination between sections in determining training needs, in order to develop a comprehensive health plan for action.

Western Samoa

Develop training coordinators' skills in teaching, personnel management, staff appraisal. training program asse~ment and evaluation.

Assistance required

Linkage of local institutions with overseas training centres to provide in-country short courses. Overseas recruitment of health professional and specialists in the short term to assist in some training programs.

Technical assistance with curriculum development and some aspects of curriculum implementation.

Expatriate trainers to give in-country training rather than sending nationals overseas.

Provide local training in anaesthesiology. surgery and public health engineering.

Technical and financial assistance in in development of training coordinator competence and in curriculum development and review.

28


Table 3.4 (Continued)


Solomon Islands

Ensure appropriate allocation of funds for training facilities, equipment, facility sites. Establish regular liaison and consultation with public service and fmance authorities on the required and affordable level of health workforce. Secure commitment from public service authority for armual increments to ensure ongoing training and employment. Develop closer coordination between training institutions and service providers.

Tonga

Elaborate existing manpower policies into a plan for effective implementation. Give preliminary training to program coordinators/teachers before taking up new role. Increase support for training from central administration. Develop system of monitoring and evaluating training programs and their impact on the health care system.

Vanuatu

Identify training priorities. Develop coordination between sections in determining training needs, in order to develop a comprehensive health plan for action.

Western Samoa

Develop training coordinators' skills in teaching, personnel management, staff appraisal. training program asse~ment and evaluation.

Assistance required

Linkage of local institutions with overseas training centres to provide in-country short courses. Overseas recruitment of health professional and specialists in the short term to assist in some training programs.

Technical assistance with curriculum development and some aspects of curriculum implementation.

Expatriate trainers to give in-country training rather than sending nationals overseas.

Provide local training in anaesthesiology. surgery and public health engineering.

Technical and financial assistance in in development of training coordinator competence and in curriculum development and review.

28


3.8 Utilization of major out-of-country training programs

The survey questionnaire sought data regarding numbers of personnel undertaking major health professional training courses out-of-country. Major courses are those which lead to a professionally recognised certificate, diploma or degree or other professional qualification. Such courses are generally of at least on academic year's duration. It is known that there was some under-reporting of utilisation of out-of-country training programs which may suggest problems in maintaining training records or difficulties in accessing records at relatively short notice. Data from Papua New Guinea was not available at the time of compiling this report.

Allowing for some under-reporting, it is clear from Tables 3.5 and 3.6 that institutions in four countries - Australia, Fiji, New Zealand and Papua New Guinea - provide the bulk of out-of-country professional training for health personnel in the eleven respondent countries.

Table 3.S Recent utilization of nuUor oot·of-eountry training programs in medicine, dentistry and nursing, selected Pacific Basin countries. *

Country in which training conducted

New Zealand

Australia

Fiji

Papua New Guinea

Hawaii, USA

England

Guam Philippines

Thailand

Israel

Japan

Malaysia

Singapore USA (excI.Hawaii)

Totals

Number of students by type of course

Medicine under post grad grad

26 1

23 31

8 4

3 3

2

1

1

1

1

81 14

Dentistry under post grad grad

5 3

10

I

5

9 16

Nursing under post grad grad

2 23

3

28

16

27 26

1

2

1

73

Total students

67 59 49 32

9 3 3

2 2

231

• Respondents were asked to report utilization for the past five years, but not all reports covered this period. Data from CNMI, Cook 18., FSM, Guam, Kiribati, Palau, Solomon Is., Tonga, Vanuatu and W. Samoa.

29


3.8 Utilization of major out-of-country training programs

The survey questionnaire sought data regarding numbers of personnel undertaking major health professional training courses out-of-country. Major courses are those which lead to a professionally recognised certificate, diploma or degree or other professional qualification. Such courses are generally of at least on academic year's duration. It is known that there was some under-reporting of utilisation of out-of-country training programs which may suggest problems in maintaining training records or difficulties in accessing records at relatively short notice. Data from Papua New Guinea was not available at the time of compiling this report.

Allowing for some under-reporting, it is clear from Tables 3.5 and 3.6 that institutions in four countries - Australia, Fiji, New Zealand and Papua New Guinea - provide the bulk of out-of-country professional training for health personnel in the eleven respondent countries.

Table 3.S Recent utilization of nuUor oot·of-eountry training programs in medicine, dentistry and nursing, selected Pacific Basin countries. *

Country in which training conducted

New Zealand

Australia

Fiji

Papua New Guinea

Hawaii, USA

England

Guam Philippines

Thailand

Israel

Japan

Malaysia

Singapore USA (excI.Hawaii)

Totals

Number of students by type of course

Medicine under post grad grad

26 1

23 31

8 4

3 3

2

1

1

1

1

81 14

Dentistry under post grad grad

5 3

10

I

5

9 16

Nursing under post grad grad

2 23

3

28

16

27 26

1

2

1

73

Total students

67 59 49 32

9 3 3

2 2

231

• Respondents were asked to report utilization for the past five years, but not all reports covered this period. Data from CNMI, Cook 18., FSM, Guam, Kiribati, Palau, Solomon Is., Tonga, Vanuatu and W. Samoa.

29


Table 3.5 illustrates the contribution of institutions in Fiji, New Zealand and Papua New Guinea to undergraduate medical education and the involvement of institutions in Australia, New Zealand and Fiji in the post graduate education of nursing personnel. The heavy reliance of respondent countries on Fiji and Papua New Guinea for training in laboratory technology, on Fiji for health inspection training and New Zealand for re-training of physiotherapists is apparent in Table 3.6.

Table 3.6 Recent utilization of major out-of-country allied health science training programs, selected Pacific Basin countries. ...

Number of students by country of training Type of

training course Fiji PNG NZ Aust S'pore Malaysia USA Total

Lab technology 21 11 1 33

Health inspection 11 I 14

Physiotherapy 10 4 14

Radiography 2 1 3 7

Health administration 3 3

Nutrition 3 3

Pharmacy 2 I 3

Health education 2 2

Biomedical engineering I

Dental nursing I

Medical records I

Sanitary engineering 1

Totals 35 15 14 13 4 1 1 83

* Respondents were asked to report utilization for the past five years, but not all reports covered this period. Data from CNMJ, Cook Is., FSM, Fiji, Guam, Kiribati, Palau, Solomon Is., Tonga, Vanuatu and W. Samoa

30


Table 3.5 illustrates the contribution of institutions in Fiji, New Zealand and Papua New Guinea to undergraduate medical education and the involvement of institutions in Australia, New Zealand and Fiji in the post graduate education of nursing personnel. The heavy reliance of respondent countries on Fiji and Papua New Guinea for training in laboratory technology, on Fiji for health inspection training and New Zealand for re-training of physiotherapists is apparent in Table 3.6.

Table 3.6 Recent utilization of major out-of-country allied health science training programs, selected Pacific Basin countries. ...

Number of students by country of training Type of

training course Fiji PNG NZ Aust S'pore Malaysia USA Total

Lab technology 21 11 1 33

Health inspection 11 I 14

Physiotherapy 10 4 14

Radiography 2 1 3 7

Health administration 3 3

Nutrition 3 3

Pharmacy 2 I 3

Health education 2 2

Biomedical engineering I

Dental nursing I

Medical records I

Sanitary engineering 1

Totals 35 15 14 13 4 1 1 83

* Respondents were asked to report utilization for the past five years, but not all reports covered this period. Data from CNMJ, Cook Is., FSM, Fiji, Guam, Kiribati, Palau, Solomon Is., Tonga, Vanuatu and W. Samoa

30


3.9 Fellowships - the "needs" list

The procedures for determining fellowships for which external funding is to be sought differs in detail from country to country depending on such factors as the size of the health service and the government administrative structure. Generally the process involves input regarding training needs from regional or divisional service heads to a central point such as a planning unit or central administrative office. The list of requests for fellowships is considered either by a committee or, in the smaller health services, the chief of the central health authority, commonly with some consultation of relevant senior officers. Where there is a national health plan the requests may be considered in the light of the plan. The final "needs" list may require the approval of the national public service authority or some other agency such as the ministry of education before passing to the funding agency. When notice of availability of funding is received candidate selection can proceed.

Different procedures may be followed for the allocation of scholarships for pre-service training, of fellowships for further training to be funded from local sources, and of externally-funded fellowships where information regarding availability of specific places initiates from the funding agency.

3.10 FeUowships and scholarships - awarding procedures

Applications for scholarship and fellowship places may be called for by some form of advertisement or candidates may be nominated by senior officers within the health service. The funding agency may prescribe criteria to be used in the selection process. Table 3.7 lists the reported procedures for the award of fellowships. Although in all countries the health authority is involved, the involvement may be as member of a panel including representation of the public service authority, education ministry or other bodies. Because fellows will be absent from their posts for the duration of their fellowships, the ratification of awards by the public service authority is usually required.

31


3.9 Fellowships - the "needs" list

The procedures for determining fellowships for which external funding is to be sought differs in detail from country to country depending on such factors as the size of the health service and the government administrative structure. Generally the process involves input regarding training needs from regional or divisional service heads to a central point such as a planning unit or central administrative office. The list of requests for fellowships is considered either by a committee or, in the smaller health services, the chief of the central health authority, commonly with some consultation of relevant senior officers. Where there is a national health plan the requests may be considered in the light of the plan. The final "needs" list may require the approval of the national public service authority or some other agency such as the ministry of education before passing to the funding agency. When notice of availability of funding is received candidate selection can proceed.

Different procedures may be followed for the allocation of scholarships for pre-service training, of fellowships for further training to be funded from local sources, and of externally-funded fellowships where information regarding availability of specific places initiates from the funding agency.

3.10 FeUowships and scholarships - awarding procedures

Applications for scholarship and fellowship places may be called for by some form of advertisement or candidates may be nominated by senior officers within the health service. The funding agency may prescribe criteria to be used in the selection process. Table 3.7 lists the reported procedures for the award of fellowships. Although in all countries the health authority is involved, the involvement may be as member of a panel including representation of the public service authority, education ministry or other bodies. Because fellows will be absent from their posts for the duration of their fellowships, the ratification of awards by the public service authority is usually required.

31


Table 3.7 Participants in award of fellowships, selected Pacific Basin countries, 1990.

Countries Parties involved in award of fellowship

CMNI The Governor, Director of Public Health and Environmental Services - sometimes senior administrators, DPH & ES.

Cook Islands

FSM

Fiji

Guam

Kiribati

Palau

PNG

Solomon Islands

Tonga

Vanuatu

Western Samoa

Director General of Health. representatives of the Manpower Development Unit, Public Service Commission, the Minister responsible for the Public Service Commission and the Public Service Commissioner.

State Directors of Health, Office of Human Resources.

Permanent Secretary and Directors, MOH and Public Service Commission.

WHO Fellowships Committee with representatives from DHSS, DMHSA, Guam Memorial Hospital, EPA and University of Guam makes recommendations to Director of Public Health Services, final approval by Governor.

Education and Training Committee, Ministry of Health and Family Planning.

Fellowships Committee (12 members - senior officers, BHS)

Fellowships Committee (senior officers, DOH), Department of Personnel Management, Ministry of Education (pre-service scholarships only).

Pre-service scholarships - National Scholarships Interview Panel (includes health professionals). Fellowships - Under-Secretaries of Health, Heads of Divisions MHMS, National Training UnitlPublic Service Commission.

Scholarships - Scholarship Advisory Committee of MOE (includes MOH representation) Fellowships - Minister of Health, National Health Selection Committee for Training (senior officers, MOH).

Director of Health, PMO's, PNO, PAO and Health Planner, MOH, Training and Scholarship Unit, Public Service Department

Minister 01 Health, Director General of Health, Heads of Divisions, MOH and Selection Committee (representatives of government departments), Public Service Commission.

32


Table 3.7 Participants in award of fellowships, selected Pacific Basin countries, 1990.

Countries Parties involved in award of fellowship

CMNI The Governor, Director of Public Health and Environmental Services - sometimes senior administrators, DPH & ES.

Cook Islands

FSM

Fiji

Guam

Kiribati

Palau

PNG

Solomon Islands

Tonga

Vanuatu

Western Samoa

Director General of Health. representatives of the Manpower Development Unit, Public Service Commission, the Minister responsible for the Public Service Commission and the Public Service Commissioner.

State Directors of Health, Office of Human Resources.

Permanent Secretary and Directors, MOH and Public Service Commission.

WHO Fellowships Committee with representatives from DHSS, DMHSA, Guam Memorial Hospital, EPA and University of Guam makes recommendations to Director of Public Health Services, final approval by Governor.

Education and Training Committee, Ministry of Health and Family Planning.

Fellowships Committee (12 members - senior officers, BHS)

Fellowships Committee (senior officers, DOH), Department of Personnel Management, Ministry of Education (pre-service scholarships only).

Pre-service scholarships - National Scholarships Interview Panel (includes health professionals). Fellowships - Under-Secretaries of Health, Heads of Divisions MHMS, National Training UnitlPublic Service Commission.

Scholarships - Scholarship Advisory Committee of MOE (includes MOH representation) Fellowships - Minister of Health, National Health Selection Committee for Training (senior officers, MOH).

Director of Health, PMO's, PNO, PAO and Health Planner, MOH, Training and Scholarship Unit, Public Service Department

Minister 01 Health, Director General of Health, Heads of Divisions, MOH and Selection Committee (representatives of government departments), Public Service Commission.

32

Health Workforce Training And Devewpment

3.11 Difficulties in obtaining suitable candidates for overseas fellowships

Lack of appropriately qualified staff to take up overseas traIrung opportunities was the most frequently mentioned problem, being reported by respondents in nine countries. Other difficulties specifically mentioned were inability of proposed candidates to meet entry requirements of overseas institutions; doctors not qualified to enter specialist training programs; doctors with clinical responsibilities could not be spared to undertake further training and lack of suitable candidates for training in equipment maintenance. One respondent noted the extra costs in time and money entailed where a 'qualifying year' overseas was required as a condition of entry to further training. In one country top high school graduates no longer make medicine their first career choice and in another few school children are interested in entering health professional training.

Also reported were refusal by the public service authority to endorse recommendations of the central health authority regarding fellowship awards; difficulties faced by trainees who have to leave young families in order to take up overseas fellowships; inequitable distribution of fellowships; and failure to apply appropriate criteria in selection of fellowship nominees.

Concern was expressed concerning resignation from their employing service of personnel who took up fellowships, and also regarding the high expectations of some fellows on return from their training overseas. One respondent mentioned that a three year post-fellowship bond irrespective of length of training created difficulties in obtaining candidates.

3.12 Liaison between service providers and training personnel in the development and conduct of training programmes.

Liaison between service providers and training personnel was reported to be strongest where the training agencies were under the control of or closely linked with the national or regional health authority. No direct liaison between service providers and out-of-country training institutions was reported. Several respondents mentioned the liaison provided by WHO between employing authorities and out-of-country fellows but it is doubtful whether this extends to consultation on training program development. Authorities in two countries reported difficulty in communicating with or managing trainees out-ryf-country. (Table 3.8)

Because the successful implementation of workforce plans is so dependent on the successful implementation of training programmes it is clearly essential to ensure a very close and continuing liaison between planning and training personnel.

33

Health Workforce Training And Devewpment

3.11 Difficulties in obtaining suitable candidates for overseas fellowships

Lack of appropriately qualified staff to take up overseas traIrung opportunities was the most frequently mentioned problem, being reported by respondents in nine countries. Other difficulties specifically mentioned were inability of proposed candidates to meet entry requirements of overseas institutions; doctors not qualified to enter specialist training programs; doctors with clinical responsibilities could not be spared to undertake further training and lack of suitable candidates for training in equipment maintenance. One respondent noted the extra costs in time and money entailed where a 'qualifying year' overseas was required as a condition of entry to further training. In one country top high school graduates no longer make medicine their first career choice and in another few school children are interested in entering health professional training.

Also reported were refusal by the public service authority to endorse recommendations of the central health authority regarding fellowship awards; difficulties faced by trainees who have to leave young families in order to take up overseas fellowships; inequitable distribution of fellowships; and failure to apply appropriate criteria in selection of fellowship nominees.

Concern was expressed concerning resignation from their employing service of personnel who took up fellowships, and also regarding the high expectations of some fellows on return from their training overseas. One respondent mentioned that a three year post-fellowship bond irrespective of length of training created difficulties in obtaining candidates.

3.12 Liaison between service providers and training personnel in the development and conduct of training programmes.

Liaison between service providers and training personnel was reported to be strongest where the training agencies were under the control of or closely linked with the national or regional health authority. No direct liaison between service providers and out-of-country training institutions was reported. Several respondents mentioned the liaison provided by WHO between employing authorities and out-of-country fellows but it is doubtful whether this extends to consultation on training program development. Authorities in two countries reported difficulty in communicating with or managing trainees out-ryf-country. (Table 3.8)

Because the successful implementation of workforce plans is so dependent on the successful implementation of training programmes it is clearly essential to ensure a very close and continuing liaison between planning and training personnel.

33


Table 3.8 Liaison between service providers and training agencies, selected Pacific Basin countries, 1990.

Country Liaison reported

FSM Liaison with WHO on progress and follow-up of trainees.

Fiji Close liaison between top management of MOH and Fiji Schools

of Medicine and Nursing.

Guam No structured liaison; some informal discussion.

Palau Communication difficulties hamper contact with agencies and

trainees out of country.

Solomon Islands

Tonga

Vanuatu

Western Samoa

Liaison between MHMS and Schools of Nursing.

Satisfactory liaison between service providers and training

personnel in training matters.

WHO provides liaison with WHO fellows; the Training and

Scholarships Unit of the Public Services Department provides

link with other trainees.

Liaison on development and implementation of local training

programs but problems with effective management of fellows in

overseas institutions.

34


Table 3.8 Liaison between service providers and training agencies, selected Pacific Basin countries, 1990.

Country Liaison reported

FSM Liaison with WHO on progress and follow-up of trainees.

Fiji Close liaison between top management of MOH and Fiji Schools

of Medicine and Nursing.

Guam No structured liaison; some informal discussion.

Palau Communication difficulties hamper contact with agencies and

trainees out of country.

Solomon Islands

Tonga

Vanuatu

Western Samoa

Liaison between MHMS and Schools of Nursing.

Satisfactory liaison between service providers and training

personnel in training matters.

WHO provides liaison with WHO fellows; the Training and

Scholarships Unit of the Public Services Department provides

link with other trainees.

Liaison on development and implementation of local training

programs but problems with effective management of fellows in

overseas institutions.

34

Worliforce Management

4. WORKFORCE MANAGEMENT

4.1 Difficulties in health personnel management

Respondents in six out of ten reporting countries named insufficient numbers of qualified staff as a health personnel management problem. Lack of skills and training among staff was reported from four countries. One respondent noted the limited opportunities for continuing education as a problem.

Inadequate staff supervision was also a common problem (reported from five countries). Reasons advanced for inadequacies included laxity on the part of those with supervisory responsibilities and lack of transportation to enable supervisors to visit their charges at their workplaces.

Organisational problems include over-concentration of functions at central office, lack of coordination at senior management levels, and inadequate definition of functions and responsibilities leading to low efficiency, frustration, misunderstandings, delay in decision making and unnecessary referral to more senior levels. Lack of management skills among personnel generally is also a problem. One respondent drew attention to the need for clear policies, procedures and rules in personnel management. Poor coordination of training activities was reported as contributing to management problems in one country.

Respondents in four countries reported poor motivation or low morale as problems. Each of the following factors related to morale and motivation was mentioned in one or other of the ten countries reporting on workforce management problems:

low emoluments poor working conditions lack of career structure limited opportunities for promotion lack of incentives for staff posted to outer stations low prestige of health professions lack of commitment to long term careers in the health field.

4.2 Job descriptions and their review

Information regarding job descriptions and their review was obtained from nine countries. In four of them job descriptions reportedly exist for all government health service posts, and in another for all permanently staffed posts. One country has job descriptions covering approximately 80 per cent of posts with brief outlines for the others, most of which are trainee

35

Worliforce Management

4. WORKFORCE MANAGEMENT

4.1 Difficulties in health personnel management

Respondents in six out of ten reporting countries named insufficient numbers of qualified staff as a health personnel management problem. Lack of skills and training among staff was reported from four countries. One respondent noted the limited opportunities for continuing education as a problem.

Inadequate staff supervision was also a common problem (reported from five countries). Reasons advanced for inadequacies included laxity on the part of those with supervisory responsibilities and lack of transportation to enable supervisors to visit their charges at their workplaces.

Organisational problems include over-concentration of functions at central office, lack of coordination at senior management levels, and inadequate definition of functions and responsibilities leading to low efficiency, frustration, misunderstandings, delay in decision making and unnecessary referral to more senior levels. Lack of management skills among personnel generally is also a problem. One respondent drew attention to the need for clear policies, procedures and rules in personnel management. Poor coordination of training activities was reported as contributing to management problems in one country.

Respondents in four countries reported poor motivation or low morale as problems. Each of the following factors related to morale and motivation was mentioned in one or other of the ten countries reporting on workforce management problems:

low emoluments poor working conditions lack of career structure limited opportunities for promotion lack of incentives for staff posted to outer stations low prestige of health professions lack of commitment to long term careers in the health field.

4.2 Job descriptions and their review

Information regarding job descriptions and their review was obtained from nine countries. In four of them job descriptions reportedly exist for all government health service posts, and in another for all permanently staffed posts. One country has job descriptions covering approximately 80 per cent of posts with brief outlines for the others, most of which are trainee

35

The Health Wor/iforce

positions. In the other two countries there are job descriptions for 20 per cent or less of posts.

Annual review of all job descriptions was reported from one country and in another annual review of the job descriptions of senior officers is required by the Public Service Commission. Elsewhere review may occur when a post becomes vacant and is to refilled, or as the result of an inquiry into an employee grievance. (Table 4.1)

Table 4.1 Job descriptions and their review, selected Pacific Basin countries, 1990

Country Posts having job descriptions and review arrangements

CNMI 80% of posts with job descriptions; other 20% job outlines. No regular review procedure.

FSM 100% coverage. 75% job descriptions are up-to-date.

Fiji 100% coverage. No regular review procedure.

Kiribati 100% coverage. Reviewed when need arises.

Palau 100% coverage. Reviewed annually.

Solomon Islands

Tonga

Vanuatu

Western Samoa

100% coverage. Reviewed when post to be refilled.

Less than 20% coverage. No regular review.


100% coverage. Annual review of senior posts mandatory. Other job descriptions not regularly reviewed.

4.3 Staff incentive schemes

Of the eleven countries supplying information on staff incentive schemes, seven reported the supply of free or low-rent staff housing and/or the payment of housing al1owances. Responses from three countries stated specifically that this incentive applied to staff working in peripheral posts. Apart from assistance with housing, the payment of special location/remote area allowances was reported from five countries. In Kiribati a special allowance is paid to nursing staff in peripheral areas because they are virtually "on duty" 24 hours a day.

36

The Health Wor/iforce

positions. In the other two countries there are job descriptions for 20 per cent or less of posts.

Annual review of all job descriptions was reported from one country and in another annual review of the job descriptions of senior officers is required by the Public Service Commission. Elsewhere review may occur when a post becomes vacant and is to refilled, or as the result of an inquiry into an employee grievance. (Table 4.1)

Table 4.1 Job descriptions and their review, selected Pacific Basin countries, 1990

Country Posts having job descriptions and review arrangements

CNMI 80% of posts with job descriptions; other 20% job outlines. No regular review procedure.

FSM 100% coverage. 75% job descriptions are up-to-date.

Fiji 100% coverage. No regular review procedure.

Kiribati 100% coverage. Reviewed when need arises.

Palau 100% coverage. Reviewed annually.

Solomon Islands

Tonga

Vanuatu

Western Samoa


Less than 20% coverage. No regular review.


100% coverage. Annual review of senior posts mandatory. Other job descriptions not regularly reviewed.

4.3 Staff incentive schemes

Of the eleven countries supplying information on staff incentive schemes, seven reported the supply of free or low-rent staff housing and/or the payment of housing al1owances. Responses from three countries stated specifically that this incentive applied to staff working in peripheral posts. Apart from assistance with housing, the payment of special location/remote area allowances was reported from five countries. In Kiribati a special allowance is paid to nursing staff in peripheral areas because they are virtually "on duty" 24 hours a day.

36

Worlr/orce MQIUIgelfUrIt

Other incentives and awards mentioned by respondents in one or other of the eleven countries were:

- higher duty allowance when acting in a higher grade post overtime payment for central hospital staff call back payment for central hospital staff

- responsibility allowance for unit heads subsidised telephone services for medical officers round trip transportation paid vacations paid sick leave storage of household goods

- health insurance life insurance attendance at off-island conferences and training courses merit award of one salary increment for exceptionally meritorious service during the year.

Although each of the items in this list was reported from only one country, it seems probable that some are provided in other countries too.

4.4 Written guidelines for routine personnel management

Respondents in ten participant countries completed a checklist of personnel management processes. They were asked to indicate whether or not there were written guidelines available for the use of staff engaged in each of the listed processes. The responses are presented in Table 4.2. Of the 120 possible responses, 84 were positive, 34 negative and 2 not recorded. (These last two were tabulated as negative).

The guidelines most widely reported to be available were those relating to recruitment procedure and to the management of personnel records. Also widely available were guidelines for the personnel selection process and supportive supervision. (Inadequate supervision was reported to be a common problem - see 4.1 above - which could indicate that the guidelines were not being used, were not very helpful or that some other factor inhibited their proper use).

Guidelines for the conduct of induction programs, performance appraisal and in service training were also generally available, being reported as present in seven of the t.en respondent countries.

Among those less widely available were guidelines for determining establishment - important for workforce planning, and task analysis guidelines - important for the design of training programs and for the preparation of job profiles. Other guidelines less widely reported were those

37

Worlr/orce MQIUIgelfUrIt

Other incentives and awards mentioned by respondents in one or other of the eleven countries were:

- higher duty allowance when acting in a higher grade post overtime payment for central hospital staff call back payment for central hospital staff

- responsibility allowance for unit heads subsidised telephone services for medical officers round trip transportation paid vacations paid sick leave storage of household goods

- health insurance life insurance attendance at off-island conferences and training courses merit award of one salary increment for exceptionally meritorious service during the year.

Although each of the items in this list was reported from only one country, it seems probable that some are provided in other countries too.

4.4 Written guidelines for routine personnel management

Respondents in ten participant countries completed a checklist of personnel management processes. They were asked to indicate whether or not there were written guidelines available for the use of staff engaged in each of the listed processes. The responses are presented in Table 4.2. Of the 120 possible responses, 84 were positive, 34 negative and 2 not recorded. (These last two were tabulated as negative).

The guidelines most widely reported to be available were those relating to recruitment procedure and to the management of personnel records. Also widely available were guidelines for the personnel selection process and supportive supervision. (Inadequate supervision was reported to be a common problem - see 4.1 above - which could indicate that the guidelines were not being used, were not very helpful or that some other factor inhibited their proper use).

Guidelines for the conduct of induction programs, performance appraisal and in service training were also generally available, being reported as present in seven of the t.en respondent countries.

Among those less widely available were guidelines for determining establishment - important for workforce planning, and task analysis guidelines - important for the design of training programs and for the preparation of job profiles. Other guidelines less widely reported were those

37


relating to designing job profiles, to specific incentives and to determining career paths.

Table 4.2 indicates that most of the respondent countries have guidelines for the majority of the personnel management processes listed. But the table also shows a considerable need for existing guidelines to be reviewed and revised.

Reports from five of the ten respondent countries commented on the quality of present guidelines - of their total 44 guidelines 25 were in need of revision.

4.5 Workforce management and workforce planning

Even the most carefully prepared and documented workforce plans will amount to little more than a paper exercise if the workforce is not managed competently. The material reviewed in this chapter indicates that there is considerable scope for improvement in personnel management practice.

38


relating to designing job profiles, to specific incentives and to determining career paths.

Table 4.2 indicates that most of the respondent countries have guidelines for the majority of the personnel management processes listed. But the table also shows a considerable need for existing guidelines to be reviewed and revised.

Reports from five of the ten respondent countries commented on the quality of present guidelines - of their total 44 guidelines 25 were in need of revision.

4.5 Workforce management and workforce planning

Even the most carefully prepared and documented workforce plans will amount to little more than a paper exercise if the workforce is not managed competently. The material reviewed in this chapter indicates that there is considerable scope for improvement in personnel management practice.

38

Table 4.2 Written guidelines for routine personnel management, selected Pacific Basin countries, 1990

Written Guidelines? Yes!No Total

Guideline Topic CNMI CI FSM Fiji Guam Pal SIs T'a Van'u WSam Yes No

Detennining establishment y* y* Y Y N Y N y* N N 6 4

Recruitment process y* y* Y Y Y Y Y y* N Y 9 I

Selection procedures Y y* Y Y Y Y Y y. N N 8 2

Induction programs N y N Y Y Y Y y. N Y 7 3

Supportive supervision process Y N Y Y Y Y Y y* N y* 8 2

w Perfonnance appraisal Y N Y y* Y Y Y N N y* 7 3 '0

In-service training Y y* N N Y Y Y Y N y* 7 3

Special incentives and rewards Y N N N Y Y Y Y N y* 6 4

Detennining career path N y* N N Y Y Y Y N y* 6 4

Task analysis procedure N y* Y N N Y Y N N y* 5 5

Designing job profiles y* y* Y N N Y N N Y y* 6 4

Management of records Y y* Y Y N Y Y y* Y y* 9

TOTAL Yes 9 9 8 7 8 12 10 9 2 10 84 36

No 3 3 4 5 4 0 2 3 10 2

* Guidelines exist but are in need of revision.

Table 4.2 Written guidelines for routine personnel management, selected Pacific Basin countries, 1990

Written Guidelines? Yes!No Total

Guideline Topic CNMI CI FSM Fiji Guam Pal SIs T'a Van'u WSam Yes No

Determining establishment y* y* y y N Y N y* N N 6 4

Recruitment process y* y* Y Y Y Y Y y* N Y 9 I Selection procedures Y y* Y Y Y Y Y y* N N 8 2

Induction programs N y N Y Y Y Y y* N Y 7 3 Supportive supervision process Y N Y Y Y Y Y y* N y* 8 2

w Performance appraisal Y N Y y* Y Y Y N N y* 7 3 '0

In-service training Y y* N N Y Y Y Y N y* 7 3

Special incentives and rewards Y N N N Y Y Y Y N y* 6 4

Determining career path N y* N N Y Y Y Y N y* 6 4

Task analysis procedure N y* Y N N Y Y N N y* 5 5

Designing job profiles y* y* Y N N Y N N Y y* 6 4

Management of records Y y* Y Y N Y Y y* Y y* 9

TOTAL Yes 9 9 8 7 8 12 10 9 2 10 84 36

No 3 3 4 5 4 0 2 3 10 2

* Guidelines exist but are in need of revision.


5. SUGGESTIONS FOR ACTION

5.1 An action agenda and information exchange

At the WHO Seminar on Manpower Development Opportunities in the Pacific, 15-16 November 1989, participants agreed that a detailed Action Agenda be developed. The agreed initial matter for action was the collation and analysis of human (health) resources data. The survey reported here represents a summary and an exploration of some of that data. It was also agreed that exchange of information relating to human resources be instituted.

In the light of the survey findings the following points are put forward as a basis for development of the Action Agenda and initiation of further information exchange.

5.2 Development of health workforce planning capacity

Important elements in the development of health workforce planning capacity are:

the recognition of health workforce planning as a top-level executive responsibility designation of the health workforce planning function to an appropriate unit establishment and operation of the workforce information system training of personnel in planning and the use of the information system.

Because of the similarity of a number of the Pacific Basin countries in terms of planning popUlation unit size, health problems, levels of health service development, patterns of health service organisation and health service resources it seems probable that the establishment of a mutual information exchange and planning support network with access to additional expertise input would be advantageous to those countries.

5.2.1 Health workforce planning as a top level executive function

Although the majority of countries covered in this review have health plans with some workforce policy and planning content, few have comprehensive workforce plans documented in detail and/or well formulated training programs. It is important that top level executives recognise the desirability of ensuring that sufficiently detailed workforce plans and their supporting information system be available to:

provide clear direction for present and future action serve as a basis for monitoring implementation, and

40


5. SUGGESTIONS FOR ACTION

5.1 An action agenda and information exchange

At the WHO Seminar on Manpower Development Opportunities in the Pacific, 15-16 November 1989, participants agreed that a detailed Action Agenda be developed. The agreed initial matter for action was the collation and analysis of human (health) resources data. The survey reported here represents a summary and an exploration of some of that data. It was also agreed that exchange of information relating to human resources be instituted.

In the light of the survey findings the following points are put forward as a basis for development of the Action Agenda and initiation of further information exchange.

5.2 Development of health workforce planning capacity

Important elements in the development of health workforce planning capacity are:

the recognition of health workforce planning as a top-level executive responsibility designation of the health workforce planning function to an appropriate unit establishment and operation of the workforce information system training of personnel in planning and the use of the information system.

Because of the similarity of a number of the Pacific Basin countries in terms of planning popUlation unit size, health problems, levels of health service development, patterns of health service organisation and health service resources it seems probable that the establishment of a mutual information exchange and planning support network with access to additional expertise input would be advantageous to those countries.

5.2.1 Health workforce planning as a top level executive function

Although the majority of countries covered in this review have health plans with some workforce policy and planning content, few have comprehensive workforce plans documented in detail and/or well formulated training programs. It is important that top level executives recognise the desirability of ensuring that sufficiently detailed workforce plans and their supporting information system be available to:

provide clear direction for present and future action serve as a basis for monitoring implementation, and

40

Suggestions for Action

provide a means whereby informed and rational choices and appropriate changes may be made when local circumstances - say for example, an economic downturn, political or constitutional upheaval or the possibility of obtaining substantial development assistance from outside sources - demand a rapid review or revisions of existing arrangements.

The meeting of these needs requires the allocation by top level executives of adequate time and other resources to the health planning function within health authorities.

5.2.2 Designation of the health pianningjunction

The preparation of draft workforce policies and plans calls for interaction between all divisions and units within a health authority, with other government departments, and possibly with non-government agencies and international development assistance organisations. The officer designated as being in charge of these planning activities should be placed at a relatively high level within the authority's organisational structure. This officer requires adequate support by way of information processing resources and clerical/word processing staff.

5.2.3 Establishment and operation of the workforce planning information system

The health workforce planning information system should be capable of producing timely information which will:

guide the health authority in its workforce management processes

provide a basis for discussion and negotiation with other government authorities having responsibility for budgeting and planning (e.g. ministries of finance and of national or regional development), government personnel management (public service authorities), education and training not directly under the control of the health authority (ministries of education, national and regional staff development bodies)

inform international development assistance agencies (WHO, World Bank, ADB etc) which may provide support by way of fellowships, technical or other aid for the development of human resources

alert overseas training agencies which offer or might consider offering or mounting training courses geared to local needs

facilitate an exchange of information between Pacific Basin countries and with other interested parties

41


provide a means whereby informed and rational choices and appropriate changes may be made when local circumstances - say for example, an economic downturn, political or constitutional upheaval or the possibility of obtaining substantial development assistance from outside sources - demand a rapid review or revisions of existing arrangements.

The meeting of these needs requires the allocation by top level executives of adequate time and other resources to the health planning function within health authorities.

5.2.2 Designation of the health pianningjunction

The preparation of draft workforce policies and plans calls for interaction between all divisions and units within a health authority, with other government departments, and possibly with non-government agencies and international development assistance organisations. The officer designated as being in charge of these planning activities should be placed at a relatively high level within the authority's organisational structure. This officer requires adequate support by way of information processing resources and clerical/word processing staff.

5.2.3 Establishment and operation of the workforce planning information system

The health workforce planning information system should be capable of producing timely information which will:

guide the health authority in its workforce management processes

provide a basis for discussion and negotiation with other government authorities having responsibility for budgeting and planning (e.g. ministries of finance and of national or regional development), government personnel management (public service authorities), education and training not directly under the control of the health authority (ministries of education, national and regional staff development bodies)

inform international development assistance agencies (WHO, World Bank, ADB etc) which may provide support by way of fellowships, technical or other aid for the development of human resources

alert overseas training agencies which offer or might consider offering or mounting training courses geared to local needs

facilitate an exchange of information between Pacific Basin countries and with other interested parties

41


provide present staff and potential entrants to the health service with a realistic statement as to the likely direction of career paths and scope for personal advancement.

It is suggested that high priority be given to the establishment of such an information system in workforce planning units.

It is further suggested that to facilitate the establishment of such systems high priority be given to commissioning a review of the computer planning packages in use in the countries surveyed and elsewhere with a view to producing a model user-friendly workforce information and planning package which could be distributed to all interested authorities. This would also greatly facilitate training of planning personnel and the development of the mutual information sharing and planning support system discussed below.

In those countries lacking the necessary computer facilities to establish a computer based information system external assistance may be required to obtain appropriate hardware, the requisite software and to train staff in their use.

5.2.4 Training of personnel in planning and the use of the information system

The majority of respondents gave high priority to increasing the level of workforce planning capacity in the countries surveyed. An important component of this is the training of personnel in planning.

Having regard to very heavy expenditure of resources entailed in the provision of health care, the complexities of health service delivery and the benefits accruing to a healthy community, each major health authority, national and regional, requires at least one staff member with formal training at graduate level in health planning. This training should include workforce planning as part of a comprehensive program covering all major aspects of health policy development and planning. Appropriate formal training would be completion of a masters degree program in health planning or perhaps in health services management with a strong planning orientation. For some Pacific Island countries assistance by way of fellowship awards may be necessary to achieve this minimal staffing standard.

For immediate action it is suggested that training for present planning personnel be closely linked with the development of in-country information systems along the lines suggested in 5.2.3. Following the preparation of the proposed information and planning package, nominees from each interested authority might attend a short course in the use and application of the

42


provide present staff and potential entrants to the health service with a realistic statement as to the likely direction of career paths and scope for personal advancement.

It is suggested that high priority be given to the establishment of such an information system in workforce planning units.

It is further suggested that to facilitate the establishment of such systems high priority be given to commissioning a review of the computer planning packages in use in the countries surveyed and elsewhere with a view to producing a model user-friendly workforce information and planning package which could be distributed to all interested authorities. This would also greatly facilitate training of planning personnel and the development of the mutual information sharing and planning support system discussed below.

In those countries lacking the necessary computer facilities to establish a computer based information system external assistance may be required to obtain appropriate hardware, the requisite software and to train staff in their use.

5.2.4 Training of personnel in planning and the use of the information system

The majority of respondents gave high priority to increasing the level of workforce planning capacity in the countries surveyed. An important component of this is the training of personnel in planning.

Having regard to very heavy expenditure of resources entailed in the provision of health care, the complexities of health service delivery and the benefits accruing to a healthy community, each major health authority, national and regional, requires at least one staff member with formal training at graduate level in health planning. This training should include workforce planning as part of a comprehensive program covering all major aspects of health policy development and planning. Appropriate formal training would be completion of a masters degree program in health planning or perhaps in health services management with a strong planning orientation. For some Pacific Island countries assistance by way of fellowship awards may be necessary to achieve this minimal staffing standard.

For immediate action it is suggested that training for present planning personnel be closely linked with the development of in-country information systems along the lines suggested in 5.2.3. Following the preparation of the proposed information and planning package, nominees from each interested authority might attend a short course in the use and application of the

42


package. At the conclusion of the course each participant would have a well prepared system to be installed in their own agency rather than some knowledge of the principles and technique of planning but no means of readily applying them to the local situation.

This training activity should be a 'hands-on' exercise and therefore conducted at a centre having facilities for all participants to have the use of personal computers.

5.2.5 A regional information exchange and mutual support network

The 1989 WHOIWPRO Seminar on Manpower Development Opportunities concluded that greater collaboration between national, regional and international health agencies was highly desirable. This recommendation was highly endorsed during the WHO Conference on Workforce Planning (Manila, 1990).

In the course of the survey reported here it was apparent that much benefit could derive from the sharing of experience and information within the region. A network linking health planners throughout the region would provide a structure through which WHOIWPRO could continue to provide its leadership and support in the field of human resource development. The network would also facilitate collaboration, sharing and exchange of information and mutual support among the region's health authorities. One centre within the network could be designated by WHOIHRH to assist in the maintenance of continuing linkages, the conduct of collaborative undertakings such as the preparation of common data processing packages and the management of training activities.

Advocates of the present widespread movement in many fields of service towards increased accountability and peer review point to the positive motivating effect of the knowledge that one's professional performance may be impartially compared with that of others, and to the possibility that performance may be further improved as the result of lessons learned from the comparison. In most health authorities within the Pacific Basin health planners work in relative isolation from those elsewhere and so the opportunities for such helpful comparison are very limited. The network would facilitate the exchange of health workforce plans, of the results of periodic reviews of plan implementation and the sharing of problems encountered in planning and the methods employed in their solution.

The benefits which may accrue from networking include opportunities for workforce planners to:

compare achievements and by doing so maintain and enhance motivation

43


package. At the conclusion of the course each participant would have a well prepared system to be installed in their own agency rather than some knowledge of the principles and technique of planning but no means of readily applying them to the local situation.

This training activity should be a 'hands-on' exercise and therefore conducted at a centre having facilities for all participants to have the use of personal computers.

5.2.5 A regional information exchange and mutual support network

The 1989 WHOIWPRO Seminar on Manpower Development Opportunities concluded that greater collaboration between national, regional and international health agencies was highly desirable. This recommendation was highly endorsed during the WHO Conference on Workforce Planning (Manila, 1990).

In the course of the survey reported here it was apparent that much benefit could derive from the sharing of experience and information within the region. A network linking health planners throughout the region would provide a structure through which WHOIWPRO could continue to provide its leadership and support in the field of human resource development. The network would also facilitate collaboration, sharing and exchange of information and mutual support among the region's health authorities. One centre within the network could be designated by WHOIHRH to assist in the maintenance of continuing linkages, the conduct of collaborative undertakings such as the preparation of common data processing packages and the management of training activities.

Advocates of the present widespread movement in many fields of service towards increased accountability and peer review point to the positive motivating effect of the knowledge that one's professional performance may be impartially compared with that of others, and to the possibility that performance may be further improved as the result of lessons learned from the comparison. In most health authorities within the Pacific Basin health planners work in relative isolation from those elsewhere and so the opportunities for such helpful comparison are very limited. The network would facilitate the exchange of health workforce plans, of the results of periodic reviews of plan implementation and the sharing of problems encountered in planning and the methods employed in their solution.

The benefits which may accrue from networking include opportunities for workforce planners to:

compare achievements and by doing so maintain and enhance motivation

43

The Hulth Work/on:~

keep abreast of events and developments which may affect or become applicable to one's local situation

seek advice from experienced planners on planning and research problems which cannot be handled adequately with one's local resources

assist less experienced planners in the development of their expertise and experience

organise and participate in trmmng actIVItIes aimed at increasing planning competence both of planners and other personnel who play some role in the planning process.

The resource centre to be designated could conveniently be established in a training institution and thus be free from the inevitable demands of a health service delivery agency. The training institution should also have adequate teaching accommodation and support facilities together with ready access to expertise additional to that found in the service authorities. The 'hands-on' training for planners suggested in 5.2.4 could be conducted in the designated centre and this would provide opportunity for the constitution of the suggested information exchange and mutual support network.

5.3 Health workforce planning and operational research

Health workforce planning within one country or region requires access to local research findings or findings from areas relatively similar in terms of health problems, healtlI status and resource availability. The survey showed very limited present research capability in Pacific Island countries.

What research findings are presently available could be made available to interested authorities through the network suggested in 5.2.5 above.

In general the resources required for research will have to come from outside the less affluent countries of the Pacific Basin. It is suggested tlIat research areas requiring support as a matter of urgency include:

establishment of workload based performance standards

skills audit to define real skills needs (Le. skills actually needed for use in the working environment), skills availability and skills training requirements

the scope for role expansion (e.g. health centre radiographer-cumlaboratory worker) and personnel substitution (e.g. nurse aide replacing student nurse or registered nurse)

optimal distribution of available personnel.

44

The Hulth Work/on:~

keep abreast of events and developments which may affect or become applicable to one's local situation

seek advice from experienced planners on planning and research problems which cannot be handled adequately with one's local resources

assist less experienced planners in the development of their expertise and experience

organise and participate in trmmng actIVItIes aimed at increasing planning competence both of planners and other personnel who play some role in the planning process.

The resource centre to be designated could conveniently be established in a training institution and thus be free from the inevitable demands of a health service delivery agency. The training institution should also have adequate teaching accommodation and support facilities together with ready access to expertise additional to that found in the service authorities. The 'hands-on' training for planners suggested in 5.2.4 could be conducted in the designated centre and this would provide opportunity for the constitution of the suggested information exchange and mutual support network.

5.3 Health workforce planning and operational research

Health workforce planning within one country or region requires access to local research findings or findings from areas relatively similar in terms of health problems, healtlI status and resource availability. The survey showed very limited present research capability in Pacific Island countries.

What research findings are presently available could be made available to interested authorities through the network suggested in 5.2.5 above.

In general the resources required for research will have to come from outside the less affluent countries of the Pacific Basin. It is suggested tlIat research areas requiring support as a matter of urgency include:

establishment of workload based performance standards

skills audit to define real skills needs (Le. skills actually needed for use in the working environment), skills availability and skills training requirements

the scope for role expansion (e.g. health centre radiographer-cumlaboratory worker) and personnel substitution (e.g. nurse aide replacing student nurse or registered nurse)

optimal distribution of available personnel.

44

Suggestions/or Action

5.4 Resolutions of the WHO 1990 Conference

During the 1990 Conference on Health Workforce Planning convened by WHO in Manila, it was resolved to give urgency to the development of both national and sub-regional (South Pacific) information systems on human resources.

The conference provided an opportunity to present reports from the participating countries and to determine specific steps towards strengthening Health Workforce Planning.

The following resolution were adopted:

• It is recognized that strategic planning of health workforce depends on the strength of national planning efforts.

• It is recommended that countries designate the responsibility for workforce planning and provide appropriate resources for its implementation.

• It is recommended that the planning of the health workforce should be undertaken with wide managerial and political participation and commitment. This should include involvement of agencies and institutions outside the health sector.

• It is recommended to provide support to countries in their planning efforts through provision of guidelines, technical assistance, and training.

• It is recommended that selected information and products useful on a regional level be identified as a basis for a Pacific Island nations information system on health workforce.

• It is recommended that the key areas identified for a regional information system include a common definition of categories of staff, information about training, and information of health workforce resources and needs.

• It is recommended that a mechanism of co-operation between countries be established to improve their capability to plan, train and manage human resources. This will include regular meetings of working groups and periodic regional meetings.

• It is recommended that a technical working group/task force be convened in order to finalize the guidelines for national health force planning, select essential information for regional health force planning and select essential information for regional data base on human resources. This working party should consolidate and expand on the guidelines and information presented and discussed in this Conference.

• It is recommended that WHO continue to playa major coordinating role in health workforce development efforts with the support of designated regional resource.

45

Suggestions/or Action

5.4 Resolutions of the WHO 1990 Conference

During the 1990 Conference on Health Workforce Planning convened by WHO in Manila, it was resolved to give urgency to the development of both national and sub-regional (South Pacific) information systems on human resources.

The conference provided an opportunity to present reports from the participating countries and to determine specific steps towards strengthening Health Workforce Planning.

The following resolution were adopted:

• It is recognized that strategic planning of health workforce depends on the strength of national planning efforts.

• It is recommended that countries designate the responsibility for workforce planning and provide appropriate resources for its implementation.

• It is recommended that the planning of the health workforce should be undertaken with wide managerial and political participation and commitment. This should include involvement of agencies and institutions outside the health sector.

• It is recommended to provide support to countries in their planning efforts through provision of guidelines, technical assistance, and training.

• It is recommended that selected information and products useful on a regional level be identified as a basis for a Pacific Island nations information system on health workforce.

• It is recommended that the key areas identified for a regional information system include a common definition of categories of staff, information about training, and information of health workforce resources and needs.

• It is recommended that a mechanism of co-operation between countries be established to improve their capability to plan, train and manage human resources. This will include regular meetings of working groups and periodic regional meetings.

• It is recommended that a technical working group/task force be convened in order to finalize the guidelines for national health force planning, select essential information for regional health force planning and select essential information for regional data base on human resources. This working party should consolidate and expand on the guidelines and information presented and discussed in this Conference.

• It is recommended that WHO continue to playa major coordinating role in health workforce development efforts with the support of designated regional resource.

45

PART II PART II

TIte HetdIIt Worlr/oree

INTRODUCTION TO PART II

This part of the publication contains a more in-depth look at current policies and practices relating to health workforce planning, training and development and management, in individual countries covered in the study. The material presented here was supplied by country health authorities, but we must again caution readers, that the information provided by the health authorities was not in some instances exhaustive or complete.

However, the content of this part represents an attempt to reflect as accurately as possible the current status in relation to these issues, as reported by designated senior health officials responsible for these areas in respective countries.

The presentation of data for each country covered in this part is conveniently divided into three sections.

Section 1 presents the country's health and economic profile; Section 2 highlights some major issues in health workforce planning and management; and Section 3 looks at the existing processes in relation to planning, training and development, and management of the health workforce. The detailed format of each section is shown below:

Section 1: Country Health and Economic Profile

1.1 Vital statistics 1.2 Leading causes of morbidity and mortality 1.3 Health facilities, bed numbers and hospital beds per 1000 population 1.4 Categories of health personnel with popUlation ratios 1.5 Current health workforce with pattern of utilisation 1.6 Current and projected health workforce according to age groups 1. 7 Trends in health sector budget in relation to national budget for the

period 1988-1990.

Section 2: Major Issues in Health Workforce Planning and Management

2.1 Major issues concerning planning, development and management of health workforce

2.2 Types of information required to enhance policy formulation and management decision making on health workforce

Section 3: Existing Processes

3.1 Workforce planning 3.2 Workforce training and development 3.3 Workforce management

For purposes of comparability between the island countries covered in the study, Australia and New Zealand are excluded because of the scale and complexity of their health care systems.

46

TIte HetdIIt Worlr/oree

INTRODUCTION TO PART II

This part of the publication contains a more in-depth look at current policies and practices relating to health workforce planning, training and development and management, in individual countries covered in the study. The material presented here was supplied by country health authorities, but we must again caution readers, that the information provided by the health authorities was not in some instances exhaustive or complete.

However, the content of this part represents an attempt to reflect as accurately as possible the current status in relation to these issues, as reported by designated senior health officials responsible for these areas in respective countries.

The presentation of data for each country covered in this part is conveniently divided into three sections.

Section 1 presents the country's health and economic profile; Section 2 highlights some major issues in health workforce planning and management; and Section 3 looks at the existing processes in relation to planning, training and development, and management of the health workforce. The detailed format of each section is shown below:


1.1 Vital statistics 1.2 Leading causes of morbidity and mortality 1.3 Health facilities, bed numbers and hospital beds per 1000 population 1.4 Categories of health personnel with popUlation ratios 1.5 Current health workforce with pattern of utilisation 1.6 Current and projected health workforce according to age groups 1. 7 Trends in health sector budget in relation to national budget for the

period 1988-1990.

Section 2: Major Issues in Health Workforce Planning and Management


2.2 Types of information required to enhance policy formulation and management decision making on health workforce


3.1 Workforce planning 3.2 Workforce training and development 3.3 Workforce management

For purposes of comparability between the island countries covered in the study, Australia and New Zealand are excluded because of the scale and complexity of their health care systems.

46

Commonwealth oj Northern Mariana Islands

COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS

Section 1: Country Health and Economic Protile

1.1 Vital statistics

Indicator

Area Estimated population Annual population growth rate Percentage of population

- less than 15 years - 65 plus years

Urban population

Data

470 sq. kIn. 38,000 2.9%

* * *

Rate of natural increase of population per annum Crude birth rate (per 1000)

2.93% 37.9 5.9 Crude death rate (per 1000)

Life expectancy at birth (years) - male - female

Infant mortl0ty rate (per 1000 live births)

50 47 19

Adult literacy rate Percent of population served with:

safe water - adequate sanitary facilities

* Information not provided.

95%

100% (urban); 85% (rural) 80% (urban)

1.2 Leading causes of morbidity and mortality

Leading Causes of Morbidity

- Influenza and flu syndrome - Gastro-enteritis - Conjunctivitis - Shigellosis - Gonorrhoea - Amoebiasis - Chickenpox

Streptococcal sore throat Salmonellosis (excluding typhoid) Hepatitis A (infectious)

Leading Causes of Mortality

- Accident (all types) - Diseases of the heart - Malignant and benign neoplasms - Cerebrovascular diseases - Homicide - Pneumonia and influenza - Nephritism, nephrotic syndrome and nephrosis - Disease of arteries, arterioles and capillaries - Suicide - Septicaemia

47

Commonwealth oj Northern Mariana Islands

COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS

Section 1: Country Health and Economic Protile


Indicator



Urban population

Data

470 sq. kIn. 38,000 2.9%

* * *


2.93% 37.9 5.9 Crude death rate (per 1000)


Infant mortl0ty rate (per 1000 live births)

50 47 19


safe water - adequate sanitary facilities


95%

100% (urban); 85% (rural) 80% (urban)



- Influenza and flu syndrome - Gastro-enteritis - Conjunctivitis - Shigellosis - Gonorrhoea - Amoebiasis - Chickenpox

Streptococcal sore throat Salmonellosis (excluding typhoid) Hepatitis A (infectious)


- Accident (all types) - Diseases of the heart - Malignant and benign neoplasms - Cerebrovascular diseases - Homicide - Pneumonia and influenza - Nephritism, nephrotic syndrome and nephrosis - Disease of arteries, arterioles and capillaries - Suicide - Septicaemia

47

Tire HetdIIe WorIifo,"

1.3 Health facilities, bed numbers and population-bed ratios

Number of Type of Health FlIdlides Total Number Bed

Main referral hospital 1 74 District hospital 0 0 Health centre/clinics 6 0

Total 7 74

1.4 Categories of health personnel with population ratios

Hospital Beds per 1000 Population

1.95

1.95

Category of Health Personnel Total No. Population Ratio

Medical Officers 19 Medical Assistants * I Dental Officers 5 Dental Assistants ** 10 Pharmacists! Assistant Pharmacists 11 Dispensary Assistants Nurses 144 Nurse Aides & Enrolled Nurses I MedicallLaboratory Technologists 10 Radiographers 6 Physiotherapists Nutritionists & Dietitians 2 Health Educators I Health Inspectors/Sanitarians 5 Community Health Workers Other Professional & Technical Suppon Staff *** 22

Total Health Workers 237

* Includes Health Officers, Health Extension Officers and Anaesthetic AssistantslTechnicians.

** Includes Dental Technicians, Therapists and Nurses.

1: 2,000 1:38,000 1: 7,600 1: 3,800 1: 3,455

1: 264 1:38,000 1: 3,800 1: 6,333

1:19,000 1:38,000 1: 7,600

1: 1,727

1: 160

*** Include Health Statisticians, Computer Operators, Bio-medical Engineers and Health Administrators.

48

Tire HetdIIe WorIifo,"


Number of Type of Health FlIdlides Total Number Bed

Main referral hospital 1 74 District hospital 0 0 Health centre/clinics 6 0

Total 7 74



1.95

1.95


Medical Officers 19 Medical Assistants * I Dental Officers 5 Dental Assistants ** 10 Pharmacists! Assistant Pharmacists 11 Dispensary Assistants Nurses 144 Nurse Aides & Enrolled Nurses I MedicallLaboratory Technologists 10 Radiographers 6 Physiotherapists Nutritionists & Dietitians 2 Health Educators I Health Inspectors/Sanitarians 5 Community Health Workers Other Professional & Technical Suppon Staff *** 22




1: 2,000 1:38,000 1: 7,600 1: 3,800 1: 3,455

1: 264 1:38,000 1: 3,800 1: 6,333

1:19,000 1:38,000 1: 7,600

1: 1,727

1: 160


48

Commonwealth of Northern Marillna Islllnds

1.5 Current health workforce with pattern of utUisation

Total Utilization as Percentage

MAJOR CATEGORIES for Main District Health 1989 Hospital Hospital Centre!

(%) (%) CUnics(%)

General Medical Practitioner 13 90 10 Specialist/Consultant 6 90 10 Health Officer Health Extension Officer Medical Assistant 100 Community Health Worker Antimalaria W orleer Dentist 5 10 90 Dental Therapist 0 100 Dental Assistant 6 0 100 Dental Technician 2 0 100 Dental Nurse 2 Nursing SisterlRegistered Nurse 116 80 20 Midwife - Nurse 10 95 5 Public Health Nurse! Community Nurse 18 0 100 Nurse Aide 1 50 50 Student Nurse 0 95 5 Medical Technologist 4 100 0 Laboratory Technologist 6 100 0 Radiographer 6 100 0 Anaesthetic Technician! Assistant Pharmacist 11 100 0 Dispensary Assistant Nutritionist 10 90 Dietitian 1 100 0 Health Education Health Personnel Educator 5 95 Health Inspector Sanitarian 5 0 100 Physiotherapist 0 100 0 Health Statistician 1 50 50 Computer Operator 10 75 25 Health Administrator 7 100 0 Bio-medical Engineer 4 100 0

Total Health Workforce 237

49

Commonwealth of Northern Marillna Islllnds

1.5 Current health workforce with pattern of utUisation



(%) (%) CUnics(%)

General Medical Practitioner 13 90 10 Specialist/Consultant 6 90 10 Health Officer Health Extension Officer Medical Assistant 100 Community Health Worker Antimalaria W orleer Dentist 5 10 90 Dental Therapist 0 100 Dental Assistant 6 0 100 Dental Technician 2 0 100 Dental Nurse 2 Nursing SisterlRegistered Nurse 116 80 20 Midwife - Nurse 10 95 5 Public Health Nurse! Community Nurse 18 0 100 Nurse Aide 1 50 50 Student Nurse 0 95 5 Medical Technologist 4 100 0 Laboratory Technologist 6 100 0 Radiographer 6 100 0 Anaesthetic Technician! Assistant Pharmacist 11 100 0 Dispensary Assistant Nutritionist 10 90 Dietitian 1 100 0 Health Education Health Personnel Educator 5 95 Health Inspector Sanitarian 5 0 100 Physiotherapist 0 100 0 Health Statistician 1 50 50 Computer Operator 10 75 25 Health Administrator 7 100 0 Bio-medical Engineer 4 100 0


49

Tile H«JltJt Worlc/orce

1.6 Current and projected bealth workforce according to age group

Number 01 Health WoI'kers Total Projection by Age Group lor lor

11·30 31-40 41-50 51-60 60+ 1989 1995

General Medical Practitioner 2 10 1 0 2 13· 40 Specialist/Consultant 0 2 1 2 6 10 Health Officer Health Extension Officer Medical Assistant 0 0 0 0 5 Community Health Worker Antimalaria Worker Dentist 0 2 2 1 5 8 Dental Therapist Dental Assistant 3 3 6 6 Dental Technician 0 2 2 10 Dental Nurse 2 2 10 Nursing Sister/Registered Nurse 25 75 25 6 116* 200 Midwife-Nurse 0 5 5 1 11 20 Public Health Nurse! Community Nurse 1 5 3 0 1 18* 30 Nurse Aide 1 0 0 0 0 0*

Student Nurse 0 0 0 0 0 0 Medical Technologist 3 0 0 0 4 10

Laboratory Technologist 2 4 0 0 0 6 20 Radiographer 2 4 0 0 0 6 20 Anaesthetic Technician! Assistant Pharmacist 5 5 1 0 0 11 20

Dispensary Assistant Nutritionist 0 0 0 0 1 4

Dietitian 0 1 0 0 0 1 4

Health Personnel Educator 0 0 0 1 0 1 10

Health Education Technician Health Inspector 0 0 0 0 0 0 3 Sanitarian 1 4 0 0 0 5 10 Physiotherapist 0 0 0 0 0 0

Health Statistician 0 1 0 0 0 1 5

Computer Operator 3 9 1 0 0 10* 40 Health Administrator 3 2 0 3 7* 10

BiD-medical Engineer 3 0 0 0 4 10

TotaJ 237 505

* These numbers do not tally with the reported totals thus signifying some error in the reporting under specific age groups.

50

Tile H«JltJt Worlc/orce

1.6 Current and projected bealth workforce according to age group

Number 01 Health WoI'kers Total Projection by Age Group lor lor

11·30 31-40 41-50 51-60 60+ 1989 1995

General Medical Practitioner 2 10 1 0 2 13· 40 Specialist/Consultant 0 2 1 2 6 10 Health Officer Health Extension Officer Medical Assistant 0 0 0 0 5 Community Health Worker Antimalaria Worker Dentist 0 2 2 1 5 8 Dental Therapist Dental Assistant 3 3 6 6 Dental Technician 0 2 2 10 Dental Nurse 2 2 10 Nursing Sister/Registered Nurse 25 75 25 6 116* 200 Midwife-Nurse 0 5 5 1 11 20 Public Health Nurse! Community Nurse 1 5 3 0 1 18* 30 Nurse Aide 1 0 0 0 0 0*

Student Nurse 0 0 0 0 0 0 Medical Technologist 3 0 0 0 4 10

Laboratory Technologist 2 4 0 0 0 6 20 Radiographer 2 4 0 0 0 6 20 Anaesthetic Technician! Assistant Pharmacist 5 5 1 0 0 11 20

Dispensary Assistant Nutritionist 0 0 0 0 1 4

Dietitian 0 1 0 0 0 1 4

Health Personnel Educator 0 0 0 1 0 1 10

Health Education Technician Health Inspector 0 0 0 0 0 0 3 Sanitarian 1 4 0 0 0 5 10 Physiotherapist 0 0 0 0 0 0

Health Statistician 0 1 0 0 0 1 5

Computer Operator 3 9 1 0 0 10* 40 Health Administrator 3 2 0 3 7* 10

BiD-medical Engineer 3 0 0 0 4 10

TotaJ 237 505

* These numbers do not tally with the reported totals thus signifying some error in the reporting under specific age groups.

50

Commonwealth of Northern Mariana [sklnds

1.7 Trends in health sector budget in relation to national budget for the period 1988-1990

Budget (US$) 1988 1989 1990

Total Public Sector Budget 77,642,300 82,975,100 ·117,104,500

Total Health Budget 13,550,300 15,004,661 24,618,278

Per Capita Allocation for Health 357 395 648

Health Budget as Percentage of Total Budget 17% 18% 21%

51

Commonwealth of Northern Mariana [sklnds


Budget (US$) 1988 1989 1990

Total Public Sector Budget 77,642,300 82,975,100 ·117,104,500




51

The HealJlt W orlc/orce

Section 2. Major Issues"


• The need to develop appropriate systems for:

- Health Planning and Policy Formulation - Health Manpower Development - Datallnformation System.

• Lack of sufficient local control on the allocation of health resources (because federal regulations are oriented more towards federal health and social programmes in United States).

• Local self-determination.

2.2 Types of information required to enhance policy formulation and management decision making relating to the above issues

Information has not been provided.

* As reported by the country respondent.

52

The HealJlt W orlc/orce



• The need to develop appropriate systems for:

- Health Planning and Policy Formulation - Health Manpower Development - Datallnformation System.

• Lack of sufficient local control on the allocation of health resources (because federal regulations are oriented more towards federal health and social programmes in United States).

• Local self-determination.


Information has not been provided.


52

Commonwealth of Northern Maria1lllisImuJs


3.1 Workforce planning

3.1.1 National health plan (NHP)

The last NHP covered the period 1980 - 1987 and was prepared by the Commonwealth Health Planning and Development Agency.

3.1.2 Health workforce plan

Present

Period covered

Body responsible for planning

Major source of planning iliformation

Planning method

Linlcage to NHP

Linlcage to other plans

Formal arrangement to share information with other agencies

Other major documentation on health workforce


Almost completed

*

Department of Public Health and Environmental Services

· Off-Island consultants · Accreditation manual for hospitals · Legislative Office · Offices of the Governor and Attorney General

Service target method

Not evident

Linked to the 'overall economic plan'

With the Office of the Governor (in process)

· Mytinger Report · Arthur D. Little Int'l Inc.

(The Seven Year Development Plan) · Mercy International Health Services · World Health Organization Reports · South Pacific Commission Reports · U.S. Public Health Service (Region IX) Reports · Pacific Regional Training Centre Reports

53

Commonwealth of Northern Maria1lllisImuJs




The last NHP covered the period 1980 - 1987 and was prepared by the Commonwealth Health Planning and Development Agency.


Present

Period covered


Major source of planning iliformation

Planning method

Linlcage to NHP

Linlcage to other plans




Almost completed

*

Department of Public Health and Environmental Services

· Off-Island consultants · Accreditation manual for hospitals · Legislative Office · Offices of the Governor and Attorney General

Service target method

Not evident

Linked to the 'overall economic plan'

With the Office of the Governor (in process)

· Mytinger Report · Arthur D. Little Int'l Inc.

(The Seven Year Development Plan) · Mercy International Health Services · World Health Organization Reports · South Pacific Commission Reports · U.S. Public Health Service (Region IX) Reports · Pacific Regional Training Centre Reports

53

The Hellith Worlcforce

3.1.3. Current planning capability of health authorities in selected areas

Capabilities Available Priority for Development

AREAS Yes No High Medium

Health Planning X X

Workforce Planning X X

Project Planning and Appraisal X

Health System Research X

Health Information System X X

Health Statistics X X

Computerising Data Base X

Planning of Educational X X Programme and Curriculum

Others

3.2 Workforce training and development

3.2.1 Policies and plans for training and development of health personnel

Existence of clear policies and plans

Body responsible for educational planning

Linkage of educational plarming to NHP

Liaison between service providers and

training institutions


No clear policies and plans exist.

*

*

*

54

Low

X

X

X

The Hellith Worlcforce



AREAS Yes No High Medium

Health Planning X X


Project Planning and Appraisal X

Health System Research X



Computerising Data Base X

Planning of Educational X X Programme and Curriculum

Others





Linkage of educational plarming to NHP

Liaison between service providers and

training institutions


No clear policies and plans exist.

*

*

*

54

Low

X

X

X

Commonwealth of Northem Mariana Islands

3.2.2 Problems associated with local training programmes and suggested remedial activities

Problems Associated with Local Training Suggested Remedial Activities

* *


3.2.3 Formal local training programmes available in 1989

Duration

* *


55

Average Intake

per Year

*

Average Graduates per Year

*

Average Attrition per Year

*




* *



Duration

* *


55

Average Intake

per Year

*


*


*


3.2.4 Major regionaVoverseas training programmes utilised over the last 5 years

Name of Number Training Name of Category of Completed

IlWtitution Program of Staff Trainees Training

l. Waianae: CCHC Fmancial (Hawaii) Management Finance Manager

2. Queens Medical Centre Supplies Manager (Head)

3. U.S. Army Forces Biomedical Biomedical U.S. Armed Forces Engineering

4. University of Guam, Nursing Program Senior Prof. 1 1 School of Nursing Nurse

5. Pacific Islands Hospital Rehabilitative Junior Nursing for Rehabilitation Management Staff

6. Waianae: CCHC Data Management Information Data Manager 1 1

3.2.5 Fellowships

Fellowship determination process · Potential candidates screened and interviewed by the Director of Public Health and Environment Services

Selection body

Difficulties in obtaining suitable candidates

Other constraints

* Information not provided

· Recommendation to Governor for final approval

· Director of Public Health and Environmental Services · Governor · Occasionally major administrators in the Department

of Public Health and Environmental Services

*

*

56




IlWtitution Program of Staff Trainees Training

l. Waianae: CCHC Fmancial (Hawaii) Management Finance Manager

2. Queens Medical Centre Supplies Manager (Head)

3. U.S. Army Forces Biomedical Biomedical U.S. Armed Forces Engineering

4. University of Guam, Nursing Program Senior Prof. 1 1 School of Nursing Nurse

5. Pacific Islands Hospital Rehabilitative Junior Nursing for Rehabilitation Management Staff

6. Waianae: CCHC Data Management Information Data Manager 1 1

3.2.5 Fellowships

Fellowship determination process · Potential candidates screened and interviewed by the Director of Public Health and Environment Services

Selection body


Other constraints

* Information not provided

· Recommendation to Governor for final approval

· Director of Public Health and Environmental Services · Governor · Occasionally major administrators in the Department

of Public Health and Environmental Services

*

*

56


3.3 Workforce management

3.3.1 Percentage of ht:alth workforce with job descriptions and review arrangements

Posts with Job Descriptions Review Arrangements

* *


3.3.2 Difficulties experienced in management of health personnel and incentives provided to staff

Difficulties Experienced in Management of Health Personnel

*

• Information not provided.

57

Incentive Provided to Staff

· Free housing · Paid vacation and sick leave · Round trip transportation · Storage of household goods · 90% tax rebate · Health and life insurance



3.3.1 Percentage of ht:alth workforce with job descriptions and review arrangements


* *




*

• Information not provided.

57


· Free housing · Paid vacation and sick leave · Round trip transportation · Storage of household goods · 90% tax rebate · Health and life insurance

The HeaIlh Workforce

3.3.3 Existence o/wriuen guidelines/or routine personnel f1UlIIQgement *

Area Yes No Stren&tbs '" Weaknesses

Determining Establishment 0 D Need revision to keep up-to-date

0 D Need workshop to better improve

Recruitment Process physicians and allied health professional recruitment process

Selection Procedures 0 D Induction Programmes D 0

D 0 Networking of supervisors will be

Supportive Supervision Process helpful to share and solve common problem

Performance Appraisal 0 D One of the best within the region

In-Service Training 0 D Special Incentives & Rewards 0 D Lack of continuity

Determining Career Path D 0 Task Analysis Procedure D 0 Designing of Job Profiles 0 D Need revision to include new job

titled not previously included

Management of Records 0 D Others D D

* As reported by the country respondent

58

The HeaIlh Workforce

3.3.3 Existence o/wriuen guidelines/or routine personnel f1UlIIQgement *

Area Yes No Stren&tbs '" Weaknesses

Determining Establishment 0 D Need revision to keep up-to-date

0 D Need workshop to better improve

Recruitment Process physicians and allied health professional recruitment process

Selection Procedures 0 D Induction Programmes D 0

D 0 Networking of supervisors will be

Supportive Supervision Process helpful to share and solve common problem

Performance Appraisal 0 D One of the best within the region

In-Service Training 0 D Special Incentives & Rewards 0 D Lack of continuity

Determining Career Path D 0 Task Analysis Procedure D 0 Designing of Job Profiles 0 D Need revision to include new job

titled not previously included

Management of Records 0 D Others D D


58

Commonwealth of Northern MariaM Islands

3.3.4 Professional bodies and their involvement in professional, industrial, or management decision making

Activity or Involvement

Professional Bodies * Professional Associations *


59

Commonwealth of Northern MariaM Islands



Professional Bodies * Professional Associations *


59

The Health Worliforr:e

COOK ISLANDS



Indicator

Area Estimated population Annual population growth rate Pe~nWgeofpopulation


Urban popUlation

Data

240sq.km. 17,179 -0.034%


36% 4.8% 29.9% 1.84 22

Crude death rate (per 1000) Life expectancy at birth (years)

- male - female

Infant mortality rate (per 1000 live births) Adult literacy rate Percent of population served with:

- safe water - adequate sanitary facilities

6.7

64 70 38.7 90% (male), 85% (female)

99% (urban), 73% (rural) 99% (urban), 86% (rural)


Leading Causes of Morbidity Leading Causes of Mortality

- Acute respiratory infection - Malignant neoplasm - Impetigo - Other diseases of circulatory system - Diarrhoeal diseases - Diabetes - Bronchitis - Certain conditions originating in prenatal period - Asthma - Hypertension - Otitis media - Other forms of heart disease - Scabies - External causes of injuries - Conjunctivitis - Pneumonia - Pneumonia - Senility - Fish poisoning

60

The Health Worliforr:e

COOK ISLANDS



Indicator

Area Estimated population Annual population growth rate Pe~nWgeofpopulation


Urban popUlation

Data

240sq.km. 17,179 -0.034%


36% 4.8% 29.9% 1.84 22

Crude death rate (per 1000) Life expectancy at birth (years)

- male - female



6.7

64 70 38.7 90% (male), 85% (female)

99% (urban), 73% (rural) 99% (urban), 86% (rural)



- Acute respiratory infection - Malignant neoplasm - Impetigo - Other diseases of circulatory system - Diarrhoeal diseases - Diabetes - Bronchitis - Certain conditions originating in prenatal period - Asthma - Hypertension - Otitis media - Other forms of heart disease - Scabies - External causes of injuries - Conjunctivitis - Pneumonia - Pneumonia - Senility - Fish poisoning

60

Coolr.lslaruls


Number of Hospital Beds per Type of Health Facilities Total Number Beds 1000 Population

Main referral hospital 1 ~} 9.0 District ·nospital 8 Health centre/clinics 62 63

Total 71 217 9.0·

* Ratio excludes health centre/clinic beds.



Medical Officers 20 Medical Assistants * Dental Officers 6 Dental Assistants ** 16 Pharmacistsl Assistant Pharmacists 2 Dispensary Assistants 4 Nurses 59 Nurse Aides & Enrolled Nurses 29 MedicallLaboratory Technologists 8 Radiographers 2 Physiotherapists 1 Nutritionists & Dietitians 1 Health Educators 1 Health Inspectors/Sanitarians 30 Community Health Workers Other Professional & Technical Support Staff *** 3




1: 859

1: 2,863 1: 1,074 1: 8,590 1: 4.295 1: 291 1: 592 1: 2,147 1: 8,590 1: 17,179 1: 17,179 1: 17,179 1: 573

1: 5.726

1: 94


61

Coolr.lslaruls



Main referral hospital 1 ~} 9.0 District ·nospital 8 Health centre/clinics 62 63

Total 71 217 9.0·




Medical Officers 20 Medical Assistants * Dental Officers 6 Dental Assistants ** 16 Pharmacistsl Assistant Pharmacists 2 Dispensary Assistants 4 Nurses 59 Nurse Aides & Enrolled Nurses 29 MedicallLaboratory Technologists 8 Radiographers 2 Physiotherapists 1 Nutritionists & Dietitians 1 Health Educators 1 Health Inspectors/Sanitarians 30 Community Health Workers Other Professional & Technical Support Staff *** 3




1: 859

1: 2,863 1: 1,074 1: 8,590 1: 4.295 1: 291 1: 592 1: 2,147 1: 8,590 1: 17,179 1: 17,179 1: 17,179 1: 573

1: 5.726

1: 94


61


1.5 Current health workforce with pattern of utilisation


MAJOR CATEGORIES for Main District Health 1989 Hospital Hospital Cenln'J

(%) (%) Clinks(%)

General Medical Practitioner 20 67 33 Specialist/Consultant Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist 6 67 33 Dental Therapist 5 100 Dental Assistant 2 100 Dental Technician 2 100 Dental Nurse 7 100 Nursing SisterlRegistered Nurse 40 67 33 Midwife - Nurse 5 100 Public Health NurselCommunity Nurse 14 64 36 Nurse Aide 29 55 45 Student Nurse 8* 100 Medical Technologist 1 100 Laboratory Technologist 7 88 14 Radiographer 2 100 Anaesthetic Technician! Assistant Pharmacist 2 100 Dispensary Assistant 4 100 Nutritionist Dietitian 100 Health Education Health Personnel Educator 1 100 Health Inspector 30 67 33 Sanitarian Physiotherapist 100 Health Statistician 100 Computer Operator Health Administrator 100 Bio-medical Engineer 100


* Not included in total health workforce as still in training.

62




MAJOR CATEGORIES for Main District Health 1989 Hospital Hospital Cenln'J

(%) (%) Clinks(%)

General Medical Practitioner 20 67 33 Specialist/Consultant Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist 6 67 33 Dental Therapist 5 100 Dental Assistant 2 100 Dental Technician 2 100 Dental Nurse 7 100 Nursing SisterlRegistered Nurse 40 67 33 Midwife - Nurse 5 100 Public Health NurselCommunity Nurse 14 64 36 Nurse Aide 29 55 45 Student Nurse 8* 100 Medical Technologist 1 100 Laboratory Technologist 7 88 14 Radiographer 2 100 Anaesthetic Technician! Assistant Pharmacist 2 100 Dispensary Assistant 4 100 Nutritionist Dietitian 100 Health Education Health Personnel Educator 1 100 Health Inspector 30 67 33 Sanitarian Physiotherapist 100 Health Statistician 100 Computer Operator Health Administrator 100 Bio-medical Engineer 100


* Not included in total health workforce as still in training.

62

Coole Islands

1.6 Current and projected health workforce according to age group

Number of Health Workers Total Projection by Age Group for for

21-30 31-40 41-50 51-60 61+~ 1989 1995

General Medi~al Practitioner 1 3 5 5 2 20* 20 Specialist/Consultant Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist 2 2 6 9 Dental Therapist 5 5 9 Dental Assistant 2 2 Dental Technician 1 1 2 Dental Nurse 1 3 3 2 Nursing SisterlRegistered Nurse 5 8 14 8 5 40 Midwife-Nurse 1 1 3 5 Public Health Nurse/Community Nurse 2 7 3 1 14 Nurse Aide 10 9 9 1 29 Student Nurse 8 8**

Medical Technologist 1 Laboratory Technologist 4 3 7 Radiographer I 1 2 Anaesthetic Technician! Assistant 3 Pharmacist 1 2 Dispensary Assistant 2 4 Nutritionist Dietitian 1 Health Personnel Educator Health Education Technician Health Inspector 19 2 5 3 1 30 Sanitarian Physiotherapist 1

Health Statistician 1 1 Computer Operator Health Administrator Bio-medical Engineer I

Total 182

* Total does not tally. Possibly due to incomplete data.

** Not included in the total workforce because still in training.

63

Coole Islands



21-30 31-40 41-50 51-60 61+~ 1989 1995

General Medi~al Practitioner 1 3 5 5 2 20* 20 Specialist/Consultant Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist 2 2 6 9 Dental Therapist 5 5 9 Dental Assistant 2 2 Dental Technician 1 1 2 Dental Nurse 1 3 3 2 Nursing SisterlRegistered Nurse 5 8 14 8 5 40 Midwife-Nurse 1 1 3 5 Public Health Nurse/Community Nurse 2 7 3 1 14 Nurse Aide 10 9 9 1 29 Student Nurse 8 8**

Medical Technologist 1 Laboratory Technologist 4 3 7 Radiographer I 1 2 Anaesthetic Technician! Assistant 3 Pharmacist 1 2 Dispensary Assistant 2 4 Nutritionist Dietitian 1 Health Personnel Educator Health Education Technician Health Inspector 19 2 5 3 1 30 Sanitarian Physiotherapist 1

Health Statistician 1 1 Computer Operator Health Administrator Bio-medical Engineer I

Total 182

* Total does not tally. Possibly due to incomplete data.

** Not included in the total workforce because still in training.

63


1.7 Trends in health sector budget in relation to national budget for the period 1988·1990

Budget (NZ$) 1988 1989 1990

Total Public Sector Budget 55,776,300 57,062,400 56,274,900

Total Health Budget 4.665.900 3.971,900 4.824.100


Health Budget as Percentage of Total Budget 8.4 6.97 8.57

64



Budget (NZ$) 1988 1989 1990


Total Health Budget 4.665.900 3.971,900 4.824.100



64

Cook lslonds

Section 2. Major Issues'


1. No designated entity directly responsible for health planning activities or health workforce planning.

2. Planning and assessment of staff requirements for the Ministry usually only carried out during preparation of annual budget.

3. Lack of proper coordination of health workforce planning at inter and intra ministry level:

e.g. - with major service division • with Public Service Commission

4. Lack of skills in workforce planning.

5. Lack of appropriate health data for health workforce planning.

2.2 Types of infonnation required to enhance policy fonnulation and management decision making relating to the above issues

1. Appropriate data base penaining to current health workforce:

- total numbers - age. sex and distribution - available specialities - factors affecting supply of manpower - training and attrition rates

2. Ministry of Health policies and priorities concerning its future direction.


65

Cook lslonds



1. No designated entity directly responsible for health planning activities or health workforce planning.

2. Planning and assessment of staff requirements for the Ministry usually only carried out during preparation of annual budget.

3. Lack of proper coordination of health workforce planning at inter and intra ministry level:

e.g. - with major service division • with Public Service Commission

4. Lack of skills in workforce planning.

5. Lack of appropriate health data for health workforce planning.

2.2 Types of infonnation required to enhance policy fonnulation and management decision making relating to the above issues

1. Appropriate data base penaining to current health workforce:

- total numbers - age. sex and distribution - available specialities - factors affecting supply of manpower - training and attrition rates

2. Ministry of Health policies and priorities concerning its future direction.


65

The Heallh Wor/iforce




The current national health plan is included in the national development plan and covers the period 1988-1992. The Director General of Health Services, in collaboration with the executive committee is responsible for development of the plan. The executive committee comprise the directors of Administration, dental, medical, nursing and public health services.


Present

Period covered


Major source of planning information

Planning method

Linkage to NHP

Linkage to other plans


Other major documentation on health worliforce

· No specific health workforce plan · Health manpower development addressed in the (draft)

development plan.

1988-1992

· Director General of Health Services and executive committee

· Manpower development unit of Public Service Commission

· Total numbers of establishment · Distribution of staff within available health facilities · Training and attrition statistics · Staffloses · Age groups of staff

Based on ad hoc needs analysis

Health manpower development is contained in the health sector plan within the (draft) national development plan for 1988-1992.

No formal arrangements exists.

Health sector plan and manpower development plan in the First Development Plan 1988-1992.

66

The Heallh Wor/iforce




The current national health plan is included in the national development plan and covers the period 1988-1992. The Director General of Health Services, in collaboration with the executive committee is responsible for development of the plan. The executive committee comprise the directors of Administration, dental, medical, nursing and public health services.


Present

Period covered



Planning method

Linkage to NHP



Other major documentation on health worliforce

· No specific health workforce plan · Health manpower development addressed in the (draft)

development plan.

1988-1992

· Director General of Health Services and executive committee

· Manpower development unit of Public Service Commission

· Total numbers of establishment · Distribution of staff within available health facilities · Training and attrition statistics · Staffloses · Age groups of staff

Based on ad hoc needs analysis

Health manpower development is contained in the health sector plan within the (draft) national development plan for 1988-1992.

No formal arrangements exists.

Health sector plan and manpower development plan in the First Development Plan 1988-1992.

66

Cook IsI4ruIs



AREAS Yes No High Medium Low

Health Planning X X


Project Planning and Appraisal X X

Health System Research X X



Computerising Data Base X X

Planning of Educational Programme and Curriculum X X

Others



Existence of clear policies and plans Policies on human resources development are reflected in the 1988-1992 (draft) development plan.

Body responsible for educational planning . Director General of Health and the executive

Linkage of educational planning to NHP

Liaison between service providers and training institutions

committee · Manpower development unit of the Public

Service Commission

· Policies for human resources development ace clearly set out in the health sector plan.

· Liaison exists between service providers and training personnel in the development of training programmes and their actual implementation.

67

Cook IsI4ruIs




Health Planning X X








Others



Existence of clear policies and plans Policies on human resources development are reflected in the 1988-1992 (draft) development plan.

Body responsible for educational planning . Director General of Health and the executive



committee · Manpower development unit of the Public

Service Commission

· Policies for human resources development ace clearly set out in the health sector plan.

· Liaison exists between service providers and training personnel in the development of training programmes and their actual implementation.

67


3.2.2 Problems associated with local training programmes and suggested remedial activities (as reported by the country correspondent)

Probleam Assodated wilh Local Trainiug Suggested Remedial Activities

· Unavailability of resource persons to properly . Selection of skilled, experienced and implement local training program committed coordinators for local training

· Lack of adequate funds to provide stationery, supplies and materials

· Outdated nursing training curriculum with no locally available expertise to review it

programmes

· Appropriate training of coordinator on implementation and evaluation of training programmes

· Selectional of trainees with better educational background

· Support from decision making level in the Ministry of Health

· Technical assistance for review of nursing curriculum


Average Average Average NameorTraining~m Duration Intake Graduates Attrition

(years) per Year per Year per Year (%)

Nursing 3 12 30

Nurse Practitioner 1 8

Dental Therapist 2 6

Public Health Inspector 3 8 20

68


3.2.2 Problems associated with local training programmes and suggested remedial activities (as reported by the country correspondent)

Probleam Assodated wilh Local Trainiug Suggested Remedial Activities

· Unavailability of resource persons to properly . Selection of skilled, experienced and implement local training program committed coordinators for local training

· Lack of adequate funds to provide stationery, supplies and materials

· Outdated nursing training curriculum with no locally available expertise to review it

programmes

· Appropriate training of coordinator on implementation and evaluation of training programmes

· Selectional of trainees with better educational background

· Support from decision making level in the Ministry of Health

· Technical assistance for review of nursing curriculum


Average Average Average NameorTraining~m Duration Intake Graduates Attrition


Nursing 3 12 30

Nurse Practitioner 1 8

Dental Therapist 2 6

Public Health Inspector 3 8 20

68

Cook lslllnds


Name 01 Number

Training Name of Category of Completed Institution Program of Staff Trainees Training

Fiji School of Medicine MBBS Trainee 8 DPHI Trainee I

NSW University MHA Senior Staff

Sydney University MDS Senior Staff

Middlemore Hospital GENT Senior Nurse

Auckland Hospital Paediatrics Nursing Sister Surgical Staff Nurse Medical

ATYNZ Advanced Diploma Nursing Sister in Nursing 4 4

Napier Hospital Theatre Staff Nurse I

Hastings Hospital Nursing Staff Nurse I

NSW University, Australia BSc Nursing Nursing Sister I

Hawaii Management PHC Nursing Sister 5 5

Ministry of Health, Fiji Midwifery Staff Nurse 7 5 Post-basic Staff Nurse 5 5 Public Health

FSM,Fiji Public Health Trainee Public 8 8 Health Inspector

Laboratory Assistant Trainee I

Australia Health Education 1

69

Cook lslllnds


Name 01 Number


Fiji School of Medicine MBBS Trainee 8 DPHI Trainee I

NSW University MHA Senior Staff

Sydney University MDS Senior Staff

Middlemore Hospital GENT Senior Nurse

Auckland Hospital Paediatrics Nursing Sister Surgical Staff Nurse Medical

ATYNZ Advanced Diploma Nursing Sister in Nursing 4 4

Napier Hospital Theatre Staff Nurse I

Hastings Hospital Nursing Staff Nurse I

NSW University, Australia BSc Nursing Nursing Sister I

Hawaii Management PHC Nursing Sister 5 5

Ministry of Health, Fiji Midwifery Staff Nurse 7 5 Post-basic Staff Nurse 5 5 Public Health

FSM,Fiji Public Health Trainee Public 8 8 Health Inspector

Laboratory Assistant Trainee I

Australia Health Education 1

69


3.2.5 Fellowships

Fellowship determination process

Selection body


Other constraints


· Heads of Divisions make recommendations to Director General of Health:

i. Shon term fellowships Director General submits recommendations to Minister for approval

ii. Long term training Director General submits recommendation to manpower development unit of Public Service Commission.

· Director General of Health · Manpower development unit of Public Service

Commission · Scholarship committee · Cabinet

· Mostly for undergraduate training

· Difficulty in retention of candidates sent for specialist trainings.

3.3.1 Percentage of health workforce with job descriptions and review arrangements


80% *


70


3.2.5 Fellowships


Selection body


Other constraints


· Heads of Divisions make recommendations to Director General of Health:

i. Shon term fellowships Director General submits recommendations to Minister for approval

ii. Long term training Director General submits recommendation to manpower development unit of Public Service Commission.

· Director General of Health · Manpower development unit of Public Service

Commission · Scholarship committee · Cabinet

· Mostly for undergraduate training

· Difficulty in retention of candidates sent for specialist trainings.



80% *


70

Cook Islands



· Laxity in effective supervision of staff and personnel management

· Lack of coordination between divisional heads in matters pertaining to effective personnel management

· Need to develop management capabilities in supervisors

71

Inc:entive Provided to Staff

. Special allowances for staff posted to outer stations

. An allowance of $18 per day or outstation allowance of 20% of gross salary is payable to staff on temporary transfer to outer-stations for periods less than six months

Cook Islands



· Laxity in effective supervision of staff and personnel management

· Lack of coordination between divisional heads in matters pertaining to effective personnel management

· Need to develop management capabilities in supervisors

71

Inc:entive Provided to Staff

. Special allowances for staff posted to outer stations

. An allowance of $18 per day or outstation allowance of 20% of gross salary is payable to staff on temporary transfer to outer-stations for periods less than six months

The HeaIIh Workforce

3.3.3 Existence o/written guidelines/or routine personnel management

Area Yes No Strengths & Weaknesses

Detennining Establishment 0 0 Need strengthening

Recruitment Process 0 0 Need reviewing

Selection Procedures 0 0 Need reviewing

Induction Programmes 0 0 Need strengthening

Supportive Supervision Process 0 0 Needed

Perfonnance Appraisal 0 0 Needed

In-Service Training 0 0 Only in some areas

Special Incentives & Rewards 0 0 Needed

Detennining Career Path 0 0 Need clear policies

Task Analysis Procedure 0 0 Need clear policies

Designing of Job Profiles 0 0 Need clear policies

Management of Records 0 0 Need technical support

Others 0 0


72

The HeaIIh Workforce

3.3.3 Existence o/written guidelines/or routine personnel management


Detennining Establishment 0 0 Need strengthening



Induction Programmes 0 0 Need strengthening

Supportive Supervision Process 0 0 Needed

Perfonnance Appraisal 0 0 Needed

In-Service Training 0 0 Only in some areas

Special Incentives & Rewards 0 0 Needed

Detennining Career Path 0 0 Need clear policies

Task Analysis Procedure 0 0 Need clear policies

Designing of Job Profiles 0 0 Need clear policies

Management of Records 0 0 Need technical support

Others 0 0


72

Cook Isltuuls

3.3.4 Professional bodies and their involvement inprofesstdnal, industrial, or management decision making

Professional Bodies

Professional Associations

1. Medical and Dental Association

2. Nursing Association


73


*

- Responsible for licensing and registration of doctors and dentists to practice medicine and dentistry

- Have powers to de-register practitioners

- Concerned with standards of nursing care

- Expresses its views and opinions to the attention of the Executive Committee

Cook Isltuuls

3.3.4 Professional bodies and their involvement inprofesstdnal, industrial, or management decision making

Professional Bodies


1. Medical and Dental Association

2. Nursing Association


73


*

- Responsible for licensing and registration of doctors and dentists to practice medicine and dentistry

- Have powers to de-register practitioners

- Concerned with standards of nursing care

- Expresses its views and opinions to the attention of the Executive Committee


FEDERATED STATES OF MICRONESIA

Section 1: Country Health and Economic Prome


*

Indicator

Area Estimated population Annual population growth rare Percentage of population


Urban population Rate of natural increase of population per annum Crude birth rate (per 1000) Crude death rate (per WOO) Life expectancy at birth (years)

- male - female



Information not provided.

Data

0.7 sq. Ian. %,000 (est. 1989) 1.8%

* * 48.0%

* 23.8

*

* * 17.9 50%

60% 60%



- Influenza - Gonorrhoea - Gastroenteritis, presumed infections - Conjunctivitis - Diarrhoea (infantile) - Chickenpox - Leprosy - Tuberculosis (pulmonary)


- Chronic obstructive pulmonary disease and allied conditions

- Diseases of heart - Benign and malignant neoplasm - Cerebrovascular diseases - Suicide - Pneumonia and influenza - Accidents. all type - Tuberculosis (all types) - Diabetes mellitus - Septicemia

74


FEDERATED STATES OF MICRONESIA



*

Indicator

Area Estimated population Annual population growth rare Percentage of population


Urban population Rate of natural increase of population per annum Crude birth rate (per 1000) Crude death rate (per WOO) Life expectancy at birth (years)

- male - female




Data

0.7 sq. Ian. %,000 (est. 1989) 1.8%

* * 48.0%

* 23.8

*

* * 17.9 50%

60% 60%



- Influenza - Gonorrhoea - Gastroenteritis, presumed infections - Conjunctivitis - Diarrhoea (infantile) - Chickenpox - Leprosy - Tuberculosis (pulmonary)


- Chronic obstructive pulmonary disease and allied conditions

- Diseases of heart - Benign and malignant neoplasm - Cerebrovascular diseases - Suicide - Pneumonia and influenza - Accidents. all type - Tuberculosis (all types) - Diabetes mellitus - Septicemia

74


Number of Type of Health Facilities Total Number Beds

Main referral hospital 4 300 District hospital Health centre/clinics 62

Total fj(j 300


Category of Health Personnel Total No.

Medical Officers 38 Medical Assistants'" 31 Dental Officers 8 Dental Assistants .... 36 Pharmacists! Assistant Pharmacists 16 Pharmacy Assistants 113 Nurses 197 Nurse Aides & Enrolled Nurses 79 MedicallLaboratory Technologists 18 Radiographers II Physiotherapist 6 Nutritionists & Dietitians 4 Health Educators 12 Health Inspectors/Sanitarians 31 Community Health Workers 7 Other Professional & Technical Suppon sta:ff*·* 26



3.1

3.1

Population Ratio

1: 1,526 I: 3,097 1: U,OOO I: 2,667 I: 6,000 I: 850 1: 487 I: 1,215 1: 5,333 1: 8,727 1: 16,000 1: 24,000 1: 8,000 1: 3,097 1: 13,714 1: 3,692

1: 151

... Includes Health Officers, Health Extension Officers and Anaesthetic AssistantslTechnicians.


*** Include Health Statisticians, Computer Operators. Bio-medical Engineers and Health Administrators.

75



Main referral hospital 4 300 District hospital Health centre/clinics 62

Total fj(j 300



Medical Officers 38 Medical Assistants'" 31 Dental Officers 8 Dental Assistants .... 36 Pharmacists! Assistant Pharmacists 16 Pharmacy Assistants 113 Nurses 197 Nurse Aides & Enrolled Nurses 79 MedicallLaboratory Technologists 18 Radiographers II Physiotherapist 6 Nutritionists & Dietitians 4 Health Educators 12 Health Inspectors/Sanitarians 31 Community Health Workers 7 Other Professional & Technical Suppon sta:ff*·* 26



3.1

3.1

Population Ratio

1: 1,526 I: 3,097 1: U,OOO I: 2,667 I: 6,000 I: 850 1: 487 I: 1,215 1: 5,333 1: 8,727 1: 16,000 1: 24,000 1: 8,000 1: 3,097 1: 13,714 1: 3,692

1: 151

... Includes Health Officers, Health Extension Officers and Anaesthetic AssistantslTechnicians.


*** Include Health Statisticians, Computer Operators. Bio-medical Engineers and Health Administrators.

75

The Health Worlcforce



MAJOR CATEGORIES for Main District Healtb 1989 Hospital Hospital Centre!

(%) (%) C6nics(%)

General Medical Practitioner 28 84 16 Specialist/Consultant 10 73 27 Health Officer 8 78 22 Health Extension Officer 6 78 22 Medical Assistant 11 73 27 Community Health Worker 7 76 24 Dentist 8 76 24 Dental Therapist 4 78 22 Dental Assistant 23 73 27 Dental Technician 9 76 24 Dental Nurse Nursing SisterfRegistered Nurse 120 93 7 Midwife - Nurse 28 76 24 Public Health Nurse/Community Nurse 49 66 34 Nurse Aide 79 66 34 Student Nurse 11* 76 24 Medical Technologist Laboratory Technologist 18 84 16 Radiographer 11 93 7 Anaesthetic Technician! Assistant 6 93 7 Pharmacist 16 93 7 Dispensary Assistant 113 43 57 Nutritionist 2 50 50 DietitianlDietetic Assistant 2 100 He~ducation 60 40 Health Personnel Educator 11 71 29 Health InspectorlEnvironmentai Health 4 83 17 Sanitarian 27 56 44 PhysiotherapistlPhysio. Assistant 6 73 27 Health Statistician 11 86 14 Computer Operator 5 94 6 Health Administration 8 76 24 Bio-medical Engineer 2 100

Total Healtb Workforce 633

* Not included in total workforce because still in training.

76




MAJOR CATEGORIES for Main District Healtb 1989 Hospital Hospital Centre!

(%) (%) C6nics(%)

General Medical Practitioner 28 84 16 Specialist/Consultant 10 73 27 Health Officer 8 78 22 Health Extension Officer 6 78 22 Medical Assistant 11 73 27 Community Health Worker 7 76 24 Dentist 8 76 24 Dental Therapist 4 78 22 Dental Assistant 23 73 27 Dental Technician 9 76 24 Dental Nurse Nursing SisterfRegistered Nurse 120 93 7 Midwife - Nurse 28 76 24 Public Health Nurse/Community Nurse 49 66 34 Nurse Aide 79 66 34 Student Nurse 11* 76 24 Medical Technologist Laboratory Technologist 18 84 16 Radiographer 11 93 7 Anaesthetic Technician! Assistant 6 93 7 Pharmacist 16 93 7 Dispensary Assistant 113 43 57 Nutritionist 2 50 50 DietitianlDietetic Assistant 2 100 He~ducation 60 40 Health Personnel Educator 11 71 29 Health InspectorlEnvironmentai Health 4 83 17 Sanitarian 27 56 44 PhysiotherapistlPhysio. Assistant 6 73 27 Health Statistician 11 86 14 Computer Operator 5 94 6 Health Administration 8 76 24 Bio-medical Engineer 2 100

Total Healtb Workforce 633


76

Federated States of Mieronesill



21-30 31-40 41-50 51-60 61+ 1989 1995

General Medical Practitioner 14 10 4 28 41 Specialist/Consultant 3 6 I 10 IS Health Officer 2 I 5 8 16 Health Extension Officer 3 3 6 10 Medical Assistant 3 6 2 II 19 Community Health Worker 2 4 I 7 12 Dentist 2 3 3 8 I3 Dental Therapist 4 4 7 Dental Assistant 4 II 7 23 30 Dental Technician 3 5 9 18 Dental Nurse Nursing SisterlRegistered Nurse 34 76 8 2 120 158 Midwife-Nurse 5 11 12 28 35 Public Health Nurse/Community Nurse 7 7 16 19 49 66 Nurse Aide 30 26 15 8 79 103 Student Nurse 5 3 3 II* 15* Medical Technologist 2 Laboratory Technologist 4 10 4 18 23 Radiographer 4 3 2 II 15 Anaesthetic T echnicianl Assistant 5 6 8 Pharmacist 5 4 5 16 19 Dispensary Assistant 14 36 27 36 113 141 Nutritionist 2 2 5 DietitianlDietetic Assistant 1 1 2 5 Health Personnel Educator 5 3 3 11 15 Health Education I 4 Health InspectoriEnvironmental Health 2 1 1 4 6 Sanitarian 3 4 16 3 0 27 35 PhysiotherapistlPhysio. Assistant 1 2 3 6 8 Health Statistician 2 2 2 5 11 14 Computer Operator 3 1 5 7 Health Administrator 4 4 8 10 Bio-medical Engineer 2 4

Total Workforce 633 864


77

Federated States of Mieronesill



21-30 31-40 41-50 51-60 61+ 1989 1995

General Medical Practitioner 14 10 4 28 41 Specialist/Consultant 3 6 I 10 IS Health Officer 2 I 5 8 16 Health Extension Officer 3 3 6 10 Medical Assistant 3 6 2 II 19 Community Health Worker 2 4 I 7 12 Dentist 2 3 3 8 I3 Dental Therapist 4 4 7 Dental Assistant 4 II 7 23 30 Dental Technician 3 5 9 18 Dental Nurse Nursing SisterlRegistered Nurse 34 76 8 2 120 158 Midwife-Nurse 5 11 12 28 35 Public Health Nurse/Community Nurse 7 7 16 19 49 66 Nurse Aide 30 26 15 8 79 103 Student Nurse 5 3 3 II* 15* Medical Technologist 2 Laboratory Technologist 4 10 4 18 23 Radiographer 4 3 2 II 15 Anaesthetic T echnicianl Assistant 5 6 8 Pharmacist 5 4 5 16 19 Dispensary Assistant 14 36 27 36 113 141 Nutritionist 2 2 5 DietitianlDietetic Assistant 1 1 2 5 Health Personnel Educator 5 3 3 11 15 Health Education I 4 Health InspectoriEnvironmental Health 2 1 1 4 6 Sanitarian 3 4 16 3 0 27 35 PhysiotherapistlPhysio. Assistant 1 2 3 6 8 Health Statistician 2 2 2 5 11 14 Computer Operator 3 1 5 7 Health Administrator 4 4 8 10 Bio-medical Engineer 2 4



77

The HeaIJh Workforce


Budget (US$) 1988 1989 1990

Total Public Sector Budget * 89.834.851 *

Total Health Budget 12.171.369

Per Capita Allocation for Health 116.96

Health Budget as Percentage of Total Budget 13.4%

* Infonnation not provided.

78

The HeaIJh Workforce


Budget (US$) 1988 1989 1990

Total Public Sector Budget * 89.834.851 *

Total Health Budget 12.171.369

Per Capita Allocation for Health 116.96

Health Budget as Percentage of Total Budget 13.4%


78

Federated States of Micronesia

Section 2. Major Issues·


1. Retention of skilled health workers. 2. Training of appropriate categories of health workers in appropriate

numbers to ensure employment at completion of training. 3. Poor working conditions and low prestige of the medical professions.


1. Inventory of existing manpower. 2. Projections of future needs. 3. Workload estimates. 4. Available training facilities. 5. Available consultants and trainers. 6. Cost-effectiveness of primary health care.


79

Federated States of Micronesia



1. Retention of skilled health workers. 2. Training of appropriate categories of health workers in appropriate

numbers to ensure employment at completion of training. 3. Poor working conditions and low prestige of the medical professions.


1. Inventory of existing manpower. 2. Projections of future needs. 3. Workload estimates. 4. Available training facilities. 5. Available consultants and trainers. 6. Cost-effectiveness of primary health care.


79

The Heallil Workforce




Individual states have separate health plans covering the period from 1990 -1995. The office of planning and statistics is responsible for coordinating these plans.


*

Present

Period covered



Planning method

Linkage to NHP




At the present time, not applicable.

No overall plan.

* Planning Manpower Section

Manpower requirements by state directors of health.

Based on needs.

*

* No formal arrangements.

No other documentations available.

80

The Heallil Workforce




Individual states have separate health plans covering the period from 1990 -1995. The office of planning and statistics is responsible for coordinating these plans.


*

Present

Period covered



Planning method

Linkage to NHP




At the present time, not applicable.

No overall plan.

* Planning Manpower Section

Manpower requirements by state directors of health.

Based on needs.

*

* No formal arrangements.

No other documentations available.

80

Federated States oj Micronesia




Health Planning X X








Others







No overall policies apart from some inhouse policies for some aspects of training.

Administrators at the State Health Depanments.

Very general.

Liaison exists with WHO and depanment of human resources.

81

Federated States oj Micronesia




Health Planning X X








Others







No overall policies apart from some inhouse policies for some aspects of training.

Administrators at the State Health Depanments.

Very general.

Liaison exists with WHO and depanment of human resources.

81



Problems Associated with Local Training

· Shortage of training staff · Low academic level of high schools · Lack of scholastic motivation · Lack of continuity as a result of

constantly changing expatriates · Insufficient resources invested in

education in general

Suggested Remedial Activities

· More emphasis on education · Educational evaluation · International exposure and training for

more educators


Average Average Average Name of Training Program Duration Intake Graduates Attrition

per Year per Year per Year

College of Micronesia School of Nursing I year

Pacific Basin no graduates Medical Officers Training 5 years 25 as yet

3.2.4 Major regional/overseas training programmes utilised over the last 5 years

Name of Training Institution

*

* No information provided

Name of Program

*

82

Category of Staff

*

Number

of Completed Trainees Training

* *




· Shortage of training staff · Low academic level of high schools · Lack of scholastic motivation · Lack of continuity as a result of

constantly changing expatriates · Insufficient resources invested in

education in general


· More emphasis on education · Educational evaluation · International exposure and training for

more educators




College of Micronesia School of Nursing I year

Pacific Basin no graduates Medical Officers Training 5 years 25 as yet


Name of Training Institution

*

* No information provided

Name of Program

*

82

Category of Staff

*

Number

of Completed Trainees Training

* *

3.2.5 Fellowships


Selection body

Difficulties in obtaining suitllble candidates

Other constraints



Federated StaUs of Micronesia

· State Health Directors identify areas of training · Human Resources Office compiles information and

presented to WHO for fellowship numbers · Final selection done at the national level

· State Health Directors · Office of Human Resources

Experienced in identifying qualified candidates

*

3.3.1 Percentage oj health worliforce with job descriptions and review arrangements


100% No information provided. 75% are up-to-date

3.3.2 Difficulties experienced in management oj health personnel and incentives provided to staff


· Insufficient management skills · Concept of long term career is not popular · Relatively low morale · Work overload · Lack of skills and training · Low prestige of health professionals

83


. Housing for staff deployed in outstations

. Annual merit increases

3.2.5 Fellowships


Selection body

Difficulties in obtaining suitllble candidates

Other constraints



Federated StaUs of Micronesia

· State Health Directors identify areas of training · Human Resources Office compiles information and

presented to WHO for fellowship numbers · Final selection done at the national level

· State Health Directors · Office of Human Resources

Experienced in identifying qualified candidates

*

3.3.1 Percentage oj health worliforce with job descriptions and review arrangements


100% No information provided. 75% are up-to-date



· Insufficient management skills · Concept of long term career is not popular · Relatively low morale · Work overload · Lack of skills and training · Low prestige of health professionals

83


. Housing for staff deployed in outstations

. Annual merit increases


3.3.3 Existence o/written guidelines/or routine personnel management *


0 D Instructions are fairly specific and

Detennining Establishment applied on an every day basis in all departments.

Recruitment Process 0 D Selection Procedures 0 D Induction Programmes D 0 Supportive Supervision Process 0 D Perfonnance Appraisal 0 D In-Service Training D 0 Special Incentives & Rewards D 0 Detennining Career Path 0 D Task Analysis Procedure 0 D Designing of Job Profiles 0 D Management of Records D D Others D D

* As reported by country respondent.

84




0 D Instructions are fairly specific and

Detennining Establishment applied on an every day basis in all departments.

Recruitment Process 0 D Selection Procedures 0 D Induction Programmes D 0 Supportive Supervision Process 0 D Perfonnance Appraisal 0 D In-Service Training D 0 Special Incentives & Rewards D 0 Detennining Career Path 0 D Task Analysis Procedure 0 D Designing of Job Profiles 0 D Management of Records D D Others D D


84

Federated States of Miero"esill


Professional Bodies State Health Advisory Board

Professional Associations Pacific Islands Health Organisation Association

South Pacific Islands Network

85


Decisions on major projects

Mediating between FSM and Northern Pacific Islands

Federated States of Miero"esill


Professional Bodies State Health Advisory Board

Professional Associations Pacific Islands Health Organisation Association

South Pacific Islands Network

85


Decisions on major projects

Mediating between FSM and Northern Pacific Islands

The Health Worliforce

FIJI



Indicator



Urban population

Data

18,300 sq. lan. 727,000 (est 1989) 2%


38.2% 2.9% 70% 2.4% 29.8 5.6 Crude death rate (per 10(0)





61 65 19.8 79%

90%

*



- Respiratory disease - Circulatory disease - Circulatory disease - Neoplasm - Injury and poisoning - Infections and parasitic diseases - Genitourinary diseases - Respiratory diseases - Infections and parasitic diseases - Endocrine. nutritional and metabolic disease

86

The Health Worliforce

FIJI



Indicator



Urban population

Data

18,300 sq. lan. 727,000 (est 1989) 2%







61 65 19.8 79%

90%

*



- Respiratory disease - Circulatory disease - Circulatory disease - Neoplasm - Injury and poisoning - Infections and parasitic diseases - Genitourinary diseases - Respiratory diseases - Infections and parasitic diseases - Endocrine. nutritional and metabolic disease

86

Fiji


Number of Hospital Beds per Type of Health FacilitieS Total Number Beds 1000 Population

Main referral hospital 3 822 } 1.76 District hospital 15 459 Health centre/clinics 151 20

Total 169 1,301 1.76*




Medical Officers 260 1: 2,796 Medical Assistants * 79 1: 9,203 Dental Officers 28 1: 25,964 Dental Assistants ** 103 1: 7,058 Pharmacists! Assistant Pharmacists 20 1: 36,350 Dispensary Assistants 10 1: 72,700 Nurses 1,485 1: 490 Nurse Aides & Enrolled Nurses MedicallLaboratory Technologists 58 I: 12,534 Radiographers 53 I: 13,717 Physiotherapists 20 1: 36,350 Nutritionists & Dietitians 23 1: 31,609 Health Educators Health Inspectors/Sanitarians 90 1: 8,078 Community Health Workers Other Professional & Technical Support staff*** 125 1: 5,816

Total Health Workers 2,354 1: 309

* Includes Health Officers, Health Extension OfflCers and Anaesthetic AssistantsIT echnicians.

**

***

Includes Dental Technicians, Therapists and Nurses.

Include Health Statisticians, Computer Operators, Bio-medical Engineers and Health Administrators.

87

Fiji


Number of Hospital Beds per Type of Health FacilitieS Total Number Beds 1000 Population

Main referral hospital 3 822 } 1.76 District hospital 15 459 Health centre/clinics 151 20

Total 169 1,301 1.76*




Medical Officers 260 1: 2,796 Medical Assistants * 79 1: 9,203 Dental Officers 28 1: 25,964 Dental Assistants ** 103 1: 7,058 Pharmacists! Assistant Pharmacists 20 1: 36,350 Dispensary Assistants 10 1: 72,700 Nurses 1,485 1: 490 Nurse Aides & Enrolled Nurses MedicallLaboratory Technologists 58 I: 12,534 Radiographers 53 I: 13,717 Physiotherapists 20 1: 36,350 Nutritionists & Dietitians 23 1: 31,609 Health Educators Health Inspectors/Sanitarians 90 1: 8,078 Community Health Workers Other Professional & Technical Support staff*** 125 1: 5,816

Total Health Workers 2,354 1: 309

* Includes Health Officers, Health Extension OfflCers and Anaesthetic AssistantsIT echnicians.

**

***

Includes Dental Technicians, Therapists and Nurses.

Include Health Statisticians, Computer Operators, Bio-medical Engineers and Health Administrators.

87


1.5 Current health workforce with paUern of utilisation


MAJOR CATEGORIES lor Main District Health 1989 Hospital Hospital Cenlrel

(%) (%) Clinics(%)

General Medical Practitioner 242 68 17 IS Specialist/Consultant 18 93 7 Health Officer 29 Health Extension Officer Medical Assistant 50 16 23 61 Community Health Worker Dentist 28 58 26 16 Dental Therapist 49 47 33 20 Dental Assistant 50 47 23 30 Dental Technician 4 100 Dental Nurse Nursing SisterlRegistered Nurse 1,485 Midwife - Nurse Public Health Nurse/Community Nurse Nurse Aide Student Nurse Medical Technologist Laboratory Technologist 58 96 4*

Radiographer 53 98 2 Anaesthetic Technician! Assistant Pharmacist 20 50 5 45 Dispensary Assistant 10 73 27 Nutritionist I 100*

Dietitian 22 83 8 9 Health Education Health Personnel Educator Health Inspector 90 100 Sanitarian Physiotherapist 20 100 Health Statistician 100**

Computer Operator Health Administration 64 26 10 Bio-medical Engineer 2 100

Total Health Workforce 2,354

* Medical School ** Ministry Headquarters

88


1.5 Current health workforce with paUern of utilisation


MAJOR CATEGORIES lor Main District Health 1989 Hospital Hospital Cenlrel

(%) (%) Clinics(%)

General Medical Practitioner 242 68 17 IS Specialist/Consultant 18 93 7 Health Officer 29 Health Extension Officer Medical Assistant 50 16 23 61 Community Health Worker Dentist 28 58 26 16 Dental Therapist 49 47 33 20 Dental Assistant 50 47 23 30 Dental Technician 4 100 Dental Nurse Nursing SisterlRegistered Nurse 1,485 Midwife - Nurse Public Health Nurse/Community Nurse Nurse Aide Student Nurse Medical Technologist Laboratory Technologist 58 96 4*

Radiographer 53 98 2 Anaesthetic Technician! Assistant Pharmacist 20 50 5 45 Dispensary Assistant 10 73 27 Nutritionist I 100*

Dietitian 22 83 8 9 Health Education Health Personnel Educator Health Inspector 90 100 Sanitarian Physiotherapist 20 100 Health Statistician 100**

Computer Operator Health Administration 64 26 10 Bio-medical Engineer 2 100

Total Health Workforce 2,354

* Medical School ** Ministry Headquarters

88

Fiji


Number of Health Workers Total Projection by Age Groop for for

21-30 31-40 41-50 51-60 61+ 1989 1995

General Medical Practitioner 77 84 30 51 242 Specialist/Consultant 3 7 8 18 Health Officer 9 10 10 29 Health Extension Officer Medical Assistant 21 29 50 Community Health Worker Dentist 9 11 2 6 28 Dental Therapist 19 23 5 2 49 Dental Assistant 22 26 2 50 Dental Technician 3 1 4 Dental Nurse Nursing Sister/Registered Nurse 155 278 399 333 317 1,485 Midwife-Nurse Public Health Nurse/Community Nurse Nurse Aide Student Nurse Medical Technologist Laboratory Technologist 33 20 3 2 58 Radiographer 28 16 9 53 Anaesthetic Technician! Assistant Pharmacist 10 7 3 20 Dispensary Assistant 1 6 2 1 10 Nutritionist 1 Dietitian 7 13 2 22 Health Personnel Educator Health Education Technician Health Inspector 22 47 10 11 90 Sanitarian Physiotherapist 11 4 4 1 20 Health Statistician 1 Computer Operator Health Administrator 32 65 17 8 122 Bio-medical Engineer 2 2

Total Workforce 2,354

89

Fiji


Number of Health Workers Total Projection by Age Groop for for

21-30 31-40 41-50 51-60 61+ 1989 1995

General Medical Practitioner 77 84 30 51 242 Specialist/Consultant 3 7 8 18 Health Officer 9 10 10 29 Health Extension Officer Medical Assistant 21 29 50 Community Health Worker Dentist 9 11 2 6 28 Dental Therapist 19 23 5 2 49 Dental Assistant 22 26 2 50 Dental Technician 3 1 4 Dental Nurse Nursing Sister/Registered Nurse 155 278 399 333 317 1,485 Midwife-Nurse Public Health Nurse/Community Nurse Nurse Aide Student Nurse Medical Technologist Laboratory Technologist 33 20 3 2 58 Radiographer 28 16 9 53 Anaesthetic Technician! Assistant Pharmacist 10 7 3 20 Dispensary Assistant 1 6 2 1 10 Nutritionist 1 Dietitian 7 13 2 22 Health Personnel Educator Health Education Technician Health Inspector 22 47 10 11 90 Sanitarian Physiotherapist 11 4 4 1 20 Health Statistician 1 Computer Operator Health Administrator 32 65 17 8 122 Bio-medical Engineer 2 2

Total Workforce 2,354

89



Budget (FJDS) 1988 1989 1990

Total Public Sector Budget 498. 10m 539.80m 538. 10m

Total Health Budget 29.40m 32.2Om 37.9Om

Per Capita Allocation for Health 39.31 42.47 49.05


m - millions

90



Budget (FJDS) 1988 1989 1990

Total Public Sector Budget 498. 10m 539.80m 538. 10m

Total Health Budget 29.40m 32.2Om 37.9Om



m - millions

90

Fiji


2.1 Major i~ues concerning planning, development and management of health workforce

1. Need for health planning and research unit to co-ordinate planning activities.

2. Limited financial resources. 3. Shortage of trained manpower. 4. Inadequate pay structure. 5. Brain drain. Professionals leaving the public service. 6. Need to further develop curriculum for Medical and Nursing Schools to

ensure relevance and practical orientation. 7. Curriculum at the two schools is too academically oriented. Needs to be

more problem based. 8. Over-centralization of the public service.

2.2 Types of information required to enhance policy formulation and management decision making relating to the above i~ues

1. Labour supply and demand - all categories. 2. Population, age, ethnicity, sex etc. 3. Epidemiological data 4. Human resources inventory. 5. Health staff/population ratio. 6. Health staff/patient hospital bed ratio. 7. Current staff establishment. 8. Disease profile.


91

Fiji



1. Need for health planning and research unit to co-ordinate planning activities.

2. Limited financial resources. 3. Shortage of trained manpower. 4. Inadequate pay structure. 5. Brain drain. Professionals leaving the public service. 6. Need to further develop curriculum for Medical and Nursing Schools to

ensure relevance and practical orientation. 7. Curriculum at the two schools is too academically oriented. Needs to be

more problem based. 8. Over-centralization of the public service.

2.2 Types of information required to enhance policy formulation and management decision making relating to the above i~ues

1. Labour supply and demand - all categories. 2. Population, age, ethnicity, sex etc. 3. Epidemiological data 4. Human resources inventory. 5. Health staff/population ratio. 6. Health staff/patient hospital bed ratio. 7. Current staff establishment. 8. Disease profile.


91





Currently there is no National Health Plan. A new planning. research and development unit is being proposed to be responsible for its preparation.


Present

Period covered



Planning method

Linkage to NHP




* Currently not applicable.

No.

Not applicable.

· Permanent Secretary of Health · Directors of Administration and Health · Principle of Fiji School of Medicine · Principle of Fiji School of Nursing

No systematic information used

Periodic meetings of the staff board comprising of the permanent secretary and directory based on needs.

*

*

With public service commission.

Personnel mes and kept as follows: Health staff - at the Personnel Unit Nursing staff - at the Nursing Unit Administrative staff - Public Service Committee

92





Currently there is no National Health Plan. A new planning. research and development unit is being proposed to be responsible for its preparation.


Present

Period covered



Planning method

Linkage to NHP




* Currently not applicable.

No.

Not applicable.

· Permanent Secretary of Health · Directors of Administration and Health · Principle of Fiji School of Medicine · Principle of Fiji School of Nursing

No systematic information used

Periodic meetings of the staff board comprising of the permanent secretary and directory based on needs.

*

*

With public service commission.

Personnel mes and kept as follows: Health staff - at the Personnel Unit Nursing staff - at the Nursing Unit Administrative staff - Public Service Committee

92

Fiji




Health Planning X X






Computerising Operation X X

Planning of Educational Programme and Curriculum X ·X

Others



Existence of clear policies and plans Yes. Instituted by both Fiji Schools of Medicine and Nursing.

Body responsible for educational planning Each separate division in collaboration with the Schools of Medicine and Nursing.

Linkage of educational planning to NHP *

Liaison between service providers and Very close link exist between the health training institutions department and the heads of the Schools of

Medicine and Nursing.


93

Fiji




Health Planning X X






Computerising Operation X X

Planning of Educational Programme and Curriculum X ·X

Others



Existence of clear policies and plans Yes. Instituted by both Fiji Schools of Medicine and Nursing.

Body responsible for educational planning Each separate division in collaboration with the Schools of Medicine and Nursing.

Linkage of educational planning to NHP *

Liaison between service providers and Very close link exist between the health training institutions department and the heads of the Schools of

Medicine and Nursing.


93




Lack of staff, funds, coordination, proper facilities and equipment

Difficulty of transport and communication with rural areas

It has been necessary to recruit expatriate teaching staff for the medical school, thus incurring high costs.


· WHO funded workshops with resource personnel are essential.

· Train staff in new teaching methods and update programs.

· More library funds.

· Fellowship awards for training in nursing education.

· More help to in-country training, use of telecommunication and TV for training in remote areas, more transport facilities, fuel etc.

· Activate internal inservice training programme to supplement the needed skills and knowledge.

94




Lack of staff, funds, coordination, proper facilities and equipment

Difficulty of transport and communication with rural areas

It has been necessary to recruit expatriate teaching staff for the medical school, thus incurring high costs.


· WHO funded workshops with resource personnel are essential.

· Train staff in new teaching methods and update programs.

· More library funds.

· Fellowship awards for training in nursing education.

· More help to in-country training, use of telecommunication and TV for training in remote areas, more transport facilities, fuel etc.

· Activate internal inservice training programme to supplement the needed skills and knowledge.

94

Fiji




MBBSDegree 6 years 30 20 3

Diploma in Dental Therapy 3 years 4 4 2

Certificate Dental Technology 3 years 2 2 I

Certificate Junior Dental Assis. 1 year 3 2 1

Diploma Medical Lab Technology 3 years 12 7 3

Diploma Diagnostic Radiography 3 years 8 6 2

Assistant LablRadio Technology (Cert) 2 years 7 6

Certificate in Pharmacy Technology 3 years 5 3 2

Diploma Dietetics & Public Health Nutrition 3 years 4 2

Certificate in Physiotherapy 3 years 3 2 1

Diploma Environmental Health 3 years 19 17 2

Diploma Health Inspection 2 years 10 10

Certificate Health Inspection 1 year 2 2

Basic Nurse (Diploma of Nursing) 3 years 120 110-115 5-10

Post Basic Courses Midwifery 6 months 25 25 Nil Public Health 4 months 20 20 Nil

Pre 1989 Course Ward Management (Being revised) 3 months 30 30 Nil

95

Fiji




MBBSDegree 6 years 30 20 3

Diploma in Dental Therapy 3 years 4 4 2

Certificate Dental Technology 3 years 2 2 I

Certificate Junior Dental Assis. 1 year 3 2 1

Diploma Medical Lab Technology 3 years 12 7 3

Diploma Diagnostic Radiography 3 years 8 6 2

Assistant LablRadio Technology (Cert) 2 years 7 6

Certificate in Pharmacy Technology 3 years 5 3 2

Diploma Dietetics & Public Health Nutrition 3 years 4 2

Certificate in Physiotherapy 3 years 3 2 1

Diploma Environmental Health 3 years 19 17 2

Diploma Health Inspection 2 years 10 10

Certificate Health Inspection 1 year 2 2

Basic Nurse (Diploma of Nursing) 3 years 120 110-115 5-10

Post Basic Courses Midwifery 6 months 25 25 Nil Public Health 4 months 20 20 Nil

Pre 1989 Course Ward Management (Being revised) 3 months 30 30 Nil

95



Name 01 Number

Training Name of Category 01 Completed Institution Program of Staff Trainees Training

Phillip Institute of Nursing Technology (Victoria) B. App. Science Administration 3 3

Sturt College (Adelaide) B. App. Science Tutor 1

Tasmania Institute of Nursing Sister Technology (Launceston) B. App. Science & Tutor 2 2

Arrnidale College of Dip. of Nursing Advanced Education Education Tutor 4 2

Massey University B.A. (Socio) Staff Nurse 1 I

Polytech (Wollongong) Dip. Nursing (CHN) Tutor 3 3 Dip.MCN 1 1

USP(Suva) B.A. (Admin) Sisters 2 2 Dip. Health Staff Nurse Sister 4 4

Management Staff Nurse (1)

Dip. Consulting Sisters (2) 3 3

Massey University Dip. Education Tutor. Senior Sister 3 3 (New Zealand) Staff Nurse

Phillip Institute Degree Prog. Principal Tutor. Assis. (Melbourne) Directors. Director 3 3

Arrnidale College of Associate Dip. Advanced Education Education Tutors 4 2

Tasmanian C.A.E. Degree Hospital Admin. Inter 2 2

Chiang Mai University Course Cert. (P.H.) Staff Nurse 1 (Thailand)

University of South Pacific Diploma/Degree Nurse Admin. 6 6

Hillcrest Hospital Psychiatric Nursing Staff Nurse 2 2

(South Australia) Course

Bendigo Horne for the Aged Geriatrics Sister 1

96



Name 01 Number

Training Name of Category 01 Completed Institution Program of Staff Trainees Training

Phillip Institute of Nursing Technology (Victoria) B. App. Science Administration 3 3

Sturt College (Adelaide) B. App. Science Tutor 1

Tasmania Institute of Nursing Sister Technology (Launceston) B. App. Science & Tutor 2 2

Arrnidale College of Dip. of Nursing Advanced Education Education Tutor 4 2

Massey University B.A. (Socio) Staff Nurse 1 I

Polytech (Wollongong) Dip. Nursing (CHN) Tutor 3 3 Dip.MCN 1 1

USP(Suva) B.A. (Admin) Sisters 2 2 Dip. Health Staff Nurse Sister 4 4

Management Staff Nurse (1)

Dip. Consulting Sisters (2) 3 3

Massey University Dip. Education Tutor. Senior Sister 3 3 (New Zealand) Staff Nurse

Phillip Institute Degree Prog. Principal Tutor. Assis. (Melbourne) Directors. Director 3 3

Arrnidale College of Associate Dip. Advanced Education Education Tutors 4 2

Tasmanian C.A.E. Degree Hospital Admin. Inter 2 2

Chiang Mai University Course Cert. (P.H.) Staff Nurse 1 (Thailand)

University of South Pacific Diploma/Degree Nurse Admin. 6 6

Hillcrest Hospital Psychiatric Nursing Staff Nurse 2 2

(South Australia) Course

Bendigo Horne for the Aged Geriatrics Sister 1

96

3.2.5 Fellowships

Fellowship determilUltion process

Selection body

Difficulties in obtaining suitable Candidates

Other constraints



Fiji

· Sponsors send details to Permanent Secretary of Health

· Candidate identified by Director and Permanent Secretary

· Permanent Secretary Health · Director and Heads of Units · Public Service Commission

*

· The Ministry of Health does not have enough autonomy in making decisions. PSC has the final say although it does not have the appropriate background.

· Shortage of staff. · Brain drain - many trainees do not return to their

country after training is completed.


Posts with Job Descriptiom Review Arrangements

100% No regular review procedure.


Difficulties Experienced in Management 01 Health Personnel

. Lack of definite career structure . Non-clarity on the issue of managerial

responsibility between Public Service Commission and the Ministry of Health

97


· Country allowance · Subsidised rental on government housing · Overtime allowances

3.2.5 Fellowships

Fellowship determilUltion process

Selection body

Difficulties in obtaining suitable Candidates

Other constraints



Fiji

· Sponsors send details to Permanent Secretary of Health

· Candidate identified by Director and Permanent Secretary

· Permanent Secretary Health · Director and Heads of Units · Public Service Commission

*

· The Ministry of Health does not have enough autonomy in making decisions. PSC has the final say although it does not have the appropriate background.

· Shortage of staff. · Brain drain - many trainees do not return to their

country after training is completed.


Posts with Job Descriptiom Review Arrangements

100% No regular review procedure.


Difficulties Experienced in Management 01 Health Personnel

. Lack of definite career structure . Non-clarity on the issue of managerial

responsibility between Public Service Commission and the Ministry of Health

97


· Country allowance · Subsidised rental on government housing · Overtime allowances


3.3.3 Existence of written guidelines for routine personnel TrUlnagement *

Area Yes No Stren&ths & Weaknesses

Determining Establishment 0 D Recruitment Process 0 D Selection Procedures 0 D Induction Programmes 0 D Supportive Supervision Process 0 D Performance Appraisal 0 D Subjective and vague assessments

In-Service Training D 0 Carried out on ad hoc basis

D 0 This is due to a fIXed salary scale

Special Incentives & Rewards unrelated to changing levels of productivity

Determining Career Path 0 0 Task Analysis Procedure D 0 Designing of Job Profiles D 0 Management of Records 0 D Others D D


98


3.3.3 Existence of written guidelines for routine personnel TrUlnagement *

Area Yes No Stren&ths & Weaknesses

Determining Establishment 0 D Recruitment Process 0 D Selection Procedures 0 D Induction Programmes 0 D Supportive Supervision Process 0 D Performance Appraisal 0 D Subjective and vague assessments

In-Service Training D 0 Carried out on ad hoc basis

D 0 This is due to a fIXed salary scale

Special Incentives & Rewards unrelated to changing levels of productivity

Determining Career Path 0 0 Task Analysis Procedure D 0 Designing of Job Profiles D 0 Management of Records 0 D Others D D


98

Fiji


*

Professional Bodies


. Fiji Medical Association

. Fiji Nursing Association



*

- Personal grievances - Negotiating for better conditions - Continuing education - Disciplinary matters

99

Fiji


*

Professional Bodies


. Fiji Medical Association

. Fiji Nursing Association



*

- Personal grievances - Negotiating for better conditions - Continuing education - Disciplinary matters

99


KIRffiATI



Indicator



Urban population

Data

720 sq. km. 66,000 2.1%

Rate of natural increase of population per annum Crude birth rate (per 10(0)



Infant mortality rate (per 1000 live births) - male - female



50.6 54.6

87 76 95%

68% (urban), 63% (rural) 63%



- Influenza - III defined intestinal infection - Wounds, sores and accidents - Acute but ill-defined conditions - Diarrhoea - Cerebrovascular diseases - Scabies - Chronic liver disease and cirrhosis - Conjunctivitis - Meningitis - Other skin conditions - Diabetes mellitus - Bronchitis - Tuberculosis - Meningitis, unspecified - Bronchial pneumonia, organisms unspecified - Measles - Pneumonia, organisms unspecified - Sore throat - Septicaemia

100


KIRffiATI



Indicator



Urban population

Data

720 sq. km. 66,000 2.1%




Infant mortality rate (per 1000 live births) - male - female



50.6 54.6

87 76 95%

68% (urban), 63% (rural) 63%



- Influenza - III defined intestinal infection - Wounds, sores and accidents - Acute but ill-defined conditions - Diarrhoea - Cerebrovascular diseases - Scabies - Chronic liver disease and cirrhosis - Conjunctivitis - Meningitis - Other skin conditions - Diabetes mellitus - Bronchitis - Tuberculosis - Meningitis, unspecified - Bronchial pneumonia, organisms unspecified - Measles - Pneumonia, organisms unspecified - Sore throat - Septicaemia

100

Kiribati



Main referral hospital 120 District hospital Health centre/clinics 69 8

Total 70 128

* Ratio excludes health centre and clinic beds.



Medical Officers 12 Medical Assistants * 24 Dental Officers 1 Dental Assistants ** 8 Pharmacists! Assistant Pharmacists 2 Dispensary Assistants 2 Nurses 142 Nurse Aides & Enrolled Nurses MedicallLaboratory Technologists 7 Radiographers 3 Physiotherapists Nutritionists & Dietitians Health Educators 8 Health InspectorsfSanitarians 28 Community Health Workers 34 Other Professional & Technical Support Staff*** 9



1.S

1.S*

Population Ratio

1: 5,500 1: 2,750 1: 66,000 1: 8,250 1: 33,000 1: 33,000 1: 465

1: 9,429 1: 22,000

1: 8,250 1: 2,357 1: 1,941 1: 7,333

1: 236

* Includes Health Officers, Health Extension Officers and Anaesthetic AssistantsfTechnicians.



101

Kiribati



Main referral hospital 120 District hospital Health centre/clinics 69 8

Total 70 128

* Ratio excludes health centre and clinic beds.



Medical Officers 12 Medical Assistants * 24 Dental Officers 1 Dental Assistants ** 8 Pharmacists! Assistant Pharmacists 2 Dispensary Assistants 2 Nurses 142 Nurse Aides & Enrolled Nurses MedicallLaboratory Technologists 7 Radiographers 3 Physiotherapists Nutritionists & Dietitians Health Educators 8 Health InspectorsfSanitarians 28 Community Health Workers 34 Other Professional & Technical Support Staff*** 9



1.S

1.S*

Population Ratio

1: 5,500 1: 2,750 1: 66,000 1: 8,250 1: 33,000 1: 33,000 1: 465

1: 9,429 1: 22,000

1: 8,250 1: 2,357 1: 1,941 1: 7,333

1: 236

* Includes Health Officers, Health Extension Officers and Anaesthetic AssistantsfTechnicians.



101




MAJOR CATEGORIES tor Main District Health 1989 Hospital Hospital Centre!

(%) (%) Clinics(%)

General Medical Practitioner 12 80 20 Specialist/Consultant Health Officer Health Extension Officer 100 Medical Assistant 24 100 Community Health Worker 34 100 Dentist 90 10 Dental Therapist 4 90 10 Dental Assistant 2 90 10 Dental Technician 2 90 10 Dental Nurse Nursing SisterlRegistered Nurse 6 Midwife - Nurse 14 100 Public Health Nurse/Community Nurse 122 100 Nurse Aide Student Nurse Medical Technologist Laboratoty Technologist 7 90 10 Radiographer 3 100 Anaesthetic Technician/Assistant Pharmacist 2 90 10 Dispensary Assistant 2 90 10 Nutritionist DietitianlDietetic Assistant Health Personnel Educator Health Education 8 75 25 Health InspectorlEnvironmentai Health 6 60 40 Sanitarian 22 5 95 PhysiotherapistlPhysio. Assistant Health Statistician Computer Operator 5 100 Health Administration 3 100 Bio-medical Engineer 95 5


102




MAJOR CATEGORIES tor Main District Health 1989 Hospital Hospital Centre!

(%) (%) Clinics(%)

General Medical Practitioner 12 80 20 Specialist/Consultant Health Officer Health Extension Officer 100 Medical Assistant 24 100 Community Health Worker 34 100 Dentist 90 10 Dental Therapist 4 90 10 Dental Assistant 2 90 10 Dental Technician 2 90 10 Dental Nurse Nursing SisterlRegistered Nurse 6 Midwife - Nurse 14 100 Public Health Nurse/Community Nurse 122 100 Nurse Aide Student Nurse Medical Technologist Laboratoty Technologist 7 90 10 Radiographer 3 100 Anaesthetic Technician/Assistant Pharmacist 2 90 10 Dispensary Assistant 2 90 10 Nutritionist DietitianlDietetic Assistant Health Personnel Educator Health Education 8 75 25 Health InspectorlEnvironmentai Health 6 60 40 Sanitarian 22 5 95 PhysiotherapistlPhysio. Assistant Health Statistician Computer Operator 5 100 Health Administration 3 100 Bio-medical Engineer 95 5


102

Kiribati



21·30 31·40 41·50 51·60 61+ 1989 1995

General Medical Practitioner 5 3 3 12 19 Specialist/Consultant 5 Health Officer Health Extension Officer Medical Assistant 20 4 24 30 Community Health Worker 3 19 12 34 Dentist I 3 Dental Therapist 3 4 6 Dental Assistant 2 2 3 Dental Technician 1 2 3 Dental Nurse Nursing SisterlRegistered Nurse 2 4 6 7 Midwife-Nurse 4 8 2 14 18 Public Health Nurse/Community Nurse 34 68 14 4 122* 150 Nurse Aide Student Nurse Medical Technologist Laboratory Technologist 6 7 12 Radiographer 2 3 3 Anaesthetic Technician! Assistant Pharmacist 2 2 2 Dispensary Assistant 2 2 2 Nutritionist DietitianlDietetic Assistant Health Personnel Educator 3 3 8* 10 Health Education Health InspectorlEnvironmental Health 3 6* 8 Sanitarian 22* 22 PhysiotherapistlPhysio. Assistant Health Statistician Computer Operator 4 5 6 Health Administrator 1 1 3* 3 Bio-medical Engineer 1 1 2


* Apparent errors in totals may be due to incomplete age group data concerning these categories.

103

Kiribati



21·30 31·40 41·50 51·60 61+ 1989 1995

General Medical Practitioner 5 3 3 12 19 Specialist/Consultant 5 Health Officer Health Extension Officer Medical Assistant 20 4 24 30 Community Health Worker 3 19 12 34 Dentist I 3 Dental Therapist 3 4 6 Dental Assistant 2 2 3 Dental Technician 1 2 3 Dental Nurse Nursing SisterlRegistered Nurse 2 4 6 7 Midwife-Nurse 4 8 2 14 18 Public Health Nurse/Community Nurse 34 68 14 4 122* 150 Nurse Aide Student Nurse Medical Technologist Laboratory Technologist 6 7 12 Radiographer 2 3 3 Anaesthetic Technician! Assistant Pharmacist 2 2 2 Dispensary Assistant 2 2 2 Nutritionist DietitianlDietetic Assistant Health Personnel Educator 3 3 8* 10 Health Education Health InspectorlEnvironmental Health 3 6* 8 Sanitarian 22* 22 PhysiotherapistlPhysio. Assistant Health Statistician Computer Operator 4 5 6 Health Administrator 1 1 3* 3 Bio-medical Engineer 1 1 2


* Apparent errors in totals may be due to incomplete age group data concerning these categories.

103



Budget (AU$) 1988 1989 1990





104



Budget (AU$) 1988 1989 1990





104



1. Shortage of:

- doctors - nurses - other health staff

2. Limited government budget

2.2 Types of information required to enhance poUcy formulation and management decision making relating to the above issues

1. Data relating to health manpower planning over the previous 10 years.

2. Data on current workforce and its effectiveness.

3. Forecasting of future needs in relation to:

- population health needs - training of health staff - duration of training programmes


105



1. Shortage of:

- doctors - nurses - other health staff

2. Limited government budget

2.2 Types of information required to enhance poUcy formulation and management decision making relating to the above issues

1. Data relating to health manpower planning over the previous 10 years.

2. Data on current workforce and its effectiveness.

3. Forecasting of future needs in relation to:

- population health needs - training of health staff - duration of training programmes


105

Tile Health Workforc~




The current National Health Plan covers the five year period 1987 - 1991. The Central Programming, Monitoring and Evaluation Board, is responsible for its preparation, and the Technical Task Force for its implementation.


Present

Period covered



Planning method

Linkage to NHP





No comprehensive workforce plan apart from a broad general statement

* ,.

Divisional/departmental perceived needs

Based on needs as perceived by divisional/departmental heads

Closely linked to the National Health Plan.

• •

•

*

106

Tile Health Workforc~




The current National Health Plan covers the five year period 1987 - 1991. The Central Programming, Monitoring and Evaluation Board, is responsible for its preparation, and the Technical Task Force for its implementation.


Present

Period covered



Planning method

Linkage to NHP





No comprehensive workforce plan apart from a broad general statement

* ,.

Divisional/departmental perceived needs

Based on needs as perceived by divisional/departmental heads

Closely linked to the National Health Plan.

• •

•

*

106

3.1.3. Cu"ent planning capability oj health authorities in selected areas

Capabilities Available Priority lor Development

AREAS Yes No mgb Medium Low

Health Planning X X




Health Infonnation System X X


Computer Operation X X

Planning of EdllCationai Programme and Curriculum X X

Others


3.2.1 Policies and plans jor training and development oj health personnel



linkage of educational planning to NHP



No fonnal policies, although training in prevention and public health programmes probably more organised than in clinical and curative divisions.

. EdllCation and Training Supportive Section

. Central Planning. Monitoring and Evaluation Board

Training is linked to the National Health Plan.

*

107

3.1.3. Cu"ent planning capability oj health authorities in selected areas

Capabilities Available Priority lor Development

AREAS Yes No mgb Medium Low

Health Planning X X




Health Infonnation System X X


Computer Operation X X

Planning of EdllCationai Programme and Curriculum X X

Others


3.2.1 Policies and plans jor training and development oj health personnel



linkage of educational planning to NHP



No fonnal policies, although training in prevention and public health programmes probably more organised than in clinical and curative divisions.

. EdllCation and Training Supportive Section

. Central Planning. Monitoring and Evaluation Board

Training is linked to the National Health Plan.

*

107

TIle H«ZIIII Workforce


Problems Assodated widl Local TrainiDg

. Shortage of staff and ttained teachers

. Most teachers are senior health staff and doctors which affects the content and regularity of lectures due to other responsibilities

Suggested Remedial Acdvides

. Recruittnent of more appropriate senior health staff and doctors

a) Public Health Nursing tutor for public health nursing programme

b) Doctors to spend more time teaching medical assistants

. Overseas trainings/attachments for senior health staff and doctors in both public health and clinical/curative areas.

3.2.3. Formal local training programmes available in 1989

Average Average Average Name of Training Program Duration Intake Graduates AUrition


Medical Assistant Training Programme I year 5 4 I

Post Graduate Public Health Nurse Training Programme I year 5 3 2

108

TIle H«ZIIII Workforce


Problems Assodated widl Local TrainiDg

. Shortage of staff and ttained teachers

. Most teachers are senior health staff and doctors which affects the content and regularity of lectures due to other responsibilities

Suggested Remedial Acdvides

. Recruittnent of more appropriate senior health staff and doctors

a) Public Health Nursing tutor for public health nursing programme

b) Doctors to spend more time teaching medical assistants

. Overseas trainings/attachments for senior health staff and doctors in both public health and clinical/curative areas.

3.2.3. Formal local training programmes available in 1989

Average Average Average Name of Training Program Duration Intake Graduates AUrition


Medical Assistant Training Programme I year 5 4 I

Post Graduate Public Health Nurse Training Programme I year 5 3 2

108

Kiribati


Name of Training

Institudon

Burwood College Victoria

University of Hawaii (Manoa)

Name of Program

Health Education Diploma

M.P.H.

Anaesthesia Centre Anaesthesiology Western Pacific Diploma (ACWP) in the University of the Philippines

University of Health Management South Pacific Diploma

University of MSc Obstetrics Malaysia & Gynaecology

University of Health Economics York (U.K.) Certificate

Number of Completed Category

ofStatr Trainees Training

Assistant Health Education Officer

Medical Officer

Medical Officer

Health Inspection

Medical Officer

Medical Officer

4 3

3 3

Numerous nurses attachments on ward management, theatre nursing, mental health, MCH, EPI, paediatric nursing etc at various venues.

Numerous laboratory staff attachments on various laboratory procedures mainly in New Zealand and Austra1ia.

109

Kiribati


Name of Training

Institudon

Burwood College Victoria

University of Hawaii (Manoa)

Name of Program

Health Education Diploma

M.P.H.

Anaesthesia Centre Anaesthesiology Western Pacific Diploma (ACWP) in the University of the Philippines

University of Health Management South Pacific Diploma

University of MSc Obstetrics Malaysia & Gynaecology

University of Health Economics York (U.K.) Certificate

Number of Completed Category

ofStatr Trainees Training

Assistant Health Education Officer

Medical Officer

Medical Officer

Health Inspection

Medical Officer

Medical Officer

4 3

3 3

Numerous nurses attachments on ward management, theatre nursing, mental health, MCH, EPI, paediatric nursing etc at various venues.

Numerous laboratory staff attachments on various laboratory procedures mainly in New Zealand and Austra1ia.

109


3.2.5 Fellowships


Selection body


Other constraints


· Based on current and future manpower needs. · Heads of Divisions make recommendations to Central

Planning, Monitoring and Evaluation Board for endorsement and then transmitted to the Education Training Committee for implementation.

Education and Training Supportive Section (Education and Training Committee).

For clinical or curative training, especially doctors.

· Difficulty in releasing doctors for post graduate training due to shortage.

· Training in public health and prevention, and nursing areas do not present too many problems.



100% When the need arises.



· Low morale · Lack of skills · Lack of punctuality · Varying quality of supervision · Lack of staff

Incentive Provided to Stair

. Allowances for all peripheral staff in recognition for provision of services on a 24 hour basis.

110


3.2.5 Fellowships


Selection body


Other constraints


· Based on current and future manpower needs. · Heads of Divisions make recommendations to Central

Planning, Monitoring and Evaluation Board for endorsement and then transmitted to the Education Training Committee for implementation.

Education and Training Supportive Section (Education and Training Committee).

For clinical or curative training, especially doctors.

· Difficulty in releasing doctors for post graduate training due to shortage.

· Training in public health and prevention, and nursing areas do not present too many problems.



100% When the need arises.



· Low morale · Lack of skills · Lack of punctuality · Varying quality of supervision · Lack of staff

Incentive Provided to Stair

. Allowances for all peripheral staff in recognition for provision of services on a 24 hour basis.

110

3.3.3 Existence of written guidelines for routine personnel management *


Detennining Establishment D D Recruitment Process D D Selection Procedures D D Induction Programmes D D Supportive Supervision Process D D Perfonnance Appraisal D D In-Service Training D D Special Incentives & Rewards D D Detennining Career Path D D Task Analysis Procedure D D Designing of Job Profiles D D Management of Records D D Others D D * Infonnation not provided.

111



Detennining Establishment D D Recruitment Process D D Selection Procedures D D Induction Programmes D D Supportive Supervision Process D D Perfonnance Appraisal D D In-Service Training D D Special Incentives & Rewards D D Detennining Career Path D D Task Analysis Procedure D D Designing of Job Profiles D D Management of Records D D Others D D * Infonnation not provided.

111



Professional Bodies


Government Bodies

1. - Budget Committee Ministry of Health - Planning Section Ministry of Finance - Public Service Division

2. - Disciplinary Committee Ministry of Health - Public Service Division - Public Service Commission

3. - Ministry of Foreign Mfairs - Ministry of Finance


112


*

*

- Budget preparation

- Promotion and discipline of staff

- Recruitment of staff



Professional Bodies


Government Bodies

1. - Budget Committee Ministry of Health - Planning Section Ministry of Finance - Public Service Division

2. - Disciplinary Committee Ministry of Health - Public Service Division - Public Service Commission

3. - Ministry of Foreign Mfairs - Ministry of Finance


112


*

*

- Budget preparation

- Promotion and discipline of staff

- Recruitment of staff

Papllll New Guinefl

PAPUA NEW GUINEA



*

Indicator



Urban population Rate of natural increase of population per annum Crude birth rate (per 10(0) Crude death rate (per 1(00) Life expectancy at birth (years) Infant mortality rate (per 1000 live births) Adult literacy rate Percent of population served with:



Data

462,840 sq. kin. 3,661,000 2.2%

41.5% 3.4% 13.0% 2.26% 34.7 12.1 49.6 (total) 72 30%

• 10%; < 10% (rural)



- Influenza - Diarrhoea - Gonorrhoea - Measles - Syphilis - Pertussis - Pigbel - Tetanus - Poliomyelitis - Malaria


- Pneumonia - Certain perinatal conditions - ill defmed intestinal infection - Tuberculosis - Meningitis - Malaria - Diseases of pulmonary circulating and other

heart diseases - Septicaemia - Anaemia - Bronchitis, chronic and unspecified emphysema

and asthma - Diarrhoeal diseases - Measles - Malignant neoplasms - Accidents and violence - Malnutrition

113

Papllll New Guinefl

PAPUA NEW GUINEA



*

Indicator



Urban population Rate of natural increase of population per annum Crude birth rate (per 10(0) Crude death rate (per 1(00) Life expectancy at birth (years) Infant mortality rate (per 1000 live births) Adult literacy rate Percent of population served with:



Data

462,840 sq. kin. 3,661,000 2.2%

41.5% 3.4% 13.0% 2.26% 34.7 12.1 49.6 (total) 72 30%

• 10%; < 10% (rural)



- Influenza - Diarrhoea - Gonorrhoea - Measles - Syphilis - Pertussis - Pigbel - Tetanus - Poliomyelitis - Malaria


- Pneumonia - Certain perinatal conditions - ill defmed intestinal infection - Tuberculosis - Meningitis - Malaria - Diseases of pulmonary circulating and other

heart diseases - Septicaemia - Anaemia - Bronchitis, chronic and unspecified emphysema

and asthma - Diarrhoeal diseases - Measles - Malignant neoplasms - Accidents and violence - Malnutrition

113



Type of Health Facilities

Main referral hospital District hospital Health centre/clinics

Total

Total Number

I 19

509

529


Number of Beds

625 } 4,072

10,638

15,335


Category of Health Personnel

Medical Officers * Medical Assistants ** Dental Officers Dental Assistants * * * Pharmacists! Assistant Pharmacists Pharmacy Assistants Nurses Nurse Aides & Enrolled Nurses MedicallLaboratory Technologists Radiographers PhysiotherapistslPhysiotherapy Assistants Nutritionists & Dietitians Health Educators Health InspectorslEnvironmental Health Community Health Workers Other Professional & Technical Support Staft*··

Total Health Workers

Total No.

422 320

11 173

35 2,447 1,445

64

16 144

4.328

9,404


1.3

1.3*

Population Ratio

1: 8,675 I: 11,441 1:332,818 I: 21,162

1:104,600 1: 1,496 1: 2.534

1: 57.203

1:228.813 1: 25,424 1: 846

1: 389

* Represents total medical officer workforce. both in Government and non-government sectors.

** Includes Health Officers. Health Extension Officers and Anaesthetic AssistantsIT echnicians.

*** Includes Dental Technicians. Therapists and Nurses.

**** Include Health Statisticians. Computer Operators. Bio-medical Engineers and Health Administrators.

114





Total

Total Number

I 19

509

529


Number of Beds

625 } 4,072

10,638

15,335


Category of Health Personnel

Medical Officers * Medical Assistants ** Dental Officers Dental Assistants * * * Pharmacists! Assistant Pharmacists Pharmacy Assistants Nurses Nurse Aides & Enrolled Nurses MedicallLaboratory Technologists Radiographers PhysiotherapistslPhysiotherapy Assistants Nutritionists & Dietitians Health Educators Health InspectorslEnvironmental Health Community Health Workers Other Professional & Technical Support Staft*··

Total Health Workers

Total No.

422 320

11 173

35 2,447 1,445

64

16 144

4.328

9,404


1.3

1.3*

Population Ratio

1: 8,675 I: 11,441 1:332,818 I: 21,162

1:104,600 1: 1,496 1: 2.534

1: 57.203

1:228.813 1: 25,424 1: 846

1: 389

* Represents total medical officer workforce. both in Government and non-government sectors.

** Includes Health Officers. Health Extension Officers and Anaesthetic AssistantsIT echnicians.

*** Includes Dental Technicians. Therapists and Nurses.

**** Include Health Statisticians. Computer Operators. Bio-medical Engineers and Health Administrators.

114

PIlpIUl New G"Utea


MAJOR CATEGORIES

General Medical Practitioner Specialist/Consultant Health Officer Health Extension Officer Medical Assistant Community Health Worker Antimalaria WoiXer Dentist Dental Therapist Dental Assistant Dental Technician Dental Nurse Nursing SisterlRegistered Nurse Midwife - Nurse Public Health NurselCommunity Nurse Nurse Aide Student Nurse Medical Technologist Laboratory Technologist RadiographerIX-Ray Assistant Anaesthetic Technician/Assistant Pharmacist Pharmacy Assistant Nutritionist Dietitian Health Education Health Personnel Educator Health Inspector Sanitarian Physiotherapist Health Statistician Computer Operator Health Administration Bio-medicaI Engineer

Total Health Workforce

.. Infonnation not provided .

Total for

1989

329** 93**

320

4.328

* 11 90 58 25

2.447

* *

1.445 *

* .. 64

.. 35 ..

.. 16

144

..

.. * * ..

9,404

Utilization In Percentage"

Main Hospital

(%)

DIstrict Health Hospital Centre!

(%) Clinics(%)

** Includes 154 expatriate doctors in both government and non-government positions.

115

PIlpIUl New G"Utea


MAJOR CATEGORIES

General Medical Practitioner Specialist/Consultant Health Officer Health Extension Officer Medical Assistant Community Health Worker Antimalaria WoiXer Dentist Dental Therapist Dental Assistant Dental Technician Dental Nurse Nursing SisterlRegistered Nurse Midwife - Nurse Public Health NurselCommunity Nurse Nurse Aide Student Nurse Medical Technologist Laboratory Technologist RadiographerIX-Ray Assistant Anaesthetic Technician/Assistant Pharmacist Pharmacy Assistant Nutritionist Dietitian Health Education Health Personnel Educator Health Inspector Sanitarian Physiotherapist Health Statistician Computer Operator Health Administration Bio-medicaI Engineer

Total Health Workforce

.. Infonnation not provided .

Total for

1989

329** 93**

320

4.328

* 11 90 58 25

2.447

* *

1.445 *

* .. 64

.. 35 ..

.. 16

144

..

.. * * ..

9,404

Utilization In Percentage"

Main Hospital

(%)

DIstrict Health Hospital Centre!

(%) Clinics(%)

** Includes 154 expatriate doctors in both government and non-government positions.

115



Number of Health Workers Total Projection ** by Age Group for

21·30 31-40 41-50 51-60 61+ 1989***

General Medical Practitioners 23 57 10 2 329**

Specialist/Consultants 93**

Health Officer Health Extension Officer 120 125 61 11 320 Medical Assistant Community Health Worker 4,328 Dentist 11 Dental Therapist 41 29 18 90 Dental Assistant 58 Dental Technician 7 11 6 25 Dental Nurse Nursing Sister/Registered Nurse 656 908 250 25 2,447 Midwife-Nurse * Public Health Nurse/Community Nurse * Nurse Aide 583 607 59 8 1,445 Student Nurse * Medical Technologist * Laboratory Technologist * Radiographers! Assist Radiographers 13 14 17 13 64 Anaesthetic Technician! Assistant Pharmacist * Dispensary Assistant 18 16 35 Nutritionist *

Dietitian *

Health Personnel Educators 6 9 16

Health Education Technician Health Inspector 58 49 3 144

Sanitarian Physiotherapist *

Health Statistician *

Computer Operator * Health Administrator * Bio-medical Engineer *

Total 9,404

* Information not provided. ** Includes 154 expatriate doctors in both government and non-government positions. *** Apparent errors possibly due to incomplete data.

116

for

1995*



Number of Health Workers Total Projection ** by Age Group for

21·30 31-40 41-50 51-60 61+ 1989***

General Medical Practitioners 23 57 10 2 329**

Specialist/Consultants 93**

Health Officer Health Extension Officer 120 125 61 11 320 Medical Assistant Community Health Worker 4,328 Dentist 11 Dental Therapist 41 29 18 90 Dental Assistant 58 Dental Technician 7 11 6 25 Dental Nurse Nursing Sister/Registered Nurse 656 908 250 25 2,447 Midwife-Nurse * Public Health Nurse/Community Nurse * Nurse Aide 583 607 59 8 1,445 Student Nurse * Medical Technologist * Laboratory Technologist * Radiographers! Assist Radiographers 13 14 17 13 64 Anaesthetic Technician! Assistant Pharmacist * Dispensary Assistant 18 16 35 Nutritionist *

Dietitian *

Health Personnel Educators 6 9 16

Health Education Technician Health Inspector 58 49 3 144

Sanitarian Physiotherapist *

Health Statistician *

Computer Operator * Health Administrator * Bio-medical Engineer *

Total 9,404

* Information not provided. ** Includes 154 expatriate doctors in both government and non-government positions. *** Apparent errors possibly due to incomplete data.

116

for

1995*


Budget (PNG KINA) 1988 1989 1990

Total Public Sector Budget 918.0m 1,037.Om 1,012.Om

Total Health Budget 88.3m lOO.2m I04Am


Health Budget as Percentage of Total Budget 9.6% 9.7% 10.3%

117


Budget (PNG KINA) 1988 1989 1990

Total Public Sector Budget 918.0m 1,037.Om 1,012.Om

Total Health Budget 88.3m lOO.2m I04Am



117


Section 2. Major Issues*


I. To ensure the availability, equitable distribution and appropriate mix of sufficient numbers of health workers to meet requirements of PNG health services within its economic resources.

2. To produce socially responsible health workers who have the necessary technical and scientific skills and knowledge that are appropriate to the requirements of the country's health services and economic resources.

3. To ensure that all health workers are well motivated with appropriate career pathways and necessary resources for optimal productivity within the country's economic resources.


1. Health workforce data 2. Health workforce supply and demand 3. Health workforce needs and distribution 4. Health workforce financial resources 5. National training policies 6. Linkages and co-ordination between provinces and central government

agencies 7. Planning and implementation responsibilities 8. Health service utilization total (annual) 9. National and provincial staffing standards

10. Training programs, institutions and curriculums II. Reward system 12. Performance assessment system 13. Staff mix 14. Staff/population ratio 15. Workload standards 16. National and Provincial health status 17. Provincial socio-economic status


118


Section 2. Major Issues*


I. To ensure the availability, equitable distribution and appropriate mix of sufficient numbers of health workers to meet requirements of PNG health services within its economic resources.

2. To produce socially responsible health workers who have the necessary technical and scientific skills and knowledge that are appropriate to the requirements of the country's health services and economic resources.

3. To ensure that all health workers are well motivated with appropriate career pathways and necessary resources for optimal productivity within the country's economic resources.


1. Health workforce data 2. Health workforce supply and demand 3. Health workforce needs and distribution 4. Health workforce financial resources 5. National training policies 6. Linkages and co-ordination between provinces and central government

agencies 7. Planning and implementation responsibilities 8. Health service utilization total (annual) 9. National and provincial staffing standards

10. Training programs, institutions and curriculums II. Reward system 12. Performance assessment system 13. Staff mix 14. Staff/population ratio 15. Workload standards 16. National and Provincial health status 17. Provincial socio-economic status


118

Papua New Guinea




The current five year national health plan expires in 1990 and the new one covering the period 1991-1995 is in preparation. The Division of Policy and Planning is responsible for preparing the plan.


Present

Period covered



Planning method

Linkage to NHP Linkage to other plans



A health worldorce plan currently exists.

1986 - 1990

Administration and Planning Division of the Department of Health (DOH).

Provinces: - Division of Health reports - Hospital reports - Training Division of DOH

Headquarter - Training Division Files - Planning Division Files - Other Divisional Files

Incremental Planning Health workforce projections for each cadre of health workers are established using training intakes, outputs and attrition rates.

This is supported by the development of a national data base on students (STUDIS), and a method for comparing workloads of health institutions and their staffing called 'Indicators of Staffing Need' (ISN).

There is some linkage between the health worldorce plan and the national health plan, and this is being strengthened. Currently there is no direct linkage with the economic plan.

No formal arrangements currently exist.

National Health Plan.

119

Papua New Guinea




The current five year national health plan expires in 1990 and the new one covering the period 1991-1995 is in preparation. The Division of Policy and Planning is responsible for preparing the plan.


Present

Period covered



Planning method




A health worldorce plan currently exists.

1986 - 1990

Administration and Planning Division of the Department of Health (DOH).

Provinces: - Division of Health reports - Hospital reports - Training Division of DOH

Headquarter - Training Division Files - Planning Division Files - Other Divisional Files

Incremental Planning Health workforce projections for each cadre of health workers are established using training intakes, outputs and attrition rates.

This is supported by the development of a national data base on students (STUDIS), and a method for comparing workloads of health institutions and their staffing called 'Indicators of Staffing Need' (ISN).

There is some linkage between the health worldorce plan and the national health plan, and this is being strengthened. Currently there is no direct linkage with the economic plan.

No formal arrangements currently exist.

National Health Plan.

119





Health Planning X X








Others

There is an obvious lack of skilled manpower in some pertinent areas related to human resources planning which constitutes one of the priority areas for development during the next five years.



Existence of clear policies and plans Clear policies and plans for trammg and development of health personnel have been formulated.

Body responsible Jor educational planning Division of Training

Linkage of educational planning to NHP There is some linkage but this area need to be strengthened.

Liaison between service providers and There is some liaison but is irregular. This area training institutions needs to be developed further.

120





Health Planning X X








Others

There is an obvious lack of skilled manpower in some pertinent areas related to human resources planning which constitutes one of the priority areas for development during the next five years.



Existence of clear policies and plans Clear policies and plans for trammg and development of health personnel have been formulated.

Body responsible Jor educational planning Division of Training

Linkage of educational planning to NHP There is some linkage but this area need to be strengthened.

Liaison between service providers and There is some liaison but is irregular. This area training institutions needs to be developed further.

120

Papua New Guillea

3.2.2 Problems associated with local training programmes and suggested remedial activities (as reponed by the country correspondent)


. Shortage of staff and resources to properly run the training programmes

Suggested Remedial Acdvlties

· Training of trainers · Improvement of facilities · Develop and improve materials and

curriculums · Recruitment of lecturers and tutors · Develop National Policy Training Plan · Develop evaluation plans for all training

programmes · Develop linkages between training

institutions and Department of Health


Average Average Average Name or Training Program Duration Intake Graduates Attrition


Medical Officer 5 years 18 10 2

Health Extension Officer 3 years 60 50 6

Nursing Officer 3 years 227 217 23

Community Health Worker 2 years 430 405 43

Health Inspector 3 years 35 25 4


*

Name or Training

Institution

*

Name or Program

*

No information provided.

121

Category or Staff

*

Number

or Completed Trainees Training

* *

Papua New Guillea

3.2.2 Problems associated with local training programmes and suggested remedial activities (as reponed by the country correspondent)


. Shortage of staff and resources to properly run the training programmes

Suggested Remedial Acdvlties

· Training of trainers · Improvement of facilities · Develop and improve materials and

curriculums · Recruitment of lecturers and tutors · Develop National Policy Training Plan · Develop evaluation plans for all training

programmes · Develop linkages between training

institutions and Department of Health




Medical Officer 5 years 18 10 2

Health Extension Officer 3 years 60 50 6

Nursing Officer 3 years 227 217 23

Community Health Worker 2 years 430 405 43

Health Inspector 3 years 35 25 4


*

Name or Training

Institution

*

Name or Program

*

No information provided.

121

Category or Staff

*

Number

or Completed Trainees Training

* *


3.2.5 Fellowships


Selection body


Other constraints


Fellowship allocation is through applications to the Department of Health.

Department of Health Committee

None



100% There is no specific provision for review.


Difficulties Experieoced in Management of Health Personnel

Quality of supervision


No specific incentives provided. Staff working in isolated areas are under the responsibilities of the respective provincial authorities.

122


3.2.5 Fellowships


Selection body


Other constraints


Fellowship allocation is through applications to the Department of Health.

Department of Health Committee

None



100% There is no specific provision for review.


Difficulties Experieoced in Management of Health Personnel

Quality of supervision


No specific incentives provided. Staff working in isolated areas are under the responsibilities of the respective provincial authorities.

122

Papua New Guinea

3.3.3 Existence ofwrinen guidelines for routine personnel management *


Determining Establishment D 0 Recruitment Process 0 D DPMPolicy

Selection Procedures 0 D DPM Policy

Induction Programmes 0 D DPMPolicy

Supportive Supervision Process D 0 No clear strategy. Ad hoc procedure

Performance Appraisal 0 D Lack of positive outcome/results from the appraisal

In-Service Training D 0 No plan

Special Incentives & Rewards D 0 No plan

Determining Career Path D 0 No plan

Task Analysis Procedure D 0 No plan

Designing of Job Profiles D 0 No plan

Management of Records D 0 No plan

Others D D


123

Papua New Guinea

3.3.3 Existence ofwrinen guidelines for routine personnel management *


Determining Establishment D 0 Recruitment Process 0 D DPMPolicy

Selection Procedures 0 D DPM Policy

Induction Programmes 0 D DPMPolicy

Supportive Supervision Process D 0 No clear strategy. Ad hoc procedure

Performance Appraisal 0 D Lack of positive outcome/results from the appraisal

In-Service Training D 0 No plan

Special Incentives & Rewards D 0 No plan

Determining Career Path D 0 No plan

Task Analysis Procedure D 0 No plan

Designing of Job Profiles D 0 No plan

Management of Records D 0 No plan

Others D D


123

The HealJh Worlcforce

3.3.4 Professional bodies and their involvement in professional. industrial. or management decision making


Professional Bodies *

Professional Associations *

* No information provided.

Notes on above tables supplied by country respondent:

Tables 1.4, 1.5 and 1.6 pertaining respectively to categories of health personnel with population ratios; current health workforce with pattern of utilisation; and current and projected health workforce according to age group are incomplete due to incomplete data.

The total health workforce for the categories whose numbers were given is shown but the actual total would be larger as no information is provided on other categories.

The total number of Medical Officers shown in table 1.4 of 422 represents both the national and expatriate doctors in the Government and non-Government Sectors.

This inclusive figure is important because it provides a better perspective of the doctor to population ratios in the country than simply stating the number of national doctors in government employment.

124

The HealJh Worlcforce



Professional Bodies *


* No information provided.

Notes on above tables supplied by country respondent:

Tables 1.4, 1.5 and 1.6 pertaining respectively to categories of health personnel with population ratios; current health workforce with pattern of utilisation; and current and projected health workforce according to age group are incomplete due to incomplete data.

The total health workforce for the categories whose numbers were given is shown but the actual total would be larger as no information is provided on other categories.

The total number of Medical Officers shown in table 1.4 of 422 represents both the national and expatriate doctors in the Government and non-Government Sectors.

This inclusive figure is important because it provides a better perspective of the doctor to population ratios in the country than simply stating the number of national doctors in government employment.

124

Republic 0/ Guam

REPUBLIC OF GUAM



Indicator Data

Area 0.54 sq. km. Estimated population Annual population growth rate Percentage of population

132,726 (1990 census) 2.2%


Urban population Rate of natural increase of population per annum Crude birth rate (per 10(0)

34.3% 3.0% 39.0% 2.34% 26.3 3.8 Total 72 69.5 75.6

Crude death rate (per 1(00) Life expectancy at birth (years)

- male - female

Infant mortality rate (per 1000 live births) Adult literacy rate

7.5 %.4%

Percent of population served with: - safe water - adequate sanitary facilities

100% 100%



- Influenza and flu syndrome - Diseases of the heart - Conjunctivitis, bacterial and NOS - Malignant neoplasms - Chickenpox - Cerebrovascular disease - Streptococcal sore throat - Motor vehicle accidents - Gonorrhoea - Pneumonia - Salmonellosis (non-typhoid) - Diabetes mellitus - Food poisoning, bacterial - Suicide - Streptococcal disease - Other diseases of the central nervous system - Shigellosis - Homicide - Tuberculosis - Drowning

- All other accidents

125

Republic 0/ Guam

REPUBLIC OF GUAM



Indicator Data

Area 0.54 sq. km. Estimated population Annual population growth rate Percentage of population

132,726 (1990 census) 2.2%


Urban population Rate of natural increase of population per annum Crude birth rate (per 10(0)

34.3% 3.0% 39.0% 2.34% 26.3 3.8 Total 72 69.5 75.6


- male - female


7.5 %.4%


100% 100%



- Influenza and flu syndrome - Diseases of the heart - Conjunctivitis, bacterial and NOS - Malignant neoplasms - Chickenpox - Cerebrovascular disease - Streptococcal sore throat - Motor vehicle accidents - Gonorrhoea - Pneumonia - Salmonellosis (non-typhoid) - Diabetes mellitus - Food poisoning, bacterial - Suicide - Streptococcal disease - Other diseases of the central nervous system - Shigellosis - Homicide - Tuberculosis - Drowning

- All other accidents

125



Number of Hospital Beds per Type or Health Facilities Total Number Beds 1000 Population

Main referral hospital 150 1.2 District hospital Health centre/clinics J

Total 4 150 1.2


Category or Health Personnel Total No. Population Ratio

Medical Officers 163 Medical Assistants

.. 15

Dental Officers 44 Dental Assistants"" 144 Pharmacistsl Assistant Pharmacists 20 Dispensary Assistants 6 Nurses 3'17 Nurse Aides & Enrolled Nurses 104 Medica1/Laboratory Technologists 54 Radiographers 20 Physiotherapists 11 Nutritionists & Dietitians 14 Health Educators 12 Health Inspectors/Sanitarians 34 Community Health Workers Other Professional & Technical Support Staff *** 26


.. Includes Health Officers, Health Extension Officers and Anaesthetic Assistantsff echnicians.

.. Includes Dental Technicians, Therapists and Nurses .

1: 814 1: 8.848 1: 3,017 1: 922 1: 6,636 1: 22,121 1: 334 1: 1,276 1: 2,458 1: 6,636 1: 12,066 1: 9,480 1: 1l,061 1: 3,904

1: 5,105

1: 125

••• Include Health Statisticians, Computer Operators, Bio-medical Engineers and Health Administrators.

126



Number of Hospital Beds per Type or Health Facilities Total Number Beds 1000 Population

Main referral hospital 150 1.2 District hospital Health centre/clinics J

Total 4 150 1.2


Category or Health Personnel Total No. Population Ratio

Medical Officers 163 Medical Assistants

.. 15

Dental Officers 44 Dental Assistants"" 144 Pharmacistsl Assistant Pharmacists 20 Dispensary Assistants 6 Nurses 3'17 Nurse Aides & Enrolled Nurses 104 Medica1/Laboratory Technologists 54 Radiographers 20 Physiotherapists 11 Nutritionists & Dietitians 14 Health Educators 12 Health Inspectors/Sanitarians 34 Community Health Workers Other Professional & Technical Support Staff *** 26


.. Includes Health Officers, Health Extension Officers and Anaesthetic Assistantsff echnicians.

.. Includes Dental Technicians, Therapists and Nurses .

1: 814 1: 8.848 1: 3,017 1: 922 1: 6,636 1: 22,121 1: 334 1: 1,276 1: 2,458 1: 6,636 1: 12,066 1: 9,480 1: 1l,061 1: 3,904

1: 5,105

1: 125

••• Include Health Statisticians, Computer Operators, Bio-medical Engineers and Health Administrators.

126

Republic of Guam


MAJOR CATEGORIES

General Medical Practitioner Specialist/Consultant Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist Dental Therapist Dental Assistant Dental Technician Dental Nurse

Total for

1989

84 79

13

44 24

113 7

Nursing SisterlRegistered Nurse 362 Midwife - Nurse 12 Public Health NurselCommunity Nurse 23 Nurse Aide 104 Student Nurse Medical Technologist Laboratory Technologist Radiographer Anaesthetic Technician! Assistant Pharmacist Dispensary Assistant Nutritionist Dietitian Health Education Health Personnel Educator Health Inspector Sanitarian Physiotherapist Health Statistician Computer Operator Health Administrator Bio-medical Engineer

20 34 20

1 20

6 5 9

12 24 10 II

12 14


* Information on utilisation percentage not provided.

127

Utilization &'i Percentage *

Main Hospital

(%)

District Health Hospital CenCrei

(%) Clinics(%)

Republic of Guam


MAJOR CATEGORIES

General Medical Practitioner Specialist/Consultant Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist Dental Therapist Dental Assistant Dental Technician Dental Nurse

Total for

1989

84 79

13

44 24

113 7

Nursing SisterlRegistered Nurse 362 Midwife - Nurse 12 Public Health NurselCommunity Nurse 23 Nurse Aide 104 Student Nurse Medical Technologist Laboratory Technologist Radiographer Anaesthetic Technician! Assistant Pharmacist Dispensary Assistant Nutritionist Dietitian Health Education Health Personnel Educator Health Inspector Sanitarian Physiotherapist Health Statistician Computer Operator Health Administrator Bio-medical Engineer

20 34 20

1 20

6 5 9

12 24 10 II

12 14


* Information on utilisation percentage not provided.

127

Utilization &'i Percentage *

Main Hospital

(%)

District Health Hospital CenCrei

(%) Clinics(%)




21-30 31-40 41-50 51-60 61+ 1989 1995··

General Medical Practitioners 1 6 5 1 84*

Specialist/Consultants 2 16 5 3 2 79*

Health Officer 1 Health Extension Officer Medical Assistant 4 7 1 13 Community Health Worker Dentist 4 9 5 4 44*

Dental Therapist 2 4 1 24*

Dental Assistant 9 15 7 113* Dental Technician 4 1 7*

Dental Nurse Nursing SisterlRegistered Nurse 38 57 31 7 1 362* Midwife-Nurse 2 2 5 3 12 Public Health Nurse/Community Nurse 5 6 9 3 23 Nurse Aide 14 42 38 9 1 104 Student Nurse Medical Technologist 2 6 8 4 20 Laboratory Technologist 15 8 9 1 1 34 Radiographer 5 8 5 2 20 Anaesthetic Technician! Assistant 1 1 Phannacist 1 6 8 4 20 Dispensary Assistant 5 6 Nutritionist 2 2 1 5 Dietitian 6 2 9 Health Personnel Educators 8 4 12 Health Education Technician Health Inspector 1 7 11 2 3 24 Sanitarian 2 5 2 10 Physiotherapist 11*

Health Statistician Computer Operator 8 3 12 Health Administrator 1 3 6 4 14 Bio-medical Engineer

Total 1064

* Apparent errors possibly due to incomplete data concerning these categories. ** Information not provided.

128




21-30 31-40 41-50 51-60 61+ 1989 1995··

General Medical Practitioners 1 6 5 1 84*

Specialist/Consultants 2 16 5 3 2 79*

Health Officer 1 Health Extension Officer Medical Assistant 4 7 1 13 Community Health Worker Dentist 4 9 5 4 44*

Dental Therapist 2 4 1 24*

Dental Assistant 9 15 7 113* Dental Technician 4 1 7*

Dental Nurse Nursing SisterlRegistered Nurse 38 57 31 7 1 362* Midwife-Nurse 2 2 5 3 12 Public Health Nurse/Community Nurse 5 6 9 3 23 Nurse Aide 14 42 38 9 1 104 Student Nurse Medical Technologist 2 6 8 4 20 Laboratory Technologist 15 8 9 1 1 34 Radiographer 5 8 5 2 20 Anaesthetic Technician! Assistant 1 1 Phannacist 1 6 8 4 20 Dispensary Assistant 5 6 Nutritionist 2 2 1 5 Dietitian 6 2 9 Health Personnel Educators 8 4 12 Health Education Technician Health Inspector 1 7 11 2 3 24 Sanitarian 2 5 2 10 Physiotherapist 11*

Health Statistician Computer Operator 8 3 12 Health Administrator 1 3 6 4 14 Bio-medical Engineer

Total 1064

* Apparent errors possibly due to incomplete data concerning these categories. ** Information not provided.

128

Republic 0/ GIUlm


Budget (US$) 1988 1989 1990

Total Public Sector Budget * * *

Total Health Budget 59.17m 67.44m 78.10m


Health Budget as Percentage of Total Budget * * *


129

Republic 0/ GIUlm


Budget (US$) 1988 1989 1990

Total Public Sector Budget * * *



Health Budget as Percentage of Total Budget * * *


129



2.1 Major issues concerning planning. development and management of health workforce

l) Lack of a designated central coordinating entity to be responsible for planning, development and monitoring of health manpower resources.

2) The need for government involvement to establish such an entity.


Initial step needs to be at local government level in relation to 2.1 above.


130



2.1 Major issues concerning planning. development and management of health workforce

l) Lack of a designated central coordinating entity to be responsible for planning, development and monitoring of health manpower resources.

2) The need for government involvement to establish such an entity.


Initial step needs to be at local government level in relation to 2.1 above.


130

Republic of GUturl




There was a five year national health plan covering the period 1985-1990. This now needs updating and the Guam Health Planning and Development Agency has been newly established to undertake this function.


Present

Period covered



Planning method

Linkage to NHP

Linkage to otMr plans



* Not applicable.

No health workforce plan at present

* · Currently no designated body · Each agency or organisation coordinates its own

planning

· Types and kinds of services to be provided · Types of agencies and their projected programme

enrolees

No centralized, coordinating system at present

When developed, hopefully to be congruent with the national health plan and an integral part of the overall Government plan for Guam

None available at present

Guam's progress and nursing shortage reports 1990

131

Republic of GUturl




There was a five year national health plan covering the period 1985-1990. This now needs updating and the Guam Health Planning and Development Agency has been newly established to undertake this function.


Present

Period covered



Planning method

Linkage to NHP

Linkage to otMr plans



* Not applicable.

No health workforce plan at present

* · Currently no designated body · Each agency or organisation coordinates its own

planning

· Types and kinds of services to be provided · Types of agencies and their projected programme

enrolees

No centralized, coordinating system at present

When developed, hopefully to be congruent with the national health plan and an integral part of the overall Government plan for Guam

None available at present

Guam's progress and nursing shortage reports 1990

131

rite Health Workforce




Health Planning X X








Others



Existence of clear policies and plans Not at present

Body responsible for educational planning . Department of Administration, for line government agencies in general areas .

. Respective agencies/organisation for specifIC education programmes.

Linkage of educational planning to NHP Not apparent at present

Liaison between service providers and No formal arrangements at present training institutions

132

rite Health Workforce




Health Planning X X








Others



Existence of clear policies and plans Not at present

Body responsible for educational planning . Department of Administration, for line government agencies in general areas .

. Respective agencies/organisation for specifIC education programmes.

Linkage of educational planning to NHP Not apparent at present

Liaison between service providers and No formal arrangements at present training institutions

132



Name of Training

Institution

Univ.ofGuam

Univ. of Philippines

Ateneo DeManiia Univ.

Univ. of Hawaii

Univ.ofMaiaya

Beaumont Army Medical Centre

Fitzsimmons Army Medical Centre

Univ.ofNSW

Name of Category Program ofStatf

Bachelor of Nursing Professional

Master in Social Work Professional

Doctorate in Psychology Professional

Master in Social Work Professional Master of Science in Nursing Professional

Bachelor of Arts in Vector Biology Technical

Emergency Nursing Profession

Biomedical Equipment maintenance and repair Technical

Health Management Training Professional

134

Number of Completed

Trainees Training

3 3

0

1

0

1

0

3 3



Name of Training

Institution

Univ.ofGuam

Univ. of Philippines

Ateneo DeManiia Univ.

Univ. of Hawaii

Univ.ofMaiaya

Beaumont Army Medical Centre

Fitzsimmons Army Medical Centre

Univ.ofNSW

Name of Category Program ofStatf

Bachelor of Nursing Professional

Master in Social Work Professional

Doctorate in Psychology Professional

Master in Social Work Professional Master of Science in Nursing Professional

Bachelor of Arts in Vector Biology Technical

Emergency Nursing Profession

Biomedical Equipment maintenance and repair Technical

Health Management Training Professional

134

Number of Completed

Trainees Training

3 3

0

1

0

1

0

3 3

3.2.5 Fellowships


Selection body


Other constraints


Republic O/GIUlIII

The WHO Fellowships Committee identifies training needs and recommends candidates to the Governor through the Director of Public and Social Services.

The WHO Fellowship Committee comprising of representatives from health and health related agencies: · Department of Public Health and Social Services · Department of Mental Health and Substance Abuse · Guam Memorial Hospital · Environmental Health Protection Agency · University of Guam

· This is encountered.

· 3-year service commitment for any length of fellowship training.

· Qualified applicants who meet requirements for the specific training.

· Shortage of manpower which impedes the ability to release more than one person at one time.

· Stipends not arriving on time.

3.3.1 Percentage of health workforce with job deSCriptions and review arrangements


* •


135

3.2.5 Fellowships


Selection body


Other constraints


Republic O/GIUlIII

The WHO Fellowships Committee identifies training needs and recommends candidates to the Governor through the Director of Public and Social Services.

The WHO Fellowship Committee comprising of representatives from health and health related agencies: · Department of Public Health and Social Services · Department of Mental Health and Substance Abuse · Guam Memorial Hospital · Environmental Health Protection Agency · University of Guam

· This is encountered.

· 3-year service commitment for any length of fellowship training.

· Qualified applicants who meet requirements for the specific training.

· Shortage of manpower which impedes the ability to release more than one person at one time.

· Stipends not arriving on time.

3.3.1 Percentage of health workforce with job deSCriptions and review arrangements


* •


135

Tire Health Worlcforce


Difficulties Experienced in Management or Health Personnel

· Limited health manpower

· Quality of supervision not conducive to: - employee's self development

creativity - initiative

· lob dissatisfaction

· Decreased morale

· Limited opportunities for continuing education


None, except for a meritous award for exceptional performance

136

Tire Health Worlcforce


Difficulties Experienced in Management or Health Personnel

· Limited health manpower

· Quality of supervision not conducive to: - employee's self development

creativity - initiative

· lob dissatisfaction

· Decreased morale

· Limited opportunities for continuing education


None, except for a meritous award for exceptional performance

136

Republic ofGUIlm



Determining Establishment 0 0 Based on need of each department

0 0 Procedure time consuming. Takes an

Recruitment Process average of 8 months from date of request to fill position to date of Certification of application.

0 0 Too time consuming. Decision

Selection Procedures made by Director, sometimes without considering comments of interview panelists.

0 D There is a general orientation

Induction Programmes workshop to all new Gov. Guam employees.

Supportive Supervision Process 0 D Performance Appraisal 0 D In-Service Training 0 D Special Incentives & Rewards 0 D Merit promotion and increment

appropriate to length of service.

Determining Career Path 0 D No coordinated effort. Left to the needs of each agency.

0 D Position descriptions periodically

Task Analysis Procedure reviewed by incumbents and evaluated by Personnel Div., DOA for line agencies; otherwise done by individual dept.

Designing of Job Proflles 0 D DOA - line agencies, otherwise individual department.

Management of Records 0 D DOA - line agencies, otherwise individual department.

Others D D


137

Republic ofGUIlm



Determining Establishment 0 0 Based on need of each department

0 0 Procedure time consuming. Takes an

Recruitment Process average of 8 months from date of request to fill position to date of Certification of application.

0 0 Too time consuming. Decision

Selection Procedures made by Director, sometimes without considering comments of interview panelists.

0 D There is a general orientation

Induction Programmes workshop to all new Gov. Guam employees.

Supportive Supervision Process 0 D Performance Appraisal 0 D In-Service Training 0 D Special Incentives & Rewards 0 D Merit promotion and increment

appropriate to length of service.

Determining Career Path 0 D No coordinated effort. Left to the needs of each agency.

0 D Position descriptions periodically

Task Analysis Procedure reviewed by incumbents and evaluated by Personnel Div., DOA for line agencies; otherwise done by individual dept.

Designing of Job Proflles 0 D DOA - line agencies, otherwise individual department.

Management of Records 0 D DOA - line agencies, otherwise individual department.

Others D D


137

The Health Work/orce


Professional Bodies · Commission of Licensure · Board of Medical Examiners · Board of Nursing Examiners · Board of Examiners for Optometry · Board of Examiners for Pharmacy · Board of Allied Health Examiners




Licensing and disciplinary activities of the respective categories of health worl<:ers under the boards

*

138

The Health Work/orce


Professional Bodies · Commission of Licensure · Board of Medical Examiners · Board of Nursing Examiners · Board of Examiners for Optometry · Board of Examiners for Pharmacy · Board of Allied Health Examiners




Licensing and disciplinary activities of the respective categories of health worl<:ers under the boards

*

138

Republie 0/ PakI"

REPUBLIC OF PALAU



Indicator



Urban population Rate of natural increase of population per annum Crude birth rate (per 1000) Crude death rate (per 10(0) Life expectancy at birth (years) Infant mortality rate (per 1000 live births) Adult literacy rate Percent of population served with:



Data

196,100 sq. kIn. 14,000 2.4%

35.0% 5.4%

* 1.43% 21.8 7.5 Total 60 26 75-85%

95% 62%



- Mental disorders - Heart disease - Pneumonia - Respiratory disease - Diseases of female genital tract - Cerebrovascular accidents - Symptoms referred to systems or organs - Neoplasms - Transportation accidents - Accidents - Other accidents - Infections - Complications related to pregnancy - Gastrointestinal diseases - Infections of skin and subcutaneous tissues - Violent deaths - Diseases of ears and mastoid - Perinatal deaths - Asthma

139

Republie 0/ PakI"

REPUBLIC OF PALAU



Indicator



Urban population Rate of natural increase of population per annum Crude birth rate (per 1000) Crude death rate (per 10(0) Life expectancy at birth (years) Infant mortality rate (per 1000 live births) Adult literacy rate Percent of population served with:



Data

196,100 sq. kIn. 14,000 2.4%

35.0% 5.4%

* 1.43% 21.8 7.5 Total 60 26 75-85%

95% 62%



- Mental disorders - Heart disease - Pneumonia - Respiratory disease - Diseases of female genital tract - Cerebrovascular accidents - Symptoms referred to systems or organs - Neoplasms - Transportation accidents - Accidents - Other accidents - Infections - Complications related to pregnancy - Gastrointestinal diseases - Infections of skin and subcutaneous tissues - Violent deaths - Diseases of ears and mastoid - Perinatal deaths - Asthma

139




Main referral hospital 60 4.3 District hospital Health centre/clinics 10

Total 11 60 4.3



Medical Officers 11 Medical Assistants" 2 Dental Officers 3 Dental Assistants "* 11 Pharmacists! Assistant Pharmacists 1 Dispensary Assistants 3 Nurses S3 Nurse Aides & Enrolled Nurses 16 MedicallLaboratory Technologists 6 Radiographers 3 Physiotherapists 2 Nutritionists & Dietitians 1 Health Educators 1 Health Inspectors/Sanitarians 3 Community Health WorkerslHealth Assistants 18 Other Professional & Technical Support Staff **" 6


" Includes Health Officers, Health Extension Officers and Anaesthetic AssistantslTechnicians.

** Includes Dental Technicians, Therapists and Nurses .

1: 1,273 1: 7,000 1: 4,667 1: 1,273 1: 14,000 1: 4,667 1: 264 1: 875 1: 2,333 1: 4,667 1: 7,000 1: 14,000 1: 14,000 1: 4,667 1: 778 1: 2,333

1: 100

.. * Include Health Statisticians, Computer Operators, Bio-medical Engineers and Health Administrators.

140




Main referral hospital 60 4.3 District hospital Health centre/clinics 10

Total 11 60 4.3



Medical Officers 11 Medical Assistants" 2 Dental Officers 3 Dental Assistants "* 11 Pharmacists! Assistant Pharmacists 1 Dispensary Assistants 3 Nurses S3 Nurse Aides & Enrolled Nurses 16 MedicallLaboratory Technologists 6 Radiographers 3 Physiotherapists 2 Nutritionists & Dietitians 1 Health Educators 1 Health Inspectors/Sanitarians 3 Community Health WorkerslHealth Assistants 18 Other Professional & Technical Support Staff **" 6


" Includes Health Officers, Health Extension Officers and Anaesthetic AssistantslTechnicians.

** Includes Dental Technicians, Therapists and Nurses .

1: 1,273 1: 7,000 1: 4,667 1: 1,273 1: 14,000 1: 4,667 1: 264 1: 875 1: 2,333 1: 4,667 1: 7,000 1: 14,000 1: 14,000 1: 4,667 1: 778 1: 2,333

1: 100

.. * Include Health Statisticians, Computer Operators, Bio-medical Engineers and Health Administrators.

140

Republic of Palau




(%) (%) Clinics( % )

General Medical Practitioner 10 80 20 Specialist/Consultant 100 Health Officer Health Extension Officer Medical Assistant Community Health WockerlHealth Assistant 18 100 Dentist 3 100 Dental Therapist 6 100 Dental Assistant Dental Technician 100 Dental Nurse 4 100 Nursing SisterlRegistered Nurse 38 84 16 Midwife - Nurse 2 100 Public Health NurselCommunity Nurse 13 100 Nurse Aide/Practical Nurse 16 100 Student Nurse 14* 100 Medical Technologist I 100 Laboratory Technologist 5 100 Radiographer 3 100 Anaesthetic Technician! Assistant 2 100 Pharmacist I 100 Dispensary Assistant/Pharmacy Assistant 3 100 Nutritionist 100 Dietitian Health Education 100 Health Personnel Educator Health Inspector 100 Sanitarian 2 100 Physiotherapist 2 100 Health Statistician Computer Operator 5 100 Health Administrator 1 100 Bio-medical Engineer


* Not included in the total worldorce because still in training.

141

Republic of Palau




(%) (%) Clinics( % )

General Medical Practitioner 10 80 20 Specialist/Consultant 100 Health Officer Health Extension Officer Medical Assistant Community Health WockerlHealth Assistant 18 100 Dentist 3 100 Dental Therapist 6 100 Dental Assistant Dental Technician 100 Dental Nurse 4 100 Nursing SisterlRegistered Nurse 38 84 16 Midwife - Nurse 2 100 Public Health NurselCommunity Nurse 13 100 Nurse Aide/Practical Nurse 16 100 Student Nurse 14* 100 Medical Technologist I 100 Laboratory Technologist 5 100 Radiographer 3 100 Anaesthetic Technician! Assistant 2 100 Pharmacist I 100 Dispensary Assistant/Pharmacy Assistant 3 100 Nutritionist 100 Dietitian Health Education 100 Health Personnel Educator Health Inspector 100 Sanitarian 2 100 Physiotherapist 2 100 Health Statistician Computer Operator 5 100 Health Administrator 1 100 Bio-medical Engineer


* Not included in the total worldorce because still in training.

141



Number or Health Workers •• by Age Group

21·30 31-40 41·50 51.(iO 60+

General Medical Practitioner Specialist/Consultant Health Officer

Health Extension Officer Medical Assistant Community Health WorkerlHealth Ass. Dentist Dental Therapist Dental Assistant Dental Technician

Dental Nurse

Nursing Sister/Registered Nurse Midwife-Nurse Public Health Nurse/Community Nurse

Nurse Aide Student Nurse Medical Technologist Laboratory Technologist

Radiographer Anaesthetic Technician! Assistant

Pharmacist Dispensary Assistant Nutritionist Dietitian Health Personnel Educator

Health Education

Health Inspector

Sanitarian Physiotherapist Health Statistician Computer Operator Health Administrator Bio-medical Engineer

Total

* Not included in the total workforce becanse still in training. ** Information not provided.

142

Total Projection for lor

1989 1995

10

18 3 6

4 38

2 13 16 14*

1 5 3 2 1 3

2 2

5 1

140

10

28 3 6

1 4

39

18 20 18

5

1 3 1

2 1 4

10

178



Number or Health Workers •• by Age Group

21·30 31-40 41·50 51.(iO 60+

General Medical Practitioner Specialist/Consultant Health Officer

Health Extension Officer Medical Assistant Community Health WorkerlHealth Ass. Dentist Dental Therapist Dental Assistant Dental Technician

Dental Nurse

Nursing Sister/Registered Nurse Midwife-Nurse Public Health Nurse/Community Nurse

Nurse Aide Student Nurse Medical Technologist Laboratory Technologist

Radiographer Anaesthetic Technician! Assistant

Pharmacist Dispensary Assistant Nutritionist Dietitian Health Personnel Educator

Health Education

Health Inspector

Sanitarian Physiotherapist Health Statistician Computer Operator Health Administrator Bio-medical Engineer

Total

* Not included in the total workforce becanse still in training. ** Information not provided.

142

Total Projection for lor

1989 1995

10

18 3 6

4 38

2 13 16 14*

1 5 3 2 1 3

2 2

5 1

140

10

28 3 6

1 4

39

18 20 18

5

1 3 1

2 1 4

10

178

Rep"blic of PaIII"


Budget (USS) 1988 1989 1990

Total Public Sector Budget (mil) 20 21 22

Total Health Budget (mil) 2 2.2 2.3


Health Budget as Percentage of Total Budget (%) 10 10 10

143

Rep"blic of PaIII"


Budget (USS) 1988 1989 1990

Total Public Sector Budget (mil) 20 21 22

Total Health Budget (mil) 2 2.2 2.3


Health Budget as Percentage of Total Budget (%) 10 10 10

143




• There are not enough good candidates for training in the health professions.

• Nurses serve in non related fields due to the lack of technicians, record keeping, clerks etc.

• Nurses leave for better paid jobs in Saipan.

• Trainees do not come back from more developed countries.

• Not enough planning and forecasting.

• Lack of proper maintenance personnel.


• Projections for future manpower needs.

• Information relevant to training need.


144




• There are not enough good candidates for training in the health professions.

• Nurses serve in non related fields due to the lack of technicians, record keeping, clerks etc.

• Nurses leave for better paid jobs in Saipan.

• Trainees do not come back from more developed countries.

• Not enough planning and forecasting.

• Lack of proper maintenance personnel.


• Projections for future manpower needs.

• Information relevant to training need.


144

Republic of Palau




Currently there is no National Health Plan, nor a designated body to oversee its development.


Present

Period covered

Body resporuible for planning


Planning method

Linkage 10 NHP





No fonnal plan exists apart from a 5 year workforce projection based on projected population.

Infonnation not available.

Office of Health Manpower Development.

· Present and projected population needs. · Size of facilities and type of services available.

Based on health service needs.

*

*

*

· Establishment targets. · Nursing establishment needs.

145

Republic of Palau




Currently there is no National Health Plan, nor a designated body to oversee its development.


Present

Period covered

Body resporuible for planning


Planning method

Linkage 10 NHP





No fonnal plan exists apart from a 5 year workforce projection based on projected population.

Infonnation not available.

Office of Health Manpower Development.

· Present and projected population needs. · Size of facilities and type of services available.

Based on health service needs.

*

*

*

· Establishment targets. · Nursing establishment needs.

145



Capabilities Available Priority For Development


Health Planning X X







Planning of Educational Programme and Cuniculum X X

Others



Existence of clear policies and plans No clear training policy. Training is ad hoc, and based on needs.

Body responsible for educational planning Health Manpower Division

Linkage of educational planning to NHP Not applicable as no National Health Plan.

Liaison between service providers and Minimal and very sporadic, through the Health training institutions Manpower Development Office.

146



Capabilities Available Priority For Development


Health Planning X X







Planning of Educational Programme and Cuniculum X X

Others



Existence of clear policies and plans No clear training policy. Training is ad hoc, and based on needs.

Body responsible for educational planning Health Manpower Division

Linkage of educational planning to NHP Not applicable as no National Health Plan.

Liaison between service providers and Minimal and very sporadic, through the Health training institutions Manpower Development Office.

146

Republic 0/ Palau


ProblelDi Associated with Local Training Suggested Remedial Activities

. Too much reliance on overseas trainers . Availability of funds to obtain appropriate

. Difficulty in obtaining teachers for higher level training.

trainers from abroad .


Name 01 Training Program Duration

Health Assistant Training 18 months

Chair Side Assistant 12 months

Practical Nurses 20 hours

Diving Medicine 40 hours

Therapeutic Touch Infant Message 21 hours

Average Intake

per Year

15

7

15

15-20

3-6



3

2


Name 01 Number

Training Name 01 Category 01 Completed Imtitution Program 01 Staff Trainees Training

Univ.ofGuam Second Step BSW Nurse 3

Prince of Wales Hospital X-Ray Technicians Group, NSW, Australia Staff Nurse 3 3

Kushu University, Japan Clinical dentistry Dental Nurse 1

147

Republic 0/ Palau


ProblelDi Associated with Local Training Suggested Remedial Activities

. Too much reliance on overseas trainers . Availability of funds to obtain appropriate

. Difficulty in obtaining teachers for higher level training.

trainers from abroad .


Name 01 Training Program Duration

Health Assistant Training 18 months

Chair Side Assistant 12 months

Practical Nurses 20 hours

Diving Medicine 40 hours

Therapeutic Touch Infant Message 21 hours

Average Intake

per Year

15

7

15

15-20

3-6



3

2


Name 01 Number

Training Name 01 Category 01 Completed Imtitution Program 01 Staff Trainees Training

Univ.ofGuam Second Step BSW Nurse 3

Prince of Wales Hospital X-Ray Technicians Group, NSW, Australia Staff Nurse 3 3

Kushu University, Japan Clinical dentistry Dental Nurse 1

147

The Hetlith Worlcforce

3.2.5 Fellowships


Selection body


Other constraints



A WHO Fellowships Committee comprising of Section Supervisors meets annually to determine fellowships.

WHO Fellowships Committee.

Only for candidates for maintenance jobs.

*



100 percent. Annual Review



· Low Remuneration

· Work overload

· Low morale

· Chronic staff shortage


· Free housing

· Differential payment to those who are deployed away from their homes.

· Trips off Island to attend conferences and training

148

The Hetlith Worlcforce

3.2.5 Fellowships


Selection body


Other constraints



A WHO Fellowships Committee comprising of Section Supervisors meets annually to determine fellowships.

WHO Fellowships Committee.

Only for candidates for maintenance jobs.

*



100 percent. Annual Review



· Low Remuneration

· Work overload

· Low morale

· Chronic staff shortage


· Free housing

· Differential payment to those who are deployed away from their homes.

· Trips off Island to attend conferences and training

148

Republic of Palau

3.3.3 Existence of written guidelinesfor routine personnel management *


Determining Establishment 0 D Recruitment Process 0 D Selection Procedures 0 D Induction Programmes 0 D Supportive Supervision Process 0 D Performance Appraisal 0 D In-Service Training 0 D Special Incentives & Rewards 0 D Determining Career Path 0 D Task Analysis Procedure D 0 Designing of Job Profiles D D Management of Records D D Others D D

* As reported by country respondent

149

Republic of Palau

3.3.3 Existence of written guidelinesfor routine personnel management *


Determining Establishment 0 D Recruitment Process 0 D Selection Procedures 0 D Induction Programmes 0 D Supportive Supervision Process 0 D Performance Appraisal 0 D In-Service Training 0 D Special Incentives & Rewards 0 D Determining Career Path 0 D Task Analysis Procedure D 0 Designing of Job Profiles D D Management of Records D D Others D D

* As reported by country respondent

149




Professional Bodies

National Civil Service Board Recruitment and disciplinary functions

National Centre Board Training function

National Scholarship Committee



150




Professional Bodies

National Civil Service Board Recruitment and disciplinary functions

National Centre Board Training function

National Scholarship Committee



150

Solomon llllmuls

SOLOMON ISLANDS



Indicator

Area Estimated population Annual population growth rate

Percentage of population - less than 15 years - 65 plus years

Urban population

Data

27,600 sq. kIn. 316,700 (est 1989) 3.5%


49.3% 3% 11.6% 3.3% 44


- male - female

10 (1986 census) 60 (total)

Infant mortality rate (per 1000 live births) 38 (female) - (1986 census) 40 (male) - (1986 census)



• Information not provided .

*

90% (urban), 59.8% (rural) 90% (urban)



- Malaria - Respiratory infections

· Influenza · Tuberculosis · Pneumonias

- Diarrhoeal diseases - Abscesses - Cardiovascular diseases - Renal diseases - Gastrointestinal diseases


- Respiratory infections · Acute including measles · Chronic

- Cardiovascular diseases · Hypertension and myocardial · infarction

- Renal failure - Neoplastic diseases - Congenital abnormalities - Diarrhoeal diseases - Obstetric/gynaecological conditions - Accidents

151

Solomon llllmuls

SOLOMON ISLANDS



Indicator

Area Estimated population Annual population growth rate

Percentage of population - less than 15 years - 65 plus years

Urban population

Data

27,600 sq. kIn. 316,700 (est 1989) 3.5%


49.3% 3% 11.6% 3.3% 44


- male - female

10 (1986 census) 60 (total)

Infant mortality rate (per 1000 live births) 38 (female) - (1986 census) 40 (male) - (1986 census)



• Information not provided .

*

90% (urban), 59.8% (rural) 90% (urban)



- Malaria - Respiratory infections

· Influenza · Tuberculosis · Pneumonias

- Diarrhoeal diseases - Abscesses - Cardiovascular diseases - Renal diseases - Gastrointestinal diseases


- Respiratory infections · Acute including measles · Chronic

- Cardiovascular diseases · Hypertension and myocardial · infarction

- Renal failure - Neoplastic diseases - Congenital abnormalities - Diarrhoeal diseases - Obstetric/gynaecological conditions - Accidents

151

The Healllt Workforce


Number of

Type of Health Facilities Total Number Beds

Main referral hospital 1 255 } District hospital 7 485 Health centre/clinics 137 506

Total 145 1,246

• Ratio excludes health centre/clinic beds.



Medical Officers 47 Medical Assistants· Dental Officers 6 Dental Assistants ** 18 Pharmacists! Assistant Pharmacists 3 Pharmacy Assistants 17 Nurses 407 Nurse Aides & Enrolled Nurses MedicallLaboratory Technologists 27 Radiographers 16 PhysiotherapistslPhysiotherapy Assistants 7 Nutritionists & Dietitians 3 Health Educators 26 Health lnspectorslEnvironmental Health 34 C' *** 27 ommuOlty Health Workers Other Professional & Technical Support Staff**** 47 Antimalarial Workers 139



2.3

Population Ratio

1: 6,738

1: 52,783 1: 17,594 1:105,567 1: 18,629 1: 778

1: 11,730 1: 17,794 1: 45,243 1:105,567 1: 12,181 I: 6,315 1: 11,730 1: 6,738 1: 2,278

1: 384



*** Include women's interest and social welfare staff.

**** Include Health Statisticians, Computer Operators, Bio-medical Engineers and Health Administrators.

152

The Healllt Workforce


Number of

Type of Health Facilities Total Number Beds

Main referral hospital 1 255 } District hospital 7 485 Health centre/clinics 137 506

Total 145 1,246

• Ratio excludes health centre/clinic beds.



Medical Officers 47 Medical Assistants· Dental Officers 6 Dental Assistants ** 18 Pharmacists! Assistant Pharmacists 3 Pharmacy Assistants 17 Nurses 407 Nurse Aides & Enrolled Nurses MedicallLaboratory Technologists 27 Radiographers 16 PhysiotherapistslPhysiotherapy Assistants 7 Nutritionists & Dietitians 3 Health Educators 26 Health lnspectorslEnvironmental Health 34 C' *** 27 ommuOlty Health Workers Other Professional & Technical Support Staff**** 47 Antimalarial Workers 139



2.3

Population Ratio

1: 6,738

1: 52,783 1: 17,594 1:105,567 1: 18,629 1: 778

1: 11,730 1: 17,794 1: 45,243 1:105,567 1: 12,181 I: 6,315 1: 11,730 1: 6,738 1: 2,278

1: 384



*** Include women's interest and social welfare staff.

**** Include Health Statisticians, Computer Operators, Bio-medical Engineers and Health Administrators.

152

Solomon l,lands

1.S Current health workforce with pattern of utilisation

Total UtiIization ~ Percentage


(%) (%) Clinics(%)

General Medical Practitioner 36 37 48 15 Specialist/Consultant 6 90 10 Medical Officerl Administration and Prevention 5 Health Extension Officer Medical Assistant Community Health Worker 100 Antimalaria W Ol'kers 139 2 60 38 Dentist 6 80 20 Dental Therapist 10 64 27 9 Dental Assistant I 100 Dental Technician 4 50 50 Dental Nurse 3 100 Nursing SisterlRegistered Nurse 407 33 37 40 Midwife - Nurse Public Health Nurse/Community Nurse Nurse Aide * 15 25 60 Student Nurse * 100 Medical Technologist 13 69 31 Laboratory Technologist 14 78 22 Radiographer 16 63 37 Anaesthetic Technician! Assistant Pharmacist 3 90 10 Pharmacy Assistant 17 59 41 Nutritionist DietitianlDietetic Assistant 3 100 Women's Interest 12 33 67 Health Education 26 19 81 Health InspectorlEnvironmental Health 34 12 80 8 Social Welfare 14 50 50 PhysiotherapistlPhysio. Assistant 7 85 15 Health Statistician 2 100 Computer Operator Health Administration 43 63 37 Bio-medical Engineer 2 90 10

Total Health Workforce ** 824


** Total government approved establishment; does not necessarily represent actual total workforce.

153

Solomon l,lands


Total UtiIization ~ Percentage


(%) (%) Clinics(%)

General Medical Practitioner 36 37 48 15 Specialist/Consultant 6 90 10 Medical Officerl Administration and Prevention 5 Health Extension Officer Medical Assistant Community Health Worker 100 Antimalaria W Ol'kers 139 2 60 38 Dentist 6 80 20 Dental Therapist 10 64 27 9 Dental Assistant I 100 Dental Technician 4 50 50 Dental Nurse 3 100 Nursing SisterlRegistered Nurse 407 33 37 40 Midwife - Nurse Public Health Nurse/Community Nurse Nurse Aide * 15 25 60 Student Nurse * 100 Medical Technologist 13 69 31 Laboratory Technologist 14 78 22 Radiographer 16 63 37 Anaesthetic Technician! Assistant Pharmacist 3 90 10 Pharmacy Assistant 17 59 41 Nutritionist DietitianlDietetic Assistant 3 100 Women's Interest 12 33 67 Health Education 26 19 81 Health InspectorlEnvironmental Health 34 12 80 8 Social Welfare 14 50 50 PhysiotherapistlPhysio. Assistant 7 85 15 Health Statistician 2 100 Computer Operator Health Administration 43 63 37 Bio-medical Engineer 2 90 10

Total Health Workforce ** 824



153



Number otHealth Workers • by Age Group

21-30 31-40 41-50 51-60 61+

General Medical Practitioner Specialist/Consultant Medical Officer/Admin. & Prevention Health Extension Officer Medical Assistant Community Health Worker Antimalaria Worker Dentist Dental Therapist Dental Assistant Dental Technician Dental Nurse Nursing SisterlRegistered Nurse Midwife-Nurse Public Health Nurse/Community Nurse Nurse Aide Student Nurse Medical Technologist Laboratory Technologist Radiographer Anaesthetic Technician! Assistant Pharmacist Pharmacy Assistant Nutritionist DietitianlDietetic Assistant Women's Interest Health Education Health InspectorlEnvironmental Health Social Welfare PhysiotherapistlPhysio. Assistant Health Statistician Computer Operator Health Administrator Bio-medical Engineer

Total Workforce **


Total Projection tor tor

1989 1995·

36 6 5

139 6

10

4 3

407

*

* 13 14 16

3 17

3 12 26 34 14 7 2

43 2

824


154



Number otHealth Workers • by Age Group

21-30 31-40 41-50 51-60 61+

General Medical Practitioner Specialist/Consultant Medical Officer/Admin. & Prevention Health Extension Officer Medical Assistant Community Health Worker Antimalaria Worker Dentist Dental Therapist Dental Assistant Dental Technician Dental Nurse Nursing SisterlRegistered Nurse Midwife-Nurse Public Health Nurse/Community Nurse Nurse Aide Student Nurse Medical Technologist Laboratory Technologist Radiographer Anaesthetic Technician! Assistant Pharmacist Pharmacy Assistant Nutritionist DietitianlDietetic Assistant Women's Interest Health Education Health InspectorlEnvironmental Health Social Welfare PhysiotherapistlPhysio. Assistant Health Statistician Computer Operator Health Administrator Bio-medical Engineer

Total Workforce **


Total Projection tor tor

1989 1995·

36 6 5

139 6

10

4 3

407

*

* 13 14 16

3 17

3 12 26 34 14 7 2

43 2

824


154

SoWmoll lskuuls


Budget (S.I.$) 1988 1989 1990

Total Public Sector Budget 173.72m 218.27m 239.9m




155

SoWmoll lskuuls


Budget (S.I.$) 1988 1989 1990

Total Public Sector Budget 173.72m 218.27m 239.9m




155

Tire Health Workforce



l. Government's financial capability. 2. High population growth. 3. Maintaining equal service distribution. 4. Availability of qualified and specialized personnel. 5. Donor agencies support. 6. Performance evaluation. 7. Quality of supervision. 8. Inadequate staff quantity.


I. The government's overall policy on training, employment and service distributions.

2. Population growth rate. 3. Local and overseas training institutions. 4. Health workforce data pertaining to demand, supply and distribution. 5. Public service projected manpower establishments. 6. Evaluation and analysis of effectiveness of current health strategies. 7. Future levels of funding.


156

Tire Health Workforce



l. Government's financial capability. 2. High population growth. 3. Maintaining equal service distribution. 4. Availability of qualified and specialized personnel. 5. Donor agencies support. 6. Performance evaluation. 7. Quality of supervision. 8. Inadequate staff quantity.


I. The government's overall policy on training, employment and service distributions.

2. Population growth rate. 3. Local and overseas training institutions. 4. Health workforce data pertaining to demand, supply and distribution. 5. Public service projected manpower establishments. 6. Evaluation and analysis of effectiveness of current health strategies. 7. Future levels of funding.


156

Solomon lslonds




The National Health Plan is drawn up every five years. The current plan covers the period between 1990-1995 and its preparation was coordinated and undertaken by the Health Planning Unit. The plan reflects the general policies of the government, and it incooperates inputs from all the provincial directors of health and various heads of divisions.


Present

Period covered

Body responsible jor planning

Major source oj plonning information

Plonning method


The second health workforce plan is currently in existence.

1990 - 1994

The Human Resources Development component of the Health Planning Unit, in collaboration with the Head of Planning, Director of Malaria Training and Research Institute and the Undersecretaries of Health

· An~ual training records (preservice and inservice) · Divisional submissions · Localization programmes · Annual population growth rate and population ratios · Public service workforce guidelines and establishments · Economic status of country

Incooperares two district areas: . the policy component . manpower projections

The policy component is based on the Government's overall training policy approved by Cabinet, and addresses key areas relating to the selection, maintenance and retainment of candidates.

The Manpower projections are largely based on the population growth rate, in an effort to maintain the existing health worker to population ratio. Health needs as identified by divisional heads are also taken into account.

Future plans need to adopt a more analytical methodology incooperating health demands analysis and appropriate costing.

Intricately linked to the NHP Closely linked to the Government's overall training policy approved by cabinet in 1989.

157

Solomon lslonds




The National Health Plan is drawn up every five years. The current plan covers the period between 1990-1995 and its preparation was coordinated and undertaken by the Health Planning Unit. The plan reflects the general policies of the government, and it incooperates inputs from all the provincial directors of health and various heads of divisions.


Present

Period covered

Body responsible jor planning

Major source oj plonning information

Plonning method


The second health workforce plan is currently in existence.

1990 - 1994

The Human Resources Development component of the Health Planning Unit, in collaboration with the Head of Planning, Director of Malaria Training and Research Institute and the Undersecretaries of Health

· An~ual training records (preservice and inservice) · Divisional submissions · Localization programmes · Annual population growth rate and population ratios · Public service workforce guidelines and establishments · Economic status of country

Incooperares two district areas: . the policy component . manpower projections

The policy component is based on the Government's overall training policy approved by Cabinet, and addresses key areas relating to the selection, maintenance and retainment of candidates.

The Manpower projections are largely based on the population growth rate, in an effort to maintain the existing health worker to population ratio. Health needs as identified by divisional heads are also taken into account.

Future plans need to adopt a more analytical methodology incooperating health demands analysis and appropriate costing.

Intricately linked to the NHP Closely linked to the Government's overall training policy approved by cabinet in 1989.

157


3.1.2 Health workforce plan (Continued)

Formal arrangement to share in/ormation with other agencies


Exists with - Ministries of Public Service and Education - Public Service Commission - Non government organizations with vested interest in

health - Donor agencies

1. 1986-1990 MHMS Training Policy 2. Annual Public Service Establishments as approved by

parliament 3. 1986 and 1989 Health Manpower Consultants Reports 4. Divisional Annual Reports 5. Provincial Health Annual Reports

3.1.3. Current planning capability of health autlwrities in selected areas



Health Planning X X








Others

Appropriate trrumng programmes are currently being undertaken for officers within the Health Planning Unit to improve the Unit's planning capability in these areas.

158



Formal arrangement to share in/ormation with other agencies


Exists with - Ministries of Public Service and Education - Public Service Commission - Non government organizations with vested interest in

health - Donor agencies

1. 1986-1990 MHMS Training Policy 2. Annual Public Service Establishments as approved by

parliament 3. 1986 and 1989 Health Manpower Consultants Reports 4. Divisional Annual Reports 5. Provincial Health Annual Reports

3.1.3. Current planning capability of health autlwrities in selected areas



Health Planning X X








Others

Appropriate trrumng programmes are currently being undertaken for officers within the Health Planning Unit to improve the Unit's planning capability in these areas.

158

Solomon Is14mls







The current trammg policy has very clear policies and plans.

The human resource development component of the planning unit in collaboration with the head of the unit and the undersecretaries.

Educational planning is closely linked to the NHP. Training of personnel both in country and overseas are to enable the implementation of health policies.

There is close liaison between the Ministry of Health and training institutions both in country and overseas that are used for training.



· Lack of adequate health staff . Clear policies and guidelines from public

· Lack of funding. equipments or facilities

· Difficulty in attracting candidates because of poor career paths

· Public service establishments do not allow for increased numbers of training

· Service commitments often prevent officers from attending training courses.

159

service on health workforce

. Proper planning and forecasting by the health Ministry based on health services demands to enable better costing of services

. Allocation of resources for: - construction of facilities - purchasing of equipments - purchase of landsites - maintenance of equipmentslfacilities - increased training

Solomon Is14mls







The current trammg policy has very clear policies and plans.

The human resource development component of the planning unit in collaboration with the head of the unit and the undersecretaries.

Educational planning is closely linked to the NHP. Training of personnel both in country and overseas are to enable the implementation of health policies.

There is close liaison between the Ministry of Health and training institutions both in country and overseas that are used for training.



· Lack of adequate health staff . Clear policies and guidelines from public

· Lack of funding. equipments or facilities

· Difficulty in attracting candidates because of poor career paths

· Public service establishments do not allow for increased numbers of training

· Service commitments often prevent officers from attending training courses.

159

service on health workforce

. Proper planning and forecasting by the health Ministry based on health services demands to enable better costing of services

. Allocation of resources for: - construction of facilities - purchasing of equipments - purchase of landsites - maintenance of equipmentslfacilities - increased training



Name of Training Program Duration

Nursing Certificate 3 years

Health Education Certificate 6 months

Microscopist 3-4 weeks

MCH & Family Planning - pilot program 12 months

Average Intake

per Year

30

14

10

12


24

14

12


6

o o

o



Institution Program of Staff Trainees Training

University of Papua New Guinea Medicine Preservice 17 4

College of Allied Health Ext Health Ext Officer Health Sciences Radiography Radiographer (PNG) Laboratory Tech Cert Lab Technicians 10 3

Fiji School of Medicine Doctors 5 3 Medicine (FSM) Radiography Cert Radiographers

Laboratory Cert Lab Technicians Dental Therapy Dental Therapists 10 8 Dental Technology Cert Dental Technicians 1 1 Physiotherapy CertlDipl Physiotherapy

Assistants 4 2 Health Inspectors Health Insp Assistants 1 Dietician Hospital 1

OtagoN.Z. Medicine Preservice 2 in progress

Auckland Medical School Medicine Preservice 4 in progress

Wellington Politec Pharmacy Preservice 2 in progress

160



Name of Training Program Duration

Nursing Certificate 3 years

Health Education Certificate 6 months

Microscopist 3-4 weeks

MCH & Family Planning - pilot program 12 months

Average Intake

per Year

30

14

10

12


24

14

12


6

o o

o




University of Papua New Guinea Medicine Preservice 17 4

College of Allied Health Ext Health Ext Officer Health Sciences Radiography Radiographer (PNG) Laboratory Tech Cert Lab Technicians 10 3

Fiji School of Medicine Doctors 5 3 Medicine (FSM) Radiography Cert Radiographers

Laboratory Cert Lab Technicians Dental Therapy Dental Therapists 10 8 Dental Technology Cert Dental Technicians 1 1 Physiotherapy CertlDipl Physiotherapy

Assistants 4 2 Health Inspectors Health Insp Assistants 1 Dietician Hospital 1

OtagoN.Z. Medicine Preservice 2 in progress

Auckland Medical School Medicine Preservice 4 in progress

Wellington Politec Pharmacy Preservice 2 in progress

160

3.2.5 Fellowships


Selection body


Other constraints


Solomon Islands

Preservice: detennined by National Fellowships Board

lnservice: · Candidates are nominated by Divisional Heads and

processed by the Planning Unit and Under Secretaries · Candidates are submitted to National Training Unit,

Ministry of Human Resources Development for approval

Preservice: National Scholarships Panel

lnservice: - Divisional Heads - Planning Unit - Under Secretaries of Health - Pennanent Secretary - National Training Unit - Public Service Commission

Especially for preservice courses

· Inadequate educational level to meet selection criteria of overseas training institutions

· Rejection by National Training Committee or Public Service Commission resulting in backlog on already planned training programme


Posts widl Job Descriptions Review Arrangements

100% When there is a change in manning the post.

161

3.2.5 Fellowships


Selection body


Other constraints


Solomon Islands

Preservice: detennined by National Fellowships Board

lnservice: · Candidates are nominated by Divisional Heads and

processed by the Planning Unit and Under Secretaries · Candidates are submitted to National Training Unit,

Ministry of Human Resources Development for approval

Preservice: National Scholarships Panel

lnservice: - Divisional Heads - Planning Unit - Under Secretaries of Health - Pennanent Secretary - National Training Unit - Public Service Commission

Especially for preservice courses

· Inadequate educational level to meet selection criteria of overseas training institutions

· Rejection by National Training Committee or Public Service Commission resulting in backlog on already planned training programme


Posts widl Job Descriptions Review Arrangements

100% When there is a change in manning the post.

161




· Lack of punctuality · Low morale · Lack of motivation · Lack of skills · Inadequate supervision · Inadequate numbers of staff · Lack of proper career paths


. Housing allowances

. Special duty allowances in lieu of overtime payments

162




· Lack of punctuality · Low morale · Lack of motivation · Lack of skills · Inadequate supervision · Inadequate numbers of staff · Lack of proper career paths



. Special duty allowances in lieu of overtime payments

162

SOWlI/O" lslllmls

3.3.3 Existence of wrinen guidelines for routine personnel management *


Determining Establishment D 0 Recruitment Process 0 D Selection Procedures 0 D Induction Programmes 0 D Supportive Supervision Process 0 D Performance Appraisal 0 D In-Service Training 0 D Special Incentives & Rewards 0 D Determining Career Path 0 D Task Analysis Procedure 0 D Designing of Job Profiles D 0 Management of Records 0 D Others D D


163

SOWlI/O" lslllmls

3.3.3 Existence of wrinen guidelines for routine personnel management *


Determining Establishment D 0 Recruitment Process 0 D Selection Procedures 0 D Induction Programmes 0 D Supportive Supervision Process 0 D Performance Appraisal 0 D In-Service Training 0 D Special Incentives & Rewards 0 D Determining Career Path 0 D Task Analysis Procedure 0 D Designing of Job Profiles D 0 Management of Records 0 D Others D D


163



Professional Bodies

Solomon Islands Medical and Dental Board Pharmacy and Poison's Board Health Workers Board Nursing Council


Solomon Islands Medical Association Solomon Islands Nursing Association Solomon Islands Paramedical Association


· Statutory bodies established under Acts of Parliament and responsible for professional and ethical practice of staff under their various jurisdictions

· They regulate. monitor and if necessary investigate professional practice and behaviour

Involved in areas relating to: · respective members conditions of service · training

164



Professional Bodies

Solomon Islands Medical and Dental Board Pharmacy and Poison's Board Health Workers Board Nursing Council


Solomon Islands Medical Association Solomon Islands Nursing Association Solomon Islands Paramedical Association


· Statutory bodies established under Acts of Parliament and responsible for professional and ethical practice of staff under their various jurisdictions

· They regulate. monitor and if necessary investigate professional practice and behaviour

Involved in areas relating to: · respective members conditions of service · training

164

Tonga


Total Udlizalion as Percentage

MAJOR CATEGORIES ror Main District Health 1989 Hospital Hospital Centrei

(%) (%) Clinics(%)

General Medical Practitioner 42 81 17 2 Specialist/Consultant 2 100 Health Officer 20 100 Health Extension Officer Medical Assistant Community Health Worker 42 100 Dentist 9 78 22 Dental Therapist 9 60 20 20 Dental Assistant 60 20 20 Dental Technician 100 Dental Nurse Nursing Sister/Registered Nurse 126 58 37 5 Midwife - Nurse 30 33 27 40 Public Health Nurse/Community Nurse 29 14 21 65 Nurse Aide Student Nurse 161* 100 Medical Technologist 2 100 Laboratory Technologist 14 72 28 Radiographer 4 25 75 Anaesthetic Technician! Assistant Pharmacist 2 75 25 Dispensary Assistant 10 71 29 Nutritionist 100 Dietitian Health Education 4 100 Health Personnel Educator 1 100 Health Inspector 14 79 21 Sanitarian Physiotherapist 2 100 Health Statistician 1 100 Computer Operator 1 100 Health Administrator 2 100 Bio-medical Engineer 3 333 33.3 33.3

Total Health Workforce l72

* Not included in total health workforce because still in training.

167

Tonga


Total Udlizalion as Percentage

MAJOR CATEGORIES ror Main District Health 1989 Hospital Hospital Centrei

(%) (%) Clinics(%)

General Medical Practitioner 42 81 17 2 Specialist/Consultant 2 100 Health Officer 20 100 Health Extension Officer Medical Assistant Community Health Worker 42 100 Dentist 9 78 22 Dental Therapist 9 60 20 20 Dental Assistant 60 20 20 Dental Technician 100 Dental Nurse Nursing Sister/Registered Nurse 126 58 37 5 Midwife - Nurse 30 33 27 40 Public Health Nurse/Community Nurse 29 14 21 65 Nurse Aide Student Nurse 161* 100 Medical Technologist 2 100 Laboratory Technologist 14 72 28 Radiographer 4 25 75 Anaesthetic Technician! Assistant Pharmacist 2 75 25 Dispensary Assistant 10 71 29 Nutritionist 100 Dietitian Health Education 4 100 Health Personnel Educator 1 100 Health Inspector 14 79 21 Sanitarian Physiotherapist 2 100 Health Statistician 1 100 Computer Operator 1 100 Health Administrator 2 100 Bio-medical Engineer 3 333 33.3 33.3

Total Health Workforce l72


167




21·30 31·40 41·50 51-60 61+ 1989 1995

General Medical Practitioner 11 10 13 4 42 48 Specialist/Consultant I I 2 Health Officer 2 6 3 2 20· 30 Health Extension Officer Medical Assistant Community Health Worker 42 Dentist 6 1 1 1 9 Dental Therapist 5 2 2 9 Dental Assistant 1*

Dental Technician 1 Dental Nurse Nursing Sister/Registered Nurse 68 31 18 7 2 126 } Midwife-Nurse 14 16 30 320 Public Health Nurse/Community Nurse 6 16 4 2 29

Nurse Aide Student Nurse 161 161**

Medical Technologist 1 1 2 Laboratory Technologist 8 4 14 Radiographer I 2 4 Anaesthetic Technician! Assistant Pharmacist 2

Dispensary Assistant 6 4 10 Nutritionist Dietitian Health Personnel Educator 1 1 Health Education Technician 2 2 4 Health Inspector 7 4 2 14 Sanitarian Physiotherapist 1 2

Health Statistician Computer Operator 1

Health Administrator 2 Bio-medical Engineer 3


* Apparent errors possibly due to incomplete data.

** Not included in total health workforce as still in training.

168




21·30 31·40 41·50 51-60 61+ 1989 1995

General Medical Practitioner 11 10 13 4 42 48 Specialist/Consultant I I 2 Health Officer 2 6 3 2 20· 30 Health Extension Officer Medical Assistant Community Health Worker 42 Dentist 6 1 1 1 9 Dental Therapist 5 2 2 9 Dental Assistant 1*

Dental Technician 1 Dental Nurse Nursing Sister/Registered Nurse 68 31 18 7 2 126 } Midwife-Nurse 14 16 30 320 Public Health Nurse/Community Nurse 6 16 4 2 29

Nurse Aide Student Nurse 161 161**

Medical Technologist 1 1 2 Laboratory Technologist 8 4 14 Radiographer I 2 4 Anaesthetic Technician! Assistant Pharmacist 2

Dispensary Assistant 6 4 10 Nutritionist Dietitian Health Personnel Educator 1 1 Health Education Technician 2 2 4 Health Inspector 7 4 2 14 Sanitarian Physiotherapist 1 2

Health Statistician Computer Operator 1

Health Administrator 2 Bio-medical Engineer 3


* Apparent errors possibly due to incomplete data.

** Not included in total health workforce as still in training.

168

Tonga


Budget (Tonga Paanga) 1988 1989 1990





169

Tonga


Budget (Tonga Paanga) 1988 1989 1990





169




1. The absence of a National Health Workforce Plan based on priorities of the Ministry of Health and factors affecting supply and demand for health workforce.

2. High attrition rates in certain key health manpower e.g. doctors (18%) and trained nurses (15%).

3. Availability of potential candidates to undertake fellowship e.g. medicine, and dentistry etc. The Ministry of Health is currently facing high failure rate (3l.8%) in its medical undergraduate training program.

4. Need to further strengthen capabilities of Health Planning and Information Division in health workforce planning, health system research and health economics.


1. Current health workforce and its distribution 2. Factors affecting supply and demand 3. Available specialities 4. Inventories of current training programme 5. National health profiles of the country 6. Percentage of health budget allocated to personal emoluments


170




1. The absence of a National Health Workforce Plan based on priorities of the Ministry of Health and factors affecting supply and demand for health workforce.

2. High attrition rates in certain key health manpower e.g. doctors (18%) and trained nurses (15%).

3. Availability of potential candidates to undertake fellowship e.g. medicine, and dentistry etc. The Ministry of Health is currently facing high failure rate (3l.8%) in its medical undergraduate training program.

4. Need to further strengthen capabilities of Health Planning and Information Division in health workforce planning, health system research and health economics.


1. Current health workforce and its distribution 2. Factors affecting supply and demand 3. Available specialities 4. Inventories of current training programme 5. National health profiles of the country 6. Percentage of health budget allocated to personal emoluments


170

Tonga




The health sector plan is included in the fifth Five Year Development Plan 1986-1990 of the Government of Tonga. The health policies of the current health sector plan.has focused attention on the main underlying issues for health care delivery system on a much wider scope than earlier Development Plans with the intention of ·further improving the health status and social welfare of the population. The equitable distribution of health care resources for better access of the population in all island groups and rural areas will continue to be an important strategy during this plan period.


Present

Period covered



Currently there is a Medical Manpower Plan 1986-1995 of the Ministry of Health fonnulated by the Health Planning and Infonnation Division and approved by the National Health Development Committee.

1986 - 1995

· Health Planning and Infonnation Division in collaboration with major head of service divisions.

· National Health Development Committee, the highest decision making body within the Ministry of Health, whose membership comprise the following:

Minister of Health (Chainnan) Director of Health (Member) Medical Superintendent (Member) Chief Medical Officer (Member) Chief Dental Officer (Member) Chief Nursing Officer (Member) Senior Assistant Secretary (Member) Director of Planning, Central Planning Department * Health Planning Officer

· Government Civil Service List

(Member) (Secretary)

· Fifth Five Year Health Development Plan 1986-1990 · Ministry of Health Annual Report · Medical Manpower Plan, 1986-1995, Ministry of

Health, Tonga.

* Indicates inter-sectoral collaboration in health planning and development.

171

Tonga




The health sector plan is included in the fifth Five Year Development Plan 1986-1990 of the Government of Tonga. The health policies of the current health sector plan.has focused attention on the main underlying issues for health care delivery system on a much wider scope than earlier Development Plans with the intention of ·further improving the health status and social welfare of the population. The equitable distribution of health care resources for better access of the population in all island groups and rural areas will continue to be an important strategy during this plan period.


Present

Period covered



Currently there is a Medical Manpower Plan 1986-1995 of the Ministry of Health fonnulated by the Health Planning and Infonnation Division and approved by the National Health Development Committee.

1986 - 1995

· Health Planning and Infonnation Division in collaboration with major head of service divisions.

· National Health Development Committee, the highest decision making body within the Ministry of Health, whose membership comprise the following:

Minister of Health (Chainnan) Director of Health (Member) Medical Superintendent (Member) Chief Medical Officer (Member) Chief Dental Officer (Member) Chief Nursing Officer (Member) Senior Assistant Secretary (Member) Director of Planning, Central Planning Department * Health Planning Officer

· Government Civil Service List

(Member) (Secretary)

· Fifth Five Year Health Development Plan 1986-1990 · Ministry of Health Annual Report · Medical Manpower Plan, 1986-1995, Ministry of

Health, Tonga.

* Indicates inter-sectoral collaboration in health planning and development.

171



Major sources of planning information

Planning metJwd

Linkage to NHP Linkage to other pll1TlS

Formal a"angement to share information with other agencies

The work study that was conducted in the main referral hospital on medical manpower identified the following:

direct and indirect patient care time provided by medical doctors per patients in the wards. general and special outpatient services the mean time and standard deviation for inpatient care services average doctors time absorbed by various disease categories and by age groups attrition rates in medical undergraduates training recurrent cost implication of the medical manpower plan

The method used in the development of the Medical Manpower Plan was health demands method. The work study identified direct and indirect patient care within various medical disciplines at inpatient and outpatient services. Utilization rates for each medical disciplines were computed and extrapolated to the end of planning period to obtain expected work load. The projected population is multiplied by the corresponding base year utilization rates to derive the likely demands for medical services (inpatient and outpatient). The planning of other health workforce was based mainly on analysis of health needs.

The health policies of the Ministry of Health continued to address the need to further invest on human resource development through training of Tongan nationals at all levels of the health care system. This is in line with the development objectives of the Government

The Medical Manpower Plan 1986-1995 upon approval by the National Health Development Committee was forwarded to the Government Scholarship Advisory Committee and the Ministry of Education for their information and to assist in their allocation of scholarships. The other staff development and training programmes of the Ministry once approved by the National Health Development Committee are submitted to Cabinet for consideration and approval, with attention drawn to proposals for the establishment of new posts or any new category of staffmg which may have direct implications for the health budget

172



Major sources of planning information

Planning metJwd

Linkage to NHP Linkage to other pll1TlS

Formal a"angement to share information with other agencies

The work study that was conducted in the main referral hospital on medical manpower identified the following:

direct and indirect patient care time provided by medical doctors per patients in the wards. general and special outpatient services the mean time and standard deviation for inpatient care services average doctors time absorbed by various disease categories and by age groups attrition rates in medical undergraduates training recurrent cost implication of the medical manpower plan

The method used in the development of the Medical Manpower Plan was health demands method. The work study identified direct and indirect patient care within various medical disciplines at inpatient and outpatient services. Utilization rates for each medical disciplines were computed and extrapolated to the end of planning period to obtain expected work load. The projected population is multiplied by the corresponding base year utilization rates to derive the likely demands for medical services (inpatient and outpatient). The planning of other health workforce was based mainly on analysis of health needs.

The health policies of the Ministry of Health continued to address the need to further invest on human resource development through training of Tongan nationals at all levels of the health care system. This is in line with the development objectives of the Government

The Medical Manpower Plan 1986-1995 upon approval by the National Health Development Committee was forwarded to the Government Scholarship Advisory Committee and the Ministry of Education for their information and to assist in their allocation of scholarships. The other staff development and training programmes of the Ministry once approved by the National Health Development Committee are submitted to Cabinet for consideration and approval, with attention drawn to proposals for the establishment of new posts or any new category of staffmg which may have direct implications for the health budget

172

Tonga

3.1.2 Health worliforce plan (Continued)


· Ministry of Health, Annual Report 1988, Tonga Government Printer, Tonga.

· Tonga Government, Tonga Civil Service 30 June 1990, Tongan Government Printer, Tonga.

· Tonga Government, Fifth Five Year Development Plan 1986-1990, Tongan Government Printer, Tonga.

· Wolfgramm S.T., Medical Workforce Plan 1986-1995, Ministry of Health, Tonga, 5 June 1986.

3.1.3. Current planning capability oj health authorities in selected areas



Health Planning X X








Others

173

Tonga

3.1.2 Health worliforce plan (Continued)


· Ministry of Health, Annual Report 1988, Tonga Government Printer, Tonga.

· Tonga Government, Tonga Civil Service 30 June 1990, Tongan Government Printer, Tonga.

· Tonga Government, Fifth Five Year Development Plan 1986-1990, Tongan Government Printer, Tonga.

· Wolfgramm S.T., Medical Workforce Plan 1986-1995, Ministry of Health, Tonga, 5 June 1986.

3.1.3. Current planning capability oj health authorities in selected areas



Health Planning X X








Others

173




Existence of clear policies and plans The health policies of the Ministry of Health in the Sixth Five Year Plan 1990-1995 addressed the need to further invest on human resource development at all levels. This is in line with the national health objectives of the Government.

Body responsible for educational planning National Health Development Committee of the Ministry of Health is directly responsible for approval of health manpower development of the Ministry. The Ministry of Education (MOE) through its Scholarship Advisory Committee is responsible for coordination and allocation of Government scholarships for overseas training programmes.

Linkage oj educational planning to NHP There is direct linkage of the educational planning agency with national health plan. Documents on health manpower development are submitted to the MOE Scholarship Advisory Committee. The training needs of the Ministry of Health are submitted to this Committee annually.

Liaison between service providers and rraining institutions

There is no liaison between the Ministry of Health and Training Institutions. The liaison is made through Ministry of Education. the responsible body for processing Government scholarships or World Health Organization Regional Office for WHO fellowships under its fellowship programme.

174




Existence of clear policies and plans The health policies of the Ministry of Health in the Sixth Five Year Plan 1990-1995 addressed the need to further invest on human resource development at all levels. This is in line with the national health objectives of the Government.

Body responsible for educational planning National Health Development Committee of the Ministry of Health is directly responsible for approval of health manpower development of the Ministry. The Ministry of Education (MOE) through its Scholarship Advisory Committee is responsible for coordination and allocation of Government scholarships for overseas training programmes.

Linkage oj educational planning to NHP There is direct linkage of the educational planning agency with national health plan. Documents on health manpower development are submitted to the MOE Scholarship Advisory Committee. The training needs of the Ministry of Health are submitted to this Committee annually.

Liaison between service providers and rraining institutions

There is no liaison between the Ministry of Health and Training Institutions. The liaison is made through Ministry of Education. the responsible body for processing Government scholarships or World Health Organization Regional Office for WHO fellowships under its fellowship programme.

174

Tonga

3.2.2 Problems associated 'IIIiM loool training programmes and suggested remedial activities (as reported by the country correspondent)

ProbJem'l Associated with Local Training

'. Staff shonages are exacerbated by withdrawal of staff from active service to undertake training

. Lack of trained coordinators

. Lack of funds to provide equipment, supplies and materials foe training programme


· Need for Ministry of Health to translate its health manpower development policies into manpower plan.

· Better coordination of local training programme .

· Coordinators need preliminary training

· Technical support from international organizations e.g. WHO.

3.2.3 Formal local training progratpmes available in 1989

Average Average Average Name 01 Training Program Duration Intake Graduates Attrition

(year) per Year per Year perYear(%)

Basic Nursing 3 25-30 29 Health Officers 2 10 8 20 Dental Therapist 2 6-10 6 16.7 Nurse Midwifes 0.5 6-10 6 6.7 Public Health Inspector 2 6 23.1 Assistant Radiographers 2 7 6 33.3 Assistant Laboratory Technician 1 8 5 37 Assistant Phannacist 2 6 6 Health Education 0.5 12

175

Tonga

3.2.2 Problems associated 'IIIiM loool training programmes and suggested remedial activities (as reported by the country correspondent)

ProbJem'l Associated with Local Training

'. Staff shonages are exacerbated by withdrawal of staff from active service to undertake training

. Lack of trained coordinators

. Lack of funds to provide equipment, supplies and materials foe training programme


· Need for Ministry of Health to translate its health manpower development policies into manpower plan.

· Better coordination of local training programme .

· Coordinators need preliminary training

· Technical support from international organizations e.g. WHO.

3.2.3 Formal local training progratpmes available in 1989

Average Average Average Name 01 Training Program Duration Intake Graduates Attrition

(year) per Year per Year perYear(%)

Basic Nursing 3 25-30 29 Health Officers 2 10 8 20 Dental Therapist 2 6-10 6 16.7 Nurse Midwifes 0.5 6-10 6 6.7 Public Health Inspector 2 6 23.1 Assistant Radiographers 2 7 6 33.3 Assistant Laboratory Technician 1 8 5 37 Assistant Phannacist 2 6 6 Health Education 0.5 12

175



Name of Number Training Name of Category of Completed Institution Program ofStalf Trainees Training

Auckl Australia FRACS Medical Officer 3 Aucldand MRCOG Medical Officer 1 Aucldand Psychiatry Medical Officer 2 Singapore Public Health Medical OffICer 2 New Zealand Medicine 9 Fiji Medicine 9 Australia Dentistry, Trainees 2 4 Uni of Otago 2 Fiji Public Health Nurse/Midwifery 5 5 Wellington PfTech Advance DiplMidwifery Nurse 3 3 New Plymouth Advance DiplMidwifery Nurse 1 1 Manawatu Advance DiplMidwifery Nurse 1 1 Australia Nursing Education Tutor 1 New Zealand Intensive Care Nurse 1 Australia Health Education Health Education

Assistant Australia Medical Records Student Australia Health Education Medical

Record Clerk Australia Pharmacy Trainee 1 Australia Sanitary Health 1

Engineering Inspector 1 FSM Laboratory Technician 1 Papua New Guinea Radiography X-ray 2 Australia NutritionfTrainee Dietitian 2

Total Current Oversea'! Training Awardees and Expected Year of Completion, as of 1990

Field of Study

Medicine (MBBS) Dentistry (BSc) Nursing (Dip. BSN, MA etc.) BSc, Chemistry & Biology Psychology

Total

15 6 5 1 I

Expected Year of Completion

1990 1991 1992 1993 1994 1995

1 1 2 1

3

176

3 1 1

2 1

2 2



Name of Number Training Name of Category of Completed Institution Program ofStalf Trainees Training

Auckl Australia FRACS Medical Officer 3 Aucldand MRCOG Medical Officer 1 Aucldand Psychiatry Medical Officer 2 Singapore Public Health Medical OffICer 2 New Zealand Medicine 9 Fiji Medicine 9 Australia Dentistry, Trainees 2 4 Uni of Otago 2 Fiji Public Health Nurse/Midwifery 5 5 Wellington PfTech Advance DiplMidwifery Nurse 3 3 New Plymouth Advance DiplMidwifery Nurse 1 1 Manawatu Advance DiplMidwifery Nurse 1 1 Australia Nursing Education Tutor 1 New Zealand Intensive Care Nurse 1 Australia Health Education Health Education

Assistant Australia Medical Records Student Australia Health Education Medical

Record Clerk Australia Pharmacy Trainee 1 Australia Sanitary Health 1

Engineering Inspector 1 FSM Laboratory Technician 1 Papua New Guinea Radiography X-ray 2 Australia NutritionfTrainee Dietitian 2

Total Current Oversea'! Training Awardees and Expected Year of Completion, as of 1990

Field of Study

Medicine (MBBS) Dentistry (BSc) Nursing (Dip. BSN, MA etc.) BSc, Chemistry & Biology Psychology

Total

15 6 5 1 I

Expected Year of Completion

1990 1991 1992 1993 1994 1995

1 1 2 1

3

176

3 1 1

2 1

2 2

3.2.5 Fellowships


Selection body


Other constraints


Tonga

Health Planning and Information Division identifies training needs of the Ministry and these are translated into fellowship requirements to be included in the programme of cooperation between Government of Tonga and WHO.

The Ministry of Health has a National Health Selection Committee for Training with its members comprises as follows: - Director of Health (Chainnan)

- Medical Superintendent (Member) - Chief Medical Officer (Member) - Chief Dental Officer (Member) - Chief Nursing Officer (Member) - Senior Assistant Secretary (Member) - Health Planning Officer (Secretary)

· Due to high entry requirements prescribed by recipient countries

· Change in the preferences of lOf sc~ among high schoolleavers towards training in health areas.

· Scarce resources

3.3. J Percentage of health workforce with job descriptions and review arrangements

Posts with Job Descriptions

Only a minimum percentage of health staff are provided with job descriptions

177

Review Arrangemeuts

Job descriptions have not been reviewed over the years

3.2.5 Fellowships


Selection body


Other constraints


Tonga

Health Planning and Information Division identifies training needs of the Ministry and these are translated into fellowship requirements to be included in the programme of cooperation between Government of Tonga and WHO.

The Ministry of Health has a National Health Selection Committee for Training with its members comprises as follows: - Director of Health (Chainnan)

- Medical Superintendent (Member) - Chief Medical Officer (Member) - Chief Dental Officer (Member) - Chief Nursing Officer (Member) - Senior Assistant Secretary (Member) - Health Planning Officer (Secretary)

· Due to high entry requirements prescribed by recipient countries

· Change in the preferences of lOf sc~ among high schoolleavers towards training in health areas.

· Scarce resources

3.3. J Percentage of health workforce with job descriptions and review arrangements

Posts with Job Descriptions

Only a minimum percentage of health staff are provided with job descriptions

177

Review Arrangemeuts

Job descriptions have not been reviewed over the years




· Lack of management skills among senior management personnel

· Lack of clear rules and.procedures especially at district level

· Weak capacity for supportive supervision

· Over concentration of authorities at headquarter


· Travelling allowance · Settling allowance · Rent-free accommodation · Responsibility allowance · Adjustment allowance when substituting

in higher post

178




· Lack of management skills among senior management personnel

· Lack of clear rules and.procedures especially at district level

· Weak capacity for supportive supervision

· Over concentration of authorities at headquarter


· Travelling allowance · Settling allowance · Rent-free accommodation · Responsibility allowance · Adjustment allowance when substituting

in higher post

178

Tonga



Determining Establishment 0 0 Need reviewing



Induction Programmes 0 0 Need reviewing

Supportive Supervision Process 0 0 Need reviewing

Performance Appraisal D 0 No set performance appraisal process

In-Service Training 0 D Quite satisfactory

Special Incentives & Rewards 0 0 Government provides certain incentives

Determining Career Path 0 D Need reviewing

Task Analysis Procedure 0 0 No set guidelines

Designing of Job Profiles 0 D No set guidelines

Management of Records 0 0 Need strengthening

Others D D

• As reported by the country respondent .

179

Tonga



Determining Establishment 0 0 Need reviewing



Induction Programmes 0 0 Need reviewing

Supportive Supervision Process 0 0 Need reviewing

Performance Appraisal D 0 No set performance appraisal process

In-Service Training 0 D Quite satisfactory

Special Incentives & Rewards 0 0 Government provides certain incentives

Determining Career Path 0 D Need reviewing

Task Analysis Procedure 0 0 No set guidelines

Designing of Job Profiles 0 D No set guidelines

Management of Records 0 0 Need strengthening

Others D D

• As reported by the country respondent .

179



Professional Bodies


*

Tongan Medical Association Nursing Association



•

Not involved in major government decision making process pertaining to health personnel management

180



Professional Bodies


*

Tongan Medical Association Nursing Association



•

Not involved in major government decision making process pertaining to health personnel management

180

VANUATU



Indicator



Urban population Rate of natural increase of population per annum Crude birth rate (per 1000) Crude death rate (per 1000) Life expectancy at birth (years)

- male - female

Infant mortality rate (per 1000 live births) - male - female Adult literacy rate

Percent of population served with: safe water

- adequate sanitary facilities


Data

12,190 sp. km. 142,630 (1989 census) 2.8%

45.5% 2.6% 18.5% 2.8% 42.8 9.2

61.1 59.3

63.5 73.8

* 95% (urban), 66% 35%


Leading Causes or Morbidity Leading Causes or MortaHty

Valluatu

- Skin infections - Pneumonia and other respiratory diseases - Respiratory diseases - Cancer - Malaria - Tuberculosis - Eye-ear conditions - Malaria - Dianiloea - Gastroenteritis

181

VANUATU



Indicator



Urban population Rate of natural increase of population per annum Crude birth rate (per 1000) Crude death rate (per 1000) Life expectancy at birth (years)

- male - female

Infant mortality rate (per 1000 live births) - male - female Adult literacy rate

Percent of population served with: safe water

- adequate sanitary facilities


Data

12,190 sp. km. 142,630 (1989 census) 2.8%

45.5% 2.6% 18.5% 2.8% 42.8 9.2

61.1 59.3

63.5 73.8

* 95% (urban), 66% 35%


Leading Causes or Morbidity Leading Causes or MortaHty

Valluatu

- Skin infections - Pneumonia and other respiratory diseases - Respiratory diseases - Cancer - Malaria - Tuberculosis - Eye-ear conditions - Malaria - Dianiloea - Gastroenteritis

181





Total

Number of Facilities

4 90

95

* Ratio excludes health centre/clinics beds.

Bed Number

684



2.7


Medical Officers 18 Medical Assistants * 7 Dental Officers 4 Dental Assistants ** 8 Pharmacists! Assistant Pharmacists 1 Dispensary Assistants 1 Nurses 314 Nurse Aides & Enrolled Nurses 46 MedicallLaboratory Technologists 15 Radiographers 8 Physiotherapists 1 Nutritionists & Dietitians 3 Health Educators 14 Health Inspectors/Sanitarians 77 Community Health Workers Other Professional & Technical Support Staff *** 11


* Includes Health Officers. Health Extension Officers and Anaesthetic Assistantsffechnicians.

** Includes Dental Technicians. Therapists and Nurses.

1: 7,924 1: 20.376 1: 35,658 1: 17.829 1:142.630 1:142.630 1: 456 1: 3.101 1: 9.509 l: 17.829 1:142.630 1: 47.543 1: 10.188 1: 1.852

l: l2.966

1: 270

*** Include Health Statisticians. Computer Operators, Bio-medical Engineers and Health Administrators.

182





Total

Number of Facilities

4 90

95


Bed Number

684



2.7


Medical Officers 18 Medical Assistants * 7 Dental Officers 4 Dental Assistants ** 8 Pharmacists! Assistant Pharmacists 1 Dispensary Assistants 1 Nurses 314 Nurse Aides & Enrolled Nurses 46 MedicallLaboratory Technologists 15 Radiographers 8 Physiotherapists 1 Nutritionists & Dietitians 3 Health Educators 14 Health Inspectors/Sanitarians 77 Community Health Workers Other Professional & Technical Support Staff *** 11


* Includes Health Officers. Health Extension Officers and Anaesthetic Assistantsffechnicians.

** Includes Dental Technicians. Therapists and Nurses.

1: 7,924 1: 20.376 1: 35,658 1: 17.829 1:142.630 1:142.630 1: 456 1: 3.101 1: 9.509 l: 17.829 1:142.630 1: 47.543 1: 10.188 1: 1.852

l: l2.966

1: 270

*** Include Health Statisticians. Computer Operators, Bio-medical Engineers and Health Administrators.

182

Vanuatu



MAJOR CA TEGORIFS for Main District Health 1989 Hospital Hospital Centre!

(%) (%) C1inics(%)

General Medical Practitioner 13 62 38 Specialist/Consultant 5 100 Health Officer Health Extension Officer 3 66 34 Medical Assistant Community Health Worker Dentist 4 100 Dental Therapist 6 100 Dental Assistant Dental Technician 2 100 Nurse Practitioner 21 33 15 52 Nursing SisterlRegistered Nurse 272 41 19 40 Midwife - Nurse 20 60 20 20 Public Health Nurse/Community Nurse 1 100 Nurse Aide 46 35 35 30 Student Nurse 9* 100 Medical Technologist Laboratory Technologist 15 73 20 7 Radiographer 8 64 36 Anaesthetic Technician! Assistant 4 100 Phannacist 100 Dispensary Assistant 100 Nutritionist 1 100 Dietitian 2 100 Health Education 6 17 66 17 Health Personnel Educator 8 86 Health Inspector 2 50 50 Sanitarian 75 100 Physiotherapist 1 100 Health Statistician 3 100 Computer Operator 2 100 Health Administrator 4 100 Bio-medical Engineer 2 100


* Not included in total health worldorce because still in training.

183

Vanuatu



MAJOR CA TEGORIFS for Main District Health 1989 Hospital Hospital Centre!

(%) (%) C1inics(%)

General Medical Practitioner 13 62 38 Specialist/Consultant 5 100 Health Officer Health Extension Officer 3 66 34 Medical Assistant Community Health Worker Dentist 4 100 Dental Therapist 6 100 Dental Assistant Dental Technician 2 100 Nurse Practitioner 21 33 15 52 Nursing SisterlRegistered Nurse 272 41 19 40 Midwife - Nurse 20 60 20 20 Public Health Nurse/Community Nurse 1 100 Nurse Aide 46 35 35 30 Student Nurse 9* 100 Medical Technologist Laboratory Technologist 15 73 20 7 Radiographer 8 64 36 Anaesthetic Technician! Assistant 4 100 Phannacist 100 Dispensary Assistant 100 Nutritionist 1 100 Dietitian 2 100 Health Education 6 17 66 17 Health Personnel Educator 8 86 Health Inspector 2 50 50 Sanitarian 75 100 Physiotherapist 1 100 Health Statistician 3 100 Computer Operator 2 100 Health Administrator 4 100 Bio-medical Engineer 2 100


* Not included in total health worldorce because still in training.

183



Number of Health Workers • by Age Group

21-30 31-40 41-50 51-60 61+

General Medical Practitioner Specialist/Consultant Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist Dental Therapist Dental Assistant Dental Technician Practical Nurse Nursing SisterlRegistered Nurse Midwife-Nurse PubLic Health Nurse! Community Nurse Nurse Aide Student Nurse Medical Technologist Laboratory Technologist Radiographer Anaesthetic Technician! Assistant Pharmacist Dispensary Assistant Nutritionist Dietitian Health Personnel Educator Health Education Technician Health Inspector Sanitarian Physiotherapist Health Statistician Computer Operator Health Administrator Bio-medical Engineer

Total

* Information has not been provided. .. Not included in total health workforce because still in training.

184

Total Projection for for

1989 1995

13 15 5 9

3 10

4 2 6 10

2 2 3

21 30 272 300

20 35 10

46 60 9**

15 20 8 12 4 10

2 5

1 3 2 4 8 10 6 8 2 4

75 85 1 2 3 5 2 4 4 6 2 4

528 670



Number of Health Workers • by Age Group

21-30 31-40 41-50 51-60 61+

General Medical Practitioner Specialist/Consultant Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist Dental Therapist Dental Assistant Dental Technician Practical Nurse Nursing SisterlRegistered Nurse Midwife-Nurse PubLic Health Nurse! Community Nurse Nurse Aide Student Nurse Medical Technologist Laboratory Technologist Radiographer Anaesthetic Technician! Assistant Pharmacist Dispensary Assistant Nutritionist Dietitian Health Personnel Educator Health Education Technician Health Inspector Sanitarian Physiotherapist Health Statistician Computer Operator Health Administrator Bio-medical Engineer

Total

* Information has not been provided. .. Not included in total health workforce because still in training.

184

Total Projection for for

1989 1995

13 15 5 9

3 10

4 2 6 10

2 2 3

21 30 272 300

20 35 10

46 60 9**

15 20 8 12 4 10

2 5

1 3 2 4 8 10 6 8 2 4

75 85 1 2 3 5 2 4 4 6 2 4

528 670

Vanuatu


Budget ('000 V A TV) 1988 1989 1990


Total Health Budget 444,755 398,023 412,500

Per Capita Allocation for Health 2,%7 2,790 2,904


185

Vanuatu


Budget ('000 V A TV) 1988 1989 1990


Total Health Budget 444,755 398,023 412,500

Per Capita Allocation for Health 2,%7 2,790 2,904


185




Planning:

- Repeated cuts in the health budget since 1986 resulting in a drop from 14% in 1986 to 9% in 1989. These cuts have set a ceiling on the departmental ability to recruit new employees.

- Continuing loss of staff to other departments.

Understaffing of the Health Planning Unit, which is responsible for workforce planning.

- Inappropriate placement of the planning unit in the current organization sometimes resulting in inertia due to differing conceptions of the planning and administrative roles and functions.

- Constraints associated with the geographic distribution of the Islands.

Development:

- Most inservice training programs limited to 3-6 months as a result of an overall shortage of staff which prevents the department from sending officers for longer periods.

- Lack of adequate co-ordination between health services providers (Health Department) and education authorities, especially in areas of teaching curriculum development leading to high proportions of failures.

Management:

- Tendency to deploy medical doctors and trained public health officers to administrative positions to facilitate localisation of posts, but may cause difficulty in workforce management.

- Lack of appropriate training and skills in the planning and administration of the workforce.


186




Planning:

- Repeated cuts in the health budget since 1986 resulting in a drop from 14% in 1986 to 9% in 1989. These cuts have set a ceiling on the departmental ability to recruit new employees.

- Continuing loss of staff to other departments.

Understaffing of the Health Planning Unit, which is responsible for workforce planning.

- Inappropriate placement of the planning unit in the current organization sometimes resulting in inertia due to differing conceptions of the planning and administrative roles and functions.

- Constraints associated with the geographic distribution of the Islands.

Development:

- Most inservice training programs limited to 3-6 months as a result of an overall shortage of staff which prevents the department from sending officers for longer periods.

- Lack of adequate co-ordination between health services providers (Health Department) and education authorities, especially in areas of teaching curriculum development leading to high proportions of failures.

Management:

- Tendency to deploy medical doctors and trained public health officers to administrative positions to facilitate localisation of posts, but may cause difficulty in workforce management.

- Lack of appropriate training and skills in the planning and administration of the workforce.


186

Vanuatu

2.2 Types of infonnation required to enhance policy formulation and management decision making relating to the above issues

Human resources requirements in the districts

Health statistics in the districts to determine the human resource requirements. (There is a need to train personnel to better utilize this information). Training needs in the districts.

187

Vanuatu

2.2 Types of infonnation required to enhance policy formulation and management decision making relating to the above issues

Human resources requirements in the districts

Health statistics in the districts to determine the human resource requirements. (There is a need to train personnel to better utilize this information). Training needs in the districts.

187





The national health plan is continued in the national development plan and covered the period 1987 - 1991. The Health Planning Unit of the Department of Health is responsible for its preparation in consultation with other sections within the Department.


Present

Period covered


Major source of planning

information

Planning method

Linkage to NHP


F or11UJ1 arrangement to share infor11UJtion with other agencies

Other 11UJjor documentation on health workforce

Currently no health workforce plan.

The Health Planning Unit.

Statistical reports on cost centres Hospital reports National plan Departmental structure and establishment Individual section reports

Based on health needs identified by inter-section committees.

With - Training and Scholarship Board - Public Service Commission

--- none.

188





The national health plan is continued in the national development plan and covered the period 1987 - 1991. The Health Planning Unit of the Department of Health is responsible for its preparation in consultation with other sections within the Department.


Present

Period covered


Major source of planning

information

Planning method

Linkage to NHP


F or11UJ1 arrangement to share infor11UJtion with other agencies

Other 11UJjor documentation on health workforce

Currently no health workforce plan.

The Health Planning Unit.

Statistical reports on cost centres Hospital reports National plan Departmental structure and establishment Individual section reports

Based on health needs identified by inter-section committees.

With - Training and Scholarship Board - Public Service Commission

--- none.

188

Vanuatu




Health Planning X X








Others







189

Policies pertaining to training are not very clear although the emphasis is towards primary health care Development of health personnel has been priority in all fields

Director of Health Health Planning Unit Principal Nursing Officer

Educational planning is geared towards the priorities of the Health Department

With WHO for WHO fellows With Training and Scholarships Unit, Public Service Department

Vanuatu




Health Planning X X








Others







189

Policies pertaining to training are not very clear although the emphasis is towards primary health care Development of health personnel has been priority in all fields

Director of Health Health Planning Unit Principal Nursing Officer

Educational planning is geared towards the priorities of the Health Department

With WHO for WHO fellows With Training and Scholarships Unit, Public Service Department



Problems associated with local training

Lack of funds for - regular training - training materials - follow up visits

Inadequate numbers of capable and skilled trainers

Determining priorities

Suggested remedial activities

· Review and updating of the School of Nursing curriculum has just been completed

· Identify priorities and improve coordination between various sections to determine needs

· Increase local training by utilizing overseas trainers

· Train local personnel in areas of anaesthesiology. surgery and engineering



per Year per Year per Year •

In-Service Training 2 weeks 300

Midwifery Training 9 months 8 8

Primary Health Care Training 3 days 20

Registered Nurses 3 years 22 9

Nurse Practitioner Training Course 1989 9 months 10 9

* Information has not been provided.

190



Problems associated with local training

Lack of funds for - regular training - training materials - follow up visits

Inadequate numbers of capable and skilled trainers

Determining priorities

Suggested remedial activities

· Review and updating of the School of Nursing curriculum has just been completed

· Identify priorities and improve coordination between various sections to determine needs

· Increase local training by utilizing overseas trainers

· Train local personnel in areas of anaesthesiology. surgery and engineering



per Year per Year per Year •

In-Service Training 2 weeks 300

Midwifery Training 9 months 8 8

Primary Health Care Training 3 days 20

Registered Nurses 3 years 22 9

Nurse Practitioner Training Course 1989 9 months 10 9

* Information has not been provided.

190

Vanuatu


Number Name of Training Name of Category of Completed


UPNG Medicine Medical 1 0

UPNG Laboratory Lab Technician 1 0

UPNG Community Community Education

FSM Medicine

FSM Laboratory

FSM Pharmacy

UK Medicine

3.2.5 Fellowships


Selection body


Other constraints

In-Service

Medical 4 0

Lab Technician 4 0

Pharmacy 0

Medical 2 0

· Candidates are recommended by heads of sections · Staff Development Committee reviews candidates in

collaboration with Training and Scholarships Unit

· Director of Health · Heads of Sections · Staff Development Committee · Training and Scholarships Unit · Principle Nursing Officers · Health Planner

· Exist due to lack of interest in high school graduates

· Insufficient educational level in high schools.

191

Vanuatu


Number Name of Training Name of Category of Completed


UPNG Medicine Medical 1 0

UPNG Laboratory Lab Technician 1 0

UPNG Community Community Education

FSM Medicine

FSM Laboratory

FSM Pharmacy

UK Medicine

3.2.5 Fellowships


Selection body


Other constraints

In-Service

Medical 4 0

Lab Technician 4 0

Pharmacy 0

Medical 2 0

· Candidates are recommended by heads of sections · Staff Development Committee reviews candidates in

collaboration with Training and Scholarships Unit

· Director of Health · Heads of Sections · Staff Development Committee · Training and Scholarships Unit · Principle Nursing Officers · Health Planner

· Exist due to lack of interest in high school graduates

· Insufficient educational level in high schools.

191





20 percent Reviewed only with new placements



· Brain drain · Lack of skills · Poor supervision of health workers due to logistics and financial difficulties


. Housing


192





20 percent Reviewed only with new placements



· Brain drain · Lack of skills · Poor supervision of health workers due to logistics and financial difficulties


. Housing


192

Vanuatu



D 0 Institutions available but lacks

Detennining Establishment appropriate knowledge and short staffed to work on the issue.

Recruitment Process D 0 Department structure is slow, manpower available.

Selection Procedures D 0 Institution that could draw up guidelines is available.

Induction Programmes D 0 Institution available, but lack of personnel

Supportive Supervision Process D 0 Institution available, but lack of support staff.

Perfonnance Appraisal D 0 Ditto

In-Service Training D 0 Institution available ideal to draw up guideline.

Special Incentives & Rewards 0 D Encourages staff to work harder.

Detennining Career Path D 0 Institution available, but lack of staff

Task Analysis Procedure D 0 Ditto

Designing of Job Profiles 0 D A voids job duplication but hardly been reviewed.

Management of Records 0 D Helps in assessing infonnation more readily.

Others D D * As reported by the country respondenL

193

Vanuatu



D 0 Institutions available but lacks

Detennining Establishment appropriate knowledge and short staffed to work on the issue.

Recruitment Process D 0 Department structure is slow, manpower available.

Selection Procedures D 0 Institution that could draw up guidelines is available.

Induction Programmes D 0 Institution available, but lack of personnel

Supportive Supervision Process D 0 Institution available, but lack of support staff.

Perfonnance Appraisal D 0 Ditto

In-Service Training D 0 Institution available ideal to draw up guideline.

Special Incentives & Rewards 0 D Encourages staff to work harder.

Detennining Career Path D 0 Institution available, but lack of staff

Task Analysis Procedure D 0 Ditto

Designing of Job Profiles 0 D A voids job duplication but hardly been reviewed.

Management of Records 0 D Helps in assessing infonnation more readily.


193



Professional Bodies


Government Bodies

· Public Service Commission

· Scholarships Committee

· Budgeting Committee



*

*

. Highest decision making body in government pertaining to training, promotion, discipline etc.

. Responsible for Coordination of all scholarships for both preservice and inservice training.

194



Professional Bodies


Government Bodies

· Public Service Commission

· Scholarships Committee

· Budgeting Committee



*

*

. Highest decision making body in government pertaining to training, promotion, discipline etc.

. Responsible for Coordination of all scholarships for both preservice and inservice training.

194

WESTERN SAMOA

Section 1: Country Health and Economic Proffie


Indicator



Urban population

Data

2.840 sq. lan. 158.257 (est. 1990) 0.4%


41.1% 3.4% 29.1% 1.6% 29.7 7.1 Crude death rate (per 1000)



63 65 24 98%


90% 84%



- Pneumonia - Bronchitis. chronic and unspecifIed - Infections of the skin and

subcutaneous tissues - Measles - Acute upper respiratory infection - Acute bronchitis - Hypertension - Influenza - Ulcer of the stomach/duodenum - Complications of pregnancy


- Pneumonia - Congestive heart failure - Cerebrovascular diseases - Suicide - Chronic liver cirrhosis - Intestinal infectious diseases - Hypertensive heart diseases

195

WESTERN SAMOA

Section 1: Country Health and Economic Proffie


Indicator



Urban population

Data

2.840 sq. lan. 158.257 (est. 1990) 0.4%


41.1% 3.4% 29.1% 1.6% 29.7 7.1 Crude death rate (per 1000)



63 65 24 98%


90% 84%



- Pneumonia - Bronchitis. chronic and unspecifIed - Infections of the skin and

subcutaneous tissues - Measles - Acute upper respiratory infection - Acute bronchitis - Hypertension - Influenza - Ulcer of the stomach/duodenum - Complications of pregnancy


- Pneumonia - Congestive heart failure - Cerebrovascular diseases - Suicide - Chronic liver cirrhosis - Intestinal infectious diseases - Hypertensive heart diseases

195


1.3 Health facilities, bed numbers and population.bed ratios


Main referral hospital 1 335 } 3.4 District hospital II 210 Health centre/clinics 22 148

Total 34 693 3.4*




Medical Officers 33 Medical Assistants * 2 Dental Officers 5 Dental Assistants ** 13 Pharmacists! Assistant Pharmacists 1 Dispensary Assistants 6 Nurses 218 Nurse Aides & Enrolled Nurses 80 MedicaIlLaboratory Technologists 2 Radiographers 7 Physiotherapists 3 Nutritionists & Dietitians 3 Health Educators 4 Health Inspectors/Sanitarians 25 Community Health Workers Other Professional & Technical Support Staff *** 7




1: 4,796 1: 79,129 1: 31,651 1: 12,173 1:158,257 1: 26,376 1: 726 1: 1,978 1: 79,129 1: 22,608 1: 52,752 1: 52,752 1: 39,564 1: 6,330

1: 22,608

1: 387


196


1.3 Health facilities, bed numbers and population.bed ratios


Main referral hospital 1 335 } 3.4 District hospital II 210 Health centre/clinics 22 148

Total 34 693 3.4*




Medical Officers 33 Medical Assistants * 2 Dental Officers 5 Dental Assistants ** 13 Pharmacists! Assistant Pharmacists 1 Dispensary Assistants 6 Nurses 218 Nurse Aides & Enrolled Nurses 80 MedicaIlLaboratory Technologists 2 Radiographers 7 Physiotherapists 3 Nutritionists & Dietitians 3 Health Educators 4 Health Inspectors/Sanitarians 25 Community Health Workers Other Professional & Technical Support Staff *** 7




1: 4,796 1: 79,129 1: 31,651 1: 12,173 1:158,257 1: 26,376 1: 726 1: 1,978 1: 79,129 1: 22,608 1: 52,752 1: 52,752 1: 39,564 1: 6,330

1: 22,608

1: 387


196

Western Sanwa



MAJOR CATEGORIES for Main District Health 1989 Hospital Hospital Centrei

(%) (%) Clinics(%)

General Medical Practitioner 24 90 5 5 Specialist/Consultant 9 90 10 Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist 5 90 10 Dental Therapist Dental Assistant 10 80 10 10 Dental Technician 3 95 5 Nursing Supervisor 18 90 10 Nursing SisterlRegistered Nurse 135 80 15 5 Midwife - Nurse 26 60 20 20 Public Health Nurse/Community Nurse 39 10 20 70 Nurse Aide 80 60 30 10 Student Nurse 35* 99 Medical Technologist Laboratory Technologist 2 98 2 Radiographer 7 95 5 Anaesthetic Technician! Assistant 2 Pharmacist 1 90 10 Dispensary Assistant 6 95 5 Nutritionist 2 100 Dietitian 1 100 Health Education Health Personnel Educator 4 100 Health Inspector 25 10 60 30 Sanitarian Physiotherapist 3 100 Health Statistician Computer Operator Health Administrator 4 95 5 Bio-medical Engineer 2

Total Health WorkfOral 409


197

Western Sanwa



MAJOR CATEGORIES for Main District Health 1989 Hospital Hospital Centrei

(%) (%) Clinics(%)

General Medical Practitioner 24 90 5 5 Specialist/Consultant 9 90 10 Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist 5 90 10 Dental Therapist Dental Assistant 10 80 10 10 Dental Technician 3 95 5 Nursing Supervisor 18 90 10 Nursing SisterlRegistered Nurse 135 80 15 5 Midwife - Nurse 26 60 20 20 Public Health Nurse/Community Nurse 39 10 20 70 Nurse Aide 80 60 30 10 Student Nurse 35* 99 Medical Technologist Laboratory Technologist 2 98 2 Radiographer 7 95 5 Anaesthetic Technician! Assistant 2 Pharmacist 1 90 10 Dispensary Assistant 6 95 5 Nutritionist 2 100 Dietitian 1 100 Health Education Health Personnel Educator 4 100 Health Inspector 25 10 60 30 Sanitarian Physiotherapist 3 100 Health Statistician Computer Operator Health Administrator 4 95 5 Bio-medical Engineer 2

Total Health WorkfOral 409


197




21-30 31-40 41·50 51-60 61+ 1989 1995

General Medical Practitioner 2 7 4 3 8 24 28 Specialist/Consultant 3 4 2 9 28

Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist 2 2 5 8 Dental Therapist

Dental Assistant 10 10 15 Dental Technician 2 3 5 Supervisor 11 6 18 Nursing Sister/Registered Nurse 69 25 21 13 7 135 220 Midwife-Nurse 2 9 7 7 I 26 45 Public Health Nurse/Community Nurse 2 4 16 13 4 39 52 Nurse Aide 31 27 14 5 3 80 120 Student Nurse 33 35*

Medical Technologist Laboratory Technologist 1 1 2 5 Radiographer 4 2 7 6 Anaesthetic Technician! Assistant 2 4 Pharmacist 1 4 Dispensary Assistant 3 3 6 11 Nutritionist 2 3 Dietitian 1 1 2 Health Personnel Educator 3 4 5 Health Education Technician Health Inspector 22 2 I 25 32 Sanitarian Physiotherapist 3 4 Health Statistician Computer Operator Health Administrator 3 4 5 Bio-medical Engineer 2 2 5

Total 409 610


198




21-30 31-40 41·50 51-60 61+ 1989 1995

General Medical Practitioner 2 7 4 3 8 24 28 Specialist/Consultant 3 4 2 9 28

Health Officer Health Extension Officer Medical Assistant Community Health Worker Dentist 2 2 5 8 Dental Therapist

Dental Assistant 10 10 15 Dental Technician 2 3 5 Supervisor 11 6 18 Nursing Sister/Registered Nurse 69 25 21 13 7 135 220 Midwife-Nurse 2 9 7 7 I 26 45 Public Health Nurse/Community Nurse 2 4 16 13 4 39 52 Nurse Aide 31 27 14 5 3 80 120 Student Nurse 33 35*

Medical Technologist Laboratory Technologist 1 1 2 5 Radiographer 4 2 7 6 Anaesthetic Technician! Assistant 2 4 Pharmacist 1 4 Dispensary Assistant 3 3 6 11 Nutritionist 2 3 Dietitian 1 1 2 Health Personnel Educator 3 4 5 Health Education Technician Health Inspector 22 2 I 25 32 Sanitarian Physiotherapist 3 4 Health Statistician Computer Operator Health Administrator 3 4 5 Bio-medical Engineer 2 2 5

Total 409 610


198

Western Samoa


Budget (TALA) 1988 1989 1990

Total Public Sector Budget 115.oI M 117.9M 136.89M

Total Health Budget 8.13M 9.3M 10.12M

Per Capita Allocation for Health 7.07% 7.9% 7.4%

Health Budget as Percentage of Total Budget 51 58.90 63.65

* M = million

199

Western Samoa


Budget (TALA) 1988 1989 1990

Total Public Sector Budget 115.oI M 117.9M 136.89M

Total Health Budget 8.13M 9.3M 10.12M

Per Capita Allocation for Health 7.07% 7.9% 7.4%

Health Budget as Percentage of Total Budget 51 58.90 63.65

* M = million

199



*


• The need to establish a national health workforce plan to address identified priorities in light of factors affecting the workforce.

• The need to establish government policy to clearly delineate the tasks and duties of respective categories of health workers, with the view to improve cost effectivity, and increased emphasis on primary health care.

• The need to strengthen capacity of the health planning, information and research unit, which as part of its functions is responsible for health workforce planning.

• Inadequate training facilities and aids.

• Lack of attractive career paths to attract or retain staff.

• High attrition rate of medical students in overseas courses.

• Brain drain to overseas countries.


• Current health workforce and its distribution.

• Factors affecting supply and demand.

• Inventories of current training programmes.

• The Ministry's policies relating to the developmental strategies of the national health plan, and health workforce development.

• The health budget.

As reported by the country respondent.

200



*


• The need to establish a national health workforce plan to address identified priorities in light of factors affecting the workforce.

• The need to establish government policy to clearly delineate the tasks and duties of respective categories of health workers, with the view to improve cost effectivity, and increased emphasis on primary health care.

• The need to strengthen capacity of the health planning, information and research unit, which as part of its functions is responsible for health workforce planning.

• Inadequate training facilities and aids.

• Lack of attractive career paths to attract or retain staff.

• High attrition rate of medical students in overseas courses.

• Brain drain to overseas countries.


• Current health workforce and its distribution.

• Factors affecting supply and demand.

• Inventories of current training programmes.

• The Ministry's policies relating to the developmental strategies of the national health plan, and health workforce development.

• The health budget.

As reported by the country respondent.

200

Western Samoa




The last health sector plan covered the period from 1988 to 1990. The Health Planning, Information and Research Unit is responsible for the development of the plan in collaboration with the Director General of Health and heads of major service divisions.


Present

Period covered



Planning method




Currently there is no comprehensive health workforce plan, but work in this area is now starting.

The Health Planning, Infonnation and Research Unit and the Administration division of the Health Department.

· Total health workforce and its distribution · Projections of workforce needs · National health proftles and annual reports · Inventories of Public Service Commission pertaining to

workforce

Based on health workforce needs as identified by respective heads of division.

The health workforce plan will be based on the health sector plan which is in turn intricately linked to the national development plan.

With Public Service Commission.

· Health for all Samoans by the year 2000, fonnulation of national policies, strategies and plan of action 1983.

· Projection of health manpower targets for the first phase 1980 - 1984 to the fourth phase 1995 - 1999.

201

Western Samoa




The last health sector plan covered the period from 1988 to 1990. The Health Planning, Information and Research Unit is responsible for the development of the plan in collaboration with the Director General of Health and heads of major service divisions.


Present

Period covered



Planning method




Currently there is no comprehensive health workforce plan, but work in this area is now starting.

The Health Planning, Infonnation and Research Unit and the Administration division of the Health Department.

· Total health workforce and its distribution · Projections of workforce needs · National health proftles and annual reports · Inventories of Public Service Commission pertaining to

workforce

Based on health workforce needs as identified by respective heads of division.

The health workforce plan will be based on the health sector plan which is in turn intricately linked to the national development plan.

With Public Service Commission.

· Health for all Samoans by the year 2000, fonnulation of national policies, strategies and plan of action 1983.

· Projection of health manpower targets for the first phase 1980 - 1984 to the fourth phase 1995 - 1999.

201





Health Planning X X








Others



Existence of clear policies and plans Policies pertammg to workforce trammg and development are contained within the health sector plan in the development plan.

Body responsible for educational planning . The Ministry through the six major divisional heads are responsible for all local training .

. The manpower planning unit of public service commission and staff training and scholarships committee are involved with overseas training.

Linmge of educational planning to NHP This is being progressively strengthened.

Liaison between service providers and This exists especially in the development training institutions and conducting of local training programmes.

202





Health Planning X X








Others



Existence of clear policies and plans Policies pertammg to workforce trammg and development are contained within the health sector plan in the development plan.

Body responsible for educational planning . The Ministry through the six major divisional heads are responsible for all local training .

. The manpower planning unit of public service commission and staff training and scholarships committee are involved with overseas training.

Linmge of educational planning to NHP This is being progressively strengthened.

Liaison between service providers and This exists especially in the development training institutions and conducting of local training programmes.

202

Western Samoa

3.2.2 Problems associated with locattraining programmes and suggested remedial activities


· Lack of trained coordinator/teachers . Appropriate development of tutors and coordinators to acquire skills in teaching,

· Inadequate facilities and training aids personnel management, staff appraisal, evaluation and assessment of programmes.

· Out dated training curricula

· Shortage of appropriate candidate to undertake training

· Lack of prospective career paths for graduates of such training programmes.

. Technical assistance in curriculum development or review of existing curriculum.

. Financial Support.


Average Average Average NameofTraining~ Duration Intake Graduates Attrition


Dental Nursing

1982 2 3 3 66 1984 2 3 3 1987 2 13 11 13 1989 2 15

Basic Nursing

1984 3 36 15 41 1985 3 36 8 27 1986 3 68 23 63 1987 3 37 22 40 1988 3 29 18 37

Post-Basic Midwifery 0.5 12 12 13

Assistant Health Inspectors 10 10 30

Community Nursing 0.5 10 9 10

203

Western Samoa

3.2.2 Problems associated with locattraining programmes and suggested remedial activities


· Lack of trained coordinator/teachers . Appropriate development of tutors and coordinators to acquire skills in teaching,

· Inadequate facilities and training aids personnel management, staff appraisal, evaluation and assessment of programmes.

· Out dated training curricula

· Shortage of appropriate candidate to undertake training

· Lack of prospective career paths for graduates of such training programmes.

. Technical assistance in curriculum development or review of existing curriculum.

. Financial Support.


Average Average Average NameofTraining~ Duration Intake Graduates Attrition


Dental Nursing

1982 2 3 3 66 1984 2 3 3 1987 2 13 11 13 1989 2 15

Basic Nursing

1984 3 36 15 41 1985 3 36 8 27 1986 3 68 23 63 1987 3 37 22 40 1988 3 29 18 37

Post-Basic Midwifery 0.5 12 12 13

Assistant Health Inspectors 10 10 30

Community Nursing 0.5 10 9 10

203



Name of Number


New Zealand Medicine 14 6

Papua New Guinea Medicine 9 3 Fiji Medicine 6 New Zealand Adv. Dip. Nursing. Tutor 9 9

New Zealand Obstetric Nursing Ward Sister

New Zealand Dental Nursing Dental Nurse

Malaysia Health Inspector Asst. Health Insp. I

Australia Health Education Health Ed. Officer I

Japan X-Ray Technician I

New Zealand X-Ray Technician I 1

Singapore Health Inspector Health Inspector 3 3 Australia Public Health Health Planner

Australia Nutrition Dietitian

New Zealand Obstetrics Doctor I

Israel Public Health Doctor I I

New Zealand Intensive Care Nurse 2 2

Australia Surgery Doctor I 1

FSM Radiography Technician I I

New Zealand Ophthalmology Doctor

New Zealand Renal Dialysis Doctor

Malaysia Orthopaedic Nurse I

Australia Curriculum Development Nurse 2

Australia BSc Nursing Nurse

Malaysia Post-Basic Public

Health Nursing Nurse 2 2

Malaysia Entomology Entomologist

New Zealand Laboratory Technician 1

Bangkok Public Health Nursing Nurse I

204



Name of Number


New Zealand Medicine 14 6

Papua New Guinea Medicine 9 3 Fiji Medicine 6 New Zealand Adv. Dip. Nursing. Tutor 9 9

New Zealand Obstetric Nursing Ward Sister

New Zealand Dental Nursing Dental Nurse

Malaysia Health Inspector Asst. Health Insp. I

Australia Health Education Health Ed. Officer I

Japan X-Ray Technician I

New Zealand X-Ray Technician I 1

Singapore Health Inspector Health Inspector 3 3 Australia Public Health Health Planner

Australia Nutrition Dietitian

New Zealand Obstetrics Doctor I

Israel Public Health Doctor I I

New Zealand Intensive Care Nurse 2 2

Australia Surgery Doctor I 1

FSM Radiography Technician I I

New Zealand Ophthalmology Doctor

New Zealand Renal Dialysis Doctor

Malaysia Orthopaedic Nurse I

Australia Curriculum Development Nurse 2

Australia BSc Nursing Nurse

Malaysia Post-Basic Public

Health Nursing Nurse 2 2

Malaysia Entomology Entomologist

New Zealand Laboratory Technician 1

Bangkok Public Health Nursing Nurse I

204

3.2.5 Fellowships


Selection body


Other constraints


Western SamOQ

· Fellowships application processed by a committee comprising the Director General of Health and heads of division.

· Recommendations submitted to Minister for approval. · Approved candidates submitted to the scholarship

committee through the manpower planning unit of public service commission for final approval.

· Director General of Health · Heads of division · Minister of Health · Manpower planning unit, public service commission · Scholarship committee

· Shortage of suitable candidates with appropriate educational background to meet entry requirements of recipient countries.

· Absence of appropriate selection criteria. · Separation from families during long term fellowship. · Preference for other fields rather than medicine at high

school level.

3.3.1 Percentage of health worliforce with job descriptions and review arrangements

Posts with Job DescriptiolL'l

100 percent

Review Arrangements

Regularly reviewed as a requirement of the Public Service Commission

205

3.2.5 Fellowships


Selection body


Other constraints


Western SamOQ

· Fellowships application processed by a committee comprising the Director General of Health and heads of division.

· Recommendations submitted to Minister for approval. · Approved candidates submitted to the scholarship

committee through the manpower planning unit of public service commission for final approval.

· Director General of Health · Heads of division · Minister of Health · Manpower planning unit, public service commission · Scholarship committee

· Shortage of suitable candidates with appropriate educational background to meet entry requirements of recipient countries.

· Absence of appropriate selection criteria. · Separation from families during long term fellowship. · Preference for other fields rather than medicine at high

school level.

3.3.1 Percentage of health worliforce with job descriptions and review arrangements

Posts with Job DescriptiolL'l

100 percent

Review Arrangements

Regularly reviewed as a requirement of the Public Service Commission

205




· Low morale

· Poor motivation

· Inadequate supervision

· Improper coordination and planning of educational training programmes

· Poor working conditions

· Inadequate incentives


District level · Free housing · Remote areas allowance · Location allowance

Central level · Overtime night allowance · Call back allowance · Shift workers penal time allowance · Special allowance for heads of uni ts · Special telephone rental rate for medical

officers

206




· Low morale

· Poor motivation

· Inadequate supervision

· Improper coordination and planning of educational training programmes

· Poor working conditions

· Inadequate incentives


District level · Free housing · Remote areas allowance · Location allowance

Central level · Overtime night allowance · Call back allowance · Shift workers penal time allowance · Special allowance for heads of uni ts · Special telephone rental rate for medical

officers

206

Weste,.,. Samoa



Detennining Establishment D 0 There is no system for assessment and detennining establishment.

0 D The process sometimes takes too

Recruitment Process long due to non availability of suitable personnel.

Selection Procedures D 0 Require to establish a selection committee in the Ministry.

Induction Programmes 0 D To be encouraged on quarterly basis.

Supportive Supervision Process 0 D Need to be strengthened.

Perfonnance Appraisal 0 D Recently reviewed.

In-Service Training 0 D Needs to be a continuous program.

Special Incentives & Rewards 0 D Will need to be improved.

0 D Need to be closely examined.

Detennining Career Path Their relativities must be detennined to the needs and subject to PSC approval.

Task Analysis Procedure 0 D Need to properly established according to the needs.

Designing of Job Profiles 0 D To be encouraged for assessment from time to time.

Management of Records 0 D Continuous follow-up.to improve current system. Not sufficiently reviewed or evaluated. Trained staff in this area is lacking.


207

Weste,.,. Samoa



Detennining Establishment D 0 There is no system for assessment and detennining establishment.

0 D The process sometimes takes too

Recruitment Process long due to non availability of suitable personnel.

Selection Procedures D 0 Require to establish a selection committee in the Ministry.

Induction Programmes 0 D To be encouraged on quarterly basis.

Supportive Supervision Process 0 D Need to be strengthened.

Perfonnance Appraisal 0 D Recently reviewed.

In-Service Training 0 D Needs to be a continuous program.

Special Incentives & Rewards 0 D Will need to be improved.

0 D Need to be closely examined.

Detennining Career Path Their relativities must be detennined to the needs and subject to PSC approval.

Task Analysis Procedure 0 D Need to properly established according to the needs.

Designing of Job Profiles 0 D To be encouraged for assessment from time to time.

Management of Records 0 D Continuous follow-up.to improve current system. Not sufficiently reviewed or evaluated. Trained staff in this area is lacking.


207



*

Professional Bodies


Western Samoan Medical Association Western Samoan Dental Association Western Samoan Registered Nurses Association Health Workers Association


208


*

}

Not involved in major government decision making process pertaining to health health personnel management



*

Professional Bodies


Western Samoan Medical Association Western Samoan Dental Association Western Samoan Registered Nurses Association Health Workers Association


208


*

}

Not involved in major government decision making process pertaining to health health personnel management

Concluding Remorks

CONCLUDING REMARKS

The material presented in this publication represents what is probably the first attempt to provide a relatively comprehensive comparative review of health workforce planning, development and management in a number of Pacific Island countries.

In most of the countries included in the study, future activities relating to health workforce development and deployment could include:

(i) further analysis of workforce age structure. training inputs and outputs and workforce attrition;

(ii) the adoption of appropriate workload and health demands oriented methods of workforce planning and utilisation;

(iii) increasing emphasis on the cost implications of personnel training and service staffing to ensure that workforce planning is conducted within a framework of realistic financial constraints.

The pursuit of these activities, aimed at improving the quality of health care delivery with the optimal utilisation of resources will be facilitated by the establishment of a health information exchange network providing timely and useful data to be readily accessed by and shared among the Pacific Island Countries.

209

Concluding Remorks

CONCLUDING REMARKS

The material presented in this publication represents what is probably the first attempt to provide a relatively comprehensive comparative review of health workforce planning, development and management in a number of Pacific Island countries.

In most of the countries included in the study, future activities relating to health workforce development and deployment could include:

(i) further analysis of workforce age structure. training inputs and outputs and workforce attrition;

(ii) the adoption of appropriate workload and health demands oriented methods of workforce planning and utilisation;

(iii) increasing emphasis on the cost implications of personnel training and service staffing to ensure that workforce planning is conducted within a framework of realistic financial constraints.

The pursuit of these activities, aimed at improving the quality of health care delivery with the optimal utilisation of resources will be facilitated by the establishment of a health information exchange network providing timely and useful data to be readily accessed by and shared among the Pacific Island Countries.

209