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Dr Stefaan Van Bastelaere (Senior Health Expert at the Belgian Development Agency) presents the Belgian Charter on Human Resources for Health at the European Congress on Tropical Medicine and International Health, held in Copenhaguen in September 2013.
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Human Resources for Health (HRH): from theory to practice
Dr Stefaan Van Bastelaere Senior Health Expert
2European Congress on Tropical Medicine and International Health
The global context of HRH
Components of a crisis : • World Health Organisation 2006
• African countries = 24% of disease burden | 3% of health professionals | 1% means
• Kampala declaration 2008 - First world forum on HRH • Global shortage estimate 4 million
• US estimate for 2020 : gap of 100,000 physicians | 1,000,000 nurses | 250,000 other health
professionals
• Systematic underproduction in some countries
• Systematic overproduction in other countries
• Poor or absent HR planning
• Poor or absent HR Monitoring & Evaluation
• Resistance to change (task-shifting, task-sharing)
• Little attention paid to clinical activities
September 2013
3European Congress on Tropical Medicine and International Health
Migration• as old as mankind • not the cause, but the solution
Drivers for migration• stick
• stay
• push
• pull
September 2013
The global context of HRH
4European Congress on Tropical Medicine and International Health
Components of a solution :
• Comprehensive HRH policies and management
Source: WHO 2006
September 2013
The global context of HRH
5European Congress on Tropical Medicine and International Health
Components of a solution :
• 2010 : Code of practice on international recruitment, World
Health Assembly
• 2012 : Belgian HRH Charter
• Reducing push forces – strengthen stick factors :
Self esteem!
Better connectivity : telemedicine
Results-Based Finance – Performance-Based Finance: motivation
strategy
Improving housing and working conditions…
September 2013
The global context of HRH
6European Congress on Tropical Medicine and International Health
The Belgian HRH Charter
5 strategic result areas
RA 1 : Partnership and harmonization
RA 2 : HRH policies and development plan
RA 3 : Training
RA 4 : Recruitment policies
RA 5 : In Belgium
September 2013
7European Congress on Tropical Medicine and International Health
RA 1 : Partnership and harmonisation
• Federal Public Service Foreign Affairs Embassies do political and policy dialogue
Long-term vision : predictability of programs 4-5 years
• BTC interventions fully embedded in local institutions Ministries of Health, Ministries of Education, Hospitals, Districts or local health
systems
Universities or local schools
Local steering bodies
• BTC actively participating in Sector-Wide Approach Development of “Compact”
Health sector cluster groups, HRH Working Group
Joint sector reviews
September 2013
From theory to practice : implementing the charter
8European Congress on Tropical Medicine and International Health
RA 2 : HRH policies and development plans
• Support HR department of Health
Ministries
• Support development and
implementation of HRH plans
(Rwanda, Burundi, Niger, DR Congo,
Mozambique, Senegal) respecting
values :
Equity
Gender
Sound geographic distribution
September 2013
From theory to practice : implementing the charter
9European Congress on Tropical Medicine and International Health
Improve professional motivation
• Performance-Based Financing
(Rwanda, Burundi)
• Better professional environment :
Investing in communication ICT
Better equipment
Housing
September 2013
RA 2 : HRH policies and development plans
From theory to practice : implementing the charter
10European Congress on Tropical Medicine and International Health
Performance-Based Financing as motivational factor
• 85-95 % of delivered services compliant to quality standards
• Substantial topping up of the salaries Figure 7: Quality of services achievement in group 1
September 2013
RA 2 : HRH policies and development plans
From theory to practice : implementing the charter
11European Congress on Tropical Medicine and International Health
RA 3 : Training
Support development of capacities by strengthening
professional education in partner countries • Nursing schools : paramedical public schools in Burundi and
Rwanda being upgraded, new curriculum developed, motivation
of teaching staff
• Undergraduate and postgraduate trainings
National University of Rwanda
• Internship, training of District Medical Officers
• Capacity-building program for hospital management teams in
South Africa
September 2013
From theory to practice : implementing the charter
12European Congress on Tropical Medicine and International Health
• Scholarship programs in all our partner countries
• Shift from ‘individual scholarships’ to an integrated
‘institutional capacity development program’
• Individual scholarships (before 2012)o Beneficiaries: individualso Sectors: allo Based on individual training needso No follow-upo Nationwide o Yearly agreement between partner states
September 2013
RA 3 : Training
From theory to practice : implementing the charter
13European Congress on Tropical Medicine and International Health
Institutional capacity development plans (as from 2012)• Beneficiaries: geographical consistency
• In line with HRH planning of partner countries and institutional
capacity development plans
• Sector-specific: in ‘concentration’ sector (health, education,
agriculture, infrastructure)
• Priority to local and regional training institutes
• Minimum 4 years’ duration
• Special focus on: Partnership with international partners (Institute for Tropical
Medicine…) | Sandwiched approaches | Distance learning | Gender balanced
September 2013
RA 3 : Training
From theory to practice : implementing the charter
14European Congress on Tropical Medicine and International Health
RA 4 : Recruitment
• Respect the WHO “Code of Practice” Right to migrate, circulation of competences ?
o BTC employed international experts without restrictions on nationality (Niger, Burundi, Senegal, Peru, Cameroun, DR Congo…)
• Compensate for negative consequences Only possible in partner countries
September 2013
From theory to practice : implementing the charter
15European Congress on Tropical Medicine and International Health
RA 5 : In Belgium
• Inform and raise awareness Charter signed and available on intranet
Information on partner country HRH plans on healthpl@form
Participation in HRH WG of Because-Health,
Collaboration on HRH issues with different NGO’s
• Collaboration with diaspora and universities IOM
Contracts with almost all Belgian universities
• Capitalise and share knowledge https://intranet.btcctb.org/claroline/
www.be-causehealth.be/en/themes-and-working-groups/human-
resources-for-health
September 2013
From theory to practice : implementing the charter
16European Congress on Tropical Medicine and International Health
Conclusions
Development agencies can make a difference Work on planning, production and monitoring Influence on push and stick factors
Harmonisation and coordination under a
national consensus is key
September 2013