Working together or hea The World Health Report 2006 orld Health
The World Health Report 2006 Working together for health
WHO Library Cataloguing-in-Publication Data Worid Health Organization. The world health report 2006: working together for health 1. World health -trends. 2. Health personnel-education 3 Education, Medical. 4. Health manpower. 5. National health programs-organization and administration. 6. World Health Organi L. Title II. Title: Working together for health. BN9241563176 LM classification: WA 530.1) BN978924156317 ppia, 1211 Geneva 27, Switzerland (teL +41 22791 3264: fax: +41 227914857: email: bookorders@who int). Requests for permission addressed to WHO Press, the above address(fax: +41 22 791 4806; email: permissions@who int The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatso- concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. he mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the ners of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. g distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. formation concerning this publication can be obtained from: 1211 Geneva 27. Switzerland E-mail: whr@who int Copies of this publication and the full report can be ordered from bookorders @who int his report was produced under the overall direction of Tim Evans (Assistant Director-General, Evidence and Information for Policy Aschwanden and Joanne McManus. Organizational supervision of the report was provided by Manuel M. Dayrit and Carmen Dolea. The Managing Editor of valuable inputs in the form of contributions, peer-review, suggestions and criticisms were received from the Director-General's Office, and from Maia m时 n Mario dal poz si orid draeger. norbert Dreesch patricia herman dez yohannes kinfu eena k ojumen, Hugo Mercer, Amit Prasad, Angelica di. Paulo ferri marajah, Patrick Kada va, Guy Kegels, Meleckidzedeck Hayes, Mirel Annick Manuel, Bruno Marchal. Tim Martin ic, Lis Wagner, Eva Wallstam, W, Tana Wuliji, Jean Yan, Sandy Yule, Manfred Zahorka, Diana Zandi, and Lingling Zhang ter GI yia, Hossein Salehi, Cheryl Sawyer, Kenji Shibuya, Karen Stanecl 出Km ki, Ruben Suarez, Emi Suzuki, Nathalie Van de Maele, Jako leff Walker, Tessa Wardlaw, Charles Waza, Jens Wilkens, John Wilmoth, and many staff in WHo country offices, governmental departments and agencies, nereport was edited by Leo vita-Finzi, assisted by panini. Editorial, administrative an ction support was provided by shelagh Probst ecns Sans Frontieres: courtesy of the worl Association. the world medical association the use of selected photographs of the Caring Physicians of the World campaign, sponsored by the Pfizer Medical Humanities Initiative. Th materialistakenfromCaringphysiciansoftheworld(wmawebsitewww.wma.net yout: Steve Ewart and Reda Sadki inting coordination: Raphael Crettaz Printed in france
WHO Library Cataloguing-in-Publication Data World Health Organization. The world health report 2006: working together for health. 1. World health – trends. 2. Health personnel – education. 3. Education, Medical. 4. Health manpower. 5. National health programs – organization and administration. 6. World Health Organization. I. Title. II. Title: Working together for health. ISBN 92 4 156317 6 (NLM classification: WA 530.1) ISBN 978 92 4 156317 8 ISSN 1020-3311 © World Health Organization 2006 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 3264; fax: +41 22 791 4857; email: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: permissions@who.int). 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 World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Information concerning this publication can be obtained from: World Health Report World Health Organization 1211 Geneva 27, Switzerland E-mail: whr@who.int Copies of this publication and the full report can be ordered from: bookorders@who.int Design: Reda Sadki Layout: Steve Ewart and Reda Sadki Figures: Christophe Grangier Printing coordination: Raphaël Crettaz Printed in France This report was produced under the overall direction of Tim Evans (Assistant Director-General, Evidence and Information for Policy). The principal authors were Lincoln Chen, David Evans, Tim Evans, Ritu Sadana, Barbara Stilwell, Phyllida Travis, Wim Van Lerberghe and Pascal Zurn, assisted by Christie Aschwanden and Joanne McManus. Organizational supervision of the report was provided by Manuel M. Dayrit and Carmen Dolea. The Managing Editor of the report was Thomson Prentice. Valuable inputs in the form of contributions, peer-review, suggestions and criticisms were received from the Director-General's Office, and from Maia Ambegaokar, Dina Balabanova, James Buchan, Gilles Dussault, Martin McKee and Barbara McPake. Significant contributions to the analytical work were received from Mario Dal Poz, Sigrid Draeger, Norbert Dreesch, Patricia Hernandez, Yohannes Kinfu, Teena Kunjumen, Hugo Mercer, Amit Prasad, Angelica Souza and Niko Speybroek. Additional help and advice were kindly provided by Regional Directors and members of their staff. Other contributors were Sabine Ablefoni, Taghreed Adam, Alayne Adams, Chris Afford, Alan Leather, Fariba Aldarazi, Ghanim Al'Sheick, Ala Alwan, Sarah Barber, Kisalaya Basu, Jacques Baudouy, Robert Beaglehole, Habib Benzian, Karin Bergstrom, Isa Bogaert, Paul Bossyns, Jean-Marc Braichet, Hilary Brown, Paul Bunnell, Francisco Campos, Eleonora Cavagnero, Xuanhao Chan, Amélina Chaouachi, Ottorino Cosivi, Nadia Danon-Hersch, Khassoum Diallo, Alimata Diarra, Marjolein Dieleman, Dela Dovlo, Nathalie Drew, Sambe Duale, Steeve Ebener, Dominique Egger, JoAnne Epping-Jordan, Marthe-Sylvie Essengue, Edwige Faydi, Paulo Ferrinho, Noela Fitzgerald, Martin Fletcher, Helga Fogstad, Gilles Forte, Kathy Fritsch, Michelle Funk, Charles Godue, Sandy Gove, Alexandre Griekspoor, Steffen Groth, Anil Gupta, Piya Hanvoravongchai, Hande Harmanci, Lisa Hinton, Sue Ineson, Anwar Islam, Anna Iversen, PT Jayawickramarajah, Patrick Kadama, Hans Karle, Julia Karnaukhova, Guy Kegels, Meleckidzedeck Khayesi, Mireille Kingma, Stephen Kinoti, Etienne Krug, Yunkap Kwankam, Chandrakant Laharyia, Gaert Laleman, Jean Pierre Lokonga, Ana Lopes Temporão, Alessandro Loretti, Pat McCarty, Judith MandelbaumSchmid, Annick Manuel, Bruno Marchal, Tim Martineau, Liz Mason, Zoe Matthews, Sandra McGinnis, Abdelhay Mechbal, Remo Meloni, Nata Menabde, Phillipa Mladovski, Dominic Montagu, Jean Moore, Krishnan Natarajan, Mwansa Nkwane, John Norcini, Ezekiel Nukoro, Isabelle Nuttal, Jennifer Nyoni, Cornelius Oepen, Judith Oulton, Francis Omaswa, Mary O'Neill, Ariel Pablos-Mendez, Fred Peccaud, Margie Peden, Galina Perfilieva, Bob Pond, Raymond Pong, Amit Prasad, Usha Raman, Tom Ricketts, Robert Ridley, Arjanne Rietsema, Felix Rigoli, Barbara Rijks, Salif Samake, Benedetto Saraceno, Shekhar Saxena, Robert Scherpbier, Lee-Martin Shook-Pui, Kit Sinclair, Alaka Singh, Ronald Skeldon, Susan Skillman, Ajay Tandon, Tessa Tan-Torres Edejer, Linda Tawfik, Michel Thieren, Anke Tijstma, Nicole Valentine, Wim Van Damme, Dirk Van der Roost, Mark van Ommeren, Paul Verboom, Marko Vujicic, Lis Wagner, Eva Wallstam, Diane Whitney, Marijke Wijnroks, Paul Wing, Christiane Wiskow, Tana Wuliji, Jean Yan, Sandy Yule, Manfred Zahorka, Diana Zandi, and Lingling Zhang. Contributors to statistical tables not already mentioned were Endre Bakka, Dorjsuren Bayarsaikhan, Ties Boerma, Eduard Bos, Thomas Buettner, Veneta Cherilova, Trevor Croft, Driss Zine Eddine Elidrissi, Anton Fric, Charu Garg, Peter Ghys, Amparo Gordillo, Eleanor Gouws, Attila Hancioglu, Kenneth Hill, Chandika Indikadahena, Mie Inoue, Gareth Jones, Joses Kirigia, Jan Klavus, Joseph Kutzin, Eduardo Levcovitz, Edilberto Loaiza, Doris Ma Fat, François Pelletier, Ravi Rannan-Elyia, Hossein Salehi, Cheryl Sawyer, Kenji Shibuya, Karen Stanecki, Rubén Suárez, Emi Suzuki, Nathalie Van de Maele, Jakob Victorin, Neff Walker, Tessa Wardlaw, Charles Waza, Jens Wilkens, John Wilmoth, and many staff in WHO country offices, governmental departments and agencies, and international institutions. The report was edited by Leo Vita-Finzi, assisted by Barbara Campanini. Editorial, administrative and production support was provided by Shelagh Probst and Gary Walker, who also coordinated the photographs. Figures and tables were provided by Gael Kernen who also was responsible for the web site version, and other electronic media. Proofreading was by Marie Fitzsimmons. The index was prepared by June Morrison. Cover photo: © AFP 2005. © AFP 2005 and © Médecins Sans Frontières: courtesy of the World Medical Association. The World Medical Association (WMA) licenses the use of selected photographs of the Caring Physicians of the World campaign, sponsored by the Pfizer Medical Humanities Initiative. The material is taken from Caring physicians of the world (WMA web site www.wma.net)
contents Message from the Director-General Overview Why the workforce is important Picture of the global workforce Driving forces: past and future Strategies: working lifespan of entry-workforce-exit Entry: preparing the workforce Workforce: enhancing performance XXII Exit: managing migration and attrition Moving forward together An imperative for action National leadership Global solidarity Plan of action Moving forward together Chapter 1 Health workers: a global profile Who are the health workers How many health workers are there? Public and private sector workers Sex and age of health workers How much is spent on the health workforce? 45678 Where are the health workers? Uneven distribution across the globe Uneven spread within countries Are there enough health workers? 9 Needs-based sufficiency 11 Addressing the shortage- how much will it cost?
iii contents Message from the Director-General xiii Overview xv Why the workforce is important xv Picture of the global workforce xvi Driving forces: past and future xvii Strategies: working lifespan of entry–workforce–exit xx Entry: preparing the workforce xx Workforce: enhancing performance xxii Exit: managing migration and attrition xxii Moving forward together xxiii An imperative for action xxiii National leadership xxiii Global solidarity xxiv Plan of action xxv Moving forward together xxvi Chapter 1 Health workers: a global profile 1 Who are the health workers? 1 How many health workers are there? 4 Public and private sector workers 5 Sex and age of health workers 6 How much is spent on the health workforce? 7 Where are the health workers? 8 Uneven distribution across the globe 8 Uneven spread within countries 8 Are there enough health workers? 9 Needs-based sufficiency 11 Addressing the shortage – how much will it cost? 13 Conclusion 15
Chapter 2 Responding to urgent health needs 19 High priority services: human resources for health and the MDGs Epidemics of in-service training 20 verburdened district staff Two tiers of salaries 21 Strategy 2.1 Scale up workforce planning Strategy 2. 2 Capitalize on synergies across priority programmes Strategy 2. 3 Simplify services and delegate appropriately 2334 Strategy 2. 4 Secure the health and safety of health workers Preparing the workforce for the growing burden of chronic diseases and injuries 24 New paradigms of care require a workforce response Strategy 2. 5 Deploy towards a continuum of care 25 Strategy 2.6 Foster collaboration Strategy 2.7 Promote continuous learning for patient safety Mobilizing for emergency needs: natural disasters and outbreaks 29 Preparedness plans can help Strategy 2.8 Take a "command and control"approach 30 Strategy 2.9 Help remove sector boundaries Strategy 2.10 Train appropriate health staff for emergency response Strategy 2. 11 Develop an emergency deployment strategy for different kinds of health workers Strategy 2. 12 Ensure adequate support for front-line workers 32 orking Strategy 2. 13 Obtain and maintain strategic information Strategy 2.14 Invest in advanced planning and focused interventions 34 Strategy 2.15 Protect what works Strategy 2.16 Repair and prepare Strategy 2. 17 Rehabilitate when stability begins 35 Conclusion 36 Chapter 3 Preparing the health workforce Workforce entry: the right mix 41 The"pipeline" for recruitment 42 Training: the right institutions to produce the right workers Governal 44 Getting the night balance of schools and graduates Strategy 3.1 Encourage training across the health care spectrum Accreditation: promoting competence and trust 46 Managing admissions to enhance diversity Strategy 3. 2 Develop admissions policies to reflect diversities 47 Retaining students through to graduation 47 Educational services Strategy 3. 3 Ensure quality and responsive curricula 47 Acquiring competencies to leam Workforce of teachers
iv Chapter 2 Responding to urgent health needs 19 High priority services: human resources for health and the MDGs 19 Epidemics of in-service training 20 Overburdened district staff 21 Two tiers of salaries 21 Strategy 2.1 Scale up workforce planning 22 Strategy 2.2 Capitalize on synergies across priority programmes 23 Strategy 2.3 Simplify services and delegate appropriately 23 Strategy 2.4 Secure the health and safety of health workers 24 Preparing the workforce for the growing burden of chronic diseases and injuries 24 New paradigms of care require a workforce response 25 Strategy 2.5 Deploy towards a continuum of care 25 Strategy 2.6 Foster collaboration 27 Strategy 2.7 Promote continuous learning for patient safety 28 Mobilizing for emergency needs: natural disasters and outbreaks 29 Preparedness plans can help 29 Strategy 2.8 Take a “command and control” approach 30 Strategy 2.9 Help remove sector boundaries 30 Strategy 2.10 Train appropriate health staff for emergency response 31 Strategy 2.11 Develop an emergency deployment strategy for different kinds of health workers 32 Strategy 2.12 Ensure adequate support for front-line workers 32 Working in conflict and post-conflict environments 34 Strategy 2.13 Obtain and maintain strategic information 34 Strategy 2.14 Invest in advanced planning and focused interventions 34 Strategy 2.15 Protect what works 35 Strategy 2.16 Repair and prepare 35 Strategy 2.17 Rehabilitate when stability begins 35 Conclusion 36 Chapter 3 Preparing the health workforce 41 Workforce entry: the right mix 41 The “pipeline” for recruitment 42 Training: the right institutions to produce the right workers 43 Governance 44 Getting the right balance of schools and graduates 44 Strategy 3.1 Encourage training across the health care spectrum 45 Accreditation: promoting competence and trust 46 Managing admissions to enhance diversity 46 Strategy 3.2 Develop admissions policies to reflect diversities 47 Retaining students through to graduation 47 Educational services 47 Strategy 3.3 Ensure quality and responsive curricula 47 Acquiring competencies to learn 48 Workforce of teachers 48
Strategy 3. 4 Encourage and support teaching excellence Financing Infrastructure and technology Strategy 3. 5 Find innovative ways to access teaching expertise and materials Information for policy-making Strategy 3.6 Evaluate institutional performance policy options and actions Rethinking recruitment: gateway to the workforce Imperfect labour markets Strategy 3. 7 Improve recruitment performance Conclusion Chapter 4 Making the most of existing health workers What is a well-performing health workforce? What determines how health workers perform? 70 What influences health workers' performance? Job-specific levers Strategy 4.1 Develop clear job descriptions Strategy 4.2 Support norms and codes of conduct Strategy 4. 3 Match skills to tasks Strategy 4.4 Exercise supportive supervision 7222355 Basic support systems Strategy 4.5 Ensure appropriate remuneration Strategy 4.6 Ensure adequate information and communication Strategy 4.7 Improve infrastructure and supplies An enabling work environment Strategy 4.8 Promote lifelong learning Strategy 4.9 Establish effective team management 224 Strategy 4 10 Combine responsibility with accountability How are levers linked to the four dimensions of health workforce performance? Availability Competence Responsiveness Productivity 67789 Chapter 5 Managing exits from the workforce Ebbs and flows of migration Why are health workers moving Impacts of migration 101 Strategies to manage migration Source country strategies Strategy 5. 1 Adjust training to need and demands Strategy 5.2 Improve local conditions Receiving country strategies 103
Strategy 3.4 Encourage and support teaching excellence 50 Financing 50 Infrastructure and technology 52 Strategy 3.5 Find innovative ways to access teaching expertise and materials 54 Information for policy-making 54 Strategy 3.6 Evaluate institutional performance, policy options and actions 54 Rethinking recruitment: gateway to the workforce 54 Imperfect labour markets 56 Strategy 3.7 Improve recruitment performance 58 Conclusion 59 Chapter 4 Making the most of existing health workers 67 What is a well-performing health workforce? 67 What determines how health workers perform? 70 What influences health workers’ performance? 71 Job-specific levers 72 Strategy 4.1 Develop clear job descriptions 72 Strategy 4.2 Support norms and codes of conduct 72 Strategy 4.3 Match skills to tasks 73 Strategy 4.4 Exercise supportive supervision 75 Basic support systems 75 Strategy 4.5 Ensure appropriate remuneration 75 Strategy 4.6 Ensure adequate information and communication 80 Strategy 4.7 Improve infrastructure and supplies 81 An enabling work environment 82 Strategy 4.8 Promote lifelong learning 82 Strategy 4.9 Establish effective team management 84 Strategy 4.10 Combine responsibility with accountability 86 How are levers linked to the four dimensions of health workforce performance? 86 Availability 86 Competence 87 Responsiveness 87 Productivity 88 Conclusion 89 Chapter 5 Managing exits from the workforce 97 Ebbs and flows of migration 98 Why are health workers moving? 99 Impacts of migration 101 Strategies to manage migration 101 Source country strategies 102 Strategy 5.1 Adjust training to need and demands 102 Strategy 5.2 Improve local conditions 103 Receiving country strategies 103
Strategy 5.3 Ensure fair treatment of migrant workers Strategy 5. 4 Adopt responsible recruitment policies 103 Strategy 5.5 Provide support to human resources in source countries 104 Intemational instruments Occupational risks to health workers 105 Strategy 5.6 Develop and implement tactics against violence 6 other risks Strategy 5.7 Initiate and reinforce a safe work environment lllness and death from hiviaids Change of occupation or work status Choosing a reduced work week Strategy 5.8 Accommodate workers' needs and expectations 107 Health workers not employed in their field Strategy 5.9 Target health workers outside the health sector Absentees and ghost workers Strategy 5.10 Keep track of the workforce 109 Retirement rates and the risk of shortages 109 Health workforce ageing Strategy 5 11 Develop the capacity and policy tools to manage retirement 111 The need for knowledge transfer 111 Strategy 5.12 Develop succession planning Conclusion Chapter 6 Formulating national health workforce strategies 119 Building trust and managing expectations Strategy 6. 1 Design and implement a workforce strategy that fosters trust Fair and cooperative governing 121 Self-regulation Muddling through"and command-and-control Watchdogs and advocates A model for effective governance Strategy 6.2 Ensure cooperative governance of national workforce policies 124 Strong leadership Strengthening strategic intelligence Strategy 6. 3 Obtain better intelligence on the health workforce in national situations Extent and nature of the national workforce problem Action taken and further options 126 National politics around the health workforce Reactions of health workers and their employers vesting in workforce institutions Learning from microinnovations Scenario building and planning
vi Strategy 5.3 Ensure fair treatment of migrant workers 103 Strategy 5.4 Adopt responsible recruitment policies 103 Strategy 5.5 Provide support to human resources in source countries 104 International instruments 104 Occupational risks to health workers 105 Violence 105 Strategy 5.6 Develop and implement tactics against violence 106 Other risks 106 Strategy 5.7 Initiate and reinforce a safe work environment 107 Illness and death from HIV/AIDS 107 Change of occupation or work status 107 Choosing a reduced work week 107 Strategy 5.8 Accommodate workers’ needs and expectations 107 Health workers not employed in their field 108 Strategy 5.9 Target health workers outside the health sector 108 Absentees and ghost workers 108 Strategy 5.10 Keep track of the workforce 109 Retirement 109 Retirement rates and the risk of shortages 109 Health workforce ageing 110 Strategy 5.11 Develop the capacity and policy tools to manage retirement 111 The need for knowledge transfer 111 Strategy 5.12 Develop succession planning 111 Conclusion 112 Chapter 6 Formulating national health workforce strategies 119 Building trust and managing expectations 120 Strategy 6.1 Design and implement a workforce strategy that fosters trust 120 Fair and cooperative governing 121 Self-regulation 121 “Muddling through” and command-and-control 122 Watchdogs and advocates 123 A model for effective governance 123 Strategy 6.2 Ensure cooperative governance of national workforce policies 124 Strong leadership 125 Strengthening strategic intelligence 126 Strategy 6.3 Obtain better intelligence on the health workforce in national situations 126 Extent and nature of the national workforce problem 126 Action taken and further options 126 National politics around the health workforce 126 Reactions of health workers and their employers 127 Investing in workforce institutions 127 Learning from microinnovations 128 Scenario building and planning 129 Conclusion 129
Chapter 7 Working together, within and across countries 135 A firm foundation for information 36 Generation and management of knowledge Pooling of expertise 141 Striking cooperative agreements Responding to the health workforce crisis An extraordinary global response is needed 144 14 Towards more worker-friendly practices 144 The imperative of sufficient, sustained financing 145 global guideline for financi Moving forward together 14 48 Plan of action Joint steps to the future Statistical Annex Explanatory notes Annex Table 3 186 Fiqures-0verview Health workers save lives! Forces driving the workforce Countries with a critical shortage of health service providers XVIl Working lifespan strategies Global stakeholder alliance Figures- Chapt Figure 1.1 Distribution of women in health service professions, by WHO region Distribution of health workers by level of health expenditure and burden of disease, by WHO region Rural-urban distribution of health service providers 9
vii Chapter 7 Working together, within and across countries 135 Catalysing knowledge and learning 135 A firm foundation for information 136 Generation and management of knowledge 139 Pooling of expertise 141 Striking cooperative agreements 143 Responding to the health workforce crisis 143 An extraordinary global response is needed 144 Coalitions around emergency plans 144 Towards more worker-friendly practices 144 The imperative of sufficient, sustained financing 145 A global guideline for financing 146 Moving forward together 147 National leadership 148 Global solidarity 149 Plan of action 150 Joint steps to the future 151 Statistical Annex Explanatory notes 155 Annex Table 1 168 Annex Table 2 178 Annex Table 3 186 Annex Table 4 190 Index 201 Figures – Overview Figure 1 Health workers save lives! xvi Figure 2 Forces driving the workforce xvii Figure 3 Countries with a critical shortage of health service providers (doctors, nurses and midwives) xviii Figure 4 Working lifespan strategies xxi Figure 5 Global stakeholder alliance xxvi Figures – Chapters Figure 1.1 Distribution of women in health service professions, by WHO region 6 Figure 1.2 Distribution of health workers by level of health expenditure and burden of disease, by WHO region 9 Figure 1.3 Rural–urban distribution of health service providers 9
Figure 1.4 Population density of health care professionals required to ensure skilled attendance at births 11 Figure 1.5 Countries with a critical shortage of health service providers (doctors, nurses and midwives) From massive deprivation to marginal exclusion: moving up the coverage ladder Figure 2.2 Optimal mix of mental health services Figure 2.3 Global distribution of psychiatrists Getting the mix right: challenges to health workforce production gure 3.2 Pipeline to generate and recruit the health workforce Figure 3.3 Relationship of education, labour and health services markets with human resources Projected time to recuperate student investments in education colombia. 2000 Figure 4.1 Patients' perception of respectful treatment at health facilities in 19 countries Levers to influence the four dimensions of health workforce performance 7 Figure 5.1 Exit routes from the health workforce Figure 5.2 Health workers' reasons to migrate in four African countries (Cameroon, South Africa, Uganda and Zimbabwe) Figure 5.3 Occupations at risk of violence, Sweden gure 5. 4 Ageing nurses in the United States of America 110 Figure 5.5 Age distribution of doctors Figure 6.1 Organizations influencing the behaviour of health workers and the health institution 124 Figure 7.1 Health information system(HIS) performance Figure 7.2 Immunization coverage and density of health workers 139 Figure 7.3 Country priorities for health systems strengthening 145 Figure 7. 4 Global stakeholder alliance
viii Figure 1.4 Population density of health care professionals required to ensure skilled attendance at births 11 Figure 1.5 Countries with a critical shortage of health service providers (doctors, nurses and midwives) 12 Figure 2.1 From massive deprivation to marginal exclusion: moving up the coverage ladder 20 Figure 2.2 Optimal mix of mental health services 26 Figure 2.3 Global distribution of psychiatrists 27 Figure 3.1 Getting the mix right: challenges to health workforce production 42 Figure 3.2 Pipeline to generate and recruit the health workforce 42 Figure 3.3 Relationship of education, labour and health services markets with human resources 56 Figure 3.4 Projected time to recuperate student investments in education, Colombia, 2000 57 Figure 4.1 Patients’ perception of respectful treatment at health facilities in 19 countries 69 Figure 4.2 Levers to influence the four dimensions of health workforce performance 71 Figure 5.1 Exit routes from the health workforce 98 Figure 5.2 Health workers’ reasons to migrate in four African countries (Cameroon, South Africa, Uganda and Zimbabwe) 99 Figure 5.3 Occupations at risk of violence, Sweden 105 Figure 5.4 Ageing nurses in the United States of America 110 Figure 5.5 Age distribution of doctors 111 Figure 6.1 Organizations influencing the behaviour of health workers and the health institutions 124 Figure 7.1 Health information system (HIS) performance 136 Figure 7.2 Immunization coverage and density of health workers 139 Figure 7.3 Country priorities for health systems strengthening 145 Figure 7.4 Global stakeholder alliance 151
Boxes-Chapters B0x1.1 B0x1.2 The invisible backbone of the health system management and support workers B0X1.3 Where are the health workers? Service Availability Mapping B0x2.1 Health workers and the Millennium Development Goals e An emergency programme for human resources in malawi Task shifting in the health care workforce Core competencies for long-term patient care B0x2.5 Patient safety B0x2.6 Responding to infectious disease outbreaks-SARS Thailand's response to epidemics and disasters Protecting health systems and biomedical practice during conflicts 36 B0x3.1 Is the future of academic medicine in jeopardy? The public health movement in South-East Asia regional initiatives and new schools B0x3.3 Rapid growth in private education of health professionals B0X3.4 Practice-based teaching problem-based learning, and patient-focused practice all go togeth B0X3.5 Faculty development programmes: training trainers in B0x3.6 From in-service to pre-service training Integrated Management of Childhood Ilness(IMCi) B0X3.7 Regionalization of training for health professionals: University of the South Pacific and the University of the West Indies The evidence base to enhance performance of health educational institutions B0X3.9 Pakistan's Lady Health Workers election and development of new cadres
ix Boxes – Chapters Box 1.1 Classifying health workers 3 Box 1.2 The invisible backbone of the health system: management and support workers 4 Box 1.3 Where are the health workers? Service Availability Mapping 10 Box 2.1 Health workers and the Millennium Development Goals 21 Box 2.2 An emergency programme for human resources in Malawi 22 Box 2.3 Task shifting in the health care workforce 24 Box 2.4 Core competencies for long-term patient care 25 Box 2.5 Patient safety 28 Box 2.6 Responding to infectious disease outbreaks – SARS 29 Box 2.7 Thailand’s response to epidemics and disasters 31 Box 2.8 Protecting health systems and biomedical practice during conflicts 36 Box 3.1 Is the future of academic medicine in jeopardy? 43 Box 3.2 The public health movement in South-East Asia: regional initiatives and new schools 45 Box 3.3 Rapid growth in private education of health professionals 46 Box 3.4 Practice-based teaching, problem-based learning, and patient-focused practice all go together 49 Box 3.5 Faculty development programmes: training trainers in professional health education 50 Box 3.6 From in-service to pre-service training: Integrated Management of Childhood Illness (IMCI) 51 Box 3.7 Regionalization of training for health professionals: University of the South Pacific and the University of the West Indies 53 Box 3.8 The evidence base to enhance performance of health educational institutions 55 Box 3.9 Pakistan’s Lady Health Workers: selection and development of new cadres 59
B0X4.1 Infant mortality and health worker density, Viet Nam B0x4.2 Differences in performance of male and female health service providers B0x43 Job-related challenges to improving health worker performance B0x4.4 Differences in salaries between countries, professions, sectors and sexes 76 Box 4 Incentives to enhance health workers' performance B0x4.6 Using modern communication technology to improve data, services and productivity B0X4.7 What sort of training works best? B0x4.8 Quality assurance, supervision and monitoring in Ugand 0X4.9 Changing tasks and therefore skill needs B0x4.10 The importance of management and leadership B0x5.1 Turning brain drain into brain gain-the Philippines BoX 5.2 Recruitment agencies and migration B0x5.3 Bilateral agreement between South Africa and the United Kingdom 104 Strategies in action: examples of exit management B0x5.5 Measures for a safe work environment hIvaids BOX 6.1 Self-regulation opportunities 122 B0x6.2 Human resources for health observatories in latin america B0x7.1 Seeking a common technical framework for human resources for health: a public good useful to all countrie 137 B0x72 Research priorities related to community health workers B0x73 Tools for health workforce assessment and development 141 B0x7.4 Technical skills for human resource policy-making 142
Box 4.1 Infant mortality and health worker density, Viet Nam 68 Box 4.2 Differences in performance of male and female health service providers 70 Box 4.3 Job-related challenges to improving health worker performance 74 Box 4.4 Differences in salaries between countries, professions, sectors and sexes 76 Box 4.5 Incentives to enhance health workers’ performance 78 Box 4.6 Using modern communication technology to improve data, services and productivity 80 Box 4.7 What sort of training works best? 82 Box 4.8 Quality assurance, supervision and monitoring in Uganda 83 Box 4.9 Changing tasks and therefore skill needs 84 Box 4.10 The importance of management and leadership 85 Box 5.1 Turning brain drain into brain gain – the Philippines 101 Box 5.2 Recruitment agencies and migration 102 Box 5.3 Bilateral agreement between South Africa and the United Kingdom 104 Box 5.4 Strategies in action: examples of exit management 106 Box 5.5 Measures for a safe work environment: HIV/AIDS 108 Box 6.1 Self-regulation opportunities 122 Box 6.2 Human resources for health observatories in Latin America 128 Box 7.1 Seeking a common technical framework for human resources for health: a public good useful to all countries? 137 Box 7.2 Research priorities related to community health workers 140 Box 7.3 Tools for health workforce assessment and development 141 Box 7.4 Technical skills for human resource policy-making 142