Health Work Force

Professionalism
Health
professionals for a
new century

Disarikan dari pustaka

oleh: Yayi Suryo
Prabandari
S2 IKM FK UGM 2014
Models and tools for health
workforce planning and
projections

Disarikan dari pustaka oleh:

Yayi S. Prabandari
S2 IKM FK UGM
When Projections are made of future health
workforce requirements and supply, they are
base:

 firstly, on past and planned production and

movements of the workforce and,

only secondly, on predictions of how the

national situation, health needs and delivery of
services will change in the future.
. In making such projections, however, planners
in the health ministry or other stakeholder
agencies are faced with substantial
uncertainties including
– The nature of changes in the country situation
(demographic, epidemiological, economic, etc);
– The capacity (both current and projected) for
implementing the proposed interventions;
– Conflicting priorities between various government
departments/ministries; and
– Leadership turnover, as well as actions of government,
civil society and other stakeholders that can impact on
health systems development
 HRH ACTION FRAMEWORK

Preparation and Planning

Country
Specific context
Including
Critical
Labour maket
Success
Factor
Policy

Finance
Leadership BETTER
HRM HEALTH
Situation Systems Improved
Analysis SERVICES BETTER
Health
Equity HEALTH
Workforce
Effectiveness
Partnership Education Outcomes OUTCOME
Efficiency
Implementation Accessibility

Other health
System
Components
Monitoring and Evaluation
Typical questions that may need to be addressed as part of
simulations include
• What are the implications for staffing numbers and mix if
salaries and benefits are increased with no budget
change?
• What are training and staffing implications of Substituting
one category of health worker in favor of another to
alleviate particular shortages? What is the political
feasibility of doing this type of substitution?
• What will be the impact of an expanding private health
sector on the training and recruitment of new and existing
staff in the public sector?
OUTLINE CONCEPT FOR LINKING HEALTH WORKFORCE REQUIREMENTS AND SUPPLY PROJCETIONS

Current population
Demography and Current health needs
Epidemiology And demands
Current staff

+
• Salary & benefits
• Terms & conditions
Existing services of employment New graduates
• Management
and motivation
+
Current numbers of Tranined staff
Staff of different cadres returning to wrk
and skills required
CHANGE
+
Returne migrants
Future population Furue health
demography and Needs and
epdemiology demands

CHANGE Out-migrants

Future services
No.

Future staff
Future numbers of EQUAL ?
available
staff of different cadres
and skillss required
Yes

CHANGE No. No.

AFFORDABLE ?

IMPLEMENTATION
Yes
 The determinants of workforce
requirements and supply

i. The workforce-to-population ratio method

ii. The health needs method
iii. The service demands method
iv. The service targets method `
Operationalizing the WHO model for workforce
requirements and supply projections

Typically, the data requirements are as follow

• Demographics:
– total population distribution in the starting (base) year;
– population distribution by age and sex, anticipated
average population growth rate over the plan/projection
period;
– urban/rural distribution of the population and how it has
been changing

• \
Operationalizing the WHO model for workforce
requirements and supply projections

Typically, the data requirements are as follow

• Epidemiology:
– current major causes of morbidity and mortality;
– expected changes in patterns of sickness and
disease over the plan period
Operationalizing the WHO model for workforce
requirements and supply projections

Typically, the data requirements are as follow

• Health workforce stock and flows:
– total staff numbers for each cadre in the public and private
health sectors,
– staff distribution by age and sex,
– expected annual percentage attrition rate for each
category of staff over the plan period;
– numbers of new graduates from health education and
training institutions (both public and private institutions);
– net flow of trained health workers into or out of health
services industry (for both the public and and private
health sectors)
Operationalizing the WHO model for workforce
requirements and supply projections

• Remuneration and other recurrent costs:

• salary bands for each type of staff (minimally for public health
sector staff), current average annual remuneration for each
of the personnel categories including all pay and other
benefits; projected changes in the annual real wage costs
(excluding any changes that are simply correcting for
inflation)
 Operationalizing the WHO model for workforce
requirements and supply projections

• Economic growth : gross domestic product (GDP) for

the base year; average predicted annual percentage
change in GDP over the plan period; total current
recurrent expenditure for the public health sector as a
whole and disaggregated between expenditure coming
from the national government and that coming from
donor oranizations (if any); current recurrent public
health sector expenditure on personnel, again
distinguishing between national versus interantional
sources; recurrent public health sector non-personnel
expenditures over the plan period
 Operationalizing the WHO model for workforce
requirements and supply projections

• Private health sector economic data: percentage

allocation of public health non personnel funding to the
private health sector; estimated private sector
expenditure in health care; personnel costs a
percentage of private health sector expenditure
 Data requirements specific to the creation of
projections on the development of services and
institutions pertain to:

• Health facilities: the current and projected number

of health facilities of each type, both those with in-
patient beds (such as general hospitals, long-term
care hospitals and mental health facilities) and those
without (health centers and sub-centers, maternal
and child health centers, health posts, etc) and
across both the public and private health sectors,
average capacity of each facility type (e.g. number of
beds, bed occupancy rate, number of discharges per
year, activity rates, e.g. ambulatory visits, surgeries,
etc).
 Data requirements specific to the creation of
projections on the development of services and
institutions pertain to:

• Facility staffing current number of staff by

type and sector of facility, and by category of
staff, current staffing rations (i.e. staff to
facilities, staff to beds, skills mix ratio);
projected changes in staffing norms ``
In addition, the health workforce is composed of a
large number of personnel located outside health
facilities. This includes health workers in:

• Government ministries and departments;

• Regional or district health offices;
• Public health offices
• Armed medical services;
• Management and support of nongovernmental
organizations delivering health services (either for-
profit or not-for-profit)
• Home-based and community-based health services;
• Research institutions;
• Education and training
• Self-employment
Professionalism &
Competencies
Professionalism
– Involving continuing training or education on
a certain science or speciality
– Orientation toward care
– Profession is determined by standardized
education and training
– Profession student learn based on experience
that socialized more than other student
– Legal aspect of profession practice is
conducted by giving license
– Legalization and profession norm are issued
by profession association
 Kompetensi
Knowledge Character –
Skills Personality

Attitude,
Behavior,
ethic

Kompetensi (SK Mendiknas No.045/U/2002 , dikutip dari Prihatiningsih, 2005)

”Seperangkat tindakan cerdas, penuh tanggungjawab yang dimiliki seseorang
sebagai syarat untuk dianggap mampu oleh masyarakat dalam melaksanakan tugas-
tugas di bidang tertentu”
Development of Competence

Beginner
Advance
Skillful
Competent
Expert
Master
 Menetapkan kompetensi pekerjaan
tertentu – perspektif psikologi
Pekerjaan atau Profesi yang akan dituju
Bila diperlukan
Kalau tidak berupa profesi
 pekerjaan atau jabatan dilakukan analisis
pekerjaan, jabatan

Analisis pekerjaan/jabatan
Jabaran
Deskripsi pekerjaan Kompetensi yang harus kompetensi
melekat pada jabatan tersebut
nya

Kompetensi telah ditetapkan untuk

jabatan/ pekerjaan/profesi tertentu
Kisi-kisi kompetensi ditetapkan Identifikasi cara untuk mengembangkannya
 Job analysis

• A job analysis involves the systematic

collection of information about a job.
 Job analysis
• Job-analytic methods are often described as
belonging to one of two approaches.
– One approach, the task-oriented job analysis,
involves an examination of the duties, tasks,
and/or competencies required by a job.
– The second approach, a worker-oriented job
analysis, involves an examination of the
knowledge, skills, abilities, and other
characteristics (KSAOs) required to
successfully perform the work.
Health Professionals for a new
century
Emerging challenge to health system
System Framework
Key components of educational system
Three generation reform
Institutions, Graduates and Workforces by Regions (2008)
Density of Medical School by Region
World map resized by population (A), Burden of disease
(B), Density of Medical Schools © and Density of
workforces
Financing of Medical and Nursing Graduates by Region
(2008)
Competency Based Education
Model of Interprofessional and Transprofessional
Education
Vission of new era of professional education
Levels of Learning
 Proposed Reform
• Adoption of competency-based curricula that are
responsive to rapidly changing needs rather
than being dominated bystatic coursework.
• Promotion of inter-professional and trans-
professional education that breaks down
professional silos while enhancing collaborative
and non-hierarchical relationships ineffective
teams.
 Proposed Reform
• Exploitation of the power of IT for learning through
development of evidence, capacity for data collection
and analysis, simulation and testing, distance learning,
collaborative connectivity, and management of the
increase in knowledge.
• Adaptation locally but harnessing of resources globally in
a way that confers capacity to flexibly address local
challenges while using global knowledge, experience,
and shared resources, including faculty, curriculum,
didactic materials, and students linked internationally
through exchange programmes.
 Proposed Reform
• Strengthening of educational resources, since faculty, syllabuses,
didactic materials, and infrastructure are necessary instruments to
achieve competencies.
• Promote a new professionalism that uses competencies as the
objective criterion for the classification of health professionals,
transforming present conventional silo
• Establishment of joint planning mechanisms in every country to
engage key stakeholders, especially ministries of education and
health, professional associations, and the academic community, to
overcome fragmentation by assessment of national conditions,
setting priorities, shaping policies, tracking change, and harmonising
the supply of and demand for health professionals to meet
the health needs of the population
 Proposed Reform
 Expansion from academic centres to academic systems, extending the
traditional discovery-care-education continuum in schools and hospitals into
primary care settings and communities, strengthened through external
collaboration as part of more responsive and dynamic professional
education systems.
 Linking together through networks, alliances, and consortia between
educational institutions worldwide and across to allied actors, such as
governments, civil society organisations, business, and media. In view of
faculty shortages and other resource constraints, every developing country
is unlikely to be able to train on its own the full complement of health
professionals that is required.
 Nurturing of a culture of critical inquiry as a central function of universities
and other institutions of higher learning, which is crucial to mobilise scientific
knowledge, ethical deliberation, and public reasoning and debate to
generate enlightened social transformation.
Recommendation and Reforms and
Enabling Actions
 Mari mendarat ke
Indonesia

 Profesi kesehatan apa yang dibutuhkan

Indonesia? Propinsi? Kota/kabupaten?
 Dokter seperti apa yang dibutuhkan?
 Perawat yang dibutuhkan?
 Profesi kesehatan lainnya?

Dan….
Berapa jumlahnya?
Terima kasih atas perhatian Ibu,
dan Bapak