DEFINITIONAL CATEGORY

REPORT

MEETING OF A WORKING GROUP

FOR THE DEVELOPMENT OF INFORMATION SYSTEMS ON HEALTH WORKFORCE FOR THE SOUTH PACIFIC

Convened by:

REGIONAL OFFICE FOR THE WESTERN PACIFIC WORLD HEALTH ORGANIZATION

Suva, Fiji 2-6 December 1991

Not for sale

Printed and distributed by:

Regional Office for the Western Pacific World Health Organization

Manila, Philippines June 1992

02 JUN 1993

The views expressed in this report are those of the temporary advisers in the

Conference and do not necessarily reflect the policy of the World Health Organization.

This report has been prepared by the Regional Office for the Western Pacific of the World Health Organization for governments of Member States in the Region and for the temporary advisers in the Meeting of a Working Group for the Development of

Information Systems on Health Workforce for the South Pacific held in Suva, Fiji, from 2 to 6 December 1991.

SUMMARy ... 1

1. INTRODUCTION ... 1

1.1 Objectives ... 2

1.2 Participants and resource persons ... 2

1.3 Organization ... 2

1.4 Opening ceremony ... 3

2. PROCEEDINGS ... 3

2.1 Presentation of working documents ... 5

2.2 Summary of discussions .... ... ... ... ... ... 5

3. CONCLUSIONS AND RECOMMENDATIONS ... 9

3.1 Conclusions ... 9

3.2 Recommendations ... 9

ANNEXES: ANNEX 1 - LIST OF PARTICIPANTS, CONSULTANTS, SECRETARIAT AND OBSERVERS ... 11

ANNEX 2 - REVISED AGENDA ... 15

ANNEX 3 - OPENING SPEECH OF THE REGIONAL DIRECTOR ... 17

ANNEX 4 - LIST OF DOCUMENTS ... 19

ANNEX 5 - THE DRAFT HEALTH WORKFORCE PLAN - STRUCTURE AND CONTENT ... 21

ANNEX 6 - HEALTH WORKFORCE PLANNING WORKSHOP MODULE ... 23

ANNEX 7 - OPERATIONAL STUDY; QUALITATIVE ANALYSIS OF HEALTH WORKFORCE RESPONSIBILITIES - SUMMARY AND CONCLUSIONS ... 25

ANNEX8 - COMPARATIVEANALYSISOF HEALTH WORKFORCE AND HEALTH FACILITY TERMINOLOGY IN SIX SOUTH PACIFIC COUNTRIES ... 27

ANNEX9 - COMPARATIVE ANALYSIS OF STAFFING AND SERVICES PROVIDED AT HEALTH FACILITIES, SIX SOUTH PACIFIC

COUNTRIES ... 29 ANNEX 10 - THE HEALTH WORKFORCES: SOUTH PACIFIC

ISLAND NATIONS - TABlE OF CONTENTS

AND EXECUTIVE SUMMARy ... 37

Keywords

Health manpower I Information systems I Human resources I Congresses I Fiji

Objectives of the meeting:

The World Health Organization Regional OffICe for the Western Pacific convened the Meeting of a Working Group for the Development of Information Systems on Health Workforce for the South Pacific, held in Suva, Fiji from 2 to 6 December 1992. The objectives were:

(a) to plan a system for sharing information about health workforce training and deployment in the South Pacific countries;

(b) to design operational studies on the roles and responsibilities of health workers at all levels; and

(c) to make recommendations to the Regional Director on activities required to strengthen national health workforce planning capabilities in the South Pacific through information sharing and joint planning exercises.

Summary of proceedings and conclusions:

During the meeting, technical and training documents were presented and reviewed.

These documents aimed to facilitate human-resource planning at national, regional or local levels. The different steps to achieve a "human resources for health" national plan were discussed. After further discussion, the group made the foUowing recommendations:

(a) to facilitate the creation and development of a "human resources for health"

network for planners in the South Pacific countries;

(b) to support this network in developing and disseminating the resource material;

(c) at the country leve~ to develop national health workforce inventories situation reports and plans;

(d) to help the network to build up, maintain and update intercountry human resources for a health data bank.

1. INTRODUcnON

Health-workforce planning is the key to human resources development in the Pacific, yet is little practiced among Pacific jurisdictions. WHO has recognized this problem and has convened a number of seminars, conferences and workshops. These meetings recommended direct action towards building the capabilities of health authorities in health-workforce planning. In particular, it has been recommended that:

( 1) support should be provided to countries for their planning efforts through the provision of guidelines, technical coUaboration and training;

(2) selected information and products, useful on a regional level should be identified as a basis for Pacific Island national information systems on health workforces;

(3) the key areas identified for a regional information system should include: a common defmition of categories of staff, information about training, and information on health-workforce supply and requirements;

(4) a technical working group/task force should be convened in order to fmalize the guidelines for national health-workforce planning and to select essential

information for a regional database on human resources. This working party should consolidate and expand on the guidelines and information presented and discussed in the 1990 Manila conference.

In keeping with these recommendations, the WHO Regional Office for the Western Pacific convened the "Working Group for the Development of Information Systems on Health Workforce for the South Pacific". In preparation for the conference various working documents were commissioned including a monograph on "The Health

Workforce: South Pacific Island Nations"; a draft health workforce plan; an operational study of health workers at the district level; a health-workforce planning training module, model health-workforce data tables and a health workshop inventory survey.

This report provides a summary of the deliberations and resolutions of the meeting of the working group on health-workforce planning.

1.1 Objectives

The working group's activities were aimed at developing mechanisms to enhance the health-workforce planning capabilities of the South Pacific Island nations.

The objectives of the working group meeting were:

(1) to plan a system for sharing information about health-workforce training and deployment in the South Pacific countries;

(2) to design operational studies on the roles and responsibilities of health workers at all levels; and

(3) to make recommendations to the Regional Director on activities required to strengthen national health-workforce planning capabilities in the South Pacific through information sharing and joint planning exercises.

1.2 Participants and resource persons

The working-group meeting brought together planners from the Pacific Islands, experts in information systems and health-workforce planning, and WHO Secretariat.

The list of temporary advisers, consultant and secretariat is attached as Annex 1.

1.3 Oq~anization

The working-group meeting took place at the Travelodge Hotel in Suva, Fiji under the chairmanship of Dr Jimmie Rodgers with the support of Dr Arie Rotem as consultant and WHO secretariat. The programme included a number of technical presentations, working subgroups, and intensive discussions. The delegates were provided with several

documents prepared specifically for this meeting. The five-day meeting concluded with firm resolutions about the importance of health-workforce planning and recommendations for further action. The agenda of the meeting is attached as Annex 2.

1.4 Opening ceremony

In the opening address of the WHO Regional Director Dr S.T. Han, (Annex 3), delivered by the WHO Representative in Suva, Dr Abn, it was indicated that the planning and management of human resources for health has been recognized for three decades as the key to meeting the needs of the population. The Regional Director reminded the group that the question was raised more than a decade ago how we can best produce, deploy and use appropriate human resources to perform health services in the right numbers at the right place and at the right time. He noted that the previous meeting in Manila had recommended information-sharing between countries on health personnel, especially in the Pacific. Now it was necessary to formulate some concrete and practical proposals, with a clear distribution of responsibilities.

The Regional Director's address noted the need for a system which complements the existing regional and national health information systems. This should specify what data would be useful to share on an intercountry and country level, what the proportion of qualitative to quantitative data should be, and how these data will be used. He stated WHO's concern that new technologies and methods should make a significant contribution to problem-solving at national and local levels in the Region and be cost effective.

Networking was suggested as a realistic approach, as it multiplies shared resources.

In the conclusion of the address it was noted that although WHO resources are not increasing, the necessary data for better health care provision are increasing, apparently ad infmitum. Dr Han said that it is essential to set priorities, and that countries can get the right information, at the right place, at the right time, and at the right price only if all the participants work together to provide the services that are needed.

2. PROCEEDINGS

Following the opening ceremony, Dr Fran~ois Canonne, Acting Regional Adviser on Human Resources for Health, addressed the group. He reiterated the points made by the Regional Director and added that human resources remain a priority for WHO in the Western Pacific Regional Office (WPRO) and globally. He described the events and resolutions which led to this conference. He suggested that the meeting must move the group forward by producing a blueprint for a human resources information system and devising a draft plan which will fit with local needs and enhance national self reliance.

He observed that the increasing worldwide preoccupation with escalating costs of health care and the need to proceed under conditions of fmancial constraints required a ranking of priorities. "It is no longer what can be funded but rather what is truly needed by the countries that must serve to guide us. Innovative proposals for the provision and funding of health activities are needed to effectively support countries in developing necessary systems in an affordable manner".

Dr Canonne indicated that there is an urgent need for innovative ideas such as an intercountry network to share information and expertise that should be self reliant with minimal input from outside organizations and to which countries contribute their

respective strengths. Training supported by operational research and other activities will help to focus priorities for each country.

The chairman of the meeting, Dr Jimmie Rodgers, reiterated the group's task, to plan a system for sharing information on human-resources development in the Pacific. He said that the central problem is not what needs to be done but how to do what needs to be done in ways that are sensitive to the area. The approach should be not prescriptive in approach.

Dr James Robey summarized current WPRO activities in this area. WPRO produces an annual regional database on socioeconomic indicators and a database called ClDPS (Country Health Information Profiles). Both these databases contain only limited information on human resources for health. All nineteen of the Global Indicators for Health are included with other evaluative measures of progress towards Health for All goals.

Dr Robey presented the Mayan Temple Chart of databases.

Global Health Health Workforce

Database

Western Pacific Regional Health Workforce

Database South Pacific Shared

Health Workforce Database

National Health Workforce Database

MAYAN TEMPLE STRUCfURE

It was suggested that databases should become successively less detailed as they move from the nationalleve1 through the subregional and regional levels to the global level.

In addition, at each level the data included and analyses performed are highly dependent on the planning methods adopted. This suggests that health-workforce development should be integrated with national health planning. In addition, partly because of this need for integration, the output from the system should be well defmed before the data system is created. Dr Robey stressed the need to ensure that the data system is a part of the whole process, and not an end itself.

Dr Arie Rotem reviewed the proposed agenda and purpose of the workgroup meeting. It was suggested that to be successful the meeting should lead to tangible and practical recommendations to the Regional Director. The need for both managerial and political support for workforce planning was said to be essential, as is the provision of appropriate technical and training support. Finally, he said, it is important to share skills and information on the many issues that need to be resolved at the subregional level.

2.1 Presentation of workins documents

The WHOjRTC in Sydney. working with health personnel from South Pacific countries. has produced the publication "Health Workforce: South Pacific Island Nations·.

a training module. a health-worker data collection questionnaire. a set of model tables for data analysis and a national level format for a workforce plan. (Annex 4 contains a list of working group meeting documents). To a large extent the programme of work for the meeting was based on the review of these documents.

Dr John Dewdney presented a prototype draft national health workforce plan. This draft was based on plans produced by the health authorities of Pacific Island countries.

particularly the Solomons. Tonga. and Papua New Guinea. It was structural rather than prescriptive with scope for adaptation to the particular needs and circumstances of the health authority using it. (Annex 5)

Mr Sione Wolfgramm presented the health worker questionnaire which was designed to collect personal data essential for the establishment of a comprehensive national health workforce database. He also presented a model set of health workforce data tables to be used as a basis for preparing a health-workforce situation report. This was followed by a presentation of a training module for health-workforce planning intended for preparing health workforce planners at regional and national levels. It is intended that a person who completes the fourteen sections of the module should be able to develop a

health-workforce plan. (Annex 6 - outline of the modules)

The four documents - questionnaire, data tables, training module and prototype national health-workforce plan - constitute the modules of a comprehensive package designed to enable staff responsible for the production of a health-workforce plan to do so with the limited resources available in most of the Pacific Island countries.

Dr Rodgers presented a Pilot Study of Roles and Responsibilities of Health Workers at the District Level. Fiji. another WHO/RTC project (Annex 7 - summary and

conclusions). He also presented tables from a cross-national (Samoa. Tonga, Papua New Guinea. Solomon Islands, Vanuatu and Fiji) comparative study of workforce and work place (see Annex 8 and 9 for tables).

Dr Rotem introduced "The Health Workforce: South Pacific Island Nations·, a monograph compiled by WHO/RTC as part of this project. This document contains data from 12 Pacific nations and analyses related to health workforce planning. (See Annex 10 for Executive Summary and Table of Contents).

2.2 SummaO' of discussions

Throughout the course of the working group meetings, discussions were lively and focused sharply on the details of the respective presentations and documents. At the conclusion of each discussion the consultant, Dr Rotem, summarized the session and suggested issues which require further clarification or resolution. The major themes of the discussions and suggestions for further action were as follows:

2.2.1 Health-workforce plan development

Data are a means to help improve the management and planning of the workforce.

The information systems developed need to respond to the needs of the system and not drive them. It is therefore important to motivate people to want to get the needed data, and if they get it, to learn how to use it. There is also a real need to continually assess the quality of the data and ensure its relevance to the plan for which the data are needed.

The draft workforce plan was referred to a subgroup for revision and returned to its originators for final editing. A revised version was then presented to the

full

working group and, subject to some changes in presentation, endorsed.

The model health-workforce data tables were very vigorously debated. The working group felt that it was important to include such tables as part of an integrated package with the training modules and draft workforce plan. Suggestions for revision proposed by a subgroup, set up to study the draft tables, were essentially accepted by the group.

The training module was felt to be an extremely useful component of the package.

Discussion centred around the most appropriate media for disseminating the content of the module to member countries. Suggestions ranged from video production, through software creation to inclusion in academic programmes.

It was agreed that the material prepared to support workforce planning should be well interpreted. The inventory of health personnel and the health-workforce situation report should underpin the workforce plan. The training module should provide specific guidelines for collecting the data and preparing the workforce plan.

It was further stressed that the materials should be sufficiently detailed yet easy to use by planners at the national level.

The group agreed that the following activities would assist national health authorities in the collection and analysis of relevant data and their use in the formulation of a national health workforce plan:

(a) Designation of authority and responsibility for health-workforce planning to an appropriate unit or person within the national health authority head office.

(b) Allocation of necessary resources ( material and staff) to undertake workforce planning authority within the context of national health planning.

(c) Establishment where appropriate of a national task-force to review workforce requirements and supply, and to recommend policies and strategies concerning the development of human resources.

(d) Strengthening and/or establishing procedures for the collection, collation and processing of information concerning the national health workforce.

( e ) Providing the development materials and other relevant resource material to countries to assist and guide the work of the health-workforce planners.

(f) Formation of a group of three to five countries at a similar stage to provide mutual support and information exchange, given the countries' differing stages of readiness to proceed with health-workforce planning. An appropriately experienced resource person could assist group members by visiting them to advise on any specific local problems and also to attend group meetings in one or other of the countries.

(g) Development of distance learning programmes, instructional software packages, electronic information exchange systems and other innovative means of increasing the planning competence of planners and facilitating exchange of relevant information between planners.

Members of the working group were of the opinion that at least three countries were ready to commence immediately on workforce-planning activities provided support was available to them.

Further groups of countries could commence planning as appropriate resources were mobilised. The group thought that by the end of 1993 at least five countries could have developed and started implementing health-workforce plans.

2.2.2 National and regional operational research support

A draft protocol for operational studies on the roles and responsibilities of health workers at all levels was presented and discussed. The pilot study field-testing a

questionnaire for use in such studies clearly indicated the need for accurate and clear defmitions in any comparative studies of the health workforce. The use of the

methodology has provided useful information and further work on its development was justified. There was agreement that operational studies could contribute significantly to the development and management of the health workforce, and generate material useful for intercountry exchange. Potential sources of funding for this type of activity were discussed.

The working group agreed that support was needed for national and regional level studies to solve problems related to the development of health-workforce plans and the training of planning personnel. These operational research efforts should include studies to clarify and analyse:

- standard defmitions of categories of health personnel;

- the specific roles, responsibilities and tasks performed by each category or level of health worker;

- areas of potential confusion and conflict in role allocation;

- the skill mix available at each level of the health care system;

- the extent to which role duplication, extension, or substitution exists;

- the level and quality of supervision available;

- the types of skills required to perform prescribed tasks;

- the appropriateness of basic training to transfer required skills;

- the type of training needed to obtain required skills;

- the appropriateness of job descriptions;

- the types of difficulties experienced at each level within the health care delivery system.

2.2.3 A regional health-workforce database

There was agreement that a subregional health-workforce database (Pacific Island nations) should be based on national level data. The precise content of this database, its establishment, maintenance and the analysis of its content, its relationship to existing

regional health-information databases, and the modes of dissemination of information derived from the database were discussed.

As noted in 2.2.4 below, there was also strong support for a regional network of health-workforce planners. The network, if supported adequately could produce and circulate newsletters and other publications; maintain and update the database and promote timely analysis of the data. The network will also be involved in updating and further analysis of the kind of material contained in the publication "Health Workforce - South Pacific Island Nations".

2.2.4 The Health-Workforce Planning Network (HWPN)

The working group strongly supported the establishment of an intercountry network of national health authorities concerned with health-workforce planning to enable

personnel with responsibilities for health-workforce planning to:

- share experiences, expertise. and resources;

- stimulate and support the development of national level workforce-planning capabilities;

- create and maintain an information system and database on human resources;

- review and recommend approaches for resolving problems concerning the health workforce;

- address issues of common interest to participating countries;

- formulate definitions and standards for the deployment and training of health personnel.

Training. research. consultation and other relevant agencies would be invited to provide technical input and other support to the network as the need arises.

To strengthen effective ties between members of the HWPN it is suggested that a HWPN Newsletter be published and circulated by network participants. The contents of this newletter would include:

- survey report summaries;

- operations research study report summaries;

- updates on planning methods. techniques. software. etc.;

- news items and any other material of interest to members.

3. CONCLUSIONS AND RECOMMENDA nONS

3.1 Conclusions

In the past few years considerable effort has been directed towards encouraging health authorities to undertake health-workforce planning activities, and commendable attempts have been made to assist these authorities to develop their planning capability.

To date however only limited progress has been made towards the establishment of effective health-workforce planning capabilities among the Pacific Island countries.

The working group concluded that this was a major concern, and a matter of urgency that the capacity to undertake health-workforce planning be enhanced in all countries.

Such capacity building must occur through use of innovative methods such as intercountry collaboration and cross-national training. This will require the ongoing support and cooperation of country health authorities as well as technical collaboration from the various training and research centres of the area.

While national health workforce planning was the obvious priority for this working group, it was also the group opinion that intercountry and regional activities would serve as a catalyst to these national tasks. In particular, the creation of an intercountry network, facilitated and supported by an appropriate agency, and consisting of those countries in the region who wish to join, was felt to be a creative way to foster planning, achieve some comparability across databases and plans, and facilitate analyses and operational research in the region.

3.2 Recommendations

In keeping with three of the six regional priorities for programme development over the next several years (human resources, information exchange and management) the working group unanimously recommends to the Regional Director the implementation of a special initiative on national health-workforce planning. It is further recommended that support continue for this initiative through the next biennium and during the Ninth General Programme of Work.

It is recommended that, as a matter of urgency, the Regional Director encourage each country in the region to formulate a national health-workforce plan in the context of their national health planning efforts.

The working group specificalJy recommends support for:

- establishment of a health-workforce planning network and support for its activities (ref. 2.2.4);

- a regularly updated regional d,ltabase of national health-workforce information (ref. 2.2.3);

- the development of national health-workforce inventories, situational reports and plans in the framework of overall national health planning (ref. 2.2.1);

- further development and dissemination of resource materials for the preparation of health-workforce planning personnel (ref. 2.2.1);

- operational research related to health-workforce planning (ref. 2.2.2);

- reports and plans in the framework of overall national health planning (ref. 2.2.1);

ANNEX 1

LIST OF PARTICIPANTS, CONSULTANTS, SECRETARIAT AND OBSERVERS

1. PARTICIPANTS Ms Marion Clark (Rapporteur) Senior Policy Analyst

Department of Health P.O.

Box

5013

Wellin&t^on New Zealand Mr Gideons J. Mael National Health Planner Health Department Private Mail Bag 009 Port Vila

Vanuatu

Dr Coleman Moni Assistant Secretary

Policy Planning and Evaluation Division Department of Health

P.O. Box 3991 Boroko, N.C.O.

Papua New Guinea

Dr Jimmie Rodgers (Chairman) Undersecretary, Health Care Ministry of Health

Honiara

Solomon Islands Ms Chieko Sakamoto

Director of Information Systems Management G.P.O. Box 825

Canberra, A.C.T. 2601 Australia

Dr Jimi Samisoni Academic Dean

Fiji School of Medicine Private Mail Bag Suva

Fiji

Mr Robert W. Spegal National Health Planner/

WHO Coordinator

Department of Human Resources FSM National Government P.O. Box PS70

Palikir Station Pohnpei. 96941

Federated States of Micronesia Mr Sione T. Wolfgramm Health Planning Officer Ministry of Health P.O. Box 59 Nuku'alofa Tonga

Dr D. William Wood (Rapporteur) Director

International Centre for Health Promotion and Disease Prevention Research University of Hawaii

Honolulu Hawaii 96822

United States of America

2. CONSULTANT

Professor Arie Rotem Director

WHO Regional Training Centre The University of New South Wales Sydney, NSW 2033

Australia

3. SECRETARIAT

Dr Franrrois Cannone Acting Regional Adviser in

Development Human Resources for Health World Health Organization

Regional Office for the Western Pacific Manila

Philippines

Dr James Robey

Regional Adviser in Health Information World Health Organization

Regional Office for the Western Pacific

Manila Philippines Dr Ruth Stark

Nurse Educator in Strengthening Nursing Management and Education World Health Organization

Regional Office for the Western Pacific Suva

Fiji

4. OBSERVERS

Mr Ronald van Konkelenberg Planning Consultant

7 May Terrace Kensington Park South Australia 5068 Dr John C.H. Dewdney

WHO Regional Training Centre for Health Development

University of New South Wales Kensington

N.S.W.2033 Australia

Mr Kitione Mulo

Acting Senior Administrative Officer Ministry of Health

Tamavua Suva Fiji

ANNEX 2

REVISED AGENDA

1. Opening ceremony

2. WHO policy and activities to support technical cooperation in health workforce planning.

3. WHO health information system with reference to the human resource component.

4. Overview and progress report on the South Pacific health workforce planning project.

5. Model health workforce plan 6. Model health workforce data tables 7. Model health workforce training modules 8. Operational research report

9. Comparative cross national research report

10. Health workforce: South Pacific Island Nations monograph 11. Recommendations

12. Closing ceremony

ANNEX 3

OPENING SPEECH BY THE REGIONAL DIRECfOR

Dear Colleagues,

On behalf of Dr S.T. Han, WHO Regional Director for the Western Pacific, let me thank aU of you for your response to WPRO's request for your contribution. Your

presence here shows the importance you attach to the development of information systems on the health workforce for the Pacific.

The planning and management of human resources for health has been recognized for three decades as the key to meeting the needs of the population.

The essential question was raised more than a decade ago: how can we best produce, deploy and use appropriate human resources to perform health services in the right numbers at the right place and at the right time?

The previous meeting stressed the importance of planning and management and the need to go beyond merely quantitative planning. It recommended information sharing between countries on health personnel, especially in the Pacific. Now it is time to formulate some concrete and practical proposals, with a clear distribution of responsibilities.

With regard to sharing information, we need a system which complements the existing regional and local health information systems. It should specify what data would be useful to share on an intercountry and country level, what the proportion of qualitative to quantitative data should be, and how these data will be used.

Useless information should be avoided at all costs. It wastes time and money, and often just serves to hide arbitrary decision-making behind a smoke-screen of figures. At present, the real question bureaucracies have to answer in this area is not "what

information to put into the system"? but "what information will be really used by decision- makers in planning and managing health personnel?"

Operational studies on the roles and responsibilities of health workers would be very useful but only if they make a significant contribution to solving well defined problems in planning, training or managing health personnel.

National authorities are responsible for maintaining up-to-date files and registers from which they can extract data on activities they are involved in and the human and financial resources available to carry them out. If expertise in selecting, registering and analysing such data is needed, intercountry exchanges of knowledge and skills should be encouraged, towards attaining self-reliance in this field.

Technical institutions should be responsible for developing new methods and facilitating the use of innovative technology through research and training activities.

Our main concern in WHO is that such new technologies and methods should make a significant contribution to problem-solving at national and local levels in the Region and be cost-effective.

Networking is one of the most realistic approaches, as it multiplies the resources we can share. Information systems provide the infrastructure needed for this, but we have to make sure they fit in with the systems that already exist. Such intercountry systems fed by local databanks, together with the new means of communication have become part of everyday life in administration, and can be very helpful for cost containment.

Our resources are not increasing but the data we have to take into account in providing better health care are increasing apparently ad infmitum. Therefore, it is essential to set priorities.

I am sure you will help to point us in the right direction for the coming years so that countries can get right information, at the right place, at the right time, and at the right price. This will enable aU of us to provide the services that are needed.

Thank you.

ANNEX 4

LIST OF DOCUMENTS

WPR/PHC/HRHO/2/91.2

WPR/PHC/HRHO/2/91.3

WPR/PHC/HRHO/2/91.4

WPR/PHC/HRHO/2/91.5

WPR/PHC/HRHO/2/91.6

WPR/PHC/HRHO/2/91.7

WPR/PHC/HRHO/2/91.8

WPR/PHC/HRHO/2/91/INF.l

WPR/PHC/HRHO/2/91/INF.2

WPR/PHC/HRHO/2/91.9

The Health Workforce - South Pacific Island Nations by Arie Rotem

and John Dewdney with the support of J. Rodgers, S. Wolfgramm and A. Drori Modules for preparation of national health workforce plans including an inventory of staff and a framework for country situation report on HRH

A module for training in health workforce planning

A protocol for operational studies on the roles and responsibilities of health workers (which was piloted in Fiji)

WHO policy and activities to support technical cooperation in health workforce planning by Dr F. Canonne

WHO health information system with reference to the human resource component by Dr J. Robey

Overview and progress report on the South Pacific Health Workforce Planning Project by Professor Arie Rotem

Minimum Set of Information in Support of Policy, Planning and Management of Human Resources of Health - Report of a

Consultative Meeting, 1 to 5 October 1990 Conference Report on the Development of a Health Workforce Plan for the Pacific Islands, Manila, Philippines,

12 to 14 November 1990

Draft format for national health workforce plan, XYZ Health Authority

THE STRUCTURE AND CONTENT OF THE DRAFT HEALTH WORKFORCE PlAN

ANNEX 5

The draft health workforce plan ftrst sets out the purpose of the plan and the way in which it is to be used. This is followed by a summary of those sections of the National Health Plan which relate to the health workforce. Then comes a statement of the health workforce policy which has guided the formulation of the plan.

The next section of the draft contains a review of the country's current health workforce situation, comparing the numbers of staff actually employed in the different categories of health personnel with the approved staffmg establishment. This section also includes a summary of the current issues relating to the health workforce such as inequities in the geographic distribution of health workers, inappropriate distribution of personnel between primary, secondary, and tertiary levels of service or inappropriate mix of health personnel categories within particular divisions, units or facilities.

The determinants of the future requirements for health personnel and the supply of personnel are then considered. Determinants are grouped into those which are relatively fixed and therefore limit decisively the range and scope of opportunities for change, and in the other group, those determinants which may be influenced by policy-makers and so are amenable to planning.

The next section of the draft plan shows what may be expected to happen over the period covered by the plan if nothing is done to change current trends. This picture of the

"unplanned future" is used to indicate what needs to be done if the staffmg of the country's health service is to meet the country's future health service needs at an acceptable level.

Having recognized what needs to be done, the plan then sets out a "planned future"

with projections on a year-by-year basis showing in detail what targets in terms of approved staffmg establishment, numbers of employed staff and training outputs are required and what other action must be taken if the acceptable level of service provision is to be reached and maintained.

The costs of implementing the "planned future" are then presented together with the proposed sources of funding and their respective contributions to the cost of training and employing the planned health workforce.

Finally, the draft format provides information to guide the implementation, monitoring, periodic review and summative evaluation of the plan.

ANNEX 6

HEAL TIl WORKFORCE PLANNING TRAINING MODULE

Objectives:

1. To strengthen health workforce planning within the Ministry/Department of Health through the development of competencies and procedures for health workforce planning.

2. To establish the principles of health workforce planning as an integral part in the overall context of health planning.

3. To select appropriate methods for projecting health workforce supply and requirements.

4. To establish a minimum set of data for effective health workforce development.

5. To design a health workforce planning model appropriate for the country.

6. To develop a preliminary plan of action for formulation of a national health workforce plan.

Outline of the workshop:

Session 1:

Session 2:

Session 3:

Session 4:

Session 5:

Session 6:

Session 7:

Session 8:

Session 9:

Session 10:

Session 11:

Session 12:

Session 13:

Introduction to the workshop

Introduction to human resource planning Elements of human resource planning process Development of health manpower policies Health manpower planning - function and responsibilities

Health manpower situation report (HWSR) Development of health workforce database Estimating requirements

Projecting supply

Matching supply and requirements

Detailed health manpower development plan Implementation. monitoring and evaluation

Formulation of recommendations to improve health workforce planning

Session 14: Conclusion and evaluation of the workshop

Expected outcomes:

At the end of the workshop, participants are expected to be able to:

1. Describe the importance of health workforce planning and development in the health care system.

2. Identify appropriate approaches for health workforce planning.

3. Understand appropriate methods for projecting health workforce supply and requirements.

4. Have a common understanding of the position of health workforce planning and development in the health care system.

5. Design a health workforce plan.

ANNEX 7

OPERATIONAL STUDY: QUALITATIVE ANALYSIS OF HEAL TIl WORKFORCE RESPONSIBILmES - SUMMARY AND CONCLUSIONS

Qualitative analysis of the health workforce is an essential, yet not well utilized component to effective health workforce planning. The importance of having clearly defIned roles for each category and level of health worker cannot be over emphasized.

Clarity about the roles and responsibilities will enable planners to determine the most appropriate mix of health personnel required to provide health services at any given level of the health system. More importantly, the appropriate mix of personnel will provide a foundation for an economic analysis of how much it costs to provide a certain amount of services at a given level.

Quite often in developing countries, health workforce planning not well coordinated, and when performed it is done on an adhoc basis and focuses mainly on a quantitative projection of figures. Knowing the roles and responsibilities of health workers will greatly assist in a more effective projection of health workforce requirements and supply. It will also help minimize unnecessary duplication of roles and enhance a more optimum utilization of resources.

To try and collect information about the major roles and responsibilities of health workers, a protocol was developed and field tested in Fiji in October, 1991.

The field study obtained useful information concerning each participating category of health workers, viz:

- the major roles and responsibilities, - the specific tasks performed,

- the key skills required to perform the tasks, - the level of supervision,

- the major problems experienced.

The study also provide information on the main types of health services provided at each level of health facility at the subdivisionallevel.

Subsequent to the pilot study the protocol was refined to improve its appropriateness in obtaining and providing the relevant information. Interested countries could probably utilize this refined protocol or adapt it to suit their specific areas of need.

Whilst other modifications may yet be required, in its present form the protocol will be able to obtain most qualitative information that would be useful for management. In essence, it is hoped that the protocol will become an integral part of the management system, obtaining information not only about the roles and responsibilities of health worker but also about other areas which are important for management planning and decision making.

It is expected that if the protocol is adapted in the Pacific Island countries, it could form the basis of a conceptual framework that could be utilized to explore the potential of standardizing certain workforce categories according to roles and responsibilities within the Pacific Island region.

In terms of future directions, other areas for qualitative operational studies would include:

(i) (ii) (iii) (iv) (v) (vi)

Development of instrument to conduct a task analysis of identified tasks.

Development of instrument of staff performance appraisal to monitor performance, productivity and competence.

Developing a mechanism to link training institutions to health delivery system needs in the field.

Assessing line of command, appropriateness of supervision and delegation practices.

Performance indicators and quality assurance.

Economic appraisal of health workforce costs.

li;f.

ANNEX 8

COMPARATIVE ANALYSIS OF HEALTH WORKFORCE AND HEALTH FACILITY TERMINOLOGY IN SIX SOUTH PACIFIC COUNTRIES

PROBABLE DEFINITIONAL CATEGORIES PROBABLE "SAME"

DEFINITIONAL CATEGORY

VILLAGE HEALTH WORKER

COMMUNITY HEALTH WORKER

NURSE AID

COMMUNITY HEALTH WORKER

ENROLLED NURSE

REGISTERED NURSE/

STAFF NURSE

PUBLIC HEALTH NURSE

DISTRICT NURSE MEDICAL ASSISTANTS HEALTH EXTENSION

OFFICER

HEALTH OFFICER NURSE

PRACTITIONERS NURSING OFFICERS REGISTERED NURSE

COUNTRIES

FIJI TONGA SOLOMONS VANUATU

SOLOMONS PNG

W/SAMOA

SOLOMONS PNG

W/SAMOA VANUATU TONGA FIJI FIJI PNG TONGA VANUATU SOLOMONS W/SAMOA

FACILITY STAFFED BY SIMILAR

CATEGORIES VILLAGE VILLAGE VILLAGE AID POST

AID POST AID POST SUB HEALTH

CENTRE CLINICS SUB HEALTH

CENTRE

HEALTH CENTRE DISPENSARY CLINIC

NURSING STATION HEALTH CENTRE HEALTH CENTRE _ HEALTH CENTRE HEALTH CENTRE HEALTH CENTRE DISTRICT HOSP.

LENGTH OF TRAINING

.3

WEEKS 3 WEEKS 6 WEEKS

6

WEEKS

1B MONTHS

& 6/12

.3

YEARS 1 YEAR

.3

YRS &

1

:5

YRS

.3

YRS

.3

YRS

:5

YRS

:5

YRS

.3

YRS

.3

YRS

.3

YRS &

1

.3

YRS &

1

.3

YRS &

EXP.

.3

YRS &

EXP.

TONGA

W/SAMOA

FIJI

VANUATU

PNG } SOLOMONS) FIJI )

NURSING SUB-CATEGORIES : REGISTEREO NURSE

STAFF NURSE - SN/PHN

: REGISTER!D NURSE NURSING SISTER

PUBLIC HEALTH NURSE - DISTRICT NURSE - SN/HCH

- ZONE NuRSE ..

- STAFF·NURSE/HC - HEALTH SISTER HOSPITAL NURSE - STAFF NURSE - SISTER

REGISTERED NURSE MIDWIFE

NURSE PRACTITIONER NURSING OFFERS

--TRAINED AND GRADUATED OVERSEAS E.G. AUSTRALIA.

NEW ZEALAND

- EQUIVALENT TO "SISTERS"

DEPLOYED ONLY TO DIST.

HOSPITAL LEVEL

LOCALLY TRAINED _ DEPLOYED TO CLINIC/HEALTH CENTRE LEVEL

.LOCALLlW' TRAINED

- DEPLOYED AT ALL LEVELS FROM CLINICS UPWARDS - SENIOR REGISTERED NURSES - DEPLOYED IN RURAL/URBAN

PUBLIC HEALTH HEALTH SERVICES - ALL LOCALLY TRAINED - ALL LOCALLY TRAINED .-

= STAFF NURSE (LOCALLY TRAINED)

= RN 'TRAINING IN MIDWIFERY

= RN , 1 YEAR TRAINING IN DIAGNOSIS & PATIENT MANAGEMENT

- SENIOR RNS

RN = SN - ALL LOCALLY TRAINED NURSING OFFICERS EQUIVALENT TO "SISTERS"

- SENIOR REGISTERED NURSE

VANUATU } : REGISTERED NURSE SIGNIFIES A NURSE (LOCAL OR OVERSEAS GRADUATE) REGISTERED

U~DER

THE

NURSING BOARD/COUNCIL PNG )

SO LOMOt::lS)

TONGA REGISTERED NURSE SIGNIFIES A NURSE WHO GRADVAJED FROM OVERSEAS

~

EQUIVALENT TO

SISTERS/~URSING

OFFICERS IN OTHER COUNTRIES

: STAFF NURSE - LOCAL GRADUATES -.CAREER STRUCTURE IMPLICATION

- PROMOTED TO SENIOR STAFF NURSE LEVEL, VERY FEW

SISTERS LEVEL

ANNEX 9

COMPARATIVE ANALYSIS OF STAFFING AND SERVICES

PROVIDED AT HEALTII FACILmES IN SIX SOUTH PACIFIC COUNTRIES

The District Health System - Western Samoa

Facility OtTacer StaffDlIx Services provided

in charge

Sub-health Enrolled Enrolled

-

Treat minor conditions

Centre Nurse Nurse

-

Community health services

-

Referral to H. Centre/

Dist. Hosp.

-

MCH education

-

Health promotion

-

Mobilize CIH

Health Registered Registered

-

All functions of sub-health

Centre Nurse Nurse centre

-

MCH/FP services

-

^Midwifery

-

Admission for observation

& rest

-

Dispense selected drugs

-

Outpatient services

-

Visits by health teams

District Registered Registered

-

All functions of health centres Hospital Nurse Nurse (RN)

-

More frequent visits by M.O.

-

Plans to deploy MOs

District Doctor Doctor

-

Outpatient services

Referral RN

-

Inpatient services

Hospital X-ray technician

-

Diagnostic services

Lab. Tech.

-

Dental services Dental

-

Public health services H. inspectors

-

^{Adm. &} support services Adm.

Clinic Public PHN

-

Outpatient services

Health

-

Treats minor conditions

Nurse (PHN)

-

MCH/FP services

-

Home deliveries

-

No drug prescription

Facility Officer StatTmix Services provided incbarge

Health H. Officer H. Officer

·

Outpatient services

Centre S. Nurse

·

Basic inpatient services

PH Nurse · MCH/FP services

· ^Midwifery

. beds

·

Limited prescription by H. Off.

. No beds M. Officer (1) MO · No prescription by nurses D. Therapist (1)

District M. Officer M. Officer · Outpatient services Hospital Reg. Nurse (SR) · Inpatient services

N. Midwife · Midwifery services

S. Nurse • Diagnostic services (LAB/XR) PH. Nurse - Dental services

XR Tech - Public health services Lab Tech - MCH/FP services Dental staff

H. Inspectors Admin (MO)

The District Health System - Fiji Fac:illty

Nursing Station (NS)

Health Centre (HC)

Sub-divisional Hospital (SDH)

otracer in charge District Nurse (SN)

Medical Assistant

Medical Officer (SDMO)

Stalfmix

District Nurse

Med. Assistant Zone Nurse MCH Nurse Staff Nurse Med. Officer Hosp. Sister Hosp. Nurse Ph. Sister Ph. Nurse Radiographer Lab. Tech.

Dental Staff H. Inspectors Admin (SDMO)

Services provided

- General outpatient services - Treat minor conditions - Referral to

Be

or SDH - Public health services

- MCH

- Community Health

- Occasionally midwifery services - Prescribed a limited of drugs - Village health worker training - All functions of nursing station - Receive referrals from nursing

Station

- Referral to SDH - Outpatient services - Inpatient services - Midwifery services - Diagnostic services - Dental services - Public health services

- MCH activities - Community activities - H. Inspectorate services

The District Health System - Vanuatu

Facility Ollker Staff mix Servkes provided

in charge

Aid Posts CHW CHW - Treat minor conditions

- Health promotion/

Education services - Referral to dispensary - Dispense aspirin,

chloroquin Dispensary Reg. Nurse Reg. Nurse - All functions of

AID posts

- Outpatient services - Basic inpatient

services (Admit & RX) - Midwifery services - Referral to health

centres/Dist. hospital - Prescribes limited

list of drugs (e.g.

penicillin, sulpha) - MCH services, and/FP - Health promotion/education

Health Nurse Nurse - All functions of dispensary

Centre Practitioners Practitioners - Slightly wider range

Midwife of prescription

Reg. Nurse Aide Cleaner

District Medical M. Officer

-

Outpatient services Hospital Officer N. Practitioner

-

Inpatient services

Midwife

-

Midwifery services Reg. Nurse

-

Diagnostic services

Aide

-

Pharmacy services

Radiographer

-

Public Health Services

Lab. Tech.

-

^MCH

Ph. Staff

-

Com. Health

Dental staff

-

H. Inspectors H. Inspector

-

Health Education H. Educator

-

Health Promotion Malaria Off.

-

Anti-malarial services

The District Health System - Papua New Guinea

Facility OfJ"lCer Stalfmix Services provided

in charge

Aid Post CHW CHW(2)

-

Treat minor conditions

-

Referral to sub-health centre

-

MCH/FP services

-

Occasionally normal deliveries

-

Dispense limited drugs e.g. aspirin, cbloroquin, penicillin

-

Community health services

-

Health promotion/Education

Sub-health RN RN

-

All functions conducted in

Centre CHW aid posts

(Beds)

-

Outpatient services

-

Basic inpatient services

-

Prescription/dispensing of some antibiotics

-

Anti-malaria treatment

-

Referral to district hospital

Health HEO HEO

-

Outpatient services

Centre Nurses

-

Inpatient services

(Beds) CHW

-

Minor operations

Lab Tech

-

Normal deliveries X-ray Tech

-

Diagnostic services Health Insp.

-

^{MCH/FP services}

Dental therapist

-

Health promotion/education Dispensers

-

Health inspection

Malaria workshop

-

Dispensing drugs Nutrition

-

Anti-malaria services

-

Nutritional services

-

Dental services

-

Referral to provincial hospital

District Doctor Doctor

-

All functions done at

Hospital HEO health centre

Nurses

-

Wider range of operations

CHW

-

Referral to provincial

Lab Tech hospital

X-ray Tech Health Ed Health Inspector Dental Therapy Dispensers Malaria workers Nutrition

Facility

Provincial Hospital

Otncer in charge Doctors

Staft'miI

Specialists General doctors Other staff as for district district hospital

Services provided

- Specialist services - All functions

conducted at district hospital - Referral to national

hospital

The District Health System - Solomon Islands

Facility OtTacer StafFma Services provided

in charge

Aid post Nurse aide Nurse aide

-

Treat minor conditions

(Beds)

-

Admit for observation/rest

-

Referral to clinic/BC

-

Antenatal/FP services

-

Occasionally normal deliveries

-

Dispense limited drugs excluding injections (e.g. aspirin, penicillin, sulphonamides)

-

Community health services

-

Health promotion

-

Malaria slides and treatment Clinic Registered R/Nurse

-

All functions of aid post

(Beds) Nurse Nurse Aide

-

Outpatient services

-

Admit/treat mild - moderate conditions

-

Prescribe/dispense larger select of drugs

-

Give injections

-

MCH services including midwifery

-

Community health services

-

Health promotion

-

Satellite clinics

-

Tours by health teams - monthly

Health Nursing N. Officer

-

All functions of clinics

Centre Officer R/Nurse

-

Inpatient treatment

(Beds) N.Aide

-

Malarial diagnosis & treat.

Dental Thera.

-

prescribe/dispense same range M. Microscop. of drugs as clinics

District Medical Med. Officer

-

Outpatient services Hospital Officer N. Officer

-

Inpatient services

(DHMS) R/Nurse

-

Midwifery services

Nurse Aide

-

Operating threatre services Radiographer

-

Diagnostic services

Lab. Tech.

-

Pharmacy services Pharmacy staff

-

Public Health Services

H. Inspector

-

^MCH

H. Educator

-

Community health Malaria Officer

-

H. Inspectorate

-

Health education & promotion

-

Anti malarial services

ANNEX 10

TABLE OF CONTENTS AND EXECUTIVE SUMMARY OF THE HEALTH WORKFORCES: SOUTH PACIFIC ISLAND NATIONS

CONTENTS

Adtnowledcemeati . • . . • . . • . . . • . . . • . . • . • • . . • . . . . Execudve SUII1ID&rJ • • • • • • • • • • • • • • • • • • • • • • . • • • • . • • . • . • • • . • . Ii LIst 01 AbbrevladollllAcroD)"IDI Used ID Tat. . . . .. iv

PART I

I. IntJ1)Cluctlc:lll... 1

1.1 Population and bcalth peIIOIIIId. • • • • • . • . • • • • • • • • • • • • • • • • " 2

Coo.nt:r* ... ,., . . . , . . . ..

2.1 Nllional de~opmCDt plana, bcalth plaDa and bcalth wodl:fon:e plana. • • • 4 2.2 Nadonal bcalth plaDa and bca.Ith wortfon::e pllDa. • • • • • • • • . • . . • • " 4 2.3 InlCpdon and directiOD of bcalth woddon:e

p1anD1na. . • • • • • . • • . • .

⁶

2.4 Health workforce plaD prcpatIIiOll. . • . . . . . . . . . . . . . . . . . .. 7 2..5 Sowcea of bcalth woMon:e Plannina data. • . • • • • • . • . • . . . . • • • •. 8 2.6 Formal atrlJllCIDCIlti for

aIwin&

bcalth woridon:e

information with other qeadea. • • . • • • . . • . . • • • • • • • • • • • • • •• 10 2.7 Present p1anniD, capacity of bcalth authoritiea. • • • • • • • • • • • • • • • .• 10 2.8 Health workforce p1annin, methods. • • • • • • • • • • • • • . • • • • • • • •• 12 2.9 ProjeclCd increases in the bcalth workforce 1989-I99S. • • • • • . • • • • •• 12 2.10 1bc composition of the bcalth workforce. • . • • . • . . • • . • . . . • . . •. 14 2.11 Health workforce distribubOll. • • • • • • . • • . . . • . • . . • . . . • . .. 17 2.12 Health workforce·.,e distribution. . • . . . • . •. 18 3. Health Workforce Trabue and Development. • • • . • • • • • • • • • • • • • • •• 20 3.1 Policies and plans for bcalth petSODDeI training and development. • . • • •• 20 3.2 Linka,e of educadonal plannin, to national bcalth plans. • • • • • • • • • •• 21 3.3 Responsibility for educational plannin,. . • • . . • • • • • . • . . • . . • • .• 22.

3.4 Local fonnal training propms. . • • • . . . . . • . • . • • • . . • . . . . . .. 23 3.S Local in-service

trainina

ldivitiel • • • • • • • • • • • • • • • • • • • • • . . •• 25 3.6 Problems associated with loc:aJ training programs. • • • . . . .. 25 3.7 Overcominalocal training problems. • • • • • • • • • • • • • • • • • • . • • •• 26 3.8 Utiliution of major lecional or overseas trainin, programs. • . . • . . . • .. 29 3.9 FeUowships· the "nceds" list. • . . • . • . . . • . . . . • • . • . . . • . .. 31 3.10 Fellowships and ecboluships - awanHn, procedwu .•••.•.•••.•••• 31 3.11 Difficulties in

obtainina

suitable RDdidalies for overseas fellowships. . • .• 33 3.12 LiWoa between service providers and trainin, personnel in

the development and cooduct of training propms. • • • • • • • • • • . • • •• 33

4. Workforce

Manacemeat. . . . ..

^3!5

4.1 Difficulties in health personnel managemenl. . . • . . . .. 3!5 4.2 Job dcacriptions and their review. • . . • . • • • • • • . • • . • • . • . . • . .• 3!5 4.3 Staff'i.Jlcentivc scl\e.rDes. • • • • • • • • , • • • • • • • • • • • • , • • • • • • • •• 36

4." Wriucn ,uideliDes for routine personnel manqement. . • • . • . • • . • • .. 37

4.5 Workforce manaaemcnt and workforce plannin,. . . . . . . . . . .. 38

5. Suc&-tJoaI for Ac:doa. . . • . • . . . .. 40

5.1 An ICtion qenda and Infonnadoa exdwI,e • • • • . • . . . . . . . • . • . .• 40

5.2 Development of bealth wortforce plaonin, capacity. . • • . • • • . • . • • .. 40

5.3 Health workforce PWlni.na and opendooal research . • • • • • • • • • • • • •• 44 5.4 Resolutions of the WHO 1990 COIlfCl'CDCO. • • • • • • • • • • • • • • • • • •• 45

PART"

IDtroducdoD. . . • . . • . . . • . . . .. 46

The Health WoI'kforce

Prome.

01 hdllc Island Nadonl 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 • • . • . . . • • • • . • . . • . . . • . • • . • • • . • • • . . 1!51 Tonga . . . • . . . 16!5 Vanuatu • . • • . . . • . • . . . • • • . • 181

Western Samoa ••••..•...•..••••••••.•..•.••••••••.••. 19!5 Condudln& Remarks. . . • . . . . • • . • • . . • . . • • . • . . • . • • • • • . •••• 209

EXECUTfVES~RY

'Ibis 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 1m, surveycn 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

Corrunonwealth of

the

Northern Mariana Islands,

Guam, Kiribati,

New Zealand and Papua New Guinea in response

to

a postal questionnaire.

Health Workforce Plannl . .

While

most

of the countries surveyed

had

a national development and/or national health plans, few

bad

included a comprehensive indicative or prescriptive health workforce plan. Although general capability in bcalth policy formulation

and

broad health planning il present in most central health authorities, competence in workforce planning is limited. Limitations arise from lack of formally trained planning penonocl and from problema 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) possjbilities for personocl substitution and role extension; (4)

the

distnbution of personocl in relation

to

worldoad; (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.

Tralnlng

In

some countries, training intakes are not clearly related to future staffing requirements. Widespread concern over shortages of competent insb'Uctors and some reported shortcomings in present curricula point

to

the need for cooperation in the development of curricula and teaching/leaming 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

othec highly specialised allied health personocl and clinical support staff (such

as laboratory scientists and bio-medical engioeen). Difficulty in attracting

adequately educated

and

well motivalCd school leavers

to

enlee pre-service

training

and

shortages of appropriately qualified staff

to .p~ further

professional studies were reported in

most

countries.

Management of Human Resources

Inadequate numbers of

staff.

lack of appropriate knowledge and

skills

and low productivity were widely reported as major health workforce manaaement 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,

togethu 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