The Health Workforce

(1)

The Health Workforce

South Pacific Island Nations

Arie Rotem and John Dewdney

with the suppon of

J. Rodgers, S. Wolfgramm and A. Drori

A Study Sponsored

Uy the

World Health Organization Western Pacific Regional Office Manila, Philippines

"HO/WPRO LrnRlllft

tlmnillJ. Pll.i~

The Health Workforce

South Pacific Island Nations

Arie Rotem and John Dewdney

with the suppon of

J. Rodgers, S. Wolfgramm and A. Drori

A Study Sponsored

Uy the

World Health Organization Western Pacific Regional Office Manila, Philippines

"HO/WPRO LrnRlllft

tlmnillJ. Pll.i~

(2)

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

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country. territory.

city or area or of its authorities or concerning the delineation of its frontiers or boundaries.

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

provided that the source is acknowledged.

Printed and distributed by the

University of New South Wales on behalf of the

WHO Regional Training Centre for Health Development

I ·;

" "

"

~

The University of New South Wales August 1991

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

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country. territory.

city or area or of its authorities or concerning the delineation of its frontiers or boundaries.

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

provided that the source is acknowledged.

Printed and distributed by the

University of New South Wales on behalf of the

WHO Regional Training Centre for Health Development

I ·;

" "

"

~

The University of New South Wales August 1991

(3)

PART I

1. Introduction... 1

1.1 Population and health personnel. . . .. 2

2. The Current Status of Health Workforce Planning in Pacific Island Countries. . . .. 4

2.1 National development plans, health plans and health workforce plans. . .. 4

2.2 National health plans and health workforce plans. . . .. 4

2.3 Integration and direction of health worldorce planning. . . 6

2.4 Health workforce plan preparation. . . .. 7

2.5 Sources of health worldorce planning data. . . .. 8

2.6 Formal arrangements for sharing health workforce information with other agencies. . . .. 10

2.7 Present planning capacity of health authorities. . . .. 10

2.8 Health workforce planning methods. . . .. 12

2.9 Projected increases in the health workforce 1989-1995 . . . " 12 2.10 The composition of the health worldorce. . . .. 14

2.11 Health worldorce distribution. . . .. 17

2.12 Health workforce - age distribution. . . .. 18

3. Health Workforce Training and Development. . . .. 20

3.1 Policies and plans for health personnel training and development. . . .. 20

3.2 Linkage of educational planning to national health plans. . . .. 21

3.3 Responsibility for educational planning. . . .. 22

3.4 Local formal training programs. . . .. 23

3.5 Local in-service training activities. . . .. 25

3.6 Problems associated with local training programs. . . .. 25

3.7 Overcoming local training problems. . . .. 26

3.8 Utilization of major regional or overseas training programs. . . .. 29

3.9 Fellowships - the "needs" list. . . .. 31

3.10 Fellowships and scholarships - awarding procedures. . . .. 31

3.11 Difficulties in obtaining suitable candidates for overseas fellowships. . . .. 33

3.12 Liaison between service providers and training personnel in the development and conduct of training programs. . . .. 33

PART I

1. Introduction... 1

1.1 Population and health personnel. . . .. 2

2. The Current Status of Health Workforce Planning in Pacific Island Countries. . . .. 4

2.1 National development plans, health plans and health workforce plans. . .. 4

2.2 National health plans and health workforce plans. . . .. 4

2.3 Integration and direction of health worldorce planning. . . 6

2.4 Health workforce plan preparation. . . .. 7

2.5 Sources of health worldorce planning data. . . .. 8

2.6 Formal arrangements for sharing health workforce information with other agencies. . . .. 10

2.7 Present planning capacity of health authorities. . . .. 10

2.8 Health workforce planning methods. . . .. 12

2.9 Projected increases in the health workforce 1989-1995 . . . " 12 2.10 The composition of the health worldorce. . . .. 14

2.11 Health worldorce distribution. . . .. 17

2.12 Health workforce - age distribution. . . .. 18

3. Health Workforce Training and Development. . . .. 20

3.1 Policies and plans for health personnel training and development. . . .. 20

3.2 Linkage of educational planning to national health plans. . . .. 21

3.3 Responsibility for educational planning. . . .. 22

3.4 Local formal training programs. . . .. 23

3.5 Local in-service training activities. . . .. 25

3.6 Problems associated with local training programs. . . .. 25

3.7 Overcoming local training problems. . . .. 26

3.8 Utilization of major regional or overseas training programs. . . .. 29

3.9 Fellowships - the "needs" list. . . .. 31

3.10 Fellowships and scholarships - awarding procedures. . . .. 31

3.11 Difficulties in obtaining suitable candidates for overseas fellowships. . . .. 33

3.12 Liaison between service providers and training personnel in the development and conduct of training programs. . . .. 33

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4. Workforce Management. . . .. 35

4.1 Difficulties in health personnel management. . . .. 35

4.2 Job descriptions and their review. . . .. 35

4.3 Staff incentive schemes. . . .. 36

4.4 Written guidelines for routine personnel management. . . .. 37

4.5 Workforce management and woMorce planning. . . .. 38

S. Suggestions for Action. . . .. 40

5.1 An action agenda and information exchange. . . .. 40

5.2 Development of health woMorce planning capacity. . . .. 40

5.3 Health workforce planning and operational research. . . .. 44

5.4 Resolutions of the WHO 1990 Conference. . . .. 45

PART II

Introduction. . . .. 46

The Health Workforce Profiles of Pacific Island Nations Commonwealth of the Northern Mariana Islands. . . .. 47

Cook Islands. . . .. 60

Federated States of Micronesia. . . .. 74

Fiji. . . .. 86

Kiribati. . . .. 100

Papua New Guinea. . . .. 113

Republic of Guam . . . 125

Republic of Palau. . . .. 139

Solomon Islands . . . 151

Tonga . . . 165

Vanuatu . . . 181

Western Samoa . . . 195

Concluding

Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

209

4. Workforce Management. . . .. 35

4.1 Difficulties in health personnel management. . . .. 35

4.2 Job descriptions and their review. . . .. 35

4.3 Staff incentive schemes. . . .. 36

4.4 Written guidelines for routine personnel management. . . .. 37

4.5 Workforce management and woMorce planning. . . .. 38

S. Suggestions for Action. . . .. 40

5.1 An action agenda and information exchange. . . .. 40

5.2 Development of health woMorce planning capacity. . . .. 40

5.3 Health workforce planning and operational research. . . .. 44

5.4 Resolutions of the WHO 1990 Conference. . . .. 45

PART II

Introduction. . . .. 46

The Health Workforce Profiles of Pacific Island Nations Commonwealth of the Northern Mariana Islands. . . .. 47

Cook Islands. . . .. 60

Federated States of Micronesia. . . .. 74

Fiji. . . .. 86

Kiribati. . . .. 100

Papua New Guinea. . . .. 113

Republic of Guam . . . 125

Republic of Palau. . . .. 139

Solomon Islands . . . 151

Tonga . . . 165

Vanuatu . . . 181

Western Samoa . . . 195

Concluding

Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

209

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ACKNOWLEDGEMENTS

'This survey was commissioned by the Western Pacific Regional Office of the W orId Health Organisation. The sustained interest and support of

Dr.

A. Romualdez Jr. is gratefully acknowledged.

The study could not have been completed without the co- operation of health authorities and their planning officers to whom we are most grateful.

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

Arie Rotem John Dewdney

ACKNOWLEDGEMENTS

'This survey was commissioned by the Western Pacific Regional Office of the W orId Health Organisation. The sustained interest and support of

Dr.

A. Romualdez Jr. is gratefully acknowledged.

The study could not have been completed without the co- operation of health authorities and their planning officers to whom we are most grateful.

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

Arie Rotem

John Dewdney

(6)

EXECUTIVE SUMMARY

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

In

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

Health Workforce Planning

While most of the countries surveyed had a national development and/or national health plans, few had included a comprehensive indicative or prescriptive health workforce plan. Although general capability in health policy formulation and broad health planning is present in most central health authorities, competence in workforce planning is limited. Limitations arise from lack of formally trained planning personnel and from problems in accessing and processing appropriate, accurate and up-to-date data.

In

countries having decentralised health service administrative arrangements, these problems are magnified. From the incomplete data reported, it is apparent that attention should be given to:

(1)

projection of the workforce requirements; (2) the present composition and mix of the health workforce;

(3) possibilities for personnel substitution and role extension; (4) the distribution of personnel in relation to workload; (5) the implications of the aging of the present workforce. It is also evident that at present very little operational research related to workforce planning is undertaken.

Training

In

some countries, training intakes are not clearly related to future staffing requirements. Widespread concern over shortages of competent instructors and some reported shortcomings in present curricula point to the need for cooperation in the development of curricula and teachingllearning materials.

While the strengthening of in-country training programs and resources is necessary, it is inevitable that most of the countries surveyed will continue to rely on out-of-country training of medical and dental officers, pharmacists and other highly specialised allied health personnel and clinical support staff (such as laboratory scientists and bio-medical engineers). Difficulty in attracting adequately educated and well motivated school leavers to enter pre-service training and shortages of appropriately qualified staff to pursue further professional studies were reported in most countries.

EXECUTIVE SUMMARY

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

In

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

Health Workforce Planning

While most of the countries surveyed had a national development and/or national health plans, few had included a comprehensive indicative or prescriptive health workforce plan. Although general capability in health policy formulation and broad health planning is present in most central health authorities, competence in workforce planning is limited. Limitations arise from lack of formally trained planning personnel and from problems in accessing and processing appropriate, accurate and up-to-date data.

In

countries having decentralised health service administrative arrangements, these problems are magnified. From the incomplete data reported, it is apparent that attention should be given to:

(1)

projection of the workforce requirements; (2) the present composition and mix of the health workforce;

(3) possibilities for personnel substitution and role extension; (4) the distribution of personnel in relation to workload; (5) the implications of the aging of the present workforce. It is also evident that at present very little operational research related to workforce planning is undertaken.

Training

In

some countries, training intakes are not clearly related to future staffing requirements. Widespread concern over shortages of competent instructors and some reported shortcomings in present curricula point to the need for cooperation in the development of curricula and teachingllearning materials.

While the strengthening of in-country training programs and resources is

necessary, it is inevitable that most of the countries surveyed will continue to

rely on out-of-country training of medical and dental officers, pharmacists and

other highly specialised allied health personnel and clinical support staff (such

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

adequately educated and well motivated school leavers to enter pre-service

training and shortages of appropriately qualified staff to pursue further

professional studies were reported in most countries.

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Management of Human Resources

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

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

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

iii

Management of Human Resources

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

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

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

iii

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LIST OF ABBREVIATIONS/ACRONYMS USED IN TEXT (Alphabetical Order)

CNMI CPMEB DA

DG

DOA DOH FSM HO HPC HRS ISN MA MHFP MHMS MOE MOH NHP PHC PNG PSB PSC RN SDC SHRDO SMC STUDIS T&SC

WHO

Commonwealth of the Northern Mariana Islands

Central Programming Monitoring and Evaluation Board Development Agency

Director General

Department of Administration Department of Health

Federal States of Micronesia Health Officer

Health Planning Committee Human Resource System Indicators of Staffing Need Medical Assistant

Ministry of Health and Family Planning Ministry of Health and Medical Services Ministry of Education

Ministry of Health National Health Plan Primary Health Care Papua New Guinea Public Service Board Public Service Commission Registered Nurse

Staff Development Committee

Senior Human Resources Development Officer Senior Management Committee

Student Information System

Training and Scholarship Committee World Health Organization

LIST OF ABBREVIATIONS/ACRONYMS USED IN TEXT (Alphabetical Order)

CNMI CPMEB DA

DG

DOA DOH FSM HO HPC HRS ISN MA MHFP MHMS MOE MOH NHP PHC PNG PSB PSC RN SDC SHRDO SMC STUDIS T&SC

WHO

Commonwealth of the Northern Mariana Islands

Central Programming Monitoring and Evaluation Board Development Agency

Director General

Department of Administration Department of Health

Federal States of Micronesia Health Officer

Health Planning Committee Human Resource System Indicators of Staffing Need Medical Assistant

Ministry of Health and Family Planning Ministry of Health and Medical Services Ministry of Education

Ministry of Health National Health Plan Primary Health Care Papua New Guinea Public Service Board Public Service Commission Registered Nurse

Staff Development Committee

Senior Human Resources Development Officer Senior Management Committee

Student Information System

Training and Scholarship Committee

World Health Organization

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PART I

(10)

1. INTRODUCTION

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

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

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

Cook Islands

Federated States of Micronesia (FSM) Fiji

Palau

Solomon Islands Tonga

Vanuatu and Western Samoa

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

The scale and complexity of the health care systems in Australia and New Zealand are very different from those in other South Pacific countries.

Accordingly, only occasional reference is made in the text to material from these two countries.

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

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

1. INTRODUCTION

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

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

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

Cook Islands

Federated States of Micronesia (FSM) Fiji

Palau

Solomon Islands Tonga

Vanuatu and Western Samoa

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

The scale and complexity of the health care systems in Australia and New Zealand are very different from those in other South Pacific countries.

Accordingly, only occasional reference is made in the text to material from these two countries.

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

The first part of the report concludes with suggestions for the development of

health workforce capability in Pacific Island countries and the resolutions of

the 1990 WHO Conference on Workforce Planning.

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The Health Workforce

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

1.1 Population and health personnel

To provide perspective on the relative size of populations to be served by health personnel in the countries included in this report, Table

1.1

gives for each country an approximation of the size of its population and the reported number of its health personnel within the categories included in the survey questionnaire. The last column in the table gives for each country a recent estimate of life expectancy at birth. This information provides a reminder that populations with similar survival expectancies may have markedly different ratios of population to health personnel.

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

2 The Health Workforce

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

1.1 Population and health personnel

To provide perspective on the relative size of populations to be served by health personnel in the countries included in this report, Table

1.1

gives for each country an approximation of the size of its population and the reported number of its health personnel within the categories included in the survey questionnaire. The last column in the table gives for each country a recent estimate of life expectancy at birth. This information provides a reminder that populations with similar survival expectancies may have markedly different ratios of population to health personnel.

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

2

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lntroducoon

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

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

(approx)

•

(approx) (years)

Australia 16,500,000 300,000 55 75

CNMI 38,000 237 160 50

Cook Islands 17,200 182 94 66

FSM 96,000 633 152 N/A

Fiji 727,000 2,354 309 63

Guam 132,700 1,064 125 73

Kiribati 66,000 280 236 53

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

Palau 14,000 140 100 66

PNG 3,661,000 9,404 389 50

Solomon Island 316,700 824 384 60

Tonga 97,300 372 262 63

Vanuatu 142,600 528 270 60

Western Samoa 158,000 409 387 64

*

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

lntroducoon

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

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

(approx)

•

(approx) (years)

Australia 16,500,000 300,000 55 75

CNMI 38,000 237 160 50

Cook Islands 17,200 182 94 66

FSM 96,000 633 152 N/A

Fiji 727,000 2,354 309 63

Guam 132,700 1,064 125 73

Kiribati 66,000 280 236 53

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

Palau 14,000 140 100 66

PNG 3,661,000 9,404 389 50

Solomon Island 316,700 824 384 60

Tonga 97,300 372 262 63

Vanuatu 142,600 528 270 60

Western Samoa 158,000 409 387 64

*

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

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

2.1 National development plans and national health plans

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

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

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

2.2 National health plans and health workforce plans

Among the contents of national health plans, whether presented as part of national development plans or as separate documents, are statements regarding (a) policy, strategies and targets relating to changes in morbidity and mortality;

^(b)

changes in service structure, activities and coverage; (c) programs of facility construction, modification and equipment and (d) the funding of health services and staffing. Matters pertaining to health personnel development ranges from rather general statements of policy to extensive tabulation of workforce projections. targets and detailed prescription for pre-service and in-service training outputs.

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

2.1 National development plans and national health plans

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

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

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

2.2 National health plans and health workforce plans

Among the contents of national health plans, whether presented as part of national development plans or as separate documents, are statements regarding (a) policy, strategies and targets relating to changes in morbidity and mortality;

^(b)

changes in service structure, activities and coverage; (c) programs of facility construction, modification and equipment and (d) the funding of health services and staffing. Matters pertaining to health personnel development ranges from rather general statements of policy to extensive tabulation of workforce projections. targets and detailed prescription for pre-service and in-service training outputs.

4

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The Current Slillus Of Health Workforce Planning In PacifIC Island Countries

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

199ft

Countries

Australia Cook Islands FSM Fiji Guam Kiribati Palau

Papua New Guinea Solomon Islands Tonga

Vanuatu Western Samoa

National Development Plan

No Yes

**

No

***

Yes Yes Yes Yes Yes

* **

***

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

National Health Plan as separate document

No No

*

No Now out of date

Yes No Yes Yes No No No

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

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

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

The Current Slillus Of Health Workforce Planning In PacifIC Island Countries

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

199ft

Countries

Australia Cook Islands FSM Fiji Guam Kiribati Palau

National Development Plan

No Yes

**

No

***

Yes Yes Yes Yes Yes

* **

***

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

National Health Plan as separate document

No No

*

No Now out of date

Yes No Yes Yes No No No

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

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

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

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2.3 Integration and direction of health workforce planning

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

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

Country Principal decision making body

CNMI Not identified

Cook Islands Director of Health and Division Heads, MOH

FSM Not identified

Fiji Staff Board - Pennanent Secretary and Directors, MOH

Guam No one central body

Kiribati Central Programming, Monitoring and Evaluation Board.

Palau Not identified

Pennanent Secretary and Directors, DOH

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

National Health Development Committee, MOH Meeting of inter-sectoral committees - SDC, SMC, T&SC,HPC.*

Director of Health and Division Heads, MOH

*

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

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

2.3 Integration and direction of health workforce planning

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

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

Country Principal decision making body

CNMI Not identified

Cook Islands Director of Health and Division Heads, MOH

FSM Not identified

Fiji Staff Board - Pennanent Secretary and Directors, MOH

Guam No one central body

Kiribati Central Programming, Monitoring and Evaluation Board.

Palau Not identified

Pennanent Secretary and Directors, DOH

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

National Health Development Committee, MOH Meeting of inter-sectoral committees - SDC, SMC, T&SC,HPC.*

Director of Health and Division Heads, MOH

*

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

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

6

(16)

The Current StIlIUs Of Heallh Workforce Planning In Pacific Island Countries

granting of fellowships for further training of government employees.

Education ministries are often concerned with pre-service education of some categories of health personnel.

In

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

The role of central health authorities is further limited by the degree to which they are able to influence and control the activities of health personnel working outside government services and by powers vested in quasi-governmental authorities such as professional Registration Boards.

The influence of the private practitioner sector on health service development is evident in Australia and New Zealand, and is becoming increasingly evident in Fiji and Papua New Guinea.

2.4 Health workforce plan preparation

In

countries having a national health plan there is a central body or administrative unit which brings together the information required for the formulation of the national health plan, including its workforce content.

Where the health workforce is small the 'unit' may be simply one or two officials whose duties include this responsibility.

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

The Current StIlIUs Of Heallh Workforce Planning In Pacific Island Countries

granting of fellowships for further training of government employees.

Education ministries are often concerned with pre-service education of some categories of health personnel.

In

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

The role of central health authorities is further limited by the degree to which they are able to influence and control the activities of health personnel working outside government services and by powers vested in quasi-governmental authorities such as professional Registration Boards.

The influence of the private practitioner sector on health service development is evident in Australia and New Zealand, and is becoming increasingly evident in Fiji and Papua New Guinea.

2.4 Health workforce plan preparation

In

countries having a national health plan there is a central body or administrative unit which brings together the information required for the formulation of the national health plan, including its workforce content.

Where the health workforce is small the 'unit' may be simply one or two officials whose duties include this responsibility.

Table 2.3 lists the units within central health authorities identified as having

responsibility for preparing the national health plan and/or health workforce

plans.

(17)

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

Country Central Planning Unit

CNMI Commonwealth Health Planning and Development Agency.

Cook Islands No designated unit

FSM Planning and Manpower Section.

Department of Human Resources.

Guam No designated unit.

Fiji No designated unit.

Kiribati General Programming.

Monitoring and Evaluation Board. BHS.

Papua New Guinea Policy and Planning Division. DOH.

Solomon Islands Health Planning Unit. MHMS.

Tonga Health Planning and Information Division. MOH.

Vanuatu Principal Administrative Officer and Health Planner. MOH.

Western Samoa Health Planning and Information Unit, MOH.

2.5 Sources of health workforce planning data

In all the countries reviewed, most of the data required for health workforce planning at national, regional, institutional and individual level is presently·

recorded. Indeed, much of the data required for workforce planning is also required for managing the day to day operations of the health service, for personnel management, for the conduct of training programs, for budgeting and financial control, and for facility and other types of planning.

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

fOnD.

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

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

Country Central Planning Unit

CNMI Commonwealth Health Planning and Development Agency.

Cook Islands No designated unit

FSM Planning and Manpower Section.

Department of Human Resources.

Guam No designated unit.

Fiji No designated unit.

Kiribati General Programming.

Monitoring and Evaluation Board. BHS.

Papua New Guinea Policy and Planning Division. DOH.

Solomon Islands Health Planning Unit. MHMS.

Tonga Health Planning and Information Division. MOH.

Vanuatu Principal Administrative Officer and Health Planner. MOH.

Western Samoa Health Planning and Information Unit, MOH.

2.5 Sources of health workforce planning data

In all the countries reviewed, most of the data required for health workforce planning at national, regional, institutional and individual level is presently·

recorded. Indeed, much of the data required for workforce planning is also required for managing the day to day operations of the health service, for personnel management, for the conduct of training programs, for budgeting and financial control, and for facility and other types of planning.

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

fOnD.

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

8

(18)

The Current StIltus

Of

HealJh Workforce Planning In PacifIC Island Countries

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

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

The central office of the Department of Health (DOH), PNG, faces to a marked degree the problem of collecting workforce planning data relating to a relatively large workforce and an extensive training program within a decentra1ised system of government administration and a large non-government health service sector.

Recognising the desirability of bringing together and providing access to workforce information, the PNG Department of Manpower Planning has embarked on an ambitious project aimed at providing an integrated government pay-roll, personnel and establishment system. This personnel management information system, which has been named Human Resource System (HRS), is designed to facilitate better planning, budgeting and control of manpower resources within the whole of the PNG Public Service. The HRS holds in summary:-

personnel information position information

position occupancy information

department structures and staff ceilings (plus staff on strength) institution information

code tables

pay-roll information

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

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

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

The Current StIltus

Of

HealJh Workforce Planning In PacifIC Island Countries

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

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

The central office of the Department of Health (DOH), PNG, faces to a marked degree the problem of collecting workforce planning data relating to a relatively large workforce and an extensive training program within a decentra1ised system of government administration and a large non-government health service sector.

Recognising the desirability of bringing together and providing access to workforce information, the PNG Department of Manpower Planning has embarked on an ambitious project aimed at providing an integrated government pay-roll, personnel and establishment system. This personnel management information system, which has been named Human Resource System (HRS), is designed to facilitate better planning, budgeting and control of manpower resources within the whole of the PNG Public Service. The HRS holds in summary:-

personnel information position information

position occupancy information

department structures and staff ceilings (plus staff on strength) institution information

code tables

pay-roll information

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

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

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

(19)

TM Heallh Workforce

2.6 Formal arrangements for sharing health workforce information with other agencies

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

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

2.7 Present planning capacity of health authorities

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

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

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

Both these problems have been experienced by some countries in the Pacific Basin.

In

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

10 TM Heallh Workforce

2.6 Formal arrangements for sharing health workforce information with other agencies

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

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

2.7 Present planning capacity of health authorities

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

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

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

Both these problems have been experienced by some countries in the Pacific Basin.

In

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

10

(20)

The Current Status OJ Healih Workforce Planning In PacifIC Island Countries

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

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

Capability present Capability not present

Specific planning capability

- Health planning 8 3

- Workforce planning 7 4

- Project planning and appraisal 8 3

- Education program planning 5 6

Planning related activities

- Health information system 7 4

- Health statistics 9 2

- Computer operation 7 4

- Health systems research 3 8

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

In

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

The Current Status OJ Healih Workforce Planning In PacifIC Island Countries

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

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

Capability present Capability not present

Specific planning capability

- Health planning 8 3

- Workforce planning 7 4

- Project planning and appraisal 8 3

- Education program planning 5 6

Planning related activities

- Health information system 7 4

- Health statistics 9 2

- Computer operation 7 4

- Health systems research 3 8

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

In

two areas - planning of educational programs and health systems research

- more limited capability was reported. Regarding educational program

planning this may have been regarded by some respondents as referring to

curriculum development rather than planning in terms of student intake,

allowance for student attrition, and relating graduate output to service needs

and similar matters. The problem of curriculum development is mentioned

in Chapter 3 of this report. The reported lack of health system research

capability is not surprising since HSR is poorly developed in most countries

throughout the world.

(21)

2.8 Health workforce planning methods

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

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

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

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

2.9 Projected increases in the health workforce 1989-1995

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

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

2.8 Health workforce planning methods

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

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

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

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

2.9 Projected increases in the health workforce 1989-1995

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

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

12

The Health Workforce

The Health Workforce

South Pacific Island Nations

Arie Rotem and John Dewdney

with the suppon of

J. Rodgers, S. Wolfgramm and A. Drori

A Study Sponsored

World Health Organization Western Pacific Regional Office Manila, Philippines

"HO/WPRO LrnRlllft

The Health Workforce

South Pacific Island Nations

Arie Rotem and John Dewdney

with the suppon of

J. Rodgers, S. Wolfgramm and A. Drori

A Study Sponsored

World Health Organization Western Pacific Regional Office Manila, Philippines

"HO/WPRO LrnRlllft

I ·;

" "

"

I ·;

" "

"

CONTENTS

PART I

CONTENTS

PART I

PART II

Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART II

Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

'This survey was commissioned by the Western Pacific Regional Office of the W orId Health Organisation. The sustained interest and support of

A. Romualdez Jr. is gratefully acknowledged.

The study could not have been completed without the co- operation of health authorities and their planning officers to whom we are most grateful.

Arie Rotem John Dewdney

'This survey was commissioned by the Western Pacific Regional Office of the W orId Health Organisation. The sustained interest and support of

A. Romualdez Jr. is gratefully acknowledged.

The study could not have been completed without the co- operation of health authorities and their planning officers to whom we are most grateful.

Arie Rotem

John Dewdney

EXECUTIVE SUMMARY

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

Health Workforce Planning

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:

projection of the workforce requirements; (2) the present composition and mix of the health workforce;

(3) possibilities for personnel substitution and role extension; (4) the distribution of personnel in relation to workload; (5) the implications of the aging of the present workforce. It is also evident that at present very little operational research related to workforce planning is undertaken.

Training

some countries, training intakes are not clearly related to future staffing requirements. Widespread concern over shortages of competent instructors and some reported shortcomings in present curricula point to the need for cooperation in the development of curricula and teachingllearning materials.

EXECUTIVE SUMMARY

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

Health Workforce Planning

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:

projection of the workforce requirements; (2) the present composition and mix of the health workforce;

(3) possibilities for personnel substitution and role extension; (4) the distribution of personnel in relation to workload; (5) the implications of the aging of the present workforce. It is also evident that at present very little operational research related to workforce planning is undertaken.

Training

some countries, training intakes are not clearly related to future staffing requirements. Widespread concern over shortages of competent instructors and some reported shortcomings in present curricula point to the need for cooperation in the development of curricula and teachingllearning materials.

While the strengthening of in-country training programs and resources is

necessary, it is inevitable that most of the countries surveyed will continue to

rely on out-of-country training of medical and dental officers, pharmacists and

other highly specialised allied health personnel and clinical support staff (such

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

adequately educated and well motivated school leavers to enter pre-service

training and shortages of appropriately qualified staff to pursue further

professional studies were reported in most countries.

Management of Human Resources

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.

Management of Human Resources

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.

LIST OF ABBREVIATIONS/ACRONYMS USED IN TEXT (Alphabetical Order)

CNMI CPMEB DA

DOA DOH FSM HO HPC HRS ISN MA MHFP MHMS MOE MOH NHP PHC PNG PSB PSC RN SDC SHRDO SMC STUDIS T&SC

Commonwealth of the Northern Mariana Islands

Central Programming Monitoring and Evaluation Board Development Agency

Director General

Department of Administration Department of Health

Federal States of Micronesia Health Officer

Health Planning Committee Human Resource System Indicators of Staffing Need Medical Assistant

Ministry of Health and Family Planning Ministry of Health and Medical Services Ministry of Education

Ministry of Health National Health Plan Primary Health Care Papua New Guinea Public Service Board Public Service Commission Registered Nurse

Staff Development Committee