Monday, April 12, 2010

Scaling up Human Resources for Health in Tanzania

I came through a research paper that has tried to estimate the needed Human Resource for Health (HRH) in Tanzania by year 2015. The numbers are big, and I doubt at our current pace we can achieve them. But I should point out that in Africa; we are doing pretty well as far as amount of healthcare workers. Many countries in the continent are in a deeper healthcare workforce crisis, and they lose more workers who run to rich countries.

Here is the chart, Courtesy of Chris Kurowski and Dr. Salim of IHI and colleagues who did this research back in 2007 (http://heapol.oxfordjournals.org/cgi/content/full/22/3/113)

Estimates of Human Resources for Health availability and requirements in 2015, likely scenario

Group of cadres

HRH_A

HRH_R

HRH_A – HRH_R

HRH_A / HRH_R


Health professionals, PPR

28 600

115 700

(87 100)

25%

Nurses and midwives

17 700

49 200

(31 500)

36%

Nurses other than community nurses

9 600

34 700

(25 100)

28%

Community nurses

1 900

6 900

(5 000)

28%

Midwives

6 200

7 600

(1 400)

82%

Clinical and medical professionals

8 200

48 500

(40 300)

17%

Clinical professionals

5 800

36 100

(30 300)

16%

Medical professionals

2 300

12 300

(10 000)

19%

Technicians

2 700

18 100

(15 400)

15%

Radiological technicians

300

500

(200)

60%

Laboratory technicians

2 000

11 700

(9 700)

17%

Pharmacological technicians

400

5 900

(5 500)

7%

Assistant health workers

18 200

8 700

9 500

209%

Health professionals, PPNR

2 300

2 300

Health professionals and assistant health workers

49 100

124 400

(75 300)

39%

Brackets indicate negative values.

HRH_A = human resources for health availability; HRH_R = human resources for health requirements; PPR = priority package relevant; PPNR = priority package not relevant.


Things have got worse because now we are treating HIV positives, putting more pressure on our health systems by adding more needy patients every day that have to be actively surveyed . Adding up HRH needed for Malaria control, a revamped TB endemic due to HIV, and other acute diseases. Clinicians in Dar would also tell you that Diabetes is massively unnoticed. All these adds up to an already overwhelmed healthcare system. Moving forward, it doesn’t matter how much money donors give us. If MOH cannot take bold initiatives to strengthen our healthcare systems, we are doomed. Creating incentives to increase retention rates is a good starting step. Increasing number of pre-service trainees is a more sustainable approach, but the recurrent costs (salary and benefits) will need a hefty economic growth in the next few years—otherwise we can’t afford to scale up. Donors will have to commit for at least 5-10 years to cover the recurrent costs while we are hoping for an economic growth. This can be done now since IMF has removed wage bill ceilings in public spending. In mean time, Ministry of Education has to tweak the curriculum especially for nurses and medical officers to have them graduate faster. And MOH has to implement task shifting to alleviate burden from Physicians and other high end professionals. But adopting these policies won’t be enough if our facilities aren’t equipped enough; again we need a commitment from government not to have ghost hospitals and health centers anymore. Financing all these is a monumental task. Engaging private sector, donors, government spending, fee for services, taxes, or trying to keep inflation down to lower prices of food and fuel and hoping folks will increase their healthcare spending.

Healthcare is often overlooked in development issues, but the truth is people won’t be productive if they are sick. Poverty and healthcare form a vicious circle that politicians do not seem to understand. If a substantial number of our children don’t reach age 5, our middle age group perishes because of NGOMA, and our older adult can’t survive a heart attack or a benign cancer then what is the point of searching for maendeleo?

3 comments:

Anonymous said...

One of the biggest problems facing our national health system (of course, like other systems) is amount of ‘waste’ incorporated in it; the consequence of this is squeezing donors’ dollars while spending a lot of time ‘doing non-added value’ activities to the patients (i.e. spending a lot of time doing administrative -like jobs).

It should be remembered that all hospitals are there to treat patients and not otherwise; so anything that doesn’t go inline with ‘treating patients’ has to be as minimal as possible, if not eliminated completely within hospitals’ bricks.

The issue of waste in national health services has gained massive popularity in recent years in many countries. This is because ‘eliminating waste’ (lean principles) has proved to increase productivity and efficiency in both service and manufacturing sectors. Many of these countries want to save money and at the same time improve health services to their peoples. Unfortunately, Tanzanians as a people, we aren’t that much keen on emphasising those aspects.

A ‘well implemented lean’ on our health system could improve the quality of treatment as well as reduce too much dependency on donors. Don’t forget when ‘efficiency’ is realised in our system [health] then the staff payment would definitely improve.

I went through a few case studies on the subject and I was amused to see how lean implementation has helped to even increase staff (nurses, doctors, administrators etc) morale; something majority of our hospitals’ staff dearly lack.

I should emphasis on one important thing here as I did on other post (‘Possibilities’) that change of ‘culture’ amongst our people is a must thing to facilitate lean implementation, just like achieving those ‘impossibilities’ in Hans Rosling’s Presentation.

-----------------------
Maghee
(JK)

Thuwein said...

I agree with you, there is too much waste in our healthcare system. I personally heard it from folks at MOH on unprecedented waste. This is definitely a problem especially with tons of problems we are facing. I think administrative costs are alright, because a hospital is as solid as its administrator.

One of the challenges that we will have to face is to reduce informal payments (kutoa mshiko kwa Daktari ili kuepuka foleni). It lowers quality and reduce MOH revenues, its just a bad practice. But again, a Physician making $500 a month, you can't really blame him for doing that. We have to start taking care of our healthcare workers, because they are key to any progress that we need.

Rumishael said...

Frankly I dont understand this artcle. The categories discussed are not claer to me 111