presentatie huraprim ec · intercontinental brain-drain. 17/03/2014 5 17/03/2014 1.health personnel...
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P R O F. J A N D E M A E S E N E E R , M D , P H D
C H A I R M A N E U R O P E A N F O R U M F O R P R I M A R Y C A R E
S E C R E TA R Y G E N E R A L T H E N E T W O R K “ T O WA R D S U N I T Y F O R H E A LT H ”
FA M I LY P H Y S I C I A N , C O M M U N I T Y H E A LT H C E N T E R – L E D E B E R G , G H E N T
V I C E - D E A N S T R AT E G I C P L A N N I N G , FA C U LT Y O F M E D I C I N E A N D H E A LT H
S C I E N C E S – G H E N T U N I V E R S I T Y
W I M P E E R S M A N , M S C , P H D
M A R I A N N E VA N L A N C K E R , M S C
M E R L I N W I L L C O X , M D
- HURAPRIM -HUMAN RESOURCES FOR
PRIMARY HEALTH CARE IN AFRICA
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1.Health personnel in PHC in Africa
2.HURAPRIM
3.Strategies for change
4.An African-wide action plan
HUMAN RESOURCES FOR
PRIMARY HEALTH CARE IN AFRICA
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1.Health personnel in PHC in Africa
2.HURAPRIM
3.Strategies for change
4.An African-wide action plan
HUMAN RESOURCES FOR
PRIMARY HEALTH CARE IN AFRICA
1. Health personnel in PHC in Africa
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Shortage, mal-distribution and brain-drain
World Health Report 2006 “Working together for Health”:
• worldwide shortfall of 4.3 million health care workers, of which 1.8 million in Africa.
• 24% of the global disease burden in Africa, but only 3% of the world’s health workers and less than 1% of the world’s health expenditure.
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1. Health personnel in PHC in Africa
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Internal
From PHC to specialist care
From horizontal to vertical
From public to private
From rural to urban
External
Within Africa
Intercontinental
Brain-drain
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1.Health personnel in PHC in Africa
2.HURAPRIM
3.Strategies for change
4.An African-wide action plan
HUMAN RESOURCES FOR
PRIMARY HEALTH CARE IN AFRICA
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2. HURAPRIM
Health workers per 10 000 in HURAPRIM –partner coun tries:
0 20 40 60
Mali
Uganda
N. Sudan
Botswana
South Africa
DoctorsNursesMidwives
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2. HURAPRIM
Research objectives :
• Asses the scope of the deficit in HR, with a focus on primary health care
• Identify and analyze the main causes of this deficit
• Develop, review and test possible interventions and strategies to address this shortage
• Formulate scientifically sound, acceptable and feasible policy directions for the future
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2. HURAPRIM
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1.Health personnel in PHC in Africa
2.HURAPRIM
3.Strategies for change
4.An African-wide action plan
HUMAN RESOURCES FOR
PRIMARY HEALTH CARE IN AFRICA
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3. Strategies for change
1. Further development of the concept and role of family medicine
2. Political action : local, national, international
3. Research and documentation
4. Education and training : The Primafamed network
5. Examples:1. Confidential enquiry (HURAPRIM)2. The Gezira project
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3. Strategies for change
1. Further development of the concept and role of fa mily medicine
African family medicine:
• Holistic nature of care
• Centrality of the person
• Importance of doctor-patient relationship
• Health promotion and disease prevention
• Community oriented primary care
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3. Strategies for change
2. Political action: local, national, internatio nal
Important factors in African Family Medicine:
• Acceptance of Ministry: as part of the health care system of the country
• Working in a team with mid-level care workers and other health workers
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3. Strategies for change
“Every Western country should reimburse the country thattrained the physicians and nurses they receive in their healthsystem, with the full cost of training in the receiving country.”
2. Political action: local, national, internatio nal
Salary scale for primary health care professionals, Uganda 2012
Grade Monthly salary (UGX)
Monthly Salary (Euro)
Medical officer special grade UGX 633,333 € 182.52 Medical officer UGX 541,667 € 156.10 Nursing officer grade 1 UGX 270,833 € 78.05 Nursing officer grade 2 UGX 233,333 € 67.24 Enrolled nurse UGX 208,333 € 60.04 Enrolled midwife UGX 208,333 € 60.04
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3. Strategies for change
Uganda: MP’s disagree over Health Budget:
“Many MPs initially insisted they would not pass the national budget if the Government did not reverse its plan to reduce health expenditure”.
“According to the 2012/13 National Budget framework paper, the health ministry’s budget reduced from sh 852b to sh 800b”.
2. Political action: local, national, internatio nal
(Source: httm://allafrica.com/stories/printable/201209300370.html)
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3. Strategies for change
Uganda: MP’s disagree over Health Budget (2):
“On Wednesday the Government announced that it would double monthly pay for doctors in health centres IV level form sh 1,2m to sh 2,5m”.
“They would also spend sh 49,5b to recruit 6,172 health workers, of which sh 6,5b was released immediately”.
2. Political action: local, national, internatio nal
(Source: httm://allafrica.com/stories/printable/201209300370.html)
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3. Strategies for change
3. Research and documentation: www.phcfm.org
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3. Strategies for change
4. Education and training:
Funded by EuropeAid
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Adopted from the Primafamed Edulink ACP EU project. M Flinkenflögel, et al.
3. Strategies for change
Progress scale for development of the Primafamed partners
Level 1 • Structural implementation of the training and department is in preparation
Level 2 • Department/unit of family medicine exists or is part of other department
(community medicine)
• Training complexes are under development
• Family medicine is part of undergraduate training
Level 3 • Department/unit of family medicine exists
• Training complexes are in place
• Curriculum is written
• Postgraduate training has started
Level 4 • Department/unit of family medicine exists
• Training complexes are in place
• Curriculum is written
• Postgraduate training has started
• The ministry of health has accepted family medicine as a specialization and
graduated family physicians are part of the health care system
Adopted from the Primafamed Edulink ACP EU project. M Flinkenflögel, et al.
3. Strategies for change
Progress of the Primafamed partners 2008 - 2010
University of Goma, DRC Level 2 Level 4
Moi University, Kenya Level 3 Level 4
National University of Rwanda Level 2 Level 4
Aga Khan University, Tanzania Level 2 Level 3
University of Lagos, Nigeria Level 1 Level 2
Makerere University, Uganda Level 3 Level 3
Mbarara University, Uganda Level 2 Level 3
Ahfad University for Women, Sudan Level 1 Level 2
Gezira University, Sudan Level 1 Level 4
University of Ghana Level 3 Level 4
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3. Strategies for change, Example 1
A confidential enquiry into maternal and child deaths in Mali and Uganda
1. To adapt the confidential enquiry as a tool which could be used in Africa
2. To test whether this tool could help to reduce under five and maternal mortality, by:
• Identifying avoidable factors• Suggesting and prioritising possible interventions• Making and implementing recommendations
� All deaths of babies and children aged <5 years are reported by Village Health Teams (VHTs) in the included subcounties
� A fieldworker visits the family, presents condolences, and invites them to be interviewed
� Informed consent
Methods: Identifying child deaths
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� VHTs were asked to report any maternal deaths in the included subcounties
� A fieldworker visits the family, presents condolences, and invites them to be interviewed
� Informed consent
Methods: Identifying maternal deaths
Interviews� “Verbal autopsy” interviews with families
� Interviews with any health workers involved at any levelel
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Monthly panel review meeting
� Fieldworkers present case summary
� Panel includes doctors, nurses, village health workers
� Agrees on most likely cause of death (diagnosis)
� Identifies avoidable factors
� Makes recommendations
� External review for quality assurance
Biannual “Grand Committee” meeting:� Local politicians and decision-makers are invited� Summary of results and recommendations presented� Feedback is invited
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3. Strategies for change, Example 1
A confidential enquiry into maternal and child deaths in Mali and Uganda
How many deaths are avoidable?
• Almost ALL deaths had at least one avoidable factor
• Missed opportunities to prevent illness
• Problems in getting treatment
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3. Strategies for change, Example 2
The Gezira family medicine project (GFMP) in Sudan
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3. Strategies for change, Example 2
The Gezira family medicine project (GFMP) in Sudan
With special thanks to Dr. Khalid Mohamed
Gezira state: • 25,549 km² with 3,7 M. Pop.in the middle part of Sudan. • 80% are living in rural areas
GFMP-project:• start 2010• Partnership: MOH & FMUG• Recruited 207 doctors in rural and urban areas• 2 years Master in Family Medicine as ”in service training”
Challenges in teaching and clinical supervision
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3. Strategies for change, Example 2
The Gezira family medicine project (GFMP) in Sudan
With special thanks to Dr. Khalid Mohamed
Components of the project:
1. The training component (UoG)
2. Service presentation component (MoH)
3. Telecommunication and information technology component to facilitate both training and service presentation
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3. Strategies for change, Example 2
With special thanks to Dr. Khalid Mohamed
1. Training:
• Master program principles
• a 2-years integrated primary care – university – hospital program:
1. University teaching, evaluation and exams2. Hospital training in relevant clinical departments,
based on a specified set of objectives (log book) for family medicine skills training
3. Primary care work (in field service) training should constitute at least 70% of the time
4. Paid training positions; salary and patient fees. Public investments in buildings and equipment. 75 new lab technicians
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3. Strategies for change, Example 2
With special thanks to Dr. Khalid Mohamed
2. Service presentation:
• Before the program there were 116 primary care doctors in Gezira in 78 health centres
• The program recruited 207 salary paid Master student doctors which are spread in 162 centers all over the state
• 84 of the centers had no doctor before the program started
• More equipment and staff (Role of F.P.)
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3. ICT: Telemedicine
3. ICT: Electronic filing system
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Distance Education3. ICT: Distance education
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3. Strategies for change, Example 2
The Gezira family medicine project (GFMP) in Sudan
With special thanks to Dr. Khalid Mohamed
Outcomes:
1. Doubling of doctors in the rural areas
2. More qualified doctors
3. More equipment and more staff
4. Reports from the Ministry of Health show:• Less hospital congestion• Less maternal mortality
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1.Health personnel in PHC in Africa
2.HURAPRIM
3.Strategies for change
4.An African-wide action plan
HUMAN RESOURCES FOR
PRIMARY HEALTH CARE IN AFRICA
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3. An African-wide action plan
“Health-care systems have the best opportunity for
sustained improvement in health outcomes when anchored
on locally appropriate action based in primary health care,
with a balance between prevention, health promotion, and
curative interventions backed with an adequate referral
system. The succes of primary health care programs
requires having enough health workers, of the right quality,
in the right mix, and appropriately distributed”
[ Nelson Sewankambo. Health Systems in Africa: learning from South-Africa. The Lancet 2009;374:957-9]
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3. An African-wide action plan
• By 2020 Africa should have 30.000 more trained family physicians! How to make this happen?
• The data suggest an estimated 10.000-11.000 graduates per year from medical schools in sub-Saharan Africa” (Mullan F et al. Medical schools in sub-Saharan Africa. The Lancet 2011:377:1113-1121)
� What happens if 50 % of these graduates are fromnow onwards trained in a 2-years program in FamilyMedicine?
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