SEA/RC65/22 - Health workforce training and education
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AbstractThe 21st century witnesses that countries are confronted with numerous health challenges such as those related to health systems, sociodemographic changes, changing disease patterns and changing vulnerabilities and risks. To cope with these challenges, health systems should be strengthened using a primary health care (PHC) approach where a good balance between public health and medical service prevails. These challenges, which are complex and require a multidisciplinary approach and multisectoral collaboration, have an impact on the work of health-care providers and thus how they are educated and trained. Since the Flexner report in 1910 substantial reform in health professional education had been taken place. However, due to rapidly changing health challenges, it is a common observation that, today, health workforce (HWF) education and training has not been well adapted to address these challenges. With exceptions in some health education institutions, this is largely because of outdated, static and fragmented curricula, which produce graduates with insufficient knowledge, skills and competence responsive to the current and future population health needs. A competent, motivated, sufficient in numbers and with the appropriate mix of skills health workforce forms the core of a high-quality and efficient health system. The World Health Report 2006 reveals that 6 out of 11 countries of the South-East Asia (SEA) Region face a human resources for health (HRH) crisis, with fewer than 23 health workers (doctors, nurses and midwives) per 10 000 population. Member States are committed to achieving effective and well-motivated HWFs as witnessed in the 2006 Dhaka Declaration on Strengthening Health Workforce in the Countries of South-East Asia Region and the Regional Committee resolution on Strengthening the Health Workforce in South-East Asia adopted at its Fifty-ninth Session. The recent review of HRH country profiles conducted in February 2012 reveals that those countries with an HRH crisis continue to be in crisis; funding support for HRH development is not sufficient to bring about the desired improvement in most countries; HRH education, deployment and management as well as migration of health workers within and outside the country remain challenges; and maldistribution of HWF exists in most countries. These challenges need to be carefully addressed to ensure effective HWFs, otherwise it will not be possible to achieve universal health coverage. As a starting-point this paper will deliberate on challenges related to HRH education to effectively address the challenges. Although considerable efforts have been made to strengthen education and training of HWFs in countries, much remains to be done to produce desirable results in most countries. There are good practices of HWF education in the Region, however most countries encounter numerous challenges in educating their HWFs. HWF training and education must therefore be further strengthened to tackle those health and educational challenges, including training and education of community-based health workers (CBHWs), to further strengthen the PHC approach. Further, an effective community-based health workforce is one of the ways to ensure that essential health interventions reach even “unreached” populations in order to achieve universal health coverage. However, efforts at the country level to strengthen HWF training and education are largely fragmented due to limited resources and lack of clear policy directions. There is thus a need to renew the commitment and investment to strengthening HWF training and education; and to have clear national health policies, strategies and plans on the focus of health systems, and on HWF requirements and education. Countries also need to find new and better ways to educate their health-care providers to meet the needs of health systems and communities in order to achieve universal health coverage. It is timely that the Regional Committee considers this issue. The High-Level Preparatory (HLP) Meeting held in the Regional Office in New Delhi from 2 to 5 July 2012 reviewed the working paper on “Health Professionals’ Education” and made the following recommendations: Actions by Member States (1) To review national health policies, strategies and plans to ensure that HWFs contribute to effective health system functioning. (2) To conduct comprehensive assessments of the current situation of HWF education and training, based on an agreed common protocol, as a foundation for evidencebased policy dialogue/formulation (3) To develop or strengthen policies for education and training of HWF as an integral part of national health and education policies. (4) To increase resources and support for the strengthening of HWF training and education, including CBHWs, in support of universal health coverage. (5) To request the Director-General through the Regional Director to place “Health workforce education and training in support of universal health coverage” as a provisional agenda item of the 132nd session of the Executive Board in January 2013. Actions by WHO-SEARO (1) To support Member States in conducting a comprehensive assessment of the current situation of HWF education and training based on an agreed common protocol. (2) To convene a regional technical consultation to review the result of the country assessments and to formulate regional strategies for strengthening health workforce training and education in the Region. (3) To support Member States in their efforts to further strengthen education and training of HWFs, including CBHWs. (4) To change the title of the paper for presentation to the Sixty-fifth Regional Committee to “Health workforce training and education in support of universal health coverage”, and to broaden its focus to cover the education and training of all health workers. The working paper was subsequently revised to expand beyond health professional’s education and to cover all health workers’ education and training. The revised working paper and the HLP recommendations are submitted to the Sixty-fifth Session of the Regional Committee for its consideration.
World Health Organization. Regional Office for South-East Asia. (2012). SEA/RC65/22 - Health workforce training and education. WHO Regional Office for South-East Asia. https://apps.who.int/iris/handle/10665/128319