Workforce & Health Systems

WORKFORCE AND HEALTH SYSTEM PERFORMANCE (WAHSP)

Overview

There is broad recognition that achieving universal health care requires a greater focus on health human resources in relation to health system performance and outcomes for children. Pediatricians have an important role and responsibility to contribute to the education of future generations of pediatricians and other health professionals, to new knowledge development, and to advance policies, and practices within national health care systems and globally.

The Workforce Challenge

Pediatric training and pediatric professional development programs are designed to ensure high levels of competence for child health providers. High levels of clinical competence help ensure optimal clinical outcomes for children. However, in many regions of the world the child health workforce is stretched, access to higher-levels of support is not readily available, and there are limited numbers of child health experts and little capacity for pediatricians to contribute to higher-order tasks such as curriculum and training development, child health advocacy and policy development, and health system strengthening including training and support of other health cadres. Yet these are the settings in which the world's children suffer the most.

Work-force distribution around child health is highly skewed. In general, countries with the worst child health outcomes have the lowest number of trained child health professionals and the lowest rates of spending on education and training for their health workforce. There is good evidence that a well-trained workforce is necessary in order to implement and sustain health interventions.

Workforce related to child health is a key priority of the WHO and the UN. The overall goal in the WHO Global Strategy Workforce 2030 is to 'improve health, social and economic development outcomes by ensuring universal availability, accessibility, acceptability, coverage and quality of the health workforce through adequate investments to strengthen health systems, and the implementation of effective policies at national, regional and global level.' Some of the suggested 2020 global milestones in this report include:

  • All countries have inclusive institutional mechanisms in place to coordinate an intersectoral health workforce agenda.
  • All countries have established accreditation mechanisms for health training institutions.
  • All countries are making progress on health workforce registries to track health workforce stock, education, distribution, flows, demand, capacity, and remuneration.
  • All bilateral and multilateral agencies are strengthening health workforce assessment and information exchange.

Child Health and Health Systems

The organization and function of health care delivery systems are an increasing focus of the global community. Concurrently there is recognition of a disconnect between professional training programs and how they prepare graduates to work within and influence operation of the health care system. The influential Lancet Commissions report on Health Professionals for the 21st Century, identified the need for greater strategic planning and interaction between education of the health workforce and the health care delivery systems if there is to be effective impact on health outcomes.

The Proposed Initiative on Workforce and Health System Performance (WaHSP)

In 2017, IPALA sponsored a workshop in London, England to focus on child health workforce and how to link workforce data to country level education and service needs and strengthen strategic planning and advocacy around health system performance. The workshop identified the clear need to a better understanding of the pediatric workforce globally and hence better tailor training and pediatric support in regions of greatest need.

IPALA WaHSP Initiatives

  1. Establish a workforce and health system performance (WaHSP) working group that links to existing global expertise able to advance knowledge and support strategic national issues related to child health workforce and health systems performance.
  2. Establish an advocacy presence in global discussions and initiatives related to child health workforce and health systems performance.
  3. Develop competency-based training modules on workforce and health system performance that can be incorporated into pediatric residency programs and continuing professional development programs.
  4. Support the development of pediatric expertise in national workforce and health system performance through establishment of a pediatric fellowship program (WaHSP Fellows).

References

  1. Global strategy on human resources for health: workforce 2030. 16059 Global Strategy Workforce 2030, WHO. https://www.who.int/health-topics/health-workforce#tab=tab_2
  2. Julio Frenk J, Chen L, Bhutta Z et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 9756; p1923-1958
  3. Skochelak SE, Lomis KD, Andrews JS, Hammoud MM, Mejicano GC, Byerley J. Realizing the vision of the lancet Comission on Education of Health Professionals for the 21st Century: Transforming medical education through the Accelerating Change in Medical Education Consortium. Medical Teacher 43(2):51-56 2021.
  4. WHO Fifth Global Forum on Human Resources for Health – Key areas for action and the way forward. https://cdn.who.int/media/docs/default-source/health-workforce/5gf/fifth-global-forum-on-hrh-outcomes-two-pager.pdf

Our publications

  1. Harper BD, Nganga W, Armstrong R, Forsyth KD, Ham HP, Keenan WJ, Russ CM. Where are the paediatricians? An international survey to understand the global paediatric workforce. BMJ Paediatr Open. 2019 Jan 31;3(1):bmjpo-2018-000397. doi: 10.1136/bmjpo-2018-000397
  2. Harper BD, Nganga W, Armstrong R, et al. Global Gaps in Training Opportunities for Pediatricians and Pediatric Subspecialists. Acad Pediatr. 2020 Aug;20(6):823-832. doi: 10.1016/j.acap.2019.12.002.

WORKING GROUP MEMBERS

  • Trupti Joshi - Associate Professor, Department of Pediatrics, Government Medical College, Aurangababad, Maharashtra, India.
  • Narmada Ashok - Director and Consultant Pediatrician, Nalam Medical Centre & Hospital, Sathuvachari, Velore, India
  • Sanjiv Lewin - Professor, Paediatrics, St. John's Medical College and Hospital, Bangalore, 560034, Karnataka, India.
  • Dharmagat Bhattarai - Chief, Division of Immunology & Ped. Rheumatology Advanced Centre for Immunology & Rheumatology (ACIR), Nepal
  • Haroon Saloojee - Professor, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
  • Amy Gray - Associate Professor, Paediatrics, The University of Melbourne, Melbourne, Australia
  • Bruder Stapleton - Emeritus Professor, Departments of Pediatrics and Global Health, University of Washington, Seattle, Washington, USA
  • Bob Armstrong - Emeritus Professor, Department of Pediatrics, University of British Columbia, Vancouver, B.C. Canada and Department of Pediatrics, Aga Khan University, East Africa