Eastern Mediterranean Region Observatory on Human Resources for Health

• What is EMR Observatory on HRH?

• Purpose

• Rationale

• Objectives

• Potential benefits

What is EMR Observatory on HRH?

The EMR Observatory on HRH is a dynamic forum used to generate evidence for policy analysis and planning. It is part of the existing Health System observatory designed to debate, and address some pressing challenges, including migration and retention, scaling up, regulations and incentive schemes among others.  

The EMR Observatory on HRH should be also viewed as a governance tool to complement HS observatory for continuously collecting, updating and disseminating key HRH information into one consolidated electronic source. The EMR Observatory on HRH is an integral part of the EMRO health system observatory, which has been specifically designed to meet the growing demand for informed health system decision-making. While the content of the regional EMR Observatory on HRH covers primarily country profiles pertaining to the health workforce (HW) dynamics, it offers an analytical platform needed for evidence-based HW planning with policy and regulatory implications.

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Purpose

The purpose of the Observatory is to assist Member States in using a proactive approach and sharing best innovative options to tackle HRH-related challenges. The observatory is not a static database or merely a collection of health workforce statistics but an up-to-date regional resource on numbers, significant correlations between major HW determinants, ratios with an operational and policy linkage to national benchmarks and regional targets. The EMR Observatory on HRH is therefore not intended only to disseminate information but rather to facilitate continuous sharing of best models that have worked well and successful experiences in resolving HRH-related problems.

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Rationale

Today, human resources for health are widely recognized as the key element for scaling up health interventions to achieve national goals and health-related targets of the Millennium Development Goals (MDGs). The health workforce accounts for 2% to 8% of the total labour force and more than 60% of national health care budgets in most countries. Therefore, evidence generation for informed policy- and decision-making is being sought by countries as part of an operational system with monitoring of progress in health workforce development in particular and health system strengthening as a whole. Precisely defining and describing HRH can help to identify opportunities and constraints for scaling up health interventions and improving the quality of health care services.

As stated in World Health Report 2006 http://www.who.int/whr/2006/en/, insufficient and imbalanced health workforce will continue to be a major constraint in attaining the MDGs for reducing poverty and disease. The challenges posed by HRH and the need for action and strategies to tackle them are also recognized. Experience to date has highlighted the urgent need for action to scale up HRH, which will require concerted efforts by Member States and all other partners. An effective action, both urgent and sustained, requires reliable and timely information, rational system analysis and a firm knowledge base. However, data analysis, research on human resources for health and technical expertise are still underdeveloped in many countries, in part due to low investment on human resources and health. National and regional learning processes must be launched to rapidly build the knowledge base – essential for guiding, accelerating and improving action. A culture of science-based knowledge building must be infused into the human resources community.

It is therefore recommended that basic information and data should be collected by all countries, backed by the Regional Office. Today, WHO is well positioned to fulfil its core responsibility for maintaining comprehensive global statistical systems, adopting standard definitions and collecting robust information on human resources

 As part of regional efforts towards upgrading national capacities in human resources development during the next decade, an action plan to respond to the health workforce crisis in the Region has been developed for 2008–2009. The action plan identifies key interventions, including gathering better intelligence through an HRH observatory to support country level efforts and strategies.

Although the collection of HRH information has already been developed in some countries, analysis, interpretation and presentation of HRH data are often still weak, leading to a dichotomy between the providers and potential users of information. Information is needed to improve the policy, planning, production and management of human resources for health; acquiring it is not an end in itself.

The experience of the Observatory of HRH in the WHO Region of the Americas has shown the observatory to be an effective tool to improve information and evidence generation and to increase advocacy for human resources issues. Similarly, successful development and use of HRH Observatory have been made within the context of the European Observatory on Health Care Systems, which has ensured good monitoring and analysis of health systems development in Europe. An EMR Observatory on HRH is therefore proposed to support country-level effort and strategies in order to address the strategic and operational issues pertaining to HRH.

In summary, the HRH regional observatory has been launched for the following reasons:

1. Knowledge base for policy analysis and informed decision making
2. Main input of national health budget (>50%)
3. First regional priority in WHO collaborative programs (RC Resolutions 41R10/45R12/48R2/49R11/53R11)
4. Direct link to burden of disease and key factor in achieving HS goals and MDGs
5. WHR 2006, EMRO resolutions, RC meetings and demand by countries
6. Globalization context and the push-pull factors

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Objectives

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Potential benefits

Strengthen HRH data and trend analysis at the country level
 

Despite the undoubted importance of human resources to the functioning of health systems, there is little consistency between countries as to how HRH strategies are monitored and evaluated. Overall, evidence-based decision-making would be facilitated by better use of HRH data sources.

Another issue of importance is the harmonization of data collection mechanisms and tools. Given that the roles and tasks of health occupations may vary between countries and in order to enhance cross-national and time-trend comparability, efforts should be made to harmonize data collection and processing methods, using internationally recognized standard classifications of occupations, industries and education.  

Developing and strengthening HRH information systems at country and regional level will therefore be one of the crucial functions of the observatories. This will involve identifying a core data set; developing guidelines for monitoring and evaluating HRH at national and sub-national levels; building and strengthening HRH analysis capacity; and supporting in-depth HRH assessment in countries.

Create and use HRH country profiles as part of the HS country profiles
 

One way to present HRH information is to develop HRH country profiles. These would serve as a tool for systematically presenting the HRH situation, policies and management. Country profiles would also facilitate information sharing and cross-country comparison. 

Standard template has been developed by HQ and has successfully been used in some countries recently. The national observatory will develop and regularly update the HRH country profiles.

Conduct in-country operations research and system-wide analysis
 

The research and analysis will have both national and regional components. At national level, policy alternatives will be proposed on the basis of analysis of core indicators, trends and policy impact. Collecting these data will make it possible to identify strengths and weaknesses of established monitoring systems and give feedback on areas for improvement. The information can be used to inform policy debate, identify problem areas in HRD, and, if previous years’ data are available, give an overall picture of trends in human resources stock and flows.

Studies will also be carried out according to the research priorities of the country concerned. These studies will be undertaken by the relevant and interested members of the national network. They will look at the impact of strategies and HRH implications of disease-based programmes.  

At regional level, the studies can be undertaken on common issues for all countries or a group of countries. The research will be carried out with the involvement of national observatories.

Use a dynamic forum for sharing and disseminating best lessons and practices among policy-makers
 

Various means will be used to communicate the research and analysis of the HRH observatories to policy-makers, such as regional forum, policy briefs, position papers and meetings. 

Annual regional and national meetings will provide opportunities to share information and to engage with policy-makers. Other opportunities, such as Regional Committee meetings and sub-regional meetings, will also be used.

National and inter country networking
 

The HRH observatory would ensure networking and communication between national stakeholders as well as with multilateral and bilateral agencies: It would provide a common platform and objectives, as well as opportunities for joint activities. These networks should not be perceived as administrative structures but as based on inter-linkages.

Similarly, national observatories would be linked to national observatories in other countries, with the possibility of sharing their experience and studies, as well as joint inter-country work.

Networking will be facilitated through videoconferences, electronic mail and well-maintained web sites. 
 

Institutional capacity building in HRH policy, planning and management
 

Capacity building is seen not only in the narrow sense of formal training sessions, but instead as including many types of activities inherent in the functioning of the observatory. The HRH Observatory will contribute to both institutional capacity and individual capacity building for HRH through its activities. Capacity for strategic planning and use of data analysis, trend analysis, equity analysis and monitoring and research will be developed in countries as part of its work.

The observatory will organize country-level and regional-level training programmes for different target groups, such as policy-makers, technical staff and academic staff. The subjects will range from policy issues such as macroeconomic and fiscal constraints, resource allocation and HRH policy development to technical issues, such as data analysis.

Because sustainability of these activities is considered crucial, strengthening national institutions and developing follow-up mechanisms for the formal training sessions will be emphasized. 

HRH expertise will be developed in the countries. A network of selected experts will facilitate the work of the observatory. The intention is to create a critical mass in the countries and the region to move the HRH agenda forward.

Organization of the HRH observatory

The EMR Observatory on HRH is envisaged as an integral part of the regional HS observatory. It is a partnership based on networking. A partnership will be developed involving national institutions and multilateral and bilateral agencies. Regional coordination of the networks is planned, in order to facilitate their functioning.

The EMR Observatory on HRH is planned to comprise:

• National observatories

• A regional secretariat

• Observatory board.

National observatories
 

National observatories will start in the countries where country action teams are established. The efforts will build on the country action teams and existing partnerships and involve other constituencies, such as academia, NGOs, professional associations and other stakeholders. The national observatory groups will monitor trends that have an impact on HRH policies as a shared agenda; undertake research/studies; share information to contribute to policy development; engage in policy dialogue; and contribute to capacity building.

The national observatories will be in constant communication. They will be motivated to promote the HRH agenda through a national day and annual meetings as well as other means of communication. International and bilateral agencies will also support national observatories.

A national focal point will facilitate planning and coordinating the work of the national network. The national focal point can be based in the Ministry of Health or one of the member institutions of the network. It is envisaged that the role of national focal point will be assumed by the country action team in the initial group of countries. The focal point will facilitate the work of the national observatory by identifying activity areas and responsible group members; ensuring dissemination of the results; organizing the national meetings and training activities; undertaking advocacy activities; and linking with the regional secretariat.

Regional secretariat

For the overall planning and coordination of the EMR Observatory on HRH and to facilitate inter country activities, a regional secretariat will be needed. The WHO Regional Office includes a three- five-member HRH and EIP team that may be augmented in the future. Considering the regional office's well-established interaction with governments and its focal points for disease-based programmes, it would be a natural host for the regional secretariat of the observatory. The regional secretariat is expected to:

• Facilitate the formation of national observatories

• Develop common guidelines and tools

• Ensure and coordinate inter country studies

• Ensure linkages with other health system interventions and disease-based activities.

• Ensure dissemination of inter country studies and sharing of national studies, and manage the web site

• Organize regional meetings and training programmes

• Facilitate the work of the board and ensure the implementation of the board decisions

• Coordinate and communicate with partners

• Mobilize resources and undertake fund-raising efforts.

The board of the observatory

As the observatory seeks international as well as national cooperation and partnership, it is expected that multilateral and bilateral agencies will contribute to the EMR Observatory on HRH. The board of the observatory is envisaged to comprise representatives of the agencies that contribute to the observatory. The joint HRH working group proposed to support country activities can serve as the board of the observatory, which would ensure the coherence of various efforts. The board will:

• Monitor the work of the observatory

• Identify policy directions and agree/advise on the priorities, annual plans and regional allocations

• Determine the inter country work, studies and capacity-building activities

• Oversee the work of the secretariat

• Participate in and support fund-raising.

Initiating the observatory

The national observatories are envisaged as starting in the countries where intensified country efforts are pursued by different agencies to form country action partnerships and teams. Based on the experience of the first group of countries, observatories will gradually be developed in other countries.

Country action teams will facilitate the formation of the national observatories by involving relevant and interested institutions, collaborating with them to identify work areas and developing work plans. 

Simultaneously, the regional secretariat will be formed and start to support the national observatories. It will ensure communication with the joint HRH working group in planning inter country activities with the participation of national observatories.
 

The initial common activities should include identification and adoption of a set of core indicators and development of guidelines for monitoring and evaluating HRH at national and sub national levels. Efforts should be made to build, improve and harmonize the available classification of health occupations, based on the International Standard Classification of Occupations. The priority study areas for management of HRH (i.e. recruitment, retention and motivation) will be another aspect of the work plans.

The national observatories will support country action teams in in-depth HRH assessment as part of the planned work. Some of the common activities for this purpose will be to upgrade and/or modify available questionnaires, methodologies and guidelines; and train key people in fostering the process of detecting and guiding the collection and systemization of data as well as undertaking some studies in identified areas.

Mechanisms will be established for sharing and disseminating the information. A web site will be maintained by the regional secretariat. Annual national and regional meetings will be organized. Other countries will also be invited to the regional meetings of the observatory for wider sharing, as well as to foster expansion of the national observatories.
 

At the end of the first year, national meetings will be organized in each country in order to share the work at national level.
 

The annual regional meeting of the observatory will be held to share the experience of the national observatories and the results of the inter country studies with a wider range of countries in the region. This will also provide an opportunity for self-assessment.
 

The board will also evaluate the progress and identify directions for the future annually.
 

It is envisaged that the number of well-functioning national observatories will increase. This would mean better information and evidence on HRH and more effective use of this intelligence in policy-making.