Human Resources Strategy for the Health Sector in Eritrea: 2006-2010

Human resources strategy for the health sector in Eritrea: 2006-2010

September 2005

Research and Human Resource Development Department

Ministry of Health, Eritrea

Table of contents

List of tables and figures 1

List of abbreviations 2

Foreword 3

Executive summary 5

Introduction 7

Situation analysis 7

Key strategies 20

Implementation of the strategies 24

Risks and assumptions 28

Resourcing the plan 30

Monitoring and evaluation 32

Implementation of the strategy 34

Annexes 36

Annex 1: Staffing norms for health facilities 37

Annex 2: Distribution of key health cadres by zoba, referral hospitals and head 39

Annex 3: Details of staffing projections for doctors, nurses, associate nurses and pharmacists 40

Annex 5: Structure of the Department of Research and Human Resource Development 47

List of tables and figures

Table 1: Health facilities in Eritrea by type and by owner 10

Table 2: MoH owned facilities by type and by zoba 10

Table 3: Number of staff by profession/qualification employed by the MoH in 2004 11

Table 4: Vacancies of key staff groups in ‘operational’ roles using new staffing norms 12

Table 5: Health professional to 100,000 population ratios for Eritrea and selected African countries 12

Table 6: MoH staff (professional and support) at zoba, referral hospital and headquarters 12

Table 7: Distribution (in percent) of key health personnel by zoba compared with distribution of population 13

Table 8: Sex of nurses by job level 14

Table 9: Distribution of staff by age for key cadres 14

Table 10: Losses for nurses, by reason and year 15

Table 11: Expected year of achieving target for number of key cadres by 2014 16

Table 12: Intake of doctors to the School of Medicine (actual and projected) by year 17

Table 13: Current training intake (2005 – 2008) for the College of Nursing and Health Technology 19

Table 14: Recommended annual training targets for key cadres 22

Table 15: Major human resource strategies by aim and related actions for 2006 – 2010 25

Table 16: Key assumptions associated with the strategies 28

Table 17: Tasks supporting the strategies and major funding or gaps as of September 2005 30

Table 18: Indicators for monitoring and evaluation of the strategy 34

Table 19: Annual review and revision cycle for the HR strategy 2006-2010 and responsibilities 35

List of abbreviations

CSA Civil Service Administration

DG Director General

HAMSET World Bank-funded programme on HIV/AIDS, TB and malaria

HAMSET II follow-on programme from HAMSET (plus RH and HR components)

HMIS health management information system

HR Human Resources

HRD human resource development

MOD Ministry of Defence

MoH Ministry of Health

NGO non-government organisation

PHARPE Public Health and Rehabilitation Program of Eritrea

PHC primary health care

R&HRDD Research and Human Resource Development Department

RH reproductive health

SSA sub-Saharan Africa

TBA traditional birth attendant

USAID United States Agency for International Development

WHO World Health Organization

ZHMT Zoba Health Management Team

Foreword

It is often said that the staff who work in the health service its greatest asset. At a time when significant efforts are being made to strengthen the health services of Eritrea, it is imperative to ensure that there is a coordinated approach to developing and managing the staff of the health services. This strategy document on human resources is therefore most timely.

Although the majority of health services are provided by Ministry of Health personnel, other providers are making an increasing contribution. It is therefore important that the human resources strategy covers the whole sector.

It is recognised that at the time of developing this human resources strategy there is some uncertainty about the future. The planners have therefore been careful to identify the assumptions that they have used in developing a strategy. As these may change during the period of the strategy, it is important that they are closely monitored and that any changes are reflected in revisions of the staffing projections and the associated strategies and targets. This strategy has been developed on the basis of the best available data on the staffing situation. As this data improves, particularly on non-government service providers, modifications may be necessary including in the training targets.

It is important that planning for human resources is integrated with the planning of service delivery. It is therefore fortuitous that the HAMSET programme, which covers four years of the period of this strategy, combines a well funded human resource component with service delivery components.

This document is a good start in the process of strengthening human resources in the health sector. However, it is only the first step. The strategies need to be translated annual action plans. In some cases additional funds will be needed to support some other strategies. And the overall strategy needs to be reviewed and revised on a regular basis in order to ensure that it remains appropriate to the needs of the health sector at the time.

Signed

Mr Saleh Meky,

Minister of Health,

Government of Eritrea

Executive summary

The purpose of this strategy is to guide the planning, management and development of human resources for health in Eritrea for the period 2006 - 2014.

Whilst much progress has been made with the staffing of the health services in the health sector, there is still more work to be done. There is a general shortage of health professionals, particularly amongst more highly skilled groups. Although geographic distribution is relatively good compared to many countries in Africa, there are still health stations and health centres that are under-staffed. There is a major shortage of midwives, exacerbating the high rate of maternal mortality.

The following major areas relating to the planning, management and training of human resources in the health sector in Eritrea need to be addressed:

1.  the number of staff available to provide health services

2.  the equitable distribution of staff

3.  the quality and performance of staff

4.  the capacity of the MoH and others in the sector to plan for, manage and develop appropriate staff to deliver the required health services.

The overall aim of the plan is to increase the number of appropriately skilled, motivated and equitably distributed health service providers for Eritrea.

The main focus of the objectives to achieve this aim will be on:

1. a coordinated approach to planning across the sector
2. increased number of equitably distributed staff
3. increased performance of staff
4. increased capacity to plan for and manage human resources.

Based on agreed staffing norms and a number of clearly stated assumptions, staffing projection have been made to the year 2014. The targets and expected achievement are given the table below of the key cadres.

Cadre / Target at 2014 / Expected achievement
Doctors (GMP) / 215 / by 2015
Specialists / 172 / only half filled by 2014
Nurses and midwives / 2095 / 285 short 2014
of which Midwives alone / 318 / by 2007
Associate nurses / 3481 / by 2015
Junior lab technicians & CLS / 339 / by 2014
Pharmacists technicians / 132 / by 2009

The main strategies, by objective, of the plan are:

1.  a coordinated approach to planning across the sector

1. by ensuring human resource planning is coordinated across the health sector and is based on the best available data
2. increased number of equitably distributed staff increasing training output by expanding the number of training places available through
3. increasing the number of applicants for training by widening participation, to ensure that groups of school leavers who might not normally apply for training are encouraged to do so.
4. improving ways of attracting and retaining staff particularly in remote rural areas
5. improving staff productivity (This could reduce the number of staff needed for certain activities. Improving productivity is also covered with other staff performance issues below.)

3.  increased performance of staff

1. improving the quality of pre-service training
2. improving the quality and cost effectiveness of in-service training (particularly training provided by specific programmes) by the coordination and the evaluation of in-service training
3. improving staff performance by providing managers with appropriate tools
4. increased capacity to plan for and manage human resources.
5. strengthening general management skills at all levels
6. strengthening the capacity of the R&HRDD and heads of facilities to develop and implement policies and strategies for the improving the staffing of health services. The implementation of all these actions will be time-consuming work needing much time of HRDD staff and many operational staff too.

A risk analysis of the plan has been carried out and key assumptions for its successful implementation are stated.

A monitoring and evaluation framework is included in the plan.

The plan is currently well financed, but the gaps have been identified and additional funding will be needed.

The plan has been developed on the best available information on the staffing situation and the policy context. This information will undoubtedly change, and the plan will need to be revised accordingly. In order to ensure that the plan remains relevant, this revision exercise should be carried out on an annual basis.

Introduction

The purpose of this strategy is to guide the planning, management and development of human resources for health in Eritrea. As well as the Ministry of Health, other government departments, faith-based organisations (FBO), non-government organisations (NGO) and the private sector provider health services and are therefore employers of health personnel[1]. Therefore this strategy covers the whole of the health sector. The strategy spans the period 2006 to 2010, though some of the decisions relating to training are based on ten-year projections.

As with all planning there is some uncertainty about the future and various assumptions have been used in developing the plans. These assumptions need to be reviewed regularly. The implementation of strategies described in this document may be delayed for one reason or another, and re-scheduling will be necessary. Therefore, the intention is that the strategy should be reviewed and revised on an annual basis.

Leadership for development and implementation of the plan is the responsibility of the Research and Human Resource Development Department (R&HRDD) on behalf of the Ministry of Health.

This strategy is based on an analysis of data from the Staffing Inventory[2] (2004) and some data from the current personnel database. Additional information is drawn from a rapid review of the human resource situation conducted in December 2004[3]. It also builds on the HR planning undertaken in 2001-2002 that led to the establishment of three associate nurse training schools outside Asmara. A first draft of the strategy was derived from a four-day retreat of the R&HRD department in April 2005. This was revised after further in-depth data analysis and staffing projections in August and September 2005 and includes feedback from a stakeholder consultation workshop conducted in early September 2005.

This document contains sections on:

·  a description and analysis of the current staffing situation of health services in Eritrea

·  the broad strategies for the next five years

·  the main risks and assumptions associated with the strategies and related actions

·  the resourcing of the plan

·  monitoring and evaluation for the plan

·  the implementation of the strategy.

More detailed supporting information, including staffing projections for key cadres, is provided in the annexes.

Situation analysis

Eritrea has been in a protracted phase of reconstruction since it gained independence in 1991. Since that time the economy has suffered for a variety of reasons. Though it is currently in recovery mode, the gross national income per capita is only US$180. Reforms are being implemented to strengthen the public sector and specific reforms of the Civil Service Administration (CSA) will have an impact on the management of human resources employed by the MoH. In the health sector the government is rebuilding and expanding its infrastructure and following a policy based on primary health care. The government has a programme of decentralisation to the zoba level and there has also been deconcentration within the MoH to zobal level.

The current health status

Significant progress has been made in improving health status in the recent past. For example the immunisation rate of 75.9% of children 12 to 23 months is one of the highest in region, and there has been a remarkable reduction in malaria mortality and morbidity[4]. However, Eritrea still faces some significant health challenges. For example, the current maternal mortality rate of 752 per 100,000[5] live births is very high and is caused in part by the fact that only 28% of deliveries were by a skilled birth attendant and although the overall adult HIV prevalence rate is low, it is high in certain geographic locations and populations.

Health services in Eritrea

The Government of Eritrea is drafting a new heath sector policy. This is likely to emphasise equitable provision of basic health services and priority is given to the control of infectious diseases, especially HIV/AIDS/STI, TB and malaria. A draft National Sexual and Reproductive Health Policy has also recently been prepared, the Ministry of Health is scaling up successful HIV/AIDS interventions to a national level and increase its coverage of the DOTS programme to tackle TB.

The main provider of health services in Eritrea is the Ministry of Health. There are three levels of care in the government health system:

·  Primary Level include Health Stations, the first contact for health services and the smallest health units, staffed by a registered nurse, a dispenser and associate nurses. They provide mainly preventative care focusing on immunization, antenatal care, control and care of communicable diseases, health education and basic curative services. Health Centres are larger than Health Stations. They have 25-30 beds and provide curative and preventative care, including polyclinic services, mother and child clinics, environmental sanitation, epidemic disease control and outreach services. Health Centres are staffed by nurses and nurse-midwives, a laboratory technician, pharmacy technician, public health technician, and a number of Associate Nurses. Staff at the health centres also supervise Health Stations and provide training to Community Health Agents and Traditional Birth Attendants. The MoH’s future plan is to upgrade Health Centres to a level of Community Hospital/1st contact hospital, depending on service areas.