Human Resource for Health (HRH)
Human Resource for Health is considered as one of the three principle health system inputs, with the other two major inputs being physical capital and consumables (World Health Report, 2000). In 2006, the World Health Organization (WHO) has identified Nepal as one of 57 countries with a critical shortage of human resources for health (HRH) (World Health Report, 2006). The health service professional ratio to 10,000 populations is 7 (doctors, nurses and midwives) in Nepal, a lot less than the minimum threshold of 23 for achieving health related millennium development goals (MDGs) i.e. MDG 4, 5 & 6 by 2015. On top of the acute shortage in number, Nepal’s Human Resources in Health is inequitably distributed, vulnerable to migration and poorly retained. There is an imbalance in the production and consumption of human resource in health. Rampant absenteeism is yet another serious problem, particularly in remote areas where the health workers are absent for a considerable length of time.
The National Health Policy 1991 has spelled out the importance and need of producing technically competent HRH in the country. Since then various policy and strategy documents of Government of Nepal (GoN) repeatedly identified issues regarding the deployment and retention of health sector staff as the major challenges in Nepal. The Nepal Health Sector Programme Implementation Plan (NHSP-IP) 2004-2009 has indicated HRH as one of the 8 outputs. In addition, Strategic Plan for Human Resources for Health 2003-2017 has been developed to address the issues of HRH for delivering essential healthcare services.
The most recently endorsed Human Resources for Health Strategic Plan 2011-2015 which was endorsed by the Cabinet during the duration of this Project aims to ensure ‘the equitable distribution of appropriately skilled human resources for health (HRH) to support the achievement of health outcomes in Nepal and, in particular, the implementation of NHSP-2. The plan contains a range of strategies and activities, captured under four main outputs:
- Appropriate supply of health workers for labour market needs;
- Equitable distribution of health workers;
- Improved health worker performance;
- Effective and coordinated HR planning, management and development across the health sector.
BNMT and HRH in Nepal
Production of technically sound and competent HRH of all categories and their deployment to serve in remote far-flung places has remained a great challenge in essential healthcare services delivery in Nepal. In this context, The Britain Nepal Medical Trust (BNMT) implemented a European Union funded 39 month project titled: “Human Resources for Health (HRH) mainstreamed in health systems through strengthened advocacy capacity of CSOs”. The project mainly focused on evidence-based advocacy for planning, monitoring and implementation of healthcare services. The project is aimed at increasing commitment at the policy and program level for effective provision and mobilisation of HRH throughout the country. This project was targeted towards policy/decision makers including civil society organizations (CSOs) to create awareness and seek commitment for improved HRH in general and Adolescent Sexual and Reproductive Health (ASRH) service in particular at all levels.
During the 39 month duration of the Project 01.02.2011 – 30.04.2014, much has been achieved by the project.
Besides evidence based advocacy, organising meetings, workshops and conferences at the central level to increase awareness on HRH, the project, the establishment and mobilisation of 20 youth information centres in 10 districts (1 in health posts + 1 in local schools) as well as the National and district level CSO/NSA Alliance on HRH are some of the achievements of this project.
CSO/NSA (Civil society organisations/non state actors) Alliance on HRH was formed as a National Consortium on September 2011 with the intention of advocacy on HRH. The central level alliance meets regularly for institutionalisation of the alliance, developing working guidelines, action plan and plan execution. The members of the Governing Body of CSO/NSA Alliance on HRH include representatives from various spheres (academia, CSOs and professional organisations). In addition, district level alliances were formed in each of the working districts. An example of the work of the HRH Alliance in Panchthar district is provided below.
One of the first activities of the HRH Alliance was to organise an interaction meeting with the Panchthar district hospital development committee where the major issues related to HRH management was identified through a SWOT analysis of the district health facilities. The report was then shared by the Alliance with the Chief District Officer (CDO) who immediately took prompt action in ensuring that sanctioned positions of doctors were filled. As a result, Panchthar is amongst the few districts in the mountain region where all of the three sanctioned positions for doctors have been filled. The Panchthar Alliance at present is also working with VDC secretaries who have expressed their commitment towards the allocating resources and ensuring that local resources are utilised for HRH to ensure quality delivery of health services throughout their VDCs.
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