Human Resource Development for comprehensive TB control

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Human Resource Development for comprehensive TB
control

• Tenth Meeting of National Tuberculosis Programme
  Managers in the Eastern Mediterranean
  RegionMuscat, Oman, 12-14 June 2005
• Karin Bergstrom
• TB Strategy and Operations
• Stop TB Department, WHO HQ

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In this talk I will..

• Outline the vision, goal and strategies for HRD
  for comprehensive TB control
• Summarize the HRD problems
• Discuss consequences for NTP to reach and sustain
  the goal
• Discuss specific activities to be considered for
  the strategic planning

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Human Resource Development for comprehensive TB
control - What do we mean?

• Human resource development for comprehensive TB
  control sets a broader agenda including not only
  the organization of specific training courses but
  the overall management of training and other HRD
  activities
• It includes the availability of enough staff of
  the categories of personnel involved in
  comprehensive TB control at all levels, clinical
  and managerial, necessary to reach a specific
  long term goal for professional competence in
  comprehensive TB control.

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Global Strategy to Stop TB 2006-2015

• Pursuing quality DOTS expansion and enhancement
• Government commitment with long-term planning and
  adequate resources to reach targets
• Case detection through bacteriology and
  strengthening of laboratory network
• Standardised treatment, under proper case
  management conditions including DOT and patient
  support
• Effective and regular drug supply system
• Monitoring system for supervision and evaluation,
  including impact measurement
• Additional components
• 2 Addressing TB/HIV and MDR-TB
• 3. Contributing to health system strengthening
• 4. Engaging all care providers
• 5. Empowering patients and communities
• 6. Enabling and promoting research

Stop TB Department
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The vision for human resource development for
comprehensive TB control

• A world where health systems, public and
  private, has the adequate staffing with the
  relevant professional competencies, with the
  needed support systems to motivate staff to use
  their competencies to provide quality preventive
  and curative services for comprehensive TB
  control to the entire population according to
  their needs

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The goal for human resource development for
comprehensive TB control

• Staff at different levels of the health system
  have the skills knowledge and attitudes
  (professional competence) necessary to
  successfully implement and sustain comprehensive
  TB control services including the implementation
  of new and revised strategies and tools, in
  relation to new interventions (eg. HIV and MDR TB
  management) and quality assurance.
• There is a sufficient number of all staff
  categories involved in comprehensive TB control
  (clinical and managerial) at all levels of the
  health system. (the right persons, in the right
  numbers, at the right places, for the right jobs,
  in the right time Health Care HRD Oman, MOH)

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Global Policies
Strategies
Guidelines
Donors
Technical partners
Advocacy
Other priority programme
Other priority programme
HIV/AIDS programme
TB programme
Competent staff at all levels to implement
programmes' activities
IMPLEMENTATION
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Problems in HRD for comprehensive TB control

• Quality of the existing workforce
• Quantity availability
• Imbalances
• Shortages

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The problem quality

• Inadequate skills of existing staff
• many staff involved in comprehensive TB control
  are not trained
• sub-optimal training (in-service training) lack
  of specific measurable learning objectives,
  training material, inadequate length of training,
  poor use of adequate training methodologies, lack
  of learning evaluation)
• an assumption by trainers and managers that
  everything taught is learned and will lead to
  quality performance
• lack of attention to other factors influencing
  behaviour change of health care providers
• training is seen as a time limited activity and
  when the DOTS strategy has reached 100 coverage
  training is no longer needed - all have been
  trained
• inadequate pre-service training

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The problem - quantity

• Imbalances in human resources for comprehensive
  TB control
• Imbalances in overall numbers
• Imbalances in distribution
• Urban /rural
• Imbalances in skills or skill-mix (a mismatch
  between the type or level of training and the
  skills required by the health system)
• High turnover of staff

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The problem - quantity

• Shortages of human resources for comprehensive TB
  control
• Increased demand on existing staff - not only by
  TB programmes
• Impact of AIDS
• Low staff retention
• Low staff motivation
• Under-skilled (inadequate / infrequent training)
• Unsupported / lack of supervision
• Poor work environment
• Poor career structure
• Underpaid
• Overburdened
• Morale problems
• Sick or caring for sick family members
• Insufficient number of posts

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Performance
Factors influencing competence Job
descriptions Basic training In-service
training, Supervision Experience
Factors influencing motivation recognition,
love of work, career structure, seeing
results, social respect
Can do Competence
Will do Motivation
Factors keeping you salary, supervision, working
conditions, adequate work load, etc.
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Challenges for NTPs and technical support
agencies in reaching the goal for HRD for
comprehensive TB control

• Ensuring that existing staff in the health
  system, managerial and clinical, are competent to
  implement
• DOTS strategy
• New interventions to address TB/HIV and MDR-TB
• New strategies such as PAL
• Appropriate case identification and management
  when the disease becomes rare
• Ensuring that there is enough staff available

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Key strategies for NTPs to reach the goal

• Organize in-service training (clinical and
  managerial)
• Initial training in basic DOTS implementation
• Retraining (major performance problems- need more
  time than a supervisory visit to solve, e.g. a
  formal training course)
• On the job training (refresher small performance
  problems that can be addressed during a
  supervisory visit)
• Continued training (to gain more skills and
  knowledge not to go through the same again to
  practice skills for rare "happenings")
• Initial training on new skills (TB/HIV, PAL etc)
• Monitor and supervise
• to detect performance deficiencies
• to identify new staff in need of training
• to identify need for additional staff
• Co-ordinate and collaborate with
• other in-service training programmes e.g.
  HIV/AIDS
• Health System Management/Human Resources for
  Health Departments of MOH
• Strengthen pre-service training (Basic training)

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For NTPs this means addressing both quality
(competence) and quantity (staffing) aspects of
the health workforce with respect to
comprehensive TB control

• Quality/competence
• Job descriptions are based on task analysis
• Training courses/programmes have skills based
  learning objectives based on the task analysis
  and the job descriptions
• Training programmes/courses use methodologies and
  time allocation that allows participants to meet
  the learning objectives
• The ratio participants/facilitators in each
  course is at a level that allows participants to
  meet the learning objectives
• Evaluation is objective to ensure that the
  learning objectives have been met
• Plans for implementation of training
  courses/programmes are realistic to ensure
  quality. The capacity to train is limited in many
  programmes

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Quantity - know the staffing needs and the gaps

• Defined tasks to be performed at each level of
  the health system to implement the DOTS strategy
• Assigned tasks to specific categories of health
  workers
• Know the time needed to implement those tasks,
  particularly at peripheral level of the health
  system (where changes in the number of cases
  diagnosed and treated and assignment of new tasks
  have the biggest impact on the workload)
• Know how many staff of the respective categories
  needed to maintain the service delivery level
  necessary to reach and maintain the disease
  control targets
• Know the number of staff of the relevant
  categories are available at any point in time
• Work with departments for health system
  management (HRH departments) to fill gaps and
  develop the long term strategy to increase the
  number of posts if necessary

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Conclusion

• Having a competent workforce for comprehensive TB
  control must be seen, and managed in the broader
  perspective of managing the health workforce for
  better performance.
• This brings together the health and educational
  sectors to achieve three core objectives of human
  resource development competence, coverage and
  motivation.
• HRD for comprehensive TB control will never be
  "done" as programmes improve their performance
  HRD becomes more complex
• HRD needs long term management