Human resources – the lack and poor use thereof – topped the healthcare challenge chart, as voted for by Salzburg Global Seminar session participants yesterday afternoon.
Heated debates arose as participants reported back to the full room. Should “patients’ needs” be added to “patients’ preferences”? Could the issue of staff competency be considered in the same human resources issue bracket as the inadequate numbers of staff? Once the participants – from such wide-ranging backgrounds as physicians, academics, government officials and donors – had negotiated and agreed upon the nuances of the challenges, they were then asked to vote on what they believed were the two greatest challenges they faced in improving healthcare.
Coming out resoundingly on top with 17 votes was human resources, including but not limited to inadequate numbers of health care workers, high turnover, maldistribution geographically, staff morale and unfilled training needs. Community and civil society involvement followed with 16 votes; this issue called for more civil society engagement and client-focus in advocacy, feedback, public protection and responsiveness. In third place was poor planning, encompassing lack of comprehensive operational plans, vertical programs that lack integration and inadequate harmonization of donor programs. Designing a system to meet patient preferences and needs and facilitating the process of addressing different perceptions of quality among providers, policymakers and the public both garnered 12 votes.
Lagging behind were limited capacity and capability to implement QI strategies – 7; leadership behavior – 6; involvement of patients and staff in the process of improving care – 6; absence of QI skills in the head of frontline managers – 6; inadequate information and poor communication – 6; interface of strategy and implementation – 4; optimization of technical skills – 3; poorly articulated arguments to donors and decision makers about the value of improvement and the costs of poor health – 2; and finally inadequate leadership with just one vote.
Talking Point: Donors in Healthcare
One issue that was raised in the day’s sessions was that of the role of donors in healthcare improvements. Several participants shared their views with Planning Committee Member Sylvia Sax.
“I don’t want donor money because it has strings attached.”
“Donors want short term solutions. When the money is gone after two years, we cannot continue the programs put in place.”
“Donors come with their own solutions and expect them to be implemented. ”
“Donors put in parallel initiatives and reporting systems.”
SGS editor Louise Hallman asked donor representatives for their response.
“An intrinsic part of what donors are trying to do is support the governments, not to impose a specific agenda. Intrinsically, improvement has got to be owned by the government, by the country itself. And the solution is a product of dialogue between the donor and the country. ”
Jim Heiby, Medical Officer and Contracting Officer’s Technical Representative, USAID Health Care Improvement Project, Washington, DC, USA
“Anything we do needs to be something that’s needed by the government and that they would like...
The role of the donor is several fold: we can provide resources, in the form of money or in the form of technical inputs. But we can also use voice, often at a global level to try and move an entire sector a specific way...
I think the best way we can have an affect and have impact is to support a country’s leadership and to try and leverage each other. We shouldn’t be independently investing here, there or wherever. The whole needs to be greater than the sum of its parts...
So it’s about integrated work, led by governments.”
Mary Taylor, Senior Program Officer, The Bill and Melinda Gates Foundation, Seattle, USA
“One of the important things for donors is to know the real situation of the governments, or what is going on in healthcare, what priorities there are, what exact problems there are, what the priorities of the ministry of health are. And then it’s very important to communicate with them and involve them in the process from the beginning...to help get them on your side while you are implementing something you know will be good for them and it will be easier to transfer to them after you leave.”
Shirin Kazimov, Health Project Management Specialist, USAID, Azerbaijan
Monday afternoon’s session, led by Sheila Leatherman, Research Professor at Gillings School of Global Public Health, University of North Carolina, USA, saw participants to split into groups to identify challenges in two categories: how to improve quality and how to improve healthcare system delivery.