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Rather than forcing responses to the questions of issues, challenges, needs and priorities into given categories, we have focused instead on their substantive content and identified themes as they emerge from the data. Towards the end of the forum Chan (2011a) 13 reported back to participants with a brief impressionistic overview of the country presentations. Elsewhere (2011b) 14 he has summarised issues raised at the meeting according to the entry/existing workforce/exit framework suggested by PHRHA. With regard to the present discussion, it is noteworthy that the table he provides shows that at least seven countries felt the need to identify one crucial and fundamental issue not explicitly covered by the framework; that of staff shortages. Responses within each theme, as well as across themes, have been compared to ensure consistent subject categorisation. Areas and themes, however, are not mutually exclusive and there is considerable overlap between many of them. For example, among its Needs and Priorities responses Vanuatu identified ‘the development of training’. Within our analysis this item has been categorised in the Policy, Management and Information subject area. Nevertheless, there are clear links with the Education and Training area. As noted earlier the data have been derived from each participant’s PowerPoint presentation. Not surprisingly, this has occasionally resulted in fragmented and cryptic responses. Data have been excluded from the analysis where the meaning is not clear. In regard to the approach adopted in this paper, we have taken our cue from the participants. First, we have made no assumptions about the adequacy of workforce numbers or otherwise, and as a consequence, second, have temporarily set aside the suggested HRH framework. Rather than forcing responses 15 to the questions of issues, challenges, needs and priorities into given categories, we have focused instead on their substantive content and identified themes as they emerge from the data. Adopting this approach has broadened the scope of the analysis and allowed for in-depth discussion of issues and needs to be based on country responses. Analysis of the data began by grouping responses into broad subject areas (for example, workforce, education and training, migration). Themes within each area were then identified (for example, within the subject area of workforce themes such as staff shortage, recruitment, and so on). They were then aggregated and ranked to indicate which were of most concern overall. Patterns and thematic trends were also identified in this way within the Needs and Priorities responses. 13 Chan, Eric (2011a) Reporting Back, paper presented at meeting Draft Framework for Action on HRH 2011-2015, 10 February 2011, Nadi, Fiji. Powerpoint presentation. 14 Chan, Eric (2011b) Draft Framework for Action on HRH 2011-2015, 10 February 2011, Nadi, Fiji. Powerpoint presentation. 15 The term response is used throughout this paper to refer to participants’ identification of issues, challenges, needs and priorities as specified in their PowerPoint presentations. 8 HRH issues and challenges in 13 Pacific Islands countries: 2011 Doyle et al.
SECTION 3. PERCEIVED HRH ISSUES AND CHALLENGES Table 3 and Appendix Table 2 have been compiled from the 13 country reports presented at the forum. Table 3 presents a summary of country contributions, while Appendix Table 2 provides more detail. Participants had been asked to nominate at least five HRH issues and five HRH challenges that were currently being experienced. Given that the notions of issue and challenge are overlapping and that formal definitions of each were not provided by PHRHA, for ease of reading the participants’ perceptions have been collapsed into one table and grouped according to broad subject focus. The following five areas of concern emerged: health workforce; HRH policy, management and information; education and training; public service conditions of employment; and emigration. Health workforce One of the most nominated areas of issues and challenges was that of the health workforce (column 1), with all countries nominating at least one sub-topic within this area (see Appendix Table 2). Of most concern to participants was current shortages of skilled, qualified and experienced health workers (nominated by seven countries), followed by the retention of health workers (nominated by six countries), the recruitment of health workers and an ageing workforce and population (both nominated by four countries). Kiribati cited current staff shortages resulting in 53 unfilled positions within its nursing service. Niue also referred to shortages of not only locally trained nurses and doctors, but also pharmacists, radiographers, physiotherapists and laboratory workers. The remaining areas of concern in this domain were: limited finances and funding, skills imbalances, difficulties imposed by geographic distance, heavy workloads, and the negative impact of government reforms on workforce numbers. With regard to the challenge of geographic distance, Kiribati, for example, drew attention to how large geographic distances between islands increased the costs of relocating staff, citing an instance where relocation costs for one staff member and their family amounted to AUD$2,000. TABLE 3: SUMMARY OF HRH ISSUES AND CHALLENGES Health Workforce HRH Policy, Management and Information Education and Training Public Service Conditions Emigration 1 2 3 4 5 Cook Islands ü ü ü ü FSM ü ü ü ü Fiji ü ü ü ü Kiribati ü ü ü ü Nauru ü ü ü ü Niue ü ü ü ü Palau ü ü ü ü RMI ü ü ü ü ü Samoa ü ü ü ü ü Solomon Islands ü ü ü ü ü Tokelau ü ü ü ü ü Tonga ü ü ü ü Vanuatu ü ü ü HRH issues and challenges in 13 Pacific Islands countries: 2011 Doyle et al. 9
Page 1 and 2: hrh issues and challenges HUMAN RES
Page 3 and 4: Contents 2 Acronyms 3 Executive sum
Page 5 and 6: EXECUTIVE SUMMARY INTRODUCTION Back
Page 7 and 8: TABLE 1: SELECTED DEMOGRAPHIC AND S
Page 9: SECTION 2. METHODOLOGY Prior to the
Page 13 and 14: SECTION 4. NEEDS AND PRIORITIES Hav
Page 15 and 16: Most discussions of the precise imp
Page 17 and 18: Developing bridging courses and out
Page 19 and 20: REFERENCES Australian Agency for In
Page 21 and 22: APPENDIX 1 TABLE 1: SELECTED INFANT
Page 23 and 24: MMR (per 100,000 live births) UNICE
Page 25 and 26: Health Workforce Policy, Management
Page 27 and 28: Health Workforce Policy, Management
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Page 31 and 32: The Knowledge Hubs for Health Initi

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