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HRH policy, management and information Equally nominated were issues concerned with HRH policy, management and information (column 2) with concerns mostly being expressed in terms of ‘lack’ or ‘absence’. Most nominated (9 countries) was the absence of an effective workforce plan or strategy. Closely related to the issue of workforce planning was the need to establish effective information systems, including updating job descriptions and developing performance management systems (nominated by at least three countries). In addition, issues around exit management, succession planning, research into the most effective use of limited resources, and the lack of trained experienced leadership were also nominated. The absence of, or inadequacy of, standards, regulations and competency frameworks were identified by five countries. Developing health workforce policies and operationalising workforce management strategies are considered difficult to implement, as the participant from the Cook Islands commented, having spent a couple of years developing and drafting a workforce plan, they were denied funding by their own government in 2010 and by NZAID in 2011. Education and training The area of education and training (column 3) was also nominated by all countries (although FSM only briefly referred to this issue with the phrase ‘trained staff’). Six countries (Niue, Kiribati, Vanuatu, RMI, Tokelau and Cook Islands) focused on student numbers and courses currently on offer as areas of concern. Other issues identified included small numbers of people applying to study, low intake numbers, and small numbers of graduating students. Closely related were issues concerned with poor pre-vocation educational preparation in secondary schools (nominated by Nauru, RMI and Samoa), restrictive entry requirements, and length and costs of completing courses. Another group of training issues identified by participants were those concerned with access to education. Absence of local training colleges and institutions, limited access to health courses, limited in-service training and professional development were nominated by six countries. Finally, at least five countries focused on funding and planning of courses and future training as important issues. FSM, for instance, described a dental program as a new program which was in need of both technical and financial support. Public service conditions of employment Working conditions within the public health sector were nominated by nine countries. Attention focussed primarily on the issue of salaries for health workers (nominated by six countries), with concern expressed about current levels of salaries and the need for incentives. RMI, for instance, described its salary structure as ‘ancient and inflexible’. The negative effects of a low retirement age on the health workforce, the absence of incentives, and poor working conditions more generally were also identified. Emigration While all the categories described thus far have been relatively straightforward, the same cannot be said of the final category of emigration. Of the seven countries who nominated emigration, only two indicated the precise nature of their concerns. In the case of Samoa, it was not emigration itself which was seen to be the problem but that the qualifications of Samoans working abroad were not being recognised and that destination countries appear to be ignoring the conditions of bilateral agreements. In the second case, the Solomon Islands, with minimal emigration (Connell 2010) identified the movement of health workers from rural to urban areas (internal migration), difficulties encountered when ‘posting’ people to outlying areas, and attraction ‘to the bright lights’. The contributions of the remaining five countries display varying degrees of ambiguity. First, given that Tokelau does not exhibit a rural/urban distinction and that it has a very small population, it seems reasonable to assume that it is emigration, along with career changes, which is impacting on Tokelaun HRH. Second, despite nominating migration, neither FSM nor Tonga indicated whether their concerns were with out-migration, internal migration, movement from public sector to private sector, or some combination of these different forms of ‘migration’; or indeed, whether, like Samoa, it is not migration itself which is at issue, but a particular aspect of the process. Third, the two remaining countries (Cook Islands and RMI) indicated unambiguously that emigration was an issue they currently face; however, again it cannot be said with absolute certainty what aspect/s of emigration is/are of concern. Nevertheless, it is worth noting, that the Cook Islands referred to ‘competition from highincome countries’, pointing to the disparity between levels of local HRH salaries and those on offer overseas, and its impact on their health sector. 10 HRH issues and challenges in 13 Pacific Islands countries: 2011 Doyle et al.
SECTION 4. NEEDS AND PRIORITIES Having described a selection of current HRH situations, obstacles, issues and challenges, each country then identified what they believed was needed to help alleviate problems within their health sector. Participants focussed primarily on two areas – health workforce policy, management and information; and education and training. Twelve of the 13 countries identified at least one aspect of health workforce policy, management and information where it was felt that some sort of action was needed. In one way or another most countries nominated workforce planning as an area requiring attention. This was followed by management needs such as addressing leadership issues, strengthening management skills, and developing policies and procedures (five countries). Similar numbers of participants focussed on stakeholder and donor support, with FSM suggesting the World Health Organization (WHO), Japan International Cooperation Agency (JICA) or PHRHA provide in-service training. Kiribati requested technical assistance with workforce plan analysis, Vanuatu stressed the need for increased political commitment and advocacy, and Niue highlighted the importance of establishing a sustainable funding mechanism. Palau identified their need for an AusAID volunteer for two years to assist in the creation of an HRH office staffed with appropriate personnel. FSM, Samoa and the Solomon Islands focused on the need to develop reliable information systems, while Tonga and Vanuatu sought to revise regulations, develop competencies and standards and establish an accreditation mechanism to facilitate health worker movement. Remaining needs drew attention to raising the age of retirement to 60, reviewing compensation levels, and conducting gap analysis. Slightly fewer (10 countries) nominated education and training as an area of need. Five countries focussed on training in general, drawing attention to such issues as the need to develop programs, to build capacity and to address an ageing workforce. Intake numbers were nominated by three countries, with the Cook Islands wanting to increase the undergraduate nursing intake to 12 per year for five years, and Kiribati hoping to increase its medical assistant intake from 9 to 12. The provision of scholarships, and professional development were each nominated by three countries. Again the Cook Islands focused on maintaining the number of Bachelor of Medicine/ Bachelor of Surgery (MBBS) scholarships at two per year, and the RMI wanting to create a scholarship scheme. Finally, RMI highlighted their need to increase the number of nurses at bachelor and master degree levels. Participants focussed primarily on two areas – health workforce policy, management and information; and education and training. The issue of pre-service education was identified (again by three countries) as an important area in need of review. Upgrading skill levels of students leaving high school and revising high school curriculum to reflect HRH course entry requirements were among the needs identified by RMI, Niue and Samoa. Closely related to the issue of prevocational education was that of obtaining support funding for improvement of high school education and training programs as suggested by Kiribati. Not surprisingly, priorities for the PHRHA to assist with tended to mirror the needs previously identified, although greater emphasis was placed on education and training (8 countries) compared to policy, management and information (4 countries). The most distinctive feature, however, was the call for support from PHRHA in obtaining technical assistance (8 countries) and funding (4 countries) in order to fulfil their education and training, and policy, management and information needs. Participants concentrated on the need for support in establishing partnerships, developing networks of local personnel of member countries to assist each other, and establishing links with relevant advisory experts, trainers and resource personnel. Participants also sought assistance in developing training programs, establishing workforce plans, carrying out succession planning and establishing standards and competencies. Despite six participant countries identifying salary levels and/ or structure as an issue of concern, only three (Fiji, Niue and Tokelau) made specific reference to it in their needs and priorities. Given that participants had only a short amount of time allotted in which to outline their concerns and needs, as well as limited space (overheads), it could be that this issue, and the overarching issue of working conditions more generally, were included within other categories (for instance RMI specified the more inclusive need to develop career pathways for each health worker). Similarly, in regard to the issue of migration, only Tonga included it among its needs and priorities, and then only in a very general manner. HRH issues and challenges in 13 Pacific Islands countries: 2011 Doyle et al. 11
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 and 10: SECTION 2. METHODOLOGY Prior to the
Page 11: SECTION 3. PERCEIVED HRH ISSUES AND
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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