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APPENDIX 2 TABLE 2: HRH ISSUES AND CHALLENGES BY COUNTRY Health Workforce Policy, Management and Information Education and Training Public Service Conditions Emigration (1) (2) (3) (4) (5) Cook Islands • Ageing • Recruitment: difficulty recruiting for outer islands • Lack of HRH ... planning/ investment/professional development • Limited financial resources • Lack of funding for MoH Workforce Development Plan 2010-2020 • Establish Health Professionals Council • Update legislation for Health Practitioners Competence Assurance Act covering registration, monitoring, credentialing and disciplinary processes for all health practitioners • Small numbers completing professional training • Nursing education and training to be strengthened • Increase focus on training with specialist visits • Migration: outward/global: young HWs (competition from highincome countries) Federated States of Micronesia • Geographic dispersal of small islands – transport and communication difficult • Shortage of health staff • Retention of trained staff • Lack HRH policy • Trained staff • Migration Fiji • Must have knowledge and attributes • How can degreed nurses be best utilised? • Research – academic; how to use resources, time and space • Policy • Training • Education specific to HR development • Training trainers (mentors/ couches) • Salaries structured according to grades – no consideration of merit for nursing – no incentives Kiribati • Shortage of nursing staff • Nursing workload (eg. nurse-patient ratios) • Geographic dispersal of islands – high relocation costs • Succession planning – lack of continuity as trained/qualified replacement staff not available • Limited/declining budget for Nursing Services • High staff turnover: high cost of relieving staff (maternity leave, retirement, long leave) • Limited intakes into health courses – classroom too small – dormitory refurbishment required • Low retirement age (50) Acronyms HRH human resources for health HW health worker MoH Ministry of Health 22 HRH issues and challenges in 13 Pacific Islands countries: 2011 Doyle et al.
Health Workforce Policy, Management and Information Education and Training Public Service Conditions Emigration (1) (2) (3) (4) (5) Nauru • Lack of skilled local personnel (paramedics, medical, nurses) • Shortage of HR: government reform (budget) • Retention: turnover of staff (e.g.expat, maternity leave cover) • Shortage of qualified personnel • Shortage of experienced personnel • Infrastructure – lack of support for training, limitation of internet access and computers (e.g. POLHN) • Leadership: lack of trained experienced leaders • Care of equipment overseas dependent • No training institution, academic prerequisite • Poor education preparation at pre-vocation level • Continuing education – donor dependent (multiple providers) • Salaries (physician, graduate physiotherapist) • Remuneration capped Niue • Shortage of trained local doctors, nurses, paramedics (pharmacy, radiography, laboratory, physiotherapy) • Ageing workforce • Ageing population • Ongoing recruitment from overseas • Generalist versus specialist skills? • Retention: unable to retain skilled workers leading to brain & skills drain • High medical staff turnover • Getting the right person to do the job • Retention of staff • Understaffed • No common understanding of and attitudes towards work performance due to age gaps between staff (i.e. young vs old) • Difficulties recruiting interested overseas personnel • Ineffective HRH plan • Limited success of succession planning • Employment authority • Poor diversity in health services provided • Non-medical staff in authoritative positions; little understanding of Health Dept and services – not seen as a priority • “Employers fail to recognise and acknowledge work done” • No standards or quality assurance. Requires regulations • High patient expectations (technology/internet/referral to centres/small community) • Clinical activity vs maintaining competency • NZ citizens • Lack of communication between Department and national training, unavailability of national HRH plan • “Long gaps in training for new trainees to fill future position” • Limited training opportunities for staff • Poor support for CME in all areas • Slow intake from high school for health training • No funding for future training • Level of remuneration unattractive – difficult to keep and retain trained local staff long-term • No key financial incentives to retain health staff Acronyms CME Continuing medical education HR human resources HRH human resources for health POLHN Pacific Open Learning Health Network HRH issues and challenges in 13 Pacific Islands countries: 2011 Doyle et al. 23
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 and 12: SECTION 3. PERCEIVED HRH ISSUES AND
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: MMR (per 100,000 live births) UNICE
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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