Education Policies in National Health Systems

Mnica Padilla Daz OPS/OMS El Salvador 9 Enero 2013

http://www.youtube.com/watch?feature=player_embedded&v=atcA76wykWk

http://www.observatoriorh.org/?q=node/430

Art Kaufman - Health Extension: Learning from Farmers How to Improve Community Health

CONTENTS
Human Resources and Health Systems HR Field Education Challenges Towards Primary Health Care and Integrated Health Networks

Health System
Inputs processes Access Quality- Efficiency Stock products

Stewardship
Securing funding

Maintain and improve health

Needs

Protect from financial risks

Resources

Provision
Participation- Equity

Satisfaction of expectations

The Health Systems demands

Universal coverage Attention model based on Primary Healthcare Organization model in Integrated Network in Health Centred around the individual, family and the communitys health. Interventions from the health determinants perspective. Guarantee warmth and quality. Efficiency and effectiveness

Link the education, labour and health services markets

Source: WHO (2006). The World Health Report 2006 Working Together for Health. Geneva, World Health Organization

The Intersections of Human Resources and Health

Health
Finances

Human Resources

Education

Work

Science and Technology

All countries must have a Human Resources National Policy

Adequate distribution and composition

2. The right people at the right places

Enough quantity 1.Plans and Policies Appropriate competencies

Migration 5. Management of Migration

3. Links between schools, needs and health services.

High quality performance

4. Dignified work conditions

Human Resources conditions for the Health System

Workforces objectives Healthy Systems performance

Human Resources Conditions

Sanitary Results

Numerical adequacy Geographical distribution Social compatibility

Coverage: SocialGeographical

Universal and Equitable access

Adequate and competitive remuneration and incentives Adequate labor relations Infrastructure

Motivation: Systems with a supporting infrastructure

Efficiency & Effectiveness

Improvement of the populations health

Education for capacities Trianing and learning Leadership and iniciative

Competencies: Capacitation/ Learning

Quality, respect & dignity

AXES OF ANALYSIS
DEPLOYMENT & DISTRIBUTION EDUCATION /COMPETENCIES WORKING CONDITIONS

DEPLOYMENT & DISTRIBUTION

There are shortages of health workers worldwide

Distribution of the global health workforce

Source: WHO (2006). The World Health Report 2006 Working Together for Health. Geneva, World Health Organization

Density of Human Resources Physicians and Nurses per 10,000 inhabitants El Salvador

45 40 35 30 25 20 15

42.7

29.9

22.0

21.3

20.8

11.0 10 5 0

9.7

8.1

8.0

7.8

7.0

5.8

4.9

4.8

4.2

SAN SALVADOR

AHUACHAPAN

SANTA ANA

CHALATENANGO

CABAAS

CUSCATLAN

USULUTAN

SAN MIGUEL

SONSONATE

LA LIBERTAD

SAN VICENTE

MORAZAN

LA PAZ

LA UNION

PAS

Rural-Urban Distribution Density of physicians in Latinamerican countries.

120

105
100

80

60

40 19.5 14.7 3.3 PERU 6.03

20

15 0.6 5.3 1.3

17.7

10.4
1.2

N ICARAGUA

BOLIVIA

COLOMBIA

ARGENTINA

PARAGUAY

DENSIDAD URBANA

DENSIDAD RURAL

Physicians according to Poverty Levels: An Inequality Issue

Per: Sensus 92, 96, 2004
20
14.31 18.81 17.57

Attention!
The increase of human resources DOES NOT MEAN DISTRIBUTION AND EQUITABLE ACCESS.

15

10.24 10.23

10

7.85

6.09 5.71

3.94 2.45

4.32 4.66 0.84

4.8 3.39

Estrato I
DISTRITOS NO POBRES

Estrato II
1992

Estrato III
1996

Estrato IV
2004

Estrato V
DISTRITOS MAS POBRES

Fuente: Observatorio Nacional de Recursos Humanos en Salud. serie Bibliogrfica Recursos Humanos en Salud No 1. Informe al pas: Situacin y Desafos de los Recursos Humanos en Salud. Gobernabilidad y desempeo con desarrollo humano. MINSA y IDREH. Lima-Per-2005.

Subsecretara de Innovacin y Calidad Direccin General de Calidad y Educacin en Salud Direccin de Polticas y Desarrollos Educativos en Salud

Especialidad de pediatra y oferta laboral de Correlacin (1991-1999-2001) proyeccin 2010 pediatras.

Demanda de insc ripc in al ENARM T endenc ia en la demanda de insc ripc in al ENARM Oferta de bec as para la espec ialidad de pediatra T endenc ia de la oferta de bec as para la espec ialidad de pediatra Oferta Laboral para Mdic os Pediatras T endenc ia de la oferta Laboral para Mdic os Pediatras Poblac in de 0 a 15 a os CONAPO

Poblacin de 0 a 15 aos1 (millones)

3,500 3,000

37 36

Sumatoria 19,070

2,500 2,000

35 34 33

1,500 32 1,000 500 0 -500 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Sumatoria 6,230

31 30 29

Sumatoria 2,596

Fuente: Comisin Interinstitucional para la Formaci n de Recursos Humanos en Salud. Bolet n de Informacin Estadstica (Recursos y Servicios) de la DGEI. Proyecciones de poblaci n CONAPO Censo 2000.

Proportional distribution / medical doctors

Fuente: http://www.worldmapper.org/images/largepng/216.png

Proportional distrubution / nurses

Fuente: http://www.worldmapper.org/images/largepng/216.png

Education Challenges Competencies

GROWS WITHOUTH QUALITY CONTROL

Evolucin del Nmero de Universidades (1960-2000)

Estudiantes de Medicina y Enfermera Per 1990-2002

Per 2010
18000 16000 14000 12000 10000 8000 6000 4000 2000 0 1990 1995 EST.MED. 2000 EST.ENF. 2002 11400 7500 12100 9600 14400 14000 12800 16800

Colombia
1.80 1.60 1.40 1.20 1.00 0.80 0.60 0.40 0.20 0.00 1.66

When compare profesional performance and health tasks include in the curricula vs. Working functions there are inconsistencies NO PERTINENCE Ex: Medicine

1.60

0.07

Clnical
Fuente: Clculo CENDEX

Teoretical - Practical

Context

Longlife learning !!!

A big responsability
Medical information doubles every five years, much of which is unstructured. 81% of physicians say they spent five hours or less per month reading medical journals. It is estimated that 1 in 5 diagnoses are inaccurate or incomplete 1.5 million errors in the way drugs are prescribed, delivered and taken into the United States each year. Between 44,000 and 98,000 Americans die each year from medical errors preventable only in hospitals.

Source: Paul Grundy, director of the project to transform health systems, IBM introduced a very
innovative conference entitled "Beyond Flexer: Death of the Master Builder Patient Centered Medical Home.

REGULATORY PROCECESS LEGAL FRAMEWORK FOR EDUCATION AND PROFESIONAL PRACTICE

Accreditation of universities Professional certification Enabling practice Recertification

Discuss innovative methods to further the social mission using the modalities developed from the Beyond Flexner Study: School Mission Pipeline Cultivation Admissions Curriculum Location of Clinical Experience Mentoring Tuition Management Post Graduate Engagement
http://www.medicaleducationfutures.org/projects/beyond-flexner

Lessons Learned
Increasing the commitment of medical schools to the social mission of medicine will be essential to achieve a fair and affordable health care system Diversity is a means to excellence in education and practice Geography matters. Medical schools need to identify communities (cities, regions, states) where they commit to educational and health care improvement Community engagement of medical schools remains an essential instrument of population health improvement Information technologies are an important tools for furthering the social mission in education Team based training is an essential precursor to interprofessional practice Core principles of public health should be incorporated into medical education

Where should HR policy target

Francisco Campos SEGETES, Brasil

LERNING OBJECT HEALTH CONCEPT METODOLOGY LEARNING ENVIROMENT

POLICIES Healing disease S C E N A R I O S

Teacher
centered Lectures

Mainly in Hospitalas

Prevention and detection of common diseases risk

Pedagogical Innovations ABP

Ambulatory Care Centers Learning Hospitals

INCENTIVES

Health Determinants

Student centered Critical Thinking (Constructivism)

Family health Comunity In their context

A donde debe dirigirse la Poltica de Educacin de RHUS Francisco Campos

BRASIL
OBJETO DE APRENDIZAJE CONCEPTO DE SALUD METODOLOGIA AMBIENTE DE ENSEANZA

POLITICA Curacin de La enfermedad E S C E N A R I O S

Centrado en el docente Clases magistrales

Principalmente Hospitalario

Prevencin de enfermedades comunes y deteccin de Riesgo

Innovaciones pedaggicas ABP

Hospitales universitarios Centros de atencin ambulatoria

INCENTIVOS

Determinantes de la Salud

Centrado en el estudiante pensamiento crtico

Salud de la familia Y la comunidad En su contexto

Our health system performance (including HR) determines our national health levels
1000
mortalidad materna (tasa por 100,000 n.v.)

900 800 700 600 500 400 300 200 100 0

tendencia USA

HA I B OL P ER

LAC
PAR PAN TRT DOR ELS VEN COL BAR ECU JA M HON M EX A RG

B RA GUT NIC

BAH COR

CA N CUB CHI URU

1900

1910

1920

1930

1940

1950

1960

1970

1980

1990

2000

Centers for Disease Control & Prevention. Achievements in Public Health 1900-1999: Healthier Mothers and Babies; 48(38):849-58; Atlanta, 1999. WHO Maternal Mortality in 2000: estimates developed by WHO, UNICEF & UNFPA; Geneva, 2002

DOCUMENTO RESUMEN OPS

Beyond Flexner Conference http://www.medicaleducationfutures.org/proj ects/beyond-flexner PAHO ON LINE DIALOGUES Human Resources Observatory : education http://www.observatoriorh.org/?q=node/437 WHO: http://www.who.int/hrh/en/