Human resource planning in health care
Professor Raqibul Mohammad Anwar

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Human resource planning is an essential component for any successful health care system, given the fact that two-thirds of the financial resources in the system is put aside for salary and wages of the health care professionals.

The history of this evolving process in the world, however, is extremely discouraging. Many countries do not have any strategic planning for human resource in health care. Few nations, including ours, have had the initiative in the past, the implementation of which never really saw the light of day. Others have had strategies which were poorly planned and resulted with an adverse effect on their health care system.

Poorly planned human resource strategy would encounter a mismatch between demand and supply, and ineffectively utilise the available health care personnel, often resulting in poor quality and an under-productive workforce.

It is common to see a partial approach to planning human resources by ignoring relationships between health professions. Even in the most developed countries of the world, there may be some central, but often inadequate, planning of the medical workforce – all from medical student intakes to forecasting future demands of the doctors.

The situation is even worse with nursing professions and allied workforce planning due to the lack of attention given to the distribution of medical and nursing staff between specialties and geographical regions, resulting in preventable inequalities.

The basic economic principle of “incentive” is simply ignored as I have discussed in my own research in “Dual job holding practitioners in Bangladesh,” which was published in the journal of Social Science and Medicine Revealed (2002 Jan;54(2):267-79). Instead, many of the policy makers and personnel (both public representatives and civil administration) associated with implementation of health care policies try using the fear factor to force out efficient delivery of services from health care professionals.

The expectations held are well beyond their skill and knowledge. Moreover, they have inadequate, inappropriate and limited resources at their disposal.

Disproportionate production of skilled health care professionals in different categories and their inappropriately planned functional and geographical placement not only result in poor use of health care but also creates a mistrust about the overall health system in the country. It drives away patients, forcing them to seek health care somewhere else, further depriving the system of the already limited resources and valuable hard earned foreign exchange reserves that a country like ours can ill-afford.

Human resource planning in health is mandatory if we care to see a health care that effectively carries out its commitment to the society. Workforce policies, though not yet planned in Bangladesh, tend to assume that existing health care delivery systems is cost-effective. The workforce requirement is driven by health care expenditure allocated from the national budget by the Chancellor of Exchequer, with resources dictating the volume of provision.

Health care policy makers in Bangladesh have to recognise the need for more integrated planning of human resources in health care, which are responsive to the system's needs and design and to the demographic transition of diseases, particularly those seen in the western world.

The Bangladesh Health System review (which was published in the Health System in Transition, volume 5, number 3, 2015) categorically states that the current health system is not prepared to address emerging health issues such as population ageing and non-communicable diseases such as cancer, diabetes, cardiovascular and emerging infectious diseases, injuries related to road traffic accidents, violence, obstetric and neonatal complex conditions and others.

It is clear from the review that Bangladesh lacks a structured policy for health care human resource planning. The first Health Workforce Strategy was published by the Ministry of Health and 
Family Welfare in 2008. Though the intention was to implement the HR strategy in collaboration with the private sector, development partners and other stakeholders review the strategy every five years for necessary updates.

The first stakeholder dialogue on Human Resources for Health was held in 2012 with the objective of starting advocacy on the need for an adequate and skilled health workforce and a well-functioning health system, but eventually resulted with no implementation(WHO, 2014).

A well planned health care workforce needs to meet the health needs of the population, as the aspiration is to achieve maximum benefit with minimum cost, while also providing service levels fit and adequate for the populace of the country.

The aim is to have the right number of people with the right skills in the right place at the right time, all in order to provide the right services to the right people.

The task is made even more challenging by the vastness of methods available along with the sparseness of consensus on the quality and appropriateness of those methods.

There is huge discrepancy between demand for health care in Bangladesh and the supply human capital with the appropriate expertise. The number of appropriately qualified doctors, nurses and technicians in comparison to their skill mix and geographical distribution is alarming. The number of doctors in Bangladesh is less than 1/8th of the WHO recommendation, our strength in nursing is less than 1/25th and that of the technicians is almost less than 1/50th of the requirement.

A number of policy measures may have to be undertaken now to correct this mismatch, such as improving curriculum content and post-graduate training, recognising overseas qualifications, introducing temporary employment regulations, subsidised education for return of service, increasing trainee salaries, raising wages, providing non-wage benefits, introducing incentives for return of skilled migrants, establishing retirement benefits, providing better living conditions, establishing safe and supportive working environments, introducing career development programs and so on.

In other words, targeted investment in health care human development from multiple sources (such as the public, NGOs and private entities) are vital. No matter how difficult it is going to be, the time is ripe to take the leap. A stitch in time saves nine!

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Professor Raqibul Mohammad Anwar

 Professor Raqibul Mohammad Anwar is a Colorectal Surgeon at Bart’s and The Royal London Hospital, Ambassador and Convener of Examinations, The Royal College of Surgeons of England, Colonel, UK Armed Forces (RAMC), and President and CEO of RAHETID (RA Hospital, Education and Training Institute Dhaka)