Status report on indicators. 20 goals for a decade in HRH

Publication year: 2013

The Terms of Reference required, inter alia, updating the 20 Regional Goals for Human Resources for Health. These 20 Regional Goals are indicators developed by PAHO to measure a country’s progress in meeting the development of its health related human resources, since the development of human resources is particularly critical for health care delivery. The methodology involved detailed discussions with a broad variety of stakeholders since the majority of the goals have a qualitative component. A comparative few of the goals do feature a quantitative component, such as goals 1, 2 and 3, which seek to ascertain the ratio of physicians and health personnel per population. These 20 goals were first measured in Belize in 2009. This updated 2012 measurement found some areas of improvement since 2009 but also noted that there were some areas where there was regression. More specifically, improvements were noted in the areas of human resources density ratio, public health & intercultural competencies of PHC workers, the HRH Unit and public health & management competencies of health services and program managers, while regression was noted in the areas of qualified nurses to physician ratio, urban rural disparity in the distribution of health personnel, and the proportion of precarious employment among health services providers. While indicators are often necessary to measure progress and to facilitate comparison across countries, some lessons learnt are that a wholesale adoption of indicators sans localized modification may often not provide a true picture of on the ground realities. With specific reference to Belize, given its population density as one of the lowest in the region, major health facilities such as regional hospitals are geographically distant and rural populations are generally served via a series of health centers, health posts and mobile clinics. Hence while it may be ideal that health professionals recruited from rural communities serve those communities, the reality is that by these professionals remaining in the rural health facilities, their professional growth and development remains stunted due to the limited opportunities at a rural facility. It is also worthy to mention that no study has been done in Belize to ascertain the impact of employment status on staff morale vis-à-vis service delivery. Belize relies on contractual employment to legally secure the services of certain highly qualified health specialists. Given the indicator as currently defined in the Handbook, this is regarded as “precarious employment.” The reality however is substantially different, and seeking modifications in their contractual status may not be feasible and would not necessarily translate to enhanced productivity. Other developments external to Belize are likely to impact Belize’s human resources in health. In the United States of America, the passage of the Patient Protection and Affordable Care Act – more popularized as “Obamacare” in 2010 - and the requirement of universal coverage starting in 2014 will result in a huge demand for primary health care physicians in that country. Enhanced remuneration and what may be regarded as better employment prospects may orient Belize’s health professionals towards migration, given that a certain percentage of Belize’s workforce in health are nonnationals. This will likely aggravate the human resources deficits in health across the country. In preparing for this looming challenge, Belize may wish to consider upgrading the skills set of its Community Health Workers and the nurses who are first point of contact with the health system. This will be cost effective since training for these categories of health professionals is offered locally and it costs substantially less to train a CHW and a nurse, as opposed to a doctor. Via this approach, more effective and efficient use will also be made of the country’s comparatively scarce primary health care physician and contribute towards the Ministry of Health’s goal of Equal Health for All.