2011年-世界发展银行全球_PNG_Health_Workforce_Crisis___A_Call_to_Action_174页_3mb

PNG Health Workforce Crisis: A Call to Action

Core Content

This report, published by the World Bank in October 2011, highlights the critical health workforce crisis in Papua New Guinea (PNG) and outlines a series of scenarios and recommendations to address it. The study emphasizes the need for systemic reform, improved data collection, and strategic planning to ensure the health sector can deliver better services to the population over the next decade.

Main Points

1. Health Workforce Crisis Overview

• PNG's health sector is facing a severe shortage of skilled personnel, which is a major obstacle to improving health outcomes.
• The crisis is driven by multiple factors:
  • Aging workforce: The existing health staff are becoming increasingly older, reducing the number of experienced professionals.
  • Limited preservice training capacity: The system is unable to produce enough qualified health workers to meet demand.
  • Weak curriculum and training programs: Training institutions lack the capacity to deliver high-quality education.
  • Lack of in-service training: There is almost no systematic in-service training, especially for rural health workers.
  • Inefficient and fragmented government spending: Despite substantial government health expenditures, the system is poorly managed and lacks coherence.

2. Current Health Workforce Characteristics

• The report provides detailed data on the composition, growth, and distribution of the publicly financed health workforce from 1988 to 2009.
• Key findings:
  • The total public sector health workforce increased from 9,082 in 1988 to 13,063 in 2009, a 21.1% increase over 11 years.
  • Doctors and Dentists increased by 80.4% from 1988 to 1998, but then declined slightly by 8.8% from 1998 to 2009.
  • Nurses saw a modest increase from 2,917 in 1988 to 3,618 in 2009, with a 23.9% growth from 1988 to 1998, followed by an 8.8% decline from 1998 to 2009.
  • Community Health Workers (CHWs) decreased from 4,982 in 1988 to 4,419 in 2009, a 17.5% decline.
  • Health Extension Officers (HEOs) saw a 108.6% increase from 1988 to 1998, but a 15.5% decline from 1998 to 2009.
  • Other/Administration staff increased significantly, from 2,874 in 1998 to 3,394 in 2009, a 177.3% rise.

3. Training System Analysis

• The report evaluates the capacity and quality of health-related training institutions, including:
  • Universities
  • Schools of Nursing
  • Community Health Worker Training Schools (Mission-owned)
• Preservice enrollments and outputs are analyzed for various health programs, showing a lack of consistency and adequacy.
• Postgraduate training is also discussed, particularly in nurse midwifery.
• Data constraints are noted, including poor documentation of training capacity and inadequate health human resource information systems (HRIS).

4. Future Workforce Demand Scenarios

• Five scenarios are proposed to project future health workforce needs from 2010 to 2030:
  • Scenario 1 (No Change in Supply): Maintains current staffing levels, leading to a worsening gap.
  • Scenario 2 (PNGDSP Aspirational Scenario): Aims for higher staffing levels, but may be too ambitious.
  • Scenario 3 (Maintaining Current Ratios): Preserves existing population-to-staff ratios, which may not be sufficient.
  • Scenario 4 (WHO Threshold Scenario): Aims to meet WHO-recommended staffing densities.
  • Scenario 5 (Recommended Scenario): A balanced approach that is both affordable and technically appropriate.

5. Recommendations

• The report recommends:
  • Improving data collection and management: Establishing a comprehensive HRIS to better plan and manage the health workforce.
  • Enhancing training programs: Updating curricula and increasing preservice training capacity, especially for nurses and midwives.
  • Implementing a "whole-of-government" approach: Coordinating efforts across all levels of government to increase and deploy the workforce effectively.
  • In-service training programs: Focusing on skills development for existing staff, particularly in emergency obstetric care.
  • Incentives for deployment: Ensuring that health workers are strategically and equitably deployed, especially to rural areas.
  • Collaboration with development partners: Strengthening partnerships with institutions like the Christian Health Services and Universities to expand training capacity.

Key Information

• Health Outcomes: PNG faces serious health challenges, including high maternal and infant mortality rates, and the burden of communicable diseases such as tuberculosis and malaria.
• Data Gaps: There is a lack of systematic data on the health workforce, which hampers effective planning and management.
• Training Institutions: The report documents the current state of health training institutions, including their expenditures, staffing, and infrastructure.
• Cost Analysis: Each scenario includes cost projections, with Scenario 5 being highlighted as the most feasible and effective option.
• Policy Context: The recommendations are framed within the context of the National Health Plan 2011–2020 and the PNG Development Strategic Plan 2010–2030.

Conclusion

The report calls for immediate and decisive action to address the health workforce crisis in PNG. It emphasizes the importance of data-driven decision-making, curriculum reform, and a coordinated government approach to ensure the availability and quality of health human resources. The recommended scenario (Scenario 5) is designed to be both affordable and aligned with PNG's health needs, providing the necessary capacity to meet the growing demand for health services. The World Bank urges the government to take these steps to improve health outcomes and ensure the sustainability of the health sector.