The title for this blog occurred when I was having discussions with a friend over dinner in Ubud, Bali recently. I immediately grabbed a restaurant brochure and scribbled it down lest I forget before I got to my computer.
It probably sounds very dismal, my previous blog was entitled “Why are Approached to Human Resources Development in Health Failing?” now I am blogging about failure again. However, I am afraid that is the reality and I think we have to take a longitudinal view of how approaches have evolved or not in order to really understand why approaches to HR are still failing.
In order to take this view we have to first recognise the essential elements of HRD systems……namely:
HR Policy, HR Planning, HR Production/purchasing, HR Management (both Personnel and Performance) and HR Financing.
Historic approaches.
In the 1950-1970s the whole approach to HR was that of “Personnel and Training” whereby thre was a Personnel Office/Department that dealt with Personnel administration and another office /department that dealt with Training issues. There was absolutely no synergy or connection between the two. Frequently the Personnel Department was headed by a senior echelon officer at director level seconded to the Ministry of Health or all ministries by the Civil Service Authority. Staff consisted of clerks who mainly filled forms and maintained the manual personnel record systems. Training Department was generally headed by a health professional who might or might not have had any experience in HR or even training.
The 1980’s brought efforts to actually quantify HR and constituted a “Planning Approach”. This was mainly undertaken by Health Planning Units which dealt with all the disease statistics and not linked to Personnel and Training Departments apart from to tell personnel the numbers required. This approach treated Health workers with the same quantitative approach that was take to identifying the number health facilities and chairs, tables and drugs required and did not recognise health workers as intelligent health professionals that they were.
This gave rise to fixed facility staffing models which persist to this day, assuming that each facility of a particular level had exactly the same number and type of cadres of staff regardless of workload, access and other geographic and demographic factors. There were already efforts commencing to involve training institutions in changing approaches to health service delivery thus ending the isolation of the training institutions from the health services resulting in inappropriate production of the product required to implement new approaches to health services..
In the 1990’s there were efforts to take a “Policy Approach” which introduced addressing strategic policy development and identification of improved skill mixes. This was influenced by the advent of Health Sector Reform and concepts such as contracting of health services.
2000 onwards, as there were efforts to integrated curative and public health services there have also been moves to implement an “Integrated/ Comprehensive Approach” that is led by a dedicated senior level HR focal unit in MOHs that is at sufficiently senior level to coordinates and addresses all the essential elements of HR working with all relevant Directorates in the MOH as well as with other relevant ministries such as Civil Service, Education etc.
OK so here we are coming towards the end of 2015 and where are we now?
Realistically it is a very varied picture. However the reality is that a comprehensive approach has made little headway. in many countries. The “personnel and training” approach prevails, as does the planning approach. Training institutions remain unlinked to health services and continue to produce graduates that are unfit to practice and deliver the new approaches to health service delivery.
Many donors continue to support individual components of HR without looking at its connections to the other components thus creating unevenness of approach. Health Planning Units tend to continue to bypass HR focal units and try to dominate HR Planning applying epidemiological quantitative approaches to planning. Computerization of HR personnel records has brought confused results due to a splintered approach to HR and competitiveness of differing Directorates in the MOHs over who should “control” HR information.
Probably the biggest issue is that there is a lack of a common understanding of HR by all actors however there are a variety of views on what it is. If there is no “common” understanding then approaches will fail if everyone is using the terms without all being on the same page.
I intend to address these issues related to each of the essential elements of HR in upcoming blogs.
