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PMAC 2014 in global context
Moving from HRH to Learning

PMAC 2014 Transformative Learning for Health Equity
The 3rd Globa...
Conference programme structure
• Monday 27 January 2014
– 23 side meetings
• Tuesday 28 January 2014
– 5 optional field vi...
Rapporteuring
• Each session had three or four rapporteurs
• Pre-meeting for rapporteurs
• Templates for abstract and summ...
Emerging conference themes
Health Equity

Health system reform
PS2.2, 2.4, 3.3, 3.7

Educational system reform
Instruction...
I. Changing Context (1/3)
• Health workforce challenges:
– “Markets drive domestic and international migration”
– Increase...
I. Changing Context (2/3)
• Students expectations

– Returns on medical education, private and specialization higher
compe...
I. Changing Context (3/3)
• Health equity embedded in UHC high in
global/regional/national agenda
– Yet health delivery sy...
II. Cross cutting issues (1/2)
• Health equity, social justice, human rights, social accountability
not explicitly embedde...
II. Cross cutting issues (2/2)
• Apply best practice, best buys options

– Robust evidence, e.g. meta-analysis approach
– ...
•
•

III. Instructional reforms (1/5)

Strategic shift from tubular vision to open architect and include
both education & ...
III. Instructional reforms (2/5)
• Broader health system reforms need to be coupled with
reform of the health education sy...
III. Instructional reforms (3/5)
• Current ivory tower models:

– Cannot meet health needs of populations

• Innovative le...
III. Instructional reforms (4/5)
• Overemphasis on hospital-based learning
– Learners exposed to unrepresentative group of...
III. Instructional reforms (5/5)
• Great potential benefits of eLearning if managed
right.
• Incorporation of on-site lear...
IV. Institutional reforms (1/2)
• Faculty development

– Ensure teaching-research-services congruence

• Building / streng...
IV. Institutional reforms (2/2)
• Institutional, legal, regulatory reform
– Key instruments for improving the quality, thr...
V. Conclusion and recommendations (1/5)
• Goals for health workers in 21st Century
– Health professionals are life time le...
V. Conclusion and recommendations (2/5)
• Cross cutting policies

– Transformative learning embedded in broader country po...
V. Conclusion and recommendations (3/5)
• Cross cutting policies
– Schools and health professions shall be socially accoun...
V. Conclusion and recommendations (4/5)
• Instructional reform
– Recruitments
• Inclusive students from disadvantage group...
V. Conclusion and recommendations (5/5)
• Institutional
– Require huge investment on infrastructure in some
countries
– Ef...
A call for action by PMAC2014
• We have come a long, long way, from 2006 World
Health Report
– Momentum has accumulated
– ...
Acknowledgements
• All PMAC 2014 supporting staffs, secretariat for
their able support and dedications
• Members of all se...
Lead Rapporteur
1. Akiko Maeda
2. Jeff
Johns

3. Estelle Quain
5. Viroj Tangcharoensathien
4. Ruediger Krech

Session Rapp...
Prochain SlideShare
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Conference PMAC synthesis 31 jan 2014

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Conference PMAC synthesis 31 jan 2014

  1. 1. 1
  2. 2. PMAC 2014 in global context Moving from HRH to Learning PMAC 2014 Transformative Learning for Health Equity The 3rd Global Forum on HRH: Recife, Brazil Asia Pacific Network on Health Education Reform (ANHER) 5C project on H Professional Education Reform 2013 2014 WHA Resolution Transformative H workforce Education 2012 Resolution of WHO SEA RC on H Professional Education Reform 2011 the 2nd Global Forum on HRH, PMAC 2011 WHO Global policy recommendations 2010 WHO Global Code of Practice on International Recruitment of Health Personnel for rural retention 2008 the 1st Global Forum on HRH: Kampala Declaration 2006 World Health Report on HRH; AAAH (Asia-Pacific Action Alliance on HRH)
  3. 3. Conference programme structure • Monday 27 January 2014 – 23 side meetings • Tuesday 28 January 2014 – 5 optional field visit sites • Wednesday 29 January- Friday 31 January 2014 – 7 Keynote addresses – 5 plenary sessions – 21 parallel sessions • Total registered participants, – 543 participants from 62 countries and Many international partners – Approx 80 conference supporting staffs 3
  4. 4. Rapporteuring • Each session had three or four rapporteurs • Pre-meeting for rapporteurs • Templates for abstract and summary • Abstracts used for this session • Both abstracts and summaries will be used for the conference proceedings • All presentations are uploaded on the web site : www.pmaconference.mahidol.ac.th • Gratefully acknowledge the contribution of all 59 rapporteurs 4
  5. 5. Emerging conference themes Health Equity Health system reform PS2.2, 2.4, 3.3, 3.7 Educational system reform Instructional Institutional PS2.1, 2.3, 2.7, 3.1, 3.4, 3.5, 3.6, 4.5, 4.6, 4.7 PS4.1, 4.2, 4.4 Cross-cutting issues PL1, PL2, PS2.6, PL3 Context e.g. demographic, economic changes, globalization, HR lifecycle PS2.5, 3.2, 4.3, 4.7, PL4
  6. 6. I. Changing Context (1/3) • Health workforce challenges: – “Markets drive domestic and international migration” – Increased demands for health and social care • Demographic and epidemiologic transitions in HIC/LMIC – Socio-economic changes • Increased expectation of population – International Labour market dynamics • Demand for health workforce from rich countries: international migration and recruitment • Growth of domestic private health market: internal migration • Requires effective health workforce policy, planning and management both HIC and LMIC 6
  7. 7. I. Changing Context (2/3) • Students expectations – Returns on medical education, private and specialization higher compensation, social prestige and leisure time, • Over-specialization against generalist and family medicine, – Market signals – The role of “hidden curriculum” – Social recognition and income • Structural health inequity – General lack of social accountability • By schools • By students and graduates – Health equity, social justice not in the curriculum, • Results in – “White (coats) follow the green ($$$)” (student debits and career choices) 7
  8. 8. I. Changing Context (3/3) • Health equity embedded in UHC high in global/regional/national agenda – Yet health delivery systems, especially PHC not equipped to provide adequate quality services – HRH: key bottleneck. – Both number and skill mix and responsiveness – Financing: government spending on health major challenge 8
  9. 9. II. Cross cutting issues (1/2) • Health equity, social justice, human rights, social accountability not explicitly embedded in curriculum and learning platform in schools – Imbue curriculum with social values and concepts in addition to evidence based medicines, competencies, etc. – Educators with a ‘good heart’, inspirational role model and leadership essential “…. if I can influence their heart, I can influence their mind, then hands and feet follow” – – – – No easy, single solution or “silver bullet”; Engagement and empowerment of the community vital; Need long term vision to guide reform directions Reforms to encompass ‘broader pool of eligible’ 9
  10. 10. II. Cross cutting issues (2/2) • Apply best practice, best buys options – Robust evidence, e.g. meta-analysis approach – Regular “tracking graduates” important inputs for improved school performance • Reforms – Stable investment in health workforce underpinned by long term political / financial commitment – Systems approach to long term solutions for improved health equity – Inclusive of difference cadres: MLP, CHW, social workers, managers, regulators – Better tools to measure and evaluate process and outcome of transformative education, health workforce performance (the 3 Gaps) 10
  11. 11. • • III. Instructional reforms (1/5) Strategic shift from tubular vision to open architect and include both education & health systems reform Education redesign principles: a) b) c) d) e) competency based learning (breadth and depth) inter- and trans-professional learning and team building flexible and modular designs of curriculum experiential learning with community engagement level of learning: a balance between online and onsite learning for three goals of development: information (more online than on site), formative and transformative learning (more onsite, inspirational, face2face on site learning is vital) f) Need to integrate instructional learning: based on balance across online, on site and in-field learning sites • Continuous leadership development: pre-service, in-service Julio Frenk 11
  12. 12. III. Instructional reforms (2/5) • Broader health system reforms need to be coupled with reform of the health education system to better equip health workers to address the societal shifts and local health needs and to perform within their health system environment. • Despite some advances and successes in health professional curricula reforms, more often than not education remains outdated and stagnant – However, there are emerging initiatives e.g. MEPI/NEPI, ANHER/AAAH, PMAC2014, others small scale evidence, – WHO Global Code of practice 2010.. – WHO global guideline 2010 (retention), 2013 (transformative scaling up), – Need to continue to build on these momentums 12
  13. 13. III. Instructional reforms (3/5) • Current ivory tower models: – Cannot meet health needs of populations • Innovative learning – Essential for transformative health professional education and training in the field – Involve stakeholders beyond health sector - intersectoral actions – Inter- and intra- professional collaborative practice, team building – Review competencies across different curricula to avoid “silo” and ensure better alignment across health professionals • Multi-stakeholder engagement – Networking and involving professional councils, associations, CSO – Community engagement: help to achieve accountable health professional education 13
  14. 14. III. Instructional reforms (4/5) • Overemphasis on hospital-based learning – Learners exposed to unrepresentative group of very ill patients, – Not acquire key clinical, problem-solving, collaboration and teamwork competencies as needed, – Lose internal motivation and altruistic drive, tend to focus on career paths of highly specialized care, and not community/ rural practice – “hidden curriculum” towards over-specialization • Need to be balanced with community based exposures and seamless linkages 14
  15. 15. III. Instructional reforms (5/5) • Great potential benefits of eLearning if managed right. • Incorporation of on-site learning throughout learning continuum 15
  16. 16. IV. Institutional reforms (1/2) • Faculty development – Ensure teaching-research-services congruence • Building / strengthening the teaching capacity: – learning physical space, pedagogical materials, Technology platforms, • Management – Strengthened management capacities – Mobilizing more financial resources, bursaries and fellowship, • Create, sustain an enabling culture and environment – Values, merits, assessment and reward systems, identity, collaboration, peer reviews, strive for excellence • Better collaboration between public and private education institute Julio Frenk 16
  17. 17. IV. Institutional reforms (2/2) • Institutional, legal, regulatory reform – Key instruments for improving the quality, through • Training institute and curriculum: quality assurance, accreditation and re-accreditation • Professional quality: national license examination, relicensing processes, continuous professional development • Licensing of public and private health facilities • Regulation a double edge sword – Can be ineffective, constrain the needed reform and undermine quality improvement. 17
  18. 18. V. Conclusion and recommendations (1/5) • Goals for health workers in 21st Century – Health professionals are life time learners who • Have intrinsic value of human rights, social justice, health equity, altruism, social accountability and ethical conducts, • Are able to enquire, search, interpret and use evidence, • Are competent in clinical, public health, able to understand and address the social determinants of health in other sectoral policies, • Able to communicate and work with other professionals, families and communities with mutual respect, collaborate in a multi-disciplinary team • Are responsive and accountable to health needs of the population 18
  19. 19. V. Conclusion and recommendations (2/5) • Cross cutting policies – Transformative learning embedded in broader country policy commitment towards health equity, social and economic justice – Generate convincing evidence • Added value of transformative learning on return of investment –short and long term, – Responding and influencing international migration requires • Better monitoring of market trends (prospective market intelligence), data from both host country and country of origin – WHO Global Code of practice on international recruitment of health personnel » Though voluntary, foster / support improved reporting from LMIC • Empowering health workers to be active “change agents” through leadership training • More active public action – Global collaboration required across rich and poor nations • Policy coherence between “health and wealth” – “health for all or job for all and economic gain from remittance” 19
  20. 20. V. Conclusion and recommendations (3/5) • Cross cutting policies – Schools and health professions shall be socially accountable for safe, quality, efficient and equitable services – Incremental small gains or “big bang” reforms depends on political context and windows of opportunity • Legal, regulatory and institutional reforms – Supported by evidence, regular update and feedback, institutional capacity to monitor and enforce, appropriate incentives and sanction actions in place, managed by good governance. – Reform process needs multi-stakeholder engagement and political ownership, ensuring sustainability 20
  21. 21. V. Conclusion and recommendations (4/5) • Instructional reform – Recruitments • Inclusive students from disadvantage group/communities, ensure they return to serve their communities – Curriculum • Health equity, social justice, social determinants of health as integral value and components of curriculum reform • Competency based, early exposure to community, ownership of community involve in the solutions, • Experiential learning based in the community: – A promising novel approach, improved knowledge and competencies, patient-centered and team-based care, student and community satisfaction, support rural retention – “Learning and practice in the community, for the community” 21
  22. 22. V. Conclusion and recommendations (5/5) • Institutional – Require huge investment on infrastructure in some countries – Effective faculty development and retention, importance of “role models”, “inspirational teachers” – Accreditation and quality across public and private institutions 22
  23. 23. A call for action by PMAC2014 • We have come a long, long way, from 2006 World Health Report – Momentum has accumulated – Global, national commitment growing though uneven, – Global/regional networks formed and functioning but need further nurturing – Post 2015 MDG challenge: • Positioning health workforce in the global goals in light of UHC • A Global HRH strategy addressing health workforce in 21st century is emerging – So join us– hand in hand 23
  24. 24. Acknowledgements • All PMAC 2014 supporting staffs, secretariat for their able support and dedications • Members of all session rapporteur 24
  25. 25. Lead Rapporteur 1. Akiko Maeda 2. Jeff Johns 3. Estelle Quain 5. Viroj Tangcharoensathien 4. Ruediger Krech Session Rapporteur 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Agostinho Ahmad Dian Angkana Arnat Aye Aye Boontuan Borwornsom Chaaim Chalermpol Chanankarn Chanwit Chiraporn Christophe Diana Edson Eva Farhan Farhan Giorgio Halit Sousa Whyudiono Sommanustweechai Wannasri Thwin Wattanakul Leerapan Pachanee Chamchan Boonyotsawad Tribuddharat Kheedee Lemiere Frymus Araujo Jarawan Marisa Isa Cometto Onar 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 Harun Al Heng-Hao Jaratdao Jintana Julian Kamolrat Kanang Kanitsorn Kari Laura Lois Maki Manasigan Michalina Monthita Natawan Nathan Orarat Panarut Payao Rasyid Chang Reynolds Jankhotkaew Fisher Turner Kantamaturapoj Samritdejkajohn Hurt Rose Schaefer Agawa Kanchanachitra Urairoj Khumsaen Satienchayakorn Wangpradit Wisawatapnimit Phonsuk Rapporteur Coordinator: Walaiporn Patcharanarumol 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Pedro Pennapa Pensom Prowpanga Saipin Simone Sirinya Srisuda Sukjai Suparpit Takahiro Thongsouy Thunthita Trassanee Viera Wannapha Weranuch Yodying Yumiko Miranda Kaweewongprasert Jumriangrit Udompap Hathirat Ross Phulkerd Ngamkham Charoensuk Von Boman Hasumi Sitanon Wisaijohn Chatmethakul Wardhani Bamrungkhet Wongwattanakul Dangprapai Yamashita

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