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Healthcare Workforce Planning for Lower-Middle Income Country of Cambodia Assessment Answer

2.4.2 Workforce performance report

Weight: 60% Type of Collaboration: Individual Due: Week 14 (Sunday, June 9th 4 11:59pm) Submission: Via Turnitin on unit vUWS site. Format: Length: 2500 words Curriculum Mode: Report

Rationale

The purpose of this assignment is to prepare a national health workforce plan for one country in the category of low and lower-middle income countries, as defined by WHO. These countries in particular have been identified in the latest report by WHO (WHO, 2016) as having a shortfall in health workers of some 18 million by 2030.

Task

The WHO has a system of classification of countries by region and income which is described in Annex 1 of the "World Health Statistics Report, 2015" . (WHO, 2015) (p.160-161). Use the table showing countries on Page 161 in the low and lower-middle income categories to select the country you will use to develop the health workforce plan. 3 This report also provides a range of statistics on the health workforce by country.

The assignment will be scaffolded so that tutorials will support the development of the National Health Work-force Plan on key topics relevant to the development of the workforce plan, including preparing an Environmental Scan, analysing the national health workforce data set, identifying critical issues and developing strategies to address the issues identified. The National Workforce Plan should be a five year plan.

1. Prepare a Table of Contents for the National Health Workforce Plan using report format. 2. Draft the Introduction for the Workforce Plan, including documentation of the rationale for selection of the country. 3. Prepare the Environmental Scan for the health workforce of the selected country using national and international health workforce references including policy and planning documents, and any relevant health workforce plans. 4. Prepare a data profile of the health workforce by category using WHO data and other data sources. Develop the workforce profile using tables and graphs and supporting explanatory text. 5. Based on the previous steps and relevant literature, identify critical issues to be addressed in the workforce plan. 6. Use the set of ten recommendations developed in the WHO 2016 report "Working for health and growth: investing in the health workforce" 4 as a framework to develop strategies relevant to implement the workforce plan (WHO, 2016, p.11-12).

Criteria

You will be assessed according to the following criteria:

— Ability to introduce the topic and findings in a well summarised Executive Summary. — Understanding of the process of the development of a health workforce plan. — Preparation of an Environmental Scan, — Capacity to analyse workforce profile data including the use of charts and tables to support the analysis and presentation. — Critical analysis and synthesis of the relevant literature to support issues identification and strategies develop-ment. — Academic writing skills, use of report format and APA.

Graphic material is an essential way of presenting health workforce data. Topics will be discussed at supporting tutorials. Use the Hints document on vUWS to identify the relevant sections for report format. WHO has established Regional Observatories on Human Resources in Health Systems, which includes an Africa Health Workforce Observatory. These regional observatories may include relevant material for the development of the National Health Workforce Plan.

Retrieved from: http://www.who.int/hrh/governance/en/ http://www.hrhresourcecenter.org/observatory Marking Criteria:

Criteria Unsatisfactory Pan Credit Distinction High Distinction Report format No executive ES may cover some Good focus on key ES covers all main ES covers all main summary (ES) or abstract only, and/or key points only. Poorly presented points in ES. points. points. no contents page and/or numbered contents page which may not match Good use of report format with some Document well formatted with few Document professionally headings in text. Formatting errors e.g. inaccurate formatting of charts, and headings. headings in text. Other formatting errors. errors. errors. presented with enhanced presentation format. No spacing between paragraphs. Used underlining instead of bold. Used familiarity and /or first person. 5 marks 1 - 2 marks 2.5 - 3 marks 3.5 marks 4 marks 4.5 - 5 marks

Answer

Healthcare Workforce Planning


Executive Summary

This report describes the environmental scan of the lower-middle income country of Cambodia to provide a health workforce plan. The immediate priorities and improvements are considered to manage the healthcare burden. The financial and social determinants of the health inequalities are linked with the insufficient staffing within the region. In this context, the improvement of the infrastructure and educational support need to be provided to provide the public with improved health outcome. The recognition of the healthcare needs indicated the immediate actions need to take to women and child health support within Cambodia. Improvement of the scope for employment is suggested for the government of Cambodia to motivate more students to join the healthcare profession.

Introduction

The health workforce plan will include the benefit of public health in the country of Cambodia. The country was chosen for the development of the health workforce plan because of the low income of the economy of the country makes it difficult to provide health benefits. As per the World Health Organisation statistics, the increasing health burden on Cambodia with the 2.7 fertility rate in the country, with 16.1 million people (Cambodia Health Statistics, 2019). The low economy and education gave rise to slow growth and development of infrastructure in the country. The health workforce plan will be based on life expectancy and mortality changes, causes of the morbidity and mortalities; the prevalence of infectious diseases, risk factors, health service coverage, expenditure, inequalities and statistics of social-economic data (The World Bank In Cambodia, 2019). The health workforce plan will mitigate the immediate healthcare priority of improving women and child health within Cambodia. The improvement of the healthcare workforce would be initiated by increasing the financial as well as non-financial benefits of the workers. Mitigation of the conflict of interest within the healthcare policymakers and the government in achieving the healthcare outcome would be important. Improving the education system within Cambodia to facilitate the employment and competency within the workforce would also be implemented in the health workforce plan. The improvement of the infrastructure in remote locations of Cambodia would ensure the retention of the existing workforce and helping to deliver the service needs.

Environmental Scan

Cambodia has recently reached the lower-middle income country status recently 2015by undergoing certain economic transactions. As per the World Bank, the Government of Cambodia aspires to reach the status of upper-middle income group of countries by 2030. The growing economy of the nation is contributed by the emergence of Cambodia as a tourism destination and improved garments exports (The World Bank In Cambodia, 2019). The stability of the country's economy has been maintained at 7.7% between 1995 to the present year. The prevalence of poverty is a burden on Cambodia; the poverty rate in 2014 was about 13.5, where 90% of the poor income families live in the countryside. 4.5 million People in Cambodia are near-poor and sufferers of health and other social determinants. Two of the biggest challenges for Cambodia is the lack of proper education and public health. The government's target in collaboration of WHO is the reduction in the mortality rate of Cambodia by 68% was achieved (World Health Statistics, 2015). The rate of immunisation of the coverage of the measles to about 90% from 1990. The government also took initiatives to reduce the maternal mortality ratio to 86% up to 2013. The government ensured that the percentage of skilled health professionals attending the maternity patients to about 71% in the country. The universal access to the reproductive health improvements for antenatal care coverage in one visit minimum (World Health Statistics, 2015). The 17% of the unmet need for family planning services in Cambodia for the projected target until 2015 was achieved. The 82% reduction of the incidence of HIV in the country was initiated by the government to halt the implications of the disease by 2015 and reverse it (World Health Statistics, 2015). As a projected target of the Cambodian government to halt the implications of malaria and other diseases by 2025 and reversing the ill effects of diseases like tuberculosis has been achieved by 68%. The government also reduce 63% of the population who did not receive healthy drinking water sources in the country by 2015. In terms of sanitation, 35% are still without the hygiene and sanitation services (World Health Statistics, 2015). 

Life Expectancy of Cambodians

Figure 1: Life Expectancy of Cambodians

Source: (Cambodia Health Statistics, 2019)

The average life expectancy of the children since birth on an average of 73 years. Individually the males have 70 years of life expectancy and 75 years for females until 2013. At the age of 60 years, the average life expectancy of the population was 20 years, and individually, males have 22 years and females 25 years (World Health Statistics, 2015). 

Life expectancy of children under five years

Figure 2: the Life expectancy of children under five years

Source: (Cambodia Health Statistics, 2019)

The average life expectancy of the neonates at birth is 60 years. Mortality of rate of neonates in Cambodia for every 1000 births is 17.6%. The mortality rate for children under five years of age for every 1000 births is about 37.9% (World Health Statistics, 2015). 

Mortality causes among adults in Cambodia

Figure 3: Mortality causes among adults in Cambodia

Source: (Cambodia Health Statistics, 2019)

The adult mortality rate for every 1000 people between 15 to 60 years is about 157 for females and 210 for males. The mortality rate due to infectious diseases is 227, non-communicable conditions are about 394 and 62 injury-related death for every 100,000 people. In children less than five years of age <1% was due to HIV/AIDS, 8% was due to diarrhoea, 2% measles and 1% malaria.  The Maternal mortality rate for every 100,000 births was 170 people, 14 people for HIV/AIDS, 1.8 for the disease until 2012 and 66 people for tuberculosis. Incidence of HIV/AIDS among every 100,000 people was 8.5 people, 1076 people for disease and 400 people until 2013. More than half the incidence of HIV/AIDS and tuberculosis was decreased until 2013 (World Health Statistics, 2015). Among all the diseases reported in the Cambodian population, tuberculosis was the highest in number until 2013. 71% of the population of Cambodia was improved by providing clean drinking water sources and 37% with improved sanitation services. However, 40% of the children in Cambodia less than five eyras have stunted growth, 29% are underweight, and 1.9% are overweight. This is due to the fact that 44% of adult women suffer from anaemic conditions (World Health Statistics, 2015).  

Data Profile of Health Workforce in Cambodia

The health workforce of a nation is defined as the number of people actively involved in providing healthcare services to the public. The data profile of the Healthcare labour market is determined through various document sources like administrative information systems, high-facility assessment, employment survey, labour force, population census and other government databases. As per the declaration of WHO, the national and sub-national data presentation for statistics of health policy information prerequisite (WHO Global Health Workforce Statistics, 2019). The challenges of publishing and reporting of the healthcare workforce statistics by all the members of the national and sub-national authorities need to be kept in mind. WHO recommends that information needs to be dispersed across all organisation, institute and infrastructure facility to improve the capacity of the healthcare workforce. In regards to making policies in the healthcare industry collection of reported data and utilisation of this information appropriately is necessary to provide the social-economic determinants of health (World Health Statistics, 2015). Protection of the public health, new designs, intelligence, responsive actions etc. all help in improving the health and safety of the population. Probability in the quality of coverage of the labour profile data in Healthcare is due to the diversity of the workforce. 

CountryPhysiciansNursing and
midwifery
personnel
Dentistry
personnel
Pharmaceutical
personnel 
PsychiatristsHospitals (per 100,000
population)
Psychiatric beds
Cambodia1.77.90.20.4<0.050.60.1

Figure 4: Health data Workforce of Cambodia

Source: (WHO Global Health Workforce Statistics, 2019)

In Cambodia, the density of physicians in every 10,000 population is 1.7, the nursing and midwifery personnel are about 7.9. The dentistry personnel, pharmaceutical personnel and psychiatrist as well as hospitals are less than 1 in Cambodia. There is also a shortage of psychiatric beds in Cambodia where less than one beds are provided for 100,000.  

Health Workforce Plan

In order to develop the public health of a region WHO has recommendations in developing a plan for health workforce needs. The human resources of health include the setting of effective planning to archive the health objective of the political government. In order to rationalise the decision of improving the healthcare workforce in a region evidence-based practice in the implementation of planning ideas, strategy to provide effective actions and maintaining the policy within the country is possible through human resources for health. It is essential for taking considerations of a short and long-term target, estimation of expenditures, improving the opportunities of education, training skilled labours, reduction of the work pressure, performance management and employing retention strategies to empower the healthcare workforce (World Health Organization, 2016). Prioritising the public health needs within a particular country, it is important to improve human resource development strategies within the region. Construction of the health care framework on the epidemiological needs of the region is taken into consideration before planning the human resource of healthcare and the development of a healthcare workforce plan. Identifying the explicit benchmarks and the indicators of public health needs and the burden is very important for planning the workforce. Collection of the national data regarding the health priorities, gaps, economic burden extra accurately improve the quality of workforce planning (World Health Organization, 2016). Workforce planning is generally targeted for the upcoming 20 years to eradicate the existing health care needs and gaps within the region. The requirement of the healthcare workforce plan is usually related to the short-term forecasts specific to the educational capacity of a country and the competency of the workers. This barrier is mainly noticed in low-income and lower-middle income countries, like Cambodia, African countries, Middle Eastern countries, India, Pakistan, Nepal, Bhutan etc., where the shortage of healthcare workers is directly related to the education system within the country. The healthcare workforce clan also contains the changes in work design, staffing, motivation, compensation, career opportunities and retention strategies that help in overcoming the short-term adjustment for the long-term projected targets in the country. 

WHO has provided a general workforce planning model for all countries to obtain effective public health outcome. 

Workforce Planning Model suggested by WHO

Figure 5: Workforce Planning Model suggested by WHO

Source: (Models and tools for health workforce planning and projections, 2019)

WHO The Healthcare workforce plan is to be obtained to a collaboration of the various departments of human resource to emphasise the improvement of Primary Health Care. In achieving the best possible outcome of Public Health partnership throughout industry need to be maintained within the government and non-governmental Healthcare facilities a light in the region.  The healthcare ministries need to plan the workforce by the intrusion of factors that inhibit improve health care through your health systems (Models and tools for health workforce planning and projections, 2019). The healthcare planning workforce model suggested by WHO develops and implements the human resource strategies effectively to sustain the labour workforce within the industry. Healthcare managers and government organisation would be benefited from this workforce model are applied in context to Cambodia.  The global effort by government organisations across the world towards achieving a shared approach of resource management and overcoming the complexities of human resource development in the healthcare workforce will ensure your better public health outcomes. The requirements of the global, as well as domestic stakeholders, would ensure that the Healthcare workers plan is comprehensive in nature. The six names of action suggested by WHO all the policies, education, leadership, finances and partnerships within the healthcare workforce planning system (Models and tools for health workforce planning and projections, 2019). The situation analysis needs to be considered before the planning and implementation of the Healthcare workforce to ensure that the evaluation and monitoring of the activities are effectively obtained. In order to make the healthcare workforce plan more inclusive in nature, the human resource managers need to include the set of critical success factor specific to the needs of the country, in this case, Cambodia. Planning and preparation of the healthcare workforce would be achieved by the HRM systems instrumented in the healthcare industry of Cambodia. The situation analysis monitoring evaluation, preparation and planning would be dependent on these HRM systems to provide strategic solutions for health needs. The critical success factors need to be outlined in consideration of the health priorities of Cambodia. In order to ensure the management of employees and workers in the healthcare industry of Cambodia, the labour market needs to be assessed, to access through the economy and improve the health outcomes of the workforce. This an intern is related to the equity, effectiveness, efficiency and accessibility of the healthcare services within the country (Models and tools for health workforce planning and projections, 2019). 

Critical issues in Health Workforce Planning

Health workforce planning definitely considered as the long-term health improvement possibilities of a particular country; however, the strategy is not incomplete without certain barriers that might increase the difficulty or challenge to implement the plan. The projected health outcome targets set by the government needs to be executed by the healthcare work first, which is dependent on the availability of the resources, proper Infrastructure and the education of the healthcare labour. Knevel Gussy & Farmer (2017) indicated that healthcare workforce planning is dependent on the production of planning process activities within the workforce, prediction of the gaps and health needs within the domestic environment, ensuring that the healthcare service delivery is appropriate and quick in nature to ensure that the help needs that immediately met.  Lopes, Almeida & Almada-Lobo, (2015) opined that the policymakers, healthcare managers, administrative and stakeholders’ uncertainties in the Healthcare industry to implement an appropriate health workforce plan.  Firstly that changes with that take place within a domestic environment with respect to the economic, epidemiological, social and political factors need to be considered to overcome the barriers of the external environment. Gibson et al. (2015) suggested that it is important to consider the capacity of the workforce before implementing the interventions needed to mitigate the healthcare needs within the region. It is also important to mitigate the conflict of interest between the different departments, government organisations and policymakers in prioritising the health care needs within the country. Employee turnover is also another important factor which determines the visibility of the healthcare workforce plan within the region. The turnover rates in the leadership positions, political actions and the community development challenge the planning of the Healthcare Workforce.

Strategies to implement a workforce plan

In order to increase the healthcare outcome of the Cambodian population should be efforts made by the government to increase the quality of healthcare workers within the country.  This can be improved by harbouring better educational programs and infrastructure to boost the improvement of community learning and capability building through financial and technical support (Van Lerberghe et al., 2014). In places where the healthcare workers are posted in remote and underdeveloped regions of Cambodia, financial and non-financial benefits need to be provided to retain such workers for longer periods within those regions. The first and foremost priority of healthcare workers is to decrease infant mortality and increase maternal health and morbidity in Cambodia (Khim, 2016). The government of Cambodia also needs to employ better distribution and health workforce employment opportunities to ensure the safety of the public health within Cambodia is also important to emphasise on the systematic capability building within the existing healthcare workers in Cambodia. This way, the continuous learning and development, as well as performance management, can be achieved through who registered and licensed healthcare facilities. The empowerment of the existing healthcare workforce will improve the career growth and delegate more students to incorporate themselves within the healthcare workforce (Lassi et al., 2016). Strengthening the education system would act as a precursor of the improvement of competency in the new healthcare graduates within Cambodia. Providing better career opportunities and conducting leadership programs in Cambodia would be effective by improving competency, promotion of performance-based curriculum and training to improve the quality of medical education in Cambodia. 

Conclusion

Mitigating health inequalities is difficult in low and lower-middle income countries like Cambodia. The socio-economic determinants of health impact the healthcare service delivery inhibit the public health of the regions. The government needs to improve its health workforce plan by creating more prospects of employment, gender equality within the workforce, improving education systems to ensure that healthcare delivery is rapid. The increasing burden of the health care needs with the ageing population would increase the pressure on the health policymakers in future for which effective management is important immediately. Prioritisation of the health crisis needs to be collected and transferred to ensure transparency and distribution of the workforce needs.

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