After many years of continued payment of doctors and dentists in the Solomon Islands under a Scheme of Service negotiated and consummated in 2005, a review of the Scheme of Services was long overdue. In 2017 the Solomon Islands Medical Association (SIMA) had petitioned the Ministry of Health and Medical Services (MHMS) to conduct a review otherwise they would engage in trade union action. Under WHO funding, the MHMS urgently sought the support of an independent consultant for this review as part of its support for change management.

The consultancy commenced in late 2017 and has included:

1. Working with an Executive Level Taskforce that includes stakeholders from the three relevant ministries (Health, Public Service and Finance) and unions (SIMA, the nurse’s association and the allied health union).
2. Developing a communication strategy that ensures all stakeholders are fully informed through all stages of the review process.
3. Ongoing work with the Permanent Secretaries (Ministry of Health and Medical Services and Ministry of Public Services)
4. Developing an implementation strategy that includes identification of coaching, mentoring, communication, to ensure the review of the Scheme of Service achieves the desired outcomes.

During a visit to the Solomon Islands in November 2017 HRDA’s main consultant, Lee Ridoutt, conducted broad and inclusive dialogue with Solomon Islands Government stakeholders, associations and presented initial observations.

Identifying major concerns with the structure of the current Scheme of Service and its tenuous relationship with the Unified Salary Structure (USS) an important pillar of public service remuneration, it was decided to create an Options Paper that would identify possible solutions to medical practitioner pay and performance, and suggest a way forward, including the development of a new Scheme of Service divorced from a structural connection with the USS. This Options Paper is now being considered as a basis for longer term structural change while trade union action is resolved I the short term.

Standardisation and inclusion in the Regional Framework for Action: A discussion paper for Pacific Health Leaders, Partners and Stakeholders

HRDA Director Dr Graham Roberts was consulted by WHO to conduct an inventory of health professions training programmes in Pacific countries and to present the findings to the 2017 Heads of Health meeting in Suva.

The Pacific Region is progressing towards achieving common levels of higher education qualifications, a common quality assurance approach to education providers’ registration, and common methods of accrediting programmes. Until these region-wide objectives are achieved the countries and education providers in the region are acting independently by establishing diplomatic and professional ties to assist each other in training, experiencing both professional mobility within the region and migration out, suffering shortages of trained staff (some countries in crisis) through insufficient production and retention, dealing with identifying equivalencies for course credit transfers, integrating overseas graduates, opening to private sector providers, struggling to retain regional academics, duplicating teaching materials and employing professionals from other countries.

The review identified 250+ individual programmes (all disciplines and all levels) provided within the Pacific. Given that all programmes require academic support, teaching materials and resourcing it could reasonably be assumed that significant rationalisations around standardised programme cores could occur within disciplines across the Region. Ac set of seven recommendations was presented. It is anticipated that this paper will be published as a WHO technical paper to inform future decisions.

HRDA has been contracted by WHO to design a Postgraduate Certificate in Health Leadership and Management to be provided through the Solomon Islands National University (SINU). It will be the first postgraduate course ever at SINU, so it is an extremely exciting project.

The course is planned to commence in the second semester (July) of 2018. The development of the Health Leadership and Management course is in response to complex management issues that constrain health service delivery within the structural, resourcing and cultural environments of the Solomon Islands. HRDA is working with key officers from the Solomon Islands Ministry of Health and Medical Services (MHMS), SINU and the Ministry of Public Service (MPS) and its key partner in Australia the Australasian College of Health Service Management (ACHSM).

The project commenced in 2017 with a visit to the Solomon Islands by two of HRDA’s consultants, Graham Roberts and Lee Ridoutt. Data was collected on the needs of the target population for the course (enrolments in the course will initially be middle to senior level managers or prospective managers from MHMS, but in future the course may be open to participants from other Pacific Island Countries) through:

• Interviews with MHMS executive and managers
• Interviews with prospective course participants
• Consultations with MPS, especially the Institute of Public Administration and Management (IPAM), which had run some short leadership courses for senior public servants)
• Consultations with SINU on the university’s formal processes for a new course
• Review of MHMS and other Government documentation

From this a Discussion Paper was created outlining the training needs and to set the broad direction of the course.
A four-day course design workshop was held in Sydney in October 2017. The primary purpose of the Workshop was to engage with the cultural and regulatory contexts and to employ methods of adult experiential learning based on scenarios developed for the context of real work. In attendance from the Solomon Islands were:

• Dr Gregory Jilini (Undersecretary for Heath Care, MHMS)
• George Pego (Head of the HR Division, MHMS),
• Verzilyn Isom (Dean of School of Nursing and Allied Health Services from SINU) and
• Jennifer Mitini from the Ministry of Public Service

HRDA directors Dr Graham Roberts, Mr. Lee Ridoutt and Ms. Carla Cowles facilitated the workshop. Important professional inputs were provided by Mr. John Rasa from the ACHSM (currently involved in university accreditation processes and international partnering), and Mr. Andrew Carnegie, the Principle Leadership Consultant of FBG Group of management consultants.

An exciting course structure, building on Pacific Island indigenous cultural concepts, and based on an agreed set of internationally recognized leadership and management competencies developed from the ACHSM Master Health Service Management Competency Framework, was developed from the Workshop. An initial course proposal has been submitted to the SINU Academic Council. The proposal outlines the course approach to credit points, level of qualification, the status of the course, purpose, proposed course structure and target student groups. The content of the course is broadly revealed in the proposed units:

• Culture, Social Responsibility and Leadership Ethics
• Leadership in the National Context
• Communication & Relationship Management
• Leading People
• Finance, Annual Planning and Budgeting
• Leading Projects and Managing Time
• Quality and Safety in Service Provision
• Major Assessment Project

In late 2017 the SINU Academic Council approved the interim proposal and so more detailed course content is currently being developed by the HRDA team.

It is intended that Solomon Island graduates of the course will contribute to the implementation of the National Health Strategy and provide leadership in the Provinces, hospitals and departments across the health sector. Because the course design will align with internationally recognized competencies developed by the ACHSM, they will be eligible for membership of ACHSM.

Keep in touch with this project by looking for news items or register to receive the HRDA newsletter which is published every quarter.

HRDA Director Dr Graham Roberts recently concluded an assignment in Myanmar’s capital Nyipyidaw assisting the Ministry of Health and Sports with drafting the National Human Resources for Health Strategy 2017-21, which was commenced by one of HRDA’s Senior Associates, Emeritus Professor Arie Rotem. The HRH Strategy links to the National Health Plan 2017-2021 and the Human Resources for Health Policy. The National Health Plan has underlined the importance of HRH for universal health coverage (UHC) with the Essential Package of Health Services (EPHS) by 2030. Specifically, the 2017-21 HRH Strategy is designed to strengthen primary health care to deliver a Basic Package of EPHS in the current NHP plan period and to lay the foundation for subsequent expansion to the next phases of EPHS.

HRDA has been contracted to map the health workforce of Pacific Islands Countries, to prepare country workforce profiles and a regional discussion paper on HRH Issues. While most PICs have made progress in improving their health workforce information systems, trend analysis is needed for decision-making among policy-makers and for cross-country comparisons to provide a more in-depth understanding of the dynamics of the health workforce in the Pacific.

In November/December 2016 one of HRDA’s Directors, Graham Roberts, commenced a consultancy on a joint UNICEF/WHO project to assess the staffing and assets needs for Reproductive, Maternal, Newborn, Childhood and Adolescent Health (RMNCAH) services in Vanuatu; with specific focus on RMNCAH services in four pilot provinces.

Workforce shortages at the community level in rural areas were compounded by the impact of tropical cyclone Pam in March 2015. The task is to:

1. focus on four pilot provinces and the critical primary health care workforce shortages that impede service delivery at a community level
2. describe the impact of such shortages on child and maternal health
3. make recommendation for the Ministry of Health to address the shortfall in service provision.

This project has now been completed and findings reveal that HRH in Vanuatu is in need of urgent attention from production to maintaining the workforce in the field. Heavy investment by Vanuatu and from donor supporters in Human Resources for Health is now critical in order to provide a health service that meets basic health needs.

The staffing information and commentary on RMNCAH provided by this project is informing The Pacific Society for Reproductive Health’s review of staffing needs for the implementation of RMNCAH across the region.

HRDA Team members Lee Ridoutt and Victoria Hirst completed a project in Ireland critical to that country’s future health financing as they move to a ‘Money follows the patient’ process of service payment – more widely understood as activity based funding (ABF).

The project overall, managed by a HRDA partner Pavilion Health, had many components aimed at ensuring that when Ireland transitions fully to an ABF basis for funding hospital services the coded casemix data on which funding is based will be as precise and timely as possible, and accurately reflect each hospital in Ireland’s real level of activity in terms of number and complexity of episodes of care. HRDA’s team members worked primarily on the HR and work organisation aspects, in particular on three components:

​1. An analysis of the management of clinical coding services with the view to finding ways services can be managed, staffed and resourced to best practice levels.
2. An analysis of the training needs of the clinical coding workforce in terms of both numbers (new coders to be trained) and
3. The content of current and future courses to ensure the workforce is competent to deliver quality coded data.

The work in Ireland could have much wider application in Europe, but also many Asian countries already experimenting with ABF or attempting to base more decision making on quality casemix data. A series of journal articles related more narrowly to the HR components of the project are due to be published in the near future, to keep abreast of HRDA’s developments you can read our newsletters or join our mailing list here.

One of HRDA’s Directors, Lee Ridoutt, recently completed a project funded by the European Bank for Reconstruction and Development (EBRD). The project involved supporting the growth ambitions of a Ukrainian private sector health services company called Mamin Dom (Mom’s House), which started with a small shop in the centre of Kharkiv (the second largest city in Ukraine on the Eastern border) in 1999 providing families with new-born babies and children under 6 necessary goods (from cloths to strollers). In 2006 a pediatric clinic called Raduga (Rainbow) was established by the same company, but until recently it has operated as a separate business structure.

In 2013 the strategy of the Company changed. It was decided to develop a unique product with the co-working of three Spaces – the space of health (pediatric clinic), the space of children’s education (educational centre for children under 6 and future mothers) and the space of children’s goods (shops with goods for future mothers and children under 6). The mission of this unique project is (translation from Russian):

“We bring up modern healthy and smart children with their mothers – guardians of the family’s future. We make the goods and special knowledge available, filling the happy moments of motherhood with care and joy”.

While culturally quite contextualised, the mission has much in common with WHO visions around child health and well-being.

The HRDA component of this project related primarily to HRH capacity. Working with a very competent HR Officer and some of her staff and several senior line manager colleagues, the objectives of the consultancy included:

• Supporting the HR Officer to develop the full range of HR functions within the organisation
• Facilitating a client focused workforce through training and awareness
• Creating an annual performance appraisal / management system for qualitative and quantitative evaluation of performance
• Developing methods to motivate supervisory and middle management to take initiative in the planning process of growth
• Developing a plan and provisions for development of human resources.

HRDA was able to review and improve all aspects of HR functioning but particularly introduce new thinking on worker (especially the health professionals) selection, training, remuneration, performance management, deployment, recruitment strategy and support changes in organisational structure and work descriptions — and tying this up in improved HR information processes.

One of HRDA’s first projects provided a chance to launch the company doing the type of work for which it was formed ― working with other HRH professionals from our region, sharing our knowledge and experience and providing access to the expertise of some of our HRH colleagues and partners in Australia.

The project was a study tour / training program organised in conjunction with HRDA’s New Zealand partners, Training and Technology Transfer. The program was designed and delivered for delegates of the Kazakhstan Ministry of Health (KazHealth). The purpose of the program was to assist the Ministry to build capacity prior to the initiation of a Human Resources in Health (HRH) Observatory in Kazakhstan. The tour therefore program covered had the following key learning objectives areas in mind:

Lee Ridoutt and Kazakhstan Study Tour Delegates – 2015

• HRH data collection and analysis and monitoring of HR capacity;
• Understanding IT options of HRH information systems;
• Methodology and application of HRH data for planning, labour market analysis and capacity building;
• Understanding stakeholders in HRH planning; and,
• Understanding the structure and function of HRH Observatories

HRDA used mostly its own resources to conduct the tour but also included site visits to key Australian health agency partners such as Departments of Health in NSW and Victoria, Australian Institute of Health & Welfare, the Australian Health Practitioners Registering Authority, and selected private sector partners (Oracle) to supplement the learning experience.

The Kazakhstan Ministry of Health delegation very much appreciated the program, a key demonstration of which was to initiate a Memorandum of Understanding between the Ministry and HRDA to facilitate and cover future relationship activities. An even stronger demonstration is the request for HRDA to organise more training programs in 2015.

Client: World Health Organisation, Western Pacific Regional Office

The main objective of study was to produce a regional analysis of specific needs and gaps with regard to the implications of population ageing for health workforce policy, planning and implementation, and identify current policies and practices that could inform policy options and priority actions of particular relevance to low and middle-income countries in the Western Pacific Region. A draft report has been provided outlining the types of health services that are likely to be pursued and the workforce required to deliver these services. Significant re-direction of workforce development, deployment and management is envisaged.

Client: World Health Organisation, Western Pacific Regional Office

The task was to gather information and consult with stakeholders and to develop draft National Health Workforce Strategic Plans for the 3 countries. This project was undertaken by one of HRDA’s Directors, Dr Graham Roberts.

Client: Ministry of Health, Malaysia

A study tour was designed and delivered to a key Ministry of Health workforce planning officer that included visits to relevant Australian government organisations and departments and private sector companies involved in health workforce data collection, data analysis and use of data for a variety of human resource research functions. Individual tuition was also provided to the officer in strategic workforce planning activities, particularly the application of HRDA’s workforce demand and supply estimation methodology.