1. 1

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. 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. 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. 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. 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. 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. 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. 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. 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. •
•
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. 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. 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. 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. III. Instructional reforms (5/5)
• Great potential benefits of eLearning if managed
right.
• Incorporation of on-site learning throughout
learning continuum
15

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. 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. 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. 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. 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. 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. 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. 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. Acknowledgements
• All PMAC 2014 supporting staffs, secretariat for
their able support and dedications
• Members of all session rapporteur
24

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