2015年-世界发展银行全球_The_Health_Workforce_in_Latin_America_and_the_Caribbean___An_Analysis_of_Colombia_Costa_Rica_Jamaica_Panama_Peru_and_Uruguay_133页_1mb

报告摘要

Summary of The Health Workforce in Latin America and the Caribbean: An Analysis of Colombia, Costa Rica, Jamaica, Panama, Peru, and Uruguay

Core Content

This report provides an in-depth analysis of the health workforce (HRH) in six Latin American and Caribbean countries: Colombia, Costa Rica, Jamaica, Panama, Peru, and Uruguay. It explores five key dimensions of HRH: financing, organization, management, regulation, and performance, with a focus on how performance management policies and incentives influence these aspects. The study highlights the challenges and progress made in each country, offering insights into the broader context of HRH in the region.

Main Points

Financing of the Health Workforce

Health workforce financing varies significantly across the six countries.
Colombia and Costa Rica have introduced performance-based financing mechanisms, such as capitation payments and performance targets, to reward health workers.
In Jamaica and Peru, a large portion of the health workforce is employed under temporary contracts, leading to instability.
Panama and Uruguay have clear salary scales that are harmonized or specified per specialization.
Financial incentives are used in all countries to encourage work in rural and remote areas, with Uruguay focusing on aligning public and private sector salaries.

Organization of the Health Workforce

The skill mix and distribution of health professionals are uneven across the region.
All countries, except Peru, have met the WHO HRH density target of 25 professionals per 10,000 population.
Colombia has a 40% PHC physician ratio, while Jamaica still struggles with PHC levels due to low salaries.
Costa Rica and Jamaica have made progress in establishing PHC teams with diverse skills.
Panama and Peru have a PHC focus in policy but lack on-the-ground implementation.
Colombia, Costa Rica, and Uruguay have community-based recruitment policies, with Colombia restricting hiring to local residents in remote areas.

Management of the Health Workforce

Migration of health professionals is a major challenge in the region, with Peru accounting for 44.7% of all outmigration.
Self-sufficiency policies and foreign-trained professional certification mechanisms have been implemented in Colombia, Costa Rica, Peru, and Uruguay to address the shortage.
Performance management includes contractual arrangements, compensation, training, promotion, and certification.
Colombia and Panama have developed certification processes for health professionals to ensure quality and uniformity.
Jamaica and Peru have high attrition rates due to low salaries and lack of promotion plans.

Regulation of the Health Workforce

All countries have introduced HRH safety policies and legislation to regulate disputes and negotiations.
Costa Rica and Uruguay face underemployment challenges, while Jamaica and Peru have high rates of precarious employment (19% and 32%, respectively).
Colombia and Panama have certification processes for health professionals, while Peru is in the early stages of accreditation.
Uruguay allows health workers to influence employment conditions, whereas in public sectors, unions and the state make decisions.
Professional associations in Panama and Colombia play a key role in policy dialogue, while unions in these countries are fragmented and have limited influence.

Performance of the Health Workforce

Health outcomes are mixed, with Colombia, Costa Rica, Jamaica, and Peru meeting basic health indicators.
Access and availability of health workers are generally sufficient, but rural and remote areas still face gaps.
Quality of care and patient satisfaction vary, with Costa Rica showing dissatisfaction with management services and Panama lacking care process protocols.
Professional practice and productivity are underdeveloped in some countries, requiring improvement in training and supervision.

Key Information

Performance management is a critical area for improving HRH systems, but limited evidence links it to health outcomes.
Education and training are increasingly accessible, but graduates are not always absorbed into the workforce.
Only Uruguay has 80% of its health sciences schools reorienting education toward PHC.
Accreditation processes are being developed or improved in all six countries, with Panama and Peru showing the most progress.
Regional cooperation and WHO guidelines are being followed, with all six countries adopting the Global Code of Practice on the international recruitment of health personnel.
Financial incentives, contracting mechanisms, and community-based recruitment are strategies to improve HRH distribution and retention.
Precarious employment remains a challenge, with Jamaica and Peru showing the highest rates.

Conclusion

The study underscores the importance of HRH in achieving health system goals and highlights the divergent approaches and challenges in the six countries. While some progress has been made in financing, organization, management, and regulation, performance remains uneven. The report recommends strengthening PHC focus, improving financial incentives, and enhancing workforce planning and retention strategies to ensure equitable and sustainable health systems.