HUMAN RESOURCES FOR HEALTH IN THE CARIBBEAN: A Review of the Workforce Situation and the National Baselines of the 20 Goals for Human Resources for Health 2011 HHUUMMAANN RREESSOOUURRCCEESS FFOORR HHEEAALLTTHH IINN TTHHEE CCAARRIIBBBBEEAANN:: AA RReevviieeww ooff tthhee WWoorrkkffoorrccee SSiittuuaattiioonn aanndd tthhee NNaattiioonnaall BBaasseelliinneess ooff tthhee 2200 GGooaallss ffoorr HHuummaann RReessoouurrcceess ffoorr HHeeaalltthh 2011 Pan American Health Organization “Human resources for health in the Caribbean: a review of the workforce situation and the national baselines of the 20 goals for human resources for health ‐ 2011” Washington, D.C.: PAHO, © 2011 © Pan American Health Organization, 2011 All rights reserved. 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Table of Contents Acknowledgements ............................................................................................................................. v Authors.............................................................................................................................................. vii Glossary.............................................................................................................................................. ix Executive summary.............................................................................................................................. 1 Profile of the Caribbean Region ........................................................................................................... 3 Chapter One: Introduction ................................................................................................................ 11 1.1 Background and Context.................................................................................................................11 1.2 Global Focus on the Importance of Human Resources for Health .................................................11 1.3 Regional Focus ................................................................................................................................12 1.4 The Caribbean .................................................................................................................................14 1.5 Purpose and Objectives of Measuring and Monitoring HRH in the Caribbean ..............................16 1.6 The Approach: Collection, Management, and Evaluation of HRH Data to Develop a Core Data Set and Establish the Baseline percentages for the 20 Goals...............................................................16 Chapter Two: Profile of the Caribbean Region................................................................................... 19 2.1 Country Profiles (Appendix A).........................................................................................................19 2.2 Demography (Appendix C)..............................................................................................................24 2.3 Population Health (Appendix C)......................................................................................................26 2.4 Health Systems (Appendix C)..........................................................................................................28 Chapter Three: Human Resources for Health..................................................................................... 31 3.1 Historical Trends (Appendix D) .......................................................................................................31 3.2 Migration of Health Workforce.......................................................................................................32 3.3 Current Supply (Appendices B & D) ................................................................................................32 3.4 Workforce Shortages ...................................................................................................................... 34 3.5 Health Education.............................................................................................................................34 Chapter Four: Tracking Regional Goals for HRH ................................................................................. 37 4.1 Introduction ....................................................................................................................................37 4.2 Challenge One: Define Long Term Policies and Plans to adapt the workforce to meet the projected changes in the health systems .......................................................................................37 4.3 Challenge Two: Put the right people in the right places in order to achieve an equitable distribution according to the health needs of the population .......................................................41 4.4 Challenge Three: Promote national and international initiatives that help countries affected by migration to retain their health workers and to avoid gaps in staffing..........................................45 4.5 Challenge Four: Generate healthy work environments that foster agreement with the institutional mission of ensuring the provision of health services of good quality for the entire population.......................................................................................................................................48 4.6 Challenge Five: Create mechanisms of cooperation between educational institutions and health services to produce health care professionals who are responsive and qualified to meet the national health system’s needs. .....................................................................................................51 iii Chapter Five: Summary and Conclusions ........................................................................................... 55 Bibliography ...................................................................................................................................... 59 Appendix A: Health Sector Overview and Population Trends............................................................ 61 Appendix B: Caribbean Human Resources for Health and Training Programs.................................... 71 Appendix C: Historical Caribbean Population Health Trends.............................................................. 75 Appendix D: Human Resources for Health in the Caribbean .............................................................. 79 Appendix E: Caribbean Regional Goals HRH Baseline Indicators ........................................................ 81 Appendix F: Summary Caribbean Region Baseline Indicators.......................................................... 111 Appendix G: Health Human Resources Planning............................................................................... 113 Appendix H: Map of the Caribbean Region....................................................................................... 119 iv Acknowledgements The Pan American Health Organization / World Health Organization (PAHO/WHO) acknowledges the leadership of the Ministries of Health of CARICOM in guiding the research and collaboration that produced the health workforce information on which this publication is based. The health authorities of the participating countries contributed significant resources from their offices and recruited national and local stakeholders to complete the referenced Human Resources in Health (HRH) studies. In addition, PAHO/WHO wants to express its appreciation of the valuable contributions of those institutions and individuals who assisted with the preparation of the material and compilation of the data for the respective human resources country reports. The participation of the many health professionals, educators, managers and program administrators has been and will remain essential to the ongoing planning of human resources for health. This publication aims to summarize the findings and information from the HRH data research and the baseline measurement of the 20 Regional Goals for HRH in order to provide an overall view of the situation across a number of Caribbean countries. It is not intended as a ranking or judgment of the countries’ performance. The information provided should be reviewed as “food for thought” in assessing the areas that may or may not need