40 41


Performance management

The issue of workforce productivity remains a high priority for the Ministry of Health (MoH) as well as its agencies in the service and regulatory units. There appears to be no clear direction as to what constitutes health workforce productivity [1]. However, with the salary enhancement, the issue of signing performance contracts at all levels was revisited. The MoH and its agencies are presently working on the criteria for the performance contract. Health worker productivity and performance covers performance management, motivation, welfare, training, and continuing professional development.

There is currently no comprehensive system for performance management for the MoH. Staff appraisal appears to be the main performance management tool employed by all age cies. However, there is no objectivity in the performance appraisal process. There is no recognition/award or sanctions for good or poor performance. The appraisals are completed annually, and the process focuses mainly on promotions. There is lack of adequate training for staff and managers on the performance management.

Workforce distribution and retention

The retirement age for all workers in Ghana is sixty years, and this is seen as an area that contributes to the loss of skilled and experienced health professionals in the health system. It appears from available information and data that the overall attrition of professional health workers is on the decline due to the several positive interventions undertaken by government between 2001 and 2007, including the recent upsurge in production interventions. The recent public payroll analysis also confirms a general decline in attrition particularly after 2006. However, a recent MoH analysis indicates that retirement from the sector stands as the most consequential reason for attrition between 2004 and 2008.

Regulation, practice standards, and competency development

The pharmacy workforce is organized into groups whose practices are regulated by the Pharmacy Council, a statutory regulatory body. This is intended to ensure and maintain quality in practice and to safeguard the wellbeing of the public. There is disconnection among workforce needs, health sector policies, and strategies adopted by Ministry of Education (MoE) and private training institutions. As a result, training institutions under the MoE appear to be slow in responding to human resources plans under various programmes of work (POW) and the need to scale up the production of health workers. The legal and regulatory framework for educating health workers is equally splintered, and has emerged in an ad hoc manner. Although this is not unusual in terms of international practice, it creates a challenging regulatory environment and is prone to coordination problems. The introduction of the Health

Workforce Observatory by the MoH is expected to address this challenge as the technical committee on training has membership of all stakeholders in training.

Policy development and implementation

One key ingredient in ensuring equitable human resources distribution is the existence of a system for identifying and tracking the movement of personnel. Over the years, there have been various efforts aimed at setting up and implementing a human resources system. These efforts were mostly fragmented and region-based, lacking standardization and continuity nationwide. In collaboration with West African Health Organization (WAHO) and Capacity Plus, the MoH has initiated the process of implementing an effective human resource information system to guide relevant decision- making. The system, when fully implemented, will have the components for planning regulation and management of human resource data that will go a long way to ensure effective distribution of staff. The system will serve as the human resources information system of a sub-regional body called the Economic Community of West African States.

................................................................................. .................................................................................

5.3.3. Strategies used and lessons learnt


Table 5.3.4. Strategies used and lessons learnt

1.0 To integrate pharmaceutical human resources planning with broader human resources for health planning

2.0 To reduce delays in recruitment and improve retention of public sector pharmaceutical personnel

3.0 To further develop, review and dissemina te a comprehensive set of practice standards for both the public and private sector

4.0 To review and reform curriculum of preservice education to be needs-based, practiceoriented and linked to required competencies within the scope of practice for each cadre

5.0 To strengthen the academic capacity of training institutions

Opportunities a. Pharmaceutical human resources planning already institutionalised within the Ministry of Health and its agencies b. WAHO to pilot internet based human resource information system for the pharmaceutical sector c. Pharmaceutical human resource indicators included in the District Health Management Information System (DHMIS)

Barriers a. Inadequate funding for human resource development b. Lack of clarity on processes to request public sector funding for pharmaceutical human resource development

Opportunities a. Two new schools of pharmacy to increase intake b. Commonwealth scholarships available for further study c. The MoH ensures that only programmes that are not available in the country are granted external fellowships

Barriers a. Lack of well developed career pathway for pharmaceutical cadres b. Lack of practice oriented post-graduate training programs c. Annual fellowship plans are not fully implemented because the budgetary allocation

Opportunities a. Public and private sector facilities are sponsoring upgrade training (eg, pharmacy technicians to undergo BPharm program) b. Pharmacy Council (PC) has an existing website which can be improved and used to run online CPD programmes as well as to disseminate information

Opportunities a. Kwame Nkrumah University of Science and Technology (KNUST) is reviewing its BPharm curriculum to develop a PharmD programme b. Pharmacy Council is developing a five year CPD programme plan for training of pharmacists, pharmacy technicians and licensed chemical sellers

Opportunities a. The establishment of Advisory Boards composed of most key stakeholders for holistic decision-making.

Ghana National Human Resource strategic plan for the health sector been revised to integrate the pharmaceutical human resource plan.

Public sector recruitment increased from 26% in 2009 to 35% in 2011.

Public sector salaries improved.

It is now more attractive to work in the public sector than the private sector.

Practice standards for all categories of pharmacy workforce developed.

The PC in collaboration with KNUST and Ohio Northern University has developed the PharmD curriculum. KNUST to admit the first batch of PharmD students this academic year. CPD programme for pharmacists undertaken by the PC annually. Similarly, LCS are trained annually.

KNUST has signed a memorandum of understanding with other international training institutions to develop faculty members and access to other training logistics.

1.1 To actively engage in the broader sectoral HRH planning processes of the MoH and GHS 1.2 To integrate the 2011 2016 pharmaceutical human resource plan into the 2011 2016 human resources for health plan

2.1 Pharmacy Council to build its capacity on pharmaceutical human resource issues by end 2012 2.2 To develop the capacity of the technical working group to advocate, negotiate, and follow up on recruitment of pharmaceutical human resources 2.3 To negotiate for improved remuneration and other incentive packages.

3.1 To form a review committee to examine existing practice standards documents (Standards for Pharmaceutical Care, Practice Standards for Pharmacists, Licensed Chemical Sellers, Pharmacy Technicians and MCAs) 3.2 To develop one draft comprehensive standards document and circulate to all stakeholders

4.1 To establish a pharmacy education reform working group 4.2 To evaluate existing tools for quality assurance and standardize them into single quality assurance tool 4.3 To conduct curriculum review and quality assessment of all pre�service training programmes 4.4 To develop and implement plans for curriculum reform based on findings

5.1 To establish a working group on academic capacity development 5.2 To identify relevant postgraduate programmes and scholarships for academic staff 5.3 To build national and international exchange programmes between training institutions as a mechanism for sharing and expanding academic capacity 5.4 To improve library capacities of training institutions and subscribe to databases and journals

Strategy Stakeholders Involved Activity/Processes Opportunities/Barriers Outcomes

Pharmaceutical human resources technical working group, Human Resource Development Directorate (HRDD) GHS; Human Resource for Health and Development (HRHD)�MoH; Human Resource for Health (HRH); Teaching Hospitals, WHO

Technical working group on pharmaceutical human resource; Pharmacy Council; Ghana Hospital Pharmacist Association (GHOSPA), Pharmacy Unit MoH; HRDD�GHS; HRHD�MoH; Ministry of Finance and Economic Planning (MOFEP)

PC, Pharmacy Unit/MoH, Ghana National Drugs Program, Pharmaceutical Society of Ghana (PSGH)

Training institutions, Pharmacy Council, Pharmacy Unit/MoH, PSGH, HRHD/MoH, HRDD/GHS, Ghana Education Service, MoE, World Health Organization (WHO)

MoE, Local and international training Institutions; Private sector, Development Partners; Ghana Education Trust Fund (GETFund)