According to World Health Organization (WHO), health workforce of a country includes the ability of the country to meet health goals and objectives majorly on knowledge, motivation, skills, and deployment of individuals for organization and deliverance of health services(“HEALTH WORKFORCE”, 2018). There are various factors that determine a type of a health workforce in a country which includes a population of the country, labor force available, health facilities, registered professionals, and civil services payroll registered (Deloitte Access Economics, 2016). This study seeks to analyze and address the health workforce of Mongolia and Australia (“Australian Health”, 2016).
In this study Mongolia is selected as it is among middle level income as state by WHO situated in the same region as Australia , that is, Western Pacific Region, thus it may health workforce issues related with Australia’s. Mongolia is a sparsely populated landlocked country situated in Central Asia with a population density of 1.8 per kilometer. The population is estimated to be 2 81188 though the figure has been increasing by 1.8 % annually (“Human Resources for Health-Mongolia”, 2014). Despite an increase in population, the human resources for health have not shown a significant increase. There is low government funding for health and the health workforce is poorly distributed (“Australian Health”, 2016). On the other hand, the population in Australia has been rapidly growing day by day. According to the health department, the aging population has created a burden due to an increase in health disabilities. People aged over 65 years are expected to increase by about 4 million by 2051 (“Australian Health”, 2016). Therefore various areas of the health workforce of the countries are included in the study which includes an environmental scan of the country, profile of health workforce available, critical issues that need to be addressed and strategies relevant to implement the workforce plan.
According to WHO-Mongolia Country Cooperation Strategy 2010-2015, the health care systems are divided into three major levels which include national levels, province levels, and the soum level. The Mongolian health system is based on a former Soviet model which put greater emphasis on the hospitals for curative care rather than on preventive and promotes care. According to WHO statistics, there are about 68 hospital beds per 10000 individuals in Mongolia (“Human Resources for Health-Mongolia”, 2014). A number of specialized hospitals and institutions like National Center for Communicable Diseases have been developed to cater for a large burden of communicable diseases. However, the challenges have remained in regulations of the quality and the cost of services. The major funding for health services in the country is from government incurring a total expenditure or around 76% of the total state budget where about 21% is covered by health insurance and the rest 3% for individual self-care service (“Health Service Delivery Profile Mongolia”, 2012).
In 2008, the statistical data and facts showed that there were about 35254 workers in the health sector of Mongolia. The number had increased up to 41124 in 2011. Although it may be considered as an increase in the health workforce, the current staffing levels are considered insufficient with a great shortage of doctors and nurses (“Human Resources for Health-Mongolia”, 2014). Women play a major role in the health workforce of Mongolia. About 82% of all workers in the health workforce of Mongolia are women. There are about 79% women medical doctors, 98% women nurses and 80% medical imaging operators. Regarding the distribution of workers, there are about 6 doctors per 10000 population and there is great shortage especially in soum and sub soum hospitals.
According to Productivity Commission of Australia in 2015, there has been an increase in demand for health and community services. At the same time growth and establishments of funding has decreased (“Workforce Overview – Australian Institute of Health and Welfare”, 2018). Therefore the government of Australia has been actively transitioning in such a way that individuals have been given responsibility to take care of their health in terms of financial contributions. These changes have brought impacts to service health providers and also the mode of delivery (“Australian Health”, 2016). Due to this reason, the government and health organizations have developed vocational education and training (VET) systems in order to support national workforce and skills development. New national structures and processes are being considered at the same time there have been experienced changes to territories and state funding (“Rural Health Workforce Australia”, 2018). Therefore the VET sector has been embracing these changes in order to develop community health services and strong health workforce that will cater for future demand. The government and all other stakeholders are working forward to ensure VET policy and funding are implemented in order to support effective workforce planning (“Australian Health Workforce”, 2015).
Unlike in Mongolia, Australia major health challenges have been attributed to the increase in aging population and chronic illness (“Rural Health Workforce Australia”, 2018). The number of individuals aged over 65 with chronic illness is expected to increase up to 4.1 million by the year 2051. Over one million of these people are considered to need high care in residential facilities and about 370, 000 are estimated to need low-level health care (“Australian Health”, 2016). Other than that, the aging health workforce and associated projected retirements have become most of the critical factor facing the government and community. Early childhood education and care sector have also increased demand due to increase in population. According to Australian Government Department of Education Employment and Workforce Relation in 2012, there has been an increase of about 20% of child care services in Australia of which the number is expected to increase by 2.2 million by 2031 (“Rural Health Workforce Australia”, 2018).
According to WHO, the aggregated data of the health workforce is classified according to 9 major groups: Physicians include all general medical practitioners and medical practitioner specialists, Midwifery and nursing personnel which include all nursing personnel, midwifery personnel, and both nursing and midwifery associates (WHO ,2015). Traditional birth attendants are included as community health workers. Public and environmental workers include environmental and public health officers, hygienists, environmental and public health technicians, district health officers, sanitarians, food sanitation, public health inspectors and safety inspectors. Community and health workers include community health officers, family health workers, traditional birth attendants, community health education workers and complementary medical practitioners(“High-Level commission on Health Employment and Economic Growth”, 2018). Other health workers include all other groups of health providers such as dieticians, medical assistants, occupation therapist, nutritionists, medical imaging, optometrist, therapeutic equipment’s technicians, opticians, personal care workers, medical trainees, physiotherapist and speech pathologist (“Australian Health”, 2016). Health management and support workers include all other categories of health systems workers such as administrative managers, health economists, health policy layers, health statisticians, medical health records specialists, ambulance drivers, health information technicians, maintenance staff and general management staff(“WHO”, 2018).
The following table represents the density of health care workers in Australia and Mongolia per 1000 population from the years 1996, 2001, 2006, 2009, 2010, 2012 and 2015 by WHO(“WHO”, 2018).
Table 1.1: Density of health care workers in Australia per 1000 population
|
Year |
Physicians density |
Nursing and midwifery personnel density |
dentistry personnel density |
Pharmaceutical personnel density |
Laboratory health workers density |
Environmental and health workers density |
Community and traditional health workers density |
Other health workers density |
Health management and support density |
|
2015 |
3.496 |
12.379 |
0.578 |
0.847 |
0.861 |
||||
|
2012 |
3.246 |
10.14 |
0.557 |
0.76 |
N/A |
0.178 |
N/A |
0.78 |
|
|
2010 |
0.866 |
N/A |
0.088 |
N/A |
0.919 |
||||
|
2009 |
2.885 |
9.246 |
0.666 |
1.11 |
NA |
N/A |
4.446 |
||
|
2006 |
2.672 |
10.78 |
1.438 |
0.744 |
0.508 |
0.049 |
10.326 |
0.095 |
|
|
2001 |
2.479 |
9.728 |
1.103 |
0.723 |
0.431 |
0.197 |
1.986 |
25.29 |
|
|
1996 |
2.53 |
010.33 |
1.273 |
0.672 |
0.356 |
0.039 |
6.668 |
Nurses and physician play a major role in the healthcare of Mongolia. However, despite the low levels of all health workforces in the country, their ratio per 10,000 populations is highly poor(“WHO”, 2018). This could have been the reason for high mortality rates for infants and mothers.
Table 1.2: Density of health care workers in Mongolia per 1000 population
|
Year |
Physicians density |
Nursing and midwifery personnel density |
dentistry personnel density |
Pharmaceutical personnel density |
Laboratory health workers density |
Environmental and health workers density |
Community and traditional health workers density |
Other health workers density |
Health management and support density |
|
2015 |
0.508 |
0.294 |
|||||||
|
2012 |
1.333 |
0.28 |
|||||||
|
2010 |
0.196 |
0.434 |
|||||||
|
2009 |
0.198 |
0.408 |
0.123 |
0.045 |
|||||
|
2008 |
0.195 |
0.444 |
1 |
0.035 |
0.023 |
0.448 |
|||
|
2002 |
0.138 |
0.447 |
2.95 |
There has been an improvement from both countries where the number of workers in both Mongolia and Austria has been increasing from year to year. The ratio of doctors to nurses in Australia is generally high as compared to Mongolia (“Australian Health”, 2016). The number of all health workers per 10000 populations in Australia is high as compared to in Mongolia. However, both countries experience a deficit in such a way neither of them can be termed as having a good health workforce (“Rural Health Workforce Australia”, 2018). The tables below represent a total number of skilled health personnel in Mongolia and Australia per 10000 population and the total number of all nurses and midwives in both countries in the years 2013, 2014 and 2015.
Table 1.3 Skilled health personnel per 10000 population and all nurses and Midwives in Mongolia
|
Years |
Skilled health personnel per 10000 population |
All nurses and midwives |
|
2014 |
72.62 |
11836 |
|
2013 |
65.6 |
10964 |
Table 1.4 Skilled health personnel per 10000 population and all nurses and Midwives in Australia
|
Years |
Skilled health personnel per 10,000 population |
All nurses and midwives |
|
2015 |
162.4 |
296701 |
|
2014 |
157.2 |
290493 |
In Mongolia, there is a significant demand and constraints on service delivery. Strengths in health service delivery include well-trained health workers and retained staff, understanding of the local condition and service needs, strategic plans, availability of data on health utilization, better management and involvement of health care workers in health service management. However, there are gaps and challenges in the health workforce (“Human Resources for Health-Mongolia”, 2014). The health workforce capacity is poorly distributed of which the responsibilities and roles including family group practices are not well defined. In addition, the health service efficiency is poor due to various reasons which include poor referral systems and gate-keeping, inappropriate use of both outpatient and inpatient care, poor distribution of hospitals and beds, poor mismatching of health needs and supplies, insufficient coordination between levels of care and responsibilities and outdated guidelines and protocols (“Health Service Delivery Profile Mongolia”, 2012).
Mongolia has a burden of both communicable and non-communicable diseases. In 2011, around 43000 cases of different communicable illnesses were registered. The incidences of mumps, viral hepatitis, scarlet fever, tick-borne diseases and syphilis increased by 0.1 to 20 percent of the cases per 10000 populations as compared to the previous years (“Health Service Delivery Profile Mongolia”, 2012). Currently, Mongolia is experiencing both demographic and epidemiological transition where there is a decline in mortality and morbidity of communicable diseases and an increase in chronic noncommunicable conditions. This is well demonstrated throughout the country where circulatory diseases and cancer contributed over 75% of the total mortality (“Human Resources for Health-Mongolia”, 2014).
The national health workforce strategic framework(NHWSF) in Australia is a policy and planning guideline for health workforce intended to take place in the next ten years (“Australian Health Workforce”, 2015). The framework was developed in order to cater for the current emerging human resources for health (HRM) challenges (Aged and Community Services Australia,2016). It covers all related frameworks covering Aboriginal and Torres Strait Islander health workforce and also the overall health workforce in both regional and remote areas (“Australian Health”, 2016). Several principles are covered in the framework which includes distribution of all health workforces in an equitable manner to all Australians that recognize the specific requirements and needs of the people (Community Services and Health Industry Skills Council,2015).
The health workforce in Mongolia faces by various challenges including the inequality distribution of human resources for health(HRM), poor management in health systems, lack of enough structural resources, inadequate health workforce, poor health workers pay, poor quality control, lack of enough trained health personnel and overall systems of governance in both public and private sectors(AHPRA,2018) . To manage these challenges, certain strategies by WHO 2016 report “Working for health and growth: investing in the health workforce” are recommended (“Australian Health”, 2016). These include jobs creation, education of health workers, gender and women rights, proper use of technology in health systems, proper approach in crises and humanitarians settings, reforms in health services and delivery, increase in health financing, encouragement and involvement in partnership and cooperation, international cooperation and proper data, information and accountability (Shamian, 2016).
The Ministry of Health of Mongolia and the governance at the local level should embrace job creation through stimulation of decent health sectors jobs majorly in youths and women with the right skills and standard numbers in both rural and urban areas (“Department of Health | Health workforce”, 2018). This can be done by creating labor market policies in health sectors which can boost sustainable health workforce thus preventing workers to have second jobs in private sectors but creating a gap for new jobs (“Human Resources for Health-Mongolia”, 2014). Due to the fact that health sector is growing in Mongolia employing women and enhancing gender equality can be of great advantage. Currently, the majority of health workers providers are women hence reducing gender biases, physical and sexual violence which is increasing the productivity in women thus enhancing the quality of the health workforce (Heywood, Harahap & Aryani, 2013).
By educating and training new doctors and nurses including all other healthcare providers with proper training and skills, the government of Mongolia can be able to remove the challenge of the inadequate health workforce (“Department of Health | Health workforce”, 2018). This can be done by providing education models and control in such a way it can shift from narrow specializations to the lifelong building of expected competencies (“Human Resources for Health-Mongolia”, 2014). Health service delivery and organization in Mongolia should now be focusing on hospital care other than prevention alone (Centre for Workforce Intelligence ,2013). In addition, since there is no clear governance of public and private sectors in Mongolia, the government should provide a clear health system that controls all sectors in order to prevent the existence of incompetent workforce in private sectors. Harnessing of proper technological power in Mongolia and Australia will be cost-effective in terms of speed, health information deliverance, education and in providing people-centered care (“Australian Health”, 2016). The capacity of the health workforce in Australia and Mongolia should be built to an extent that it has the capability to detect and respond to public health crises’ and risks when they appear. This is due to the fact that, fragile and conflict setting found in Mongolia can escalate the existing shortcomings for providing both social and basic healthcare (White, Blackard & Satterfield, 2016).
Conclusion
Mongolia has a National Health System which has six subsystems which include: health efforts, health financing , human resource for health, supply of pharmacy and health equipment’s, management and health information plus community involvement whose role is to support human rights , partner with various stakeholders, ensure good governance, synergism, gender responsiveness, anticipation for environmental changes and regulation of laws and enforcement. Its workforce plan is faced with various challenges majorly being inadequate workforce. Other problems include inequality distribution of HRM, poor management in health systems, lack of enough structural resources, inadequate health workforce, poor health workers pay and poor quality control. These challenges can be addressed through more jobs creation, education of more health workers, articulation of gender and women rights, proper use of technology in health systems, the proper approach to various crises, reforms in health services and delivery, increase in health financing, encouragement and involvement in partnership and cooperation and international cooperation.
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