- Role of Retention Strategies
<|> Prof. Kayode ODUSOTE
Health Systems Development, 9th General Assembly, International
Agency for the Prevention of Blindness, Hyderabad, India,
17 – 20 Sept. 2012.
Vision 2020: Strategy
T he 3 Pillar s
of V ision
2020
D isease
C ontrol
S uppor t
A ctivities
H um. R es .
D evpt
T he V ision
2020
T r iangle
Infrast &
E qpt D evpt
Coordination: International and National
Resource Mobilisation
Advocacy
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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies
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PERSONNEL IN EYE CARE by 2020
 Ophthalmologists
 Cataract Surgeons
1: 250,000
(1:250,000)
 Ophthalmic Assistants/ON
1:100,000
 Optometrists/Refractionists 1:50,000
 Community/PEC Workers
1:5,000
 Ophthalmic Equip. Technicians
??
 Managers & Administrative Personnel
100% of 3o and 50% of 2o
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HREH in WA - Role of Retention Intervention Strategies
CHANGE IN AVAILABILITY OF EYE HEALTH WORKERS
Gambia
No. Category of EHWs
Ophthalmic
1 Nurse/Ophthalmic
Medical Assistant
2 Cataract Surgeon
3 Ophthalmologist
4 Optometrist
Optometrist
5
Assistant
6 LPED Technicians
7 Low Vision Workers
Nigeria
Sierra Leone+
1994
2008
1994
2008
1994
2008
1994
2008
18
33
102
239
310
946
38
25
3
2
3
13
3
1
1
24
25
1
48
63
NA
157
100*
NA
400
1,475
5
-
7
3
0
4
9
3
1
10
-
6
11
?
2
1
9
?
?
?
5
?
22
12
6
?
4
4
* - Probably an underestimation
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Ghana
+ - Effect of Civil War
HREH in WA - Role of Retention Intervention Strategies
Inadequate number of all categories
of health professionals.
 Mal-distribution of available staff.
 Inappropriate mix of health workers.
 Poor performance associated with
poor motivation.

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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies
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HREH in WA - Role of Retention Intervention Strategies

Living conditions
◦ Housing
◦ Infrastructure – roads, water, electricity, telephone
◦ School for children, work for spouse


Opportunities for Career Progression
Work Environment
◦ In Eye Health – lack of facilities for specialized care.


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Professional Development and isolation
Opportunity Cost.
HREH in WA - Role of Retention Intervention Strategies

Financial incentives – rural allowance, etc
◦ main issue is sustainability

Enhanced career progression –
◦ reduced length of service for promotion to next
grade

Hire Purchase facilities for car purchase
◦ less effective with high cost of new vehicles and
lower cost of imported used cars.
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HREH in WA - Role of Retention Intervention Strategies

Compulsory rural service
◦ effect is only short-term and does not make for
sustained retention

Bonding for sponsored training
◦ Difficult to police sometimes, effect is short-term
and requires other packages for long-term retention.

Priority for further training or overseas trips
◦ dependent on volume of available sponsorships.

Decentralized recruitment
◦ works in a situation of adequate supply and no
vacancies in the major cities/
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HREH in WA - Role of Retention Intervention Strategies
TRAINING
Intervention
Potential for
Effectiveness
Students from rural backgrounds
Pos
Health Professional schools outside major
cities
Prb
Clinical rotations in rural areas during studies
Prb
Curricula that reflect rural health issues
NL
Continuous professional development for
rural health workers
Pos (if)
Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely
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HREH in WA - Role of Retention Intervention Strategies
REGULATION
Intervention
Potential for
Effectiveness
Enhance scope of Practice
Pos
Different types of health workers
Def
Compulsory service
Def
Subsidized education for return of
service
Def
Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely
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HREH in WA - Role of Retention Intervention Strategies
FINANCIAL INCENTIVES
Intervention
Appropriate financial incentives
Potential for
Effectiveness
Def (but)
Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely
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HREH in WA - Role of Retention Intervention Strategies
PROFESSIONAL AND PERSONAL SUPPORT
Intervention
Potential for
Effectiveness
Better living conditions
Pos
Safe and supportive working conditions
Prb
Outreach support
Prb
Career development programmes
Pos (if)
Professional Networks
NL
Public recognition measures
Prb
Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely
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HREH in WA - Role of Retention Intervention Strategies

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By 2020 –
Every person, everywhere, should have
access to a well-trained and wellmotivated specialized eye health
worker within 50 km and a welltrained and well-motivated primary
eye care worker within 5 km of where
he/she lives.
HREH in WA - Role of Retention Intervention Strategies

We need retention strategies to achieve the new
goal, but
◦ No single intervention works for all situations and for all
categories.
◦ Package of financial and non-financial incentives have
better chances of success.


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Eye Health remains low in priority of governments
in WA and so is Human Resources for Eye Health.
We appreciate the support of the IAPB family and
would continue to depend on this support for the
development of HREH in WA at least until 2015 and
possibly beyond.
HREH in WA - Role of Retention Intervention Strategies
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