Strategies to Improve Health Systems(cont...)

Use Regional Education and Training Capacity to Complement the National Needs for Human Resources in order to Improve both Staffing and Skill Levels Health professionals play a vital role in the prevention and, especially, treatment of people with NCDs, yet most countries in South Asia are significantly short of health professionals.

The larger countries are investing in additional training, and the smaller ones heavily depend on them for training their own nationals. There is considerable migration across regional countries among health professionals in addition to out-migration to more prosperous countries beyond the region. Thus several aspects involving labor, training, and migration of health professionals could be addressed from a regional perspective.

A better understanding of the country-level dynamics of HRH within and outside the region would lend insight to where efforts might be strategically placed to address shortages and needed skills. For small countries, cross-national training of health professionals would offer benefits, including lower costs and a higher-quality education in settings with greater clinical expertise and a population with an adequate case load for training.

One possibility is to have the initial years of training carried out in one country and then have formal clinical rotations to other countries. In the United States, for example, an HRH training program has all the initial training for physicians and nurses from rural western states in Washington state, which has a large urban center; then the clinical rotations are to the trainees’ home states.

These rural states do not have the funds or the population to support a medical or nursing school, but they help support the medical school in Washington state and, in return, are allowed to admit their students to Washington state medical school for basic training and then continue the clinical training in their home state. This is a model that could benefit the smaller countries in the region, and has multiple advantages.

It allows more training of health professionals from smaller countries; it does not require larger countries to fill gaps smaller countries health professionals needs; and means that people in smaller countries can be treated by people from their own country. The rationale for adopting a regional approach for the HRH gaps that most countries are facing stems from the economies of scale achievable.