4 ANÁLISIS ECONÓMICO-FINANCIERO DE LAS SAD Y LOS CLUBES DE FÚTBOL
4.2 L AS C UENTAS DE P ÉRDIDAS Y G ANANCIAS
The Government spends for postgraduate training of Doctors. It is reported that the loss of board certified specialists ranged from 9.7% to 15.9%10 during the period 1993 to 2004.
Specialty training: Currently there is a dearth of General Surgeons, Geriatric specialists, Neurosurgeons, Thoracic surgeons, and Psychiatrists, but this is not reflected in any training plan for specialized services.
Paediatricians are in oversupply and the College of Paediatricians has urged the Department of Health Services to deploy some as Community Paediatricians.
There is also a tendency for sub specialty development despite the need for more general physicians and general surgeons.
10
Mendis L, Jayawardena J, Preena N ( 2005) Brain Drain of Specialist Doctors from Sri Lanka. Proceedings of the South Asian Conference on postgraduate medical education, August, Colombo, Sri Lanka
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Table 7: Problem Analysis on HRH Training and Production
Main areas of Issues &
challenges Problem Cause
Existing status of policy in relation to issues
1. Recruitment 1.1 Pressure on the management
units of the training centres to cope with large numbers of new recruits.
1.2 Ineffective alignment of recruitment of trainees to staffing requirements
Unplanned recruitment of trainees and rushed actions taken by the recruitment units
Insufficient resources in the training environment to cope with the increased intake
1.2 Coordination between recruitment units and training facilities are weak.
Projections of supply are not reviewed.
Intake of trainees has not been according to
There is no explicit policy regarding trainee recruitments. There is a policy of incremental annual increase of budget (more resources) for teaching facilities managed by Ministries of Higher Education but no such policy for MOH training schools.
a predetermined plan. No regular intake of trainees.
2. Quality of the Training Programmes
2.1 Adaptability
2.2 Training curricula
2.1 Training output does not meet the current service needs required to face transitional challenges
2.2 Lack of consistency in training programmes within the schools or between the batches recruited in different academic years of same category
2.1 Training programmes are not updated to accommodate the changes in the service needs from epidemiological and demographic transitions
Lack of diversity in training programs that are required to meet the present demands.
2.2 Some of the training programmes have only guidelines/outline of the training courses
No specific policy relating to quality of training programmes
Regulatory body for assessment of standards of education is available only for doctors. Medical Council addresses standards for medical education.
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Curricula and teaching guidelines used for training are not updated for more than a decade.
Training programmes do not meet the gaps in service performances
Absence of training needs assessment based curricula and an updating system
Competency-based training methodologies are not in use (except in some medical faculties)
Learning objectives are not organised under an associated core competency.
The absence of trainers with competency in curriculum design, development and management
Lack of attention to emerging health problems
Periodical evaluation of performance of the professionals at their workplaces and feed back to training institutions not done
Inadequate attention for development of standard curricula for training
Introduction of Competency based curriculum methodologies constrained due to lack of resources
There is no policy of training needs assessment for periodic updating of curricula
Health policies do not adequately reflect staff patient relationships. Attempts are being made to develop a Patient’s Charter.
No clear policy on competency based training
Few Medical Schools have adopted competency based curricula
2.3 Trainers
Teachers in training schools are not fully prepared for problem based teaching and team work approach
Training does not adequately address the need for a more responsive and a favourable attitude towards patients.
2.3 Shortage of full time trainers in most of the schools( under MOH)
Most of the trainers do not get a pre-placement training on educational sciences
Insufficient attention to teach problem based learning and teamwork approach
The teachers lack training to play a guiding role in problem based learning process
Behaviour change communication (BCC)is not adequately addressed in training
2.3 Other than for the medical faculties, a training career is not attractive enough to draw new recruits (e.g. no professional recognition, low incentive for teaching) No provision is identified as Trainers Cadre for some schools, (Eg PHI)
Delay in statutory approval of cadres for training centres due to administrative lapses
No regular pre-placement professional training for the tutors (except for NTS tutors) working in the Ministry of Health.
No policy on updating knowledge and skills of teachers
No policy to train all teachers on BCC.
Policy procedures are available on trainer recruitment, their career development, promotional schemes, academic gains, welfare schemes, incentives/allowances etc .This varies for each category
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2.4 Quality assurance of the Training Programmes
Lack of opportunities for continuous professional development of trainers
Some clinical trainers lack training skills and correct attitudes to function as a teacher
2.4 No proper evaluation system available to assess the quality of the training programme (except medical faculties)
Continuous Professional Development programmes are not available.
Absence of teaching guidelines and opportunities for development of teaching skills for the clinical trainers.
Clinical trainers are not provided with incentives for their additional function of training
Clinical trainers are not identified as a separate entity from the service providers
2.4 Evaluation of trainees performances Some of the courses do not have standardized guidelines except those in medical faculties.
PGIM offers a certificate courses for education training only for medical professionals No clear policies on professional development.
Staff development centres offer certificate courses (CTHE) to teaching staff in Medical Colleges which is essential prior to
confirmation
No policies with regard to clinical trainers
2.5 Management of training
Training schools of the Ministry of Health are not accredited
2.5 Unsatisfactory management of some training schools under the MOH.
Course evaluation is not carried out in any of the training programmes
Evaluation of the Trainers performances is not carried out in any of the training programmes
Accreditation is not seen as a priority. The mechanism for accreditation has not been initiated in any school or training institution under the Ministry of Health
2.5 Competencies in the managerial functions are lacking
Vacancies are not filled on time
No policy relating to evaluation of courses
No policies for accreditation of the training institutions
Accreditation body for
universities is functioning under the UGC is available
No specific policies for
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No recovery of expenditure incurred on trainees who drop out or leave the service early
(applicable to training under the MoH)
Cost efficiency of training programs are not known
The existing system to recover the funds spent on training by the government is too complex. In the event of trainees leaving prematurely, either during the training period or the period of compulsory service in the Department, working out cost incurred is difficult and recoveries do not happen
Studies on cost evaluations have not been carried out
The policies on cost-recovery available but not implemented to the full.
3. Degree Programmes 3.1 Production of health
professionals are not based on the service needs of the country
3.2 No recruitment plan to absorb the graduates of allied health sciences to the Dept of Health Services
3.1 Lack of effective coordination between the Ministry of Health and Ministry of Higher Education / UGC/ PGIM in planning and establishing training programmes for different categories of health professionals.
3.2 Some of the categories of the allied health workers are trained in degree programs by the Ministry of Higher education, but there are no cadre positions for them in Ministry of Health.
No clear policy agreement between Ministry of Higher Education/PGIM and the Ministry of Health in training of health professionals.
Policies on recruitment of degree holders for most of the allied health sciences categories into the government health system are not clear.
4. In-service programmes & Continuous professional development CPD)
4.1 Absence of regular in-service programs for most categories of staff to update their competencies
4.2 CPD programmes planned for the Medical Officers by the National Centre for CPD/SLMA and colleges are not well established
4.3 Uncoordinated in-service training programmes has lead to training of same people over and over again
4.1 This subject is not given sufficient attention.
4.2 In practice, the planned CPD
programme for Medical Officers, organized by the SLMA, is not fully linked with the programmes of Department of Health Services.
4.3 Lack of integration of training and inadequacies in monitoring
Absence of a training database Absence of a training calendar
No explicit policy for in-service training
The policies on promotions are present (promotion schemes)
No policies on CPD / in-service programmes
National CPD program is to be linked with the validation of doctor’s certification by the SLMC by 2015. There is some opposition to this by the trade unions.
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5. Post graduate programmes
5.1 Over supply of some specialties whilst others are undersupplied.
5.2 After local specialist training, trainees sometimes wait for a long period to get a suitable placement for overseas training for various reasons
5.1 Absorption of MOO to some PG training programmes is not based on MoH service needs, but on individual preferences
Non availability of a medium term plan based on workload analysis and projections of number and types of specialists needed.
MOH does not coordinate adequately with PGIM on its requirements for specialists
5.2 Some placements for overseas training have to be arranged by the candidates themselves.
There is no HRH projection plan for specialists based on the service needs of the country
Policies with regard to PGIM training are available
Policies on overseas training for PGIM trainees are available
Flexible overseas training options available to complete board certification
5.3 Non return of post graduates after foreign training
5.3 Weak bonding mechanism Policies with regard to bonding (bond is mainly to cover the cost of the overseas training period spent by the MoH but not the cost of training by the PGIM) are weak.
6. Private sector 6.1 Numbers of trained nursing care providers and other allied healthcare categories are below the requirements of the private sector
6.2 Private sector institutions depend on government employed health professionals to carry out their services on a part-time basis, with deleterious effects on the government sector.
6.1 Basic and / or in-service training programmes of adequate quality are not available in the private sector for nurses and allied health professionals
Private Medical Institutions Bill available (No mention of private training facilities for HRH)