Health Professionals for a New Century

Strengthening 21st Century Global Health Systems:

Investing Strategically in the Health Care Workforce
Julio Frenk

New York City

October 13, 2011 1
Report Covers

3
 Education of
The Commission Health Professionals
for the 21st Century

Global
Advisory Inputs
Multi-professional
• Scientific advisors
• Youth commissioners Commissioners Evidence-based
• Papers (20)
• Consultations Instruction-institution
• Research
 Report Title

Health Professionals for a New Century:

Transforming Education to Strengthen Health Systems
in an Interdependent World

5
 What’s New

• Global outlook

• Focus on all health professions beyond traditional silos, with

emphasis on medicine, nursing, and public health

• Long-term perspective on post-secondary education

• Integrative framework

• New vision driving specific recommendations

6
 Outline

1. A Century of Progress, a Time of New Challenges

2. An Integrative Framework

3. Major Findings

4. Reforms for a Second Century

5. Follow-Up

7
General Report Outline

1. A Century of Progress, a Time of New Challenges

2. An Integrative Framework

3. Major Findings

4. Reforms for a Second Century

5. Follow-Up

8
The Health Revolution of the
20th Century

9
Life Expectancy and Income per
capita, by Decade

10
Knowledge Translation and the
Improvement of Health

Technology

Knowledge
Behavior

Evidence

Policy

11
 Emerging challenges

Epidemiological and
demographic transitions

Technological
Health Professional
innovation
System differentiation

Population
demands
General Report Outline

1. A Century of Progress, a Time of New Challenges

2. An Integrative Framework

3. Major Findings

4. Reforms for a Second Century

5. Follow-Up

13
 A Systems Approach

Labor market for

Supply of health Demand for health
health
workforce workforce
professionals

Provision
Provision
Education Health
System System
Demand Demand

Needs Needs

Population
14
 Key components of the educational system
Structure Process
Institutional Design Instructional Design
•Systemic Level
Stewardship and governance
Financing
Resource generation •Criteria for admission
Service provision •Competencies
Context •Channels
•Organizational level
Ownership Global-Local •Career pathways
Affiliation
Internal structure
•Global level
Stewardship
Networks and partnerships

Proposed Outcomes

Interdependence in Transformative
Education Learning
General Report Outline

1. A Century of Progress, a Time of New Challenges

2. An Integrative Framework

3. Major Findings

4. Reforms for a Second Century

5. Follow-Up

16
 Systemic failures

• Mismatch of competencies to needs

• Weak teamwork
• Gender stratification
• Hospital dominance over primary care
• Labour market imbalances
• Weak leadership for health system
performance

17
Density of medical schools by region
Distribution of Public Health Schools

19
Resized world maps
 Countries by number of medical schools
45

40

35

27
Number of countries

30 Other

25 Sub-Saharan Africa

20 22

15 16
23 24
10 12
17 10 18
5 9 8
7
4 4
0 1 2 2
0
0 1 2 3 4 5 6 - 10 11 - 20 More
than 20
Number of medical schools
Institutions, graduates and workforce by region (2008)

Estimated number of Estimated graduates per Workforce

schools year (thousands) (thousands)
Population
Region
(millions) Public Nurses/ Nurses/
Medical Doctors Doctors
Health midwives midwives

China 1371 188 72 175 29 1861 1259

India 1230 300 4 30 36 646 1372

Asia
Other 1075 241 33 18 55 494 1300

Central 82 51 2 6 15 235 603

High Income Asia Pacific 227 168 26 10 56 409 1543

Central 122 64 19 8 28 281 670

Europe
Eastern 212 100 15 22 48 840 1798

Western 435 282 52 42 119 1350 3379

North America 361 173 65 19 74 793 2997

Americas

Latin America/Caribbean 602 513 82 35 33 827 1099

North Africa/Middle East 450 206 46 17 22 540 925

Africa

Sub - Saharan Africa 868 134 51 6 26 125 739

World 7036 2420 467 389 541 8401 17684

Financing of medical and nursing graduates by region (2008)

Doctors Nurses/midwives

Region Estimated Estimated Estimated

Estimated $US Total Total
number of number of $US
expenditure per expenditure expenditure
graduates graduates expenditure
graduate ($US ($US
per year per year per graduate
(thousands) billions) billions)
(thousands) (thousands) (thousands)

China 175 14 2.5 29 3 0.1

India 30 35 1.0 36 7 0.2

Asia
Other 18 85 1.6 55 20 1.1
Central 6 74 0.4 15 13 0.2

High Income Asia Pacific 10 381 3.8 56 75 4.2

Central 8 181 1.4 28 39 1.1

Europe
Eastern 22 151 3.4 48 29 1.4

Western 42 400 17.0 119 82 9.8

America North America 19 497 9.7 74 101 7.5

Latin America/Caribbean 35 132 4.6 33 26 0.9

Africa North Africa/Middle East 17 113 1.9 22 24 0.5

Sub-Saharan Africa 6 52 0.3 26 11 0.3

World 389 122 47.6 541 50 27.2

Investment in total health expenditure
and health professional education
 Macro and Micro Estimates of Physician Education
Expenditures
Education expenditure in USD (billions) 20
18
16
14
12
10
Macro
8 Micro
6
4
2
0
Africa Asia Europe LAC N. Oceania
Regions America
General Report Outline

1. A Century of Progress, a Time of New Challenges

2. An Integrative Framework

3. Major Findings

4. Reforms for a Second Century

5. Follow-Up

27
 Three Generations of Reform

1900 Science-based Problem-based Systems-based 2000+

Instructional

Competency
Scientific Problem-based
driven:
curriculum learning
local-global
Institutional

University Health and

Academic
based education
centers
systems
 Vision

Transformative Interdependence
Learning in Education

Equity in Health

Individuals Population-
Patient-Centered Based

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 Recommendations

Reforms Enabling Actions

Instructional
• Competency-driven • Mobilize leadership
• Local responsiveness with Goal
global connectivity
Transformative
• Inter- & trans-professional • Enhance investments and
education interdependent
• IT-empowered professional
• Educational resources education for
• Align accreditation
equity in health
• New professionalism

Institutional • Strengthen
• Joint planning global learning
• Academic systems
• Global networks
• Culture of critical inquiry
 Competency-based education

Traditional model

Educational
Curriculum objectives

Assessment

Competency-based education model

Health needs Competencies

Curriculum
Health systems outcomes

Assessment
Models of inter- and trans-professional education

Model Pre-secondary Post-secondary education Practice

education

MD
Dominant Common Nursing
Teamwork
Public health

Other

Inter- Common Core + specific Systematic

Teamwork
professional competencies teamwork

Trans- Common Core + specific Systematic

Teamwork
professional competencies teamwork

Community
health workers
 Levels of Learning

Level Objectives Outcome

Informative • Information Experts
• Skills

Formative • Socialization Professionals

• Values

Transformative • Leadership attributes Change agents

16
General Report Outline

1. A Century of Progress, a Time of New Challenges

2. An Integrative Framework

3. Major Findings

4. Reforms for a Second Century

5. Follow-Up

34
 Follow-Up

• Worldwide Launches: 20
• National Initiatives
USA – IOM, IAMP, CUGH, Harvard
Canada, Brazil, Peru, Lebanon
Thailand, China, Vietnam, India, Japan
• Regional Networks
Asia 5-C network
 Knowledge

“The pursuit, production, dissemination, application, and

preservation of knowledge are the central activities of a civilization.
Knowledge is social memory, a connection to the past; and it is
social hope, an investment in the future. The ability to create
knowledge and put it to use is the adaptive characteristic of
humans. It is how we reproduce ourselves as social beings and how
we change—how we keep our feet on the ground and our heads in
the clouds.”

Louis Menand
The Marketplace of Ideas, 2010

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