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1. BACKGROUND

The Asia-Pacific Action Alliance on Human Resources for Health (AAAH) is a regional partnership mechanism established in response to the international recognition of the need for global and regional action to strengthen country health workforce planning and action.

As of 2012, AAAH has 16 members including Bangladesh, Cambodia, China, Fiji, India, Indonesia, Lao PDR, Mongolia, Myanmar, Nepal, Papua New Guinea, Philippines, Samoa, Sri Lanka, Thailand, and Vietnam.

AAAH’s 5 priority actions are the following: HRH advocacy, information monitoring, capacity strengthening, knowledge generation, and technical coordination.

AAAH is managed by a small Secretariat team under the guidance of the Steering Committee. Each country in the network has a focal point who acts as a coordinator between the AAAH and agencies within the country.

The Vision of the AAAH network is:

“Countries have strong HRH research, planning and management capacity to support the development of equitable and effective health systems in the Asia-Pacific region”

2. ACTIVITIES

There are key actions to initiate HRH activities in the region including, advocacy and support for strengthening HRH planning and implementation; knowledge generation, management and sharing; and coordination and technical support to partners in order to build capacity for HRH research, planning and management.

2.1 Advocacy and support for strengthening HRH planning

AAAH website and blogs : Visit the new AAAH Website at www.aaahrh.org.

AAAH Newsletter : The AAAH newsletters have been published bimonthly since 2007 and are available for download from the AAAH Website.

Participation in other meetings/workshops : AAAH Secretariat staff and Steering Committee members have attended a number of HRH-related meetings to advocate for the importance of HRH and to create opportunities for collaboration with potential partners.

2.2 Knowledge generation, management and sharing

The AAAH Annual Conference : The AAAH Conference is arranged on an annual basis in the second half of the year. It is an international forum aiming to facilitate the exchange of HRH knowledge and experience among the AAAH country members and international partners.

·   The 1st AAAH Annual Conference 2006 was held in Ayutthaya, Thailand, 28-31 October 2006: 90 participants attended.
·   The 2nd AAAH Annual Conference 2007 was held in Beijing, China, 12-14 October 2007. The theme was “Human Resources for Rural Health and Primary Healthcare”: 96 participants attended.
·   The 3rd AAAH Annual Conference 2008 was held in Sri Lanka, 12-15 October 2008 on the theme of “Globalization and its Implications for Health Care and Human Resources for Health”: 90 participants attended.
·   The 4th AAAH Annual Conference 2009 was held in Hanoi, Vietnam, 23-25 November 2009 under the theme of “Getting Committed Health Workers to Underserved Areas: A Challenge for Health Systems.” This conference was organized jointly with the 3rd Meeting of the WHO Expert Group on “Increasing access to health workers in remote and rural areas through improved retention” and 134 participants attended.
·   The 5th AAAH Annual Conference 2010 was held in Bali Indonesia, 3-6 October 2010 with the theme of “HRH Challenges for Achieving MDGs”. This conference was also part of the preparatory meeting for the Second Global Forum on HRH and around 130 participants attended the meeting.
·   The 6th AAAH Annual Conference 2011 was held in Cebu, the Philippines, 9-11 November 2011. The theme was “Capacity for HRH Management and Development to Support Universal Health Coverage”; around 150 participants attended the meeting.
·   The 7th AAAH Annual Conference 2012 was held in Bangkok from 5th-7th December 2012 on the theme of “Leadership Development for Health System Strengthening: A Focus on Human Resources for Health”.

Knowledge sharing:Materials relating to the AAAH annual conferences e.g. proceedings from the 1st-6th annual conferences are posted on the AAAH website. The AAAH website also facilitates knowledge sharing through country based blogs, a register of researchers and their interests, and  a web discussion board.

Knowledge generation, management and sharing:The 8th AAAH Conference 2014 was held in Weihai, China from  27th – 31st October 2014 on the theme of “Move Ahead: Strengthening HRH Strategies and Action towards UHC in Post-2015 era”.

2.3 Capacity Building

AAAH supports capacity building for a new generation of researchers to join the AAAH annual conference and make presentations and network with experts in other countries. At the 6th annual conference, 72 abstracts were submitted representing all the AAAH member countries. Some of the selected presenters were newcomers to the field of HRH research and the AAAH Annual Conference.

Additionally, Sri Lanka is conducting a technical report on HRH under the priority country project, a AAAH initiative, supported by the Rockefeller Foundation.

AAAH has taken part in the development of the Asia Pacific Regional Network of Health Professional Training Institutes, supported by WHO/SEARO. Additionally, in 2012, there are 2 intersession activities which will strengthen in-country capacity in conducting research and create both in-country and network ownership and accountability:

  1. Policy Mapping and Analysis of Rural Retention Policy

2. Policy Analysis on the Roles of the Public and Private Sectors in Health Professional Production/Employment

3. CHALLENGES

In the Cebu conference 2011, AAAH conducted a SWOT analysis. It revealed the following:

Strengths

1. AAAH is country driven (not donor driven), naturally formed network for common problems

2. AAAH convenes 16 countries across Asia Pacific (from both SEARO and WPRO regions).

3. Country contexts are various. Country members can learn and get support from each others.

4. AAAH is regional solidarity, trust-based, and voluntarism.

5. AAAH has operated under good governance, it is collegial operating on a basis of equal partnership, solidarity, and rotation of leadership. AAAH is not a money-driven organization.

Weaknesses

1. Talk-based network

2. AAAH only convenes annual conference but fails to drive national agenda.

3. Inter-session activities are limited.

4. Focal points and secretariat overwhelmed by other competing demands.

5. HRH units in respective Ministries of Health are weak.

6. The nature of AAAH is complex, for instance, the members are from multiple-sectors (public – private)

Opportunity

1. Since there are 16 country members from all over the Asia-Pacific region: this opens opportunities for cross country collaborations to generate evidence and to build capacity.

2. The network can be strengthened to become more  “task-based”.

3. The demand for evidence in policy decision will be increased.

4. Funding support will be continued as long as AAAH shows value added.

5. SC, Focal Points, and Secretariat can demonstrate mutual accountability.

6. There is a strong collaboration between regions through six years collegial partnership.

Threats

1. Threats includes the ad-hoc manner of mobilizing one-off funding support for annual conference.

According to this SWOT analysis, we concluded that the AAAH can move forward in more sustainable way by shifting from being a talk-based network to become a task-based network. The inter-session activities of mutual interest among groups of concerned countries can be increased. Moreover, “homework” of focal points must be maintained for inter-session activities to be effective. Clearly defined indicators must be set up in order to be able to compare the results between country members.

Focal points also identified the priority HRH research that needs to be conducted in their country, as follows;

  1. Rural Retention(Nepal, Philippine, Vietnam) included mapping of policies on rural retention; critical assessment of key policy on rural retention; scaling up effective policies, resolving weakness of unsuccessful policy implementation.
  2. HRH Information System (Samoa, Myanmar, Philippines, Nepal), this included critical assessment of the bottlenecks of HRH information systems and cross country sharing of experiences of success/failure.
  3. Strategic Planning in HRH Production (Myanmar, Indonesia, Philippine, Nepal)
    1. Policy analysis: mushrooming of private health professional education institutes; regulatory environment; quality of professionals; responsiveness to country health needs
    2. Application of 5C [tools are public goods freely available to ALL] for national level assessment; institutional level assessment of nurse, doctors, public health schools; student assessment of those who are about to leave school
    3. Health professional reform: prioritizing the most feasible paths
    4. Build up momentum, bind-in support from key stakeholdersManagement System/Migration (Thailand, Nepal, India, Philippines)
    1. In light of ASEAN Economic Community: International flows of patients (Mode 2); International migration of health professionals (Mode 4)
    2. In light of private health sector growth: domestic migration from public to private, rural to urban

4. CONCLUSION

AAAH is the only regional network on human resources for health, and has already survived for 7 years.To achieve its objectives, the AAAH plans to continue updating and monitoring the HRH situation in AAAH member countries and report in the annual conference.

In 2012, intersession research has begun on two themes, ‘Policy Mapping and Analysis on Rural Retention Policy’ and ‘Policy Analysis on Public and Private Roles in Health Professional/Employment’. The progress of this research will be reported to the 7th Annual AAAH Conference in Bangkok.

Additionally, AAAH will take part in the development of the Asia Pacific Regional Network of Health Professional Training institutes, supported by WHO/SEARO. The aim of that project is to develop a platform for collaboration on knowledge synthesis and evidence generation for health professional education reforms movementsin response to changing health determinants and health system development.

To sum up, the active involvement of country focal points must be maintained for HRH activities to be effective. Their continued work is key to the sustainability of the AAAH network, and to achieving AAAH’s vision.