཯ᇌᘍ૎ඥʴ‫׎‬ᇌ‫׎‬ᨥҔၲᄂᆮ⇡∙⇥∞‫׎‬ᨥҔၲңщ‫ޅ‬ἘἁἝỽἽὉἾἯὊἚ vol.

04

March, 2013̬ͤʴ஬᧏ႆ⇝⇟⇬∆Ўௌ∈⇭∑↗
᧏ႆᡦɥ‫↚׎‬ⅹↀ↺෇ဇHouse Model-User's guideNaonal Center for
Global Health and Medicine
Bureau of Internaonal Medical Cooperaon,Japan

独立行政法人国立国際医療研究センター
国際医療協力局

テクニカル・レポート vol.

04

March, 2013

保健人材開発システム分析モデルと開発途上国における活用
House Model-User's guideISBN 978-4-909675-15-6

目次

目次

目次

002

１． はじめに003

２． 保健人材開発とシステムの視点

004

３． House Model とは

007

４． House Model の活用例

011１） 保健人材開発制度アセスメントとチェックリスト

011

２） アフガニスタンへの支援

012

３） カンボジアの人材開発制度の変遷

013

４） コンゴ民主共和国の関係者分析調査

016

５） 研修への応用 ‐ 仏語圏アフリカ保健人材開発集団研修017

５． House Model の活用と限界

020

参考文献

021

資料

023

１． 保健人材開発システムアセスメントチェックリスト

024

２． 保健人材開発システムに関する調査報告書 ( カンボジア )032

３． Study Report on Stakeholder Analysis in the Developmentof HRH in the Democratic Republic of the Congo
４． Glossary

2

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138

1. はじめに1. はじめに

このテクニカルレポートで紹介する House model は
保健人材開発をシステムとしてとらえた場合の包括的な見取り図あるいは全体地図である。 NCGM 国際医療協力局の著者らがこれまでに関わった、 カンボジア、
アフガニスタン、 コンゴ民主共和国 （以下コンゴ民） といったいわゆる 「紛争後国家」 における国際保健医療協力の経験から生まれた。 これらの国は、 10 ‐ 20
年以上の内戦状態の結果、 保健や医療だけではなく教育やインフラなど社会制度そのものが崩壊している。
やらなければいけないことは山積みであることは誰もが承知しているが、 援助側である我々が、 実際にどこから何を支援することが効果的なのか、 その判断を何に基づいてすればいいのか、 といった疑問から出発した。
緊急救援から開発援助に向けては、 数多くの国際社
会のドナーがその国や地域になだれ込み、 援助機関
主導で支援が実施されることが多い。 受け入れ政府の能力、 特に組織体制の弱体な省庁 （保健省） や州 ・郡保健局、 育成学校や病院 ・ 診療所といったあらゆるレベルにおいて能力のある保健人材の不足により受け入れ側のキャパシティが不足するなかで、 受け入れ側の許容範囲を超えた金額が援助として流れていく。
「人材が重要」 と誰もが思い、 研修を実施し、 教育を支援する。 ドナー調整が行われるとはいっても、 往々にして支援は保健人材開発のなかの一部分に集中し、10 年単位の視野でことを動かさなければいけないのにもかかわらず、 関係者の誰もが全体を見渡すことなく、支援が効果的とはいえないことも多い。 保健人材開発
全体を見ながら、 過不足のある部分を確認しつつバラ
ンスよく支援してくことが重要であろう、 そのために包括的に全体を見渡し、 関係者が共有できるようなものはないか、 と考えたところから生まれたものである。

本テクニカルレポートでは House Model を具体的な活用例とともに解説した。 例えば保健人材開発制度に対するアセスメント調査、 5-10 年の単位で変化あるいは成熟していく保健人材開発制度の変遷の記録、 保
健人材に関わる関係者分析への応用、 保健人材研
修への活用、 などである。 国際協力に携わる、 あるいは関心のある人たちが手にとって利用できるものとなれ
ば幸いである。

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

32. 保健人材開発とシステムの視点

2. 保健人材開発とシステムの視点

保健人材は人々の健康を増進することを目的とした活動に関わる人々と定義され、 専門教育を受けた専門職 （医 ・ 歯 ・ 薬 ・ 看護助産 ・ 臨床検査 ・ 放射線 ・理学療法師など） の他に、 事務職や保健ボランティアも含まれる１）。 保健サービスを計画 ・ 運営管理し、 提3供する人材がいなければ、 変化する健康課題に対応できる保健システムは機能せず、 WHO 保健システム
フレームワークで示され 6 つのブロックのひとつとして、保健人材は保健システム強化の文脈の中で重要な役割を果たしている２）。

E V E RY B ODY ’S BUSI N E S S S – I N T RODUC T ION

THe WHO HealTH sysTem fRameWORk
sysTem building blOcks

OVeRall gOals / OuTcOmes

ServICe deLIvery

HeALTH WOrKFOrCe

ACCeSS

IMPrOved HeALTH (LeveL ANd eQUITy)

COverAGe
INFOrMATIONreSPONSIveNeSS

MedICAL PrOdUCTS, vACCINeS & TeCHNOLOGIeSSOCIAL ANd FINANCIAL rISK PrOTeCTIONQUALITy

FINANCING

SAFeTyIMPrOved eFFICIeNCy

LeAderSHIP / GOverNANCe
図 1 WHO six building blocks
出典 ： WHO (2007)Everybody’s Business – Strengthening health systems to improve health outcomes. www.who.int/entity/healthsystems/strategy/everybodys_
business.pdf

THe six building blOcks Of a HealTH sysTem: aims and desiRable aTTRibuTes• Good health services are those which deliver effective, safe, quality
personal and non-personal health interventions to those who needthem, when and where needed, with minimum waste of resources.
• A well-performing health workforce is one which works in ways thatare responsive, fair and efficient to achieve the best health outcomes
possible, given available resources and circumstances. I.e. There aresufficient numbers and mix of staff, fairly distributed; they are competent,
responsive and productive.		

• A well-functioning health information system is one that ensures
the production, analysis, dissemination and use of reliable and timely
information on health determinants, health systems performance andhealth status.

4•• A well-functioning health system ensures equitable access to essential
medical products, vaccines and technologies of assured quality,
safety, efficacy and cost-effectiveness, and their scientifically sound andcost-effective use.
• A good health financing system raises adequate funds for health, inways that ensure people can use needed services, and are protectedfrom financial catastrophe or impoverishment associated with having to
pay for them.
• Leadership and governance involves ensuring strategic policy
frameworks exist and are combined with effective oversight, coalitionbuilding, the provision of appropriate regulations and incentives,attention to system-design, and accountability.

Health system building blocks

vol.04all 保健人材開発システム分析モデルと開発途上国における活用
テクニカル・ レポートTo achieve
their goals,
health systems have to carry out some basic functions, regardlessof how they are organized: they have to provide services; develop health workers and otherkey resources; mobilize and allocate finances, and ensure health system leadership andgovernance (also known as stewardship, which is about oversight and guidance of the wholesystem). For the purpose of clearly articulating what WHO will do to help strengthen health2. 保健人材開発とシステムの視点

人材開発というと、 いかに個人や組織の能力を高めるかといったキャパシティビルディングやエンパワーメ
ントに関心が寄せられることが多い。 実際にこれまでの国際協力の現状を見てみると保健人材を養成する学校の教育カリキュラム開発、 現場で働く保健スタッフへの研修実施、 保健サービス提供をモニターするためのスーパービジョン、 学校や病院、 保健局の運営組織
開発に向けた支援、 などが行われてきた。 しかしいくら
現場に適応可能な教育や実習カリキュラムを作っても卒業した人材の就職先がない、 現場で働く保健スタッ
フの給与や待遇が悪いため研修が収入の一環となり研修に忙しくサービスの提供やその質の向上につながらない、 といったことも往々にしておこっていたことである。
個人や組織だけではなく、 システムとして人材開発を包括的に、全体のバランスを見ることが、国際協力を実施する我々には忘れてはいけない視点と考えられる 3）。
保健システムのサブシステムとして保健人材開発をどのように考えるかについてはいくつかのフレームワークが存在している。 WHO は、 保健人材システムの構成
要素を時系列から見たステージとしてとらえ、 図２のように表現した。 すなわち適切な教育を受けた十分な数の人材が、 適正に配置され、 健康課題に対応できる十分な能力をもち続けサービスを提供できることが保健人材システムの機能している姿であり、 それを達成するために、 限られた資源をどのように公平に、 効率的に活用するかということが取り組むべき対策となる１）。

Stages of health workforce development
Enabling effective regulation of theeducational system and the job
market towards an equitable
distribution of health workers

Achieving an appropriate mixof health workers responsible
to population needs
Developing national workforce
plans and strategies

ENTRY

Preparing the workforce• Planning• Education• Recruitment

EXIT

Managing attrition• Migration• Career choice• Health and safety• Retirement

WORKFORCE PERFORMANCEWORKFORCE

Enhancing worker
performance• Supervision• Compensation• Systems supports• Lifelong learning

Availability
Competence
ResponsivenessProductivity

Improving the management of
the health workforce and theenvironment in which it works
World Health Organization, 2006

図 2 Stages of health workforce development
出典 ： WHO (2006). The World Health Report 2006 - Working together for health. http://www.who.int/whr/2006/en/index.html

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52. 保健人材開発とシステムの視点

この発展型として、 GHWA、 WHO、 Capacity Project(USAID) は HRH Action framework を提唱している。 これは、人材の不足や偏在、技術やコンピテンシー、
定着やモチベーション、 などといった保健人材に関する課題を明らかにし、 政策決定者や組織のマネージャーたちが人材開発の戦略をたて、 有効で持続可
能な保健人材というゴールを達成するためにツールとして用いる包括的なフレームワークとされている。 図 3 のように 6 つの分野 （人材管理システム、リーダーシップ、パートナーシップ、 財政、 教育、 政策） と 4 つのフェー
ズ （現状分析、計画、実施、モニターと評価） からなっていて、 WHO 西太平洋地域などでは国レベルでの国家人材開発戦略作成に利用されている。

しかし現場で保健省関係者とともに働く我々から見ると、 HRH Action Framework は保健省関係者自らがツールとして用いるには抽象的であり、 保健省の縦割り業務の中で、 他者との情報共有の認識が薄い開発途
上国では、 Action の基盤となる保健人材に関する現状を関係者が共有し、 課題を明らかにすること自体が困難であるという印象であった。 これらの分析フレーム
ワークをもとに、保健省関係者自らが利用できるような、
具体的でわかりやすいツールとして、 筆者らの現場の経験を踏まえて開発したのが House Model である。

図 3 Human Resource for Health Action framework (2009)http://www.who.int/workforcealliance/knowledge/resources/haf/en/index.html

6

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

3. House Model とは

3. House Model とはHouse Model とは保健人材開発システムを包括的にとらえるためのツール、 分析の枠組みである。 保健
人材開発制度を包括的にとらえるために 11 の要素をもち、 全体として 「家」 の形をとっているため、 利用
者がなじみやすいよう、 House Model とニックネームをつけた。

⑨
HR systems responding
to health needs⑦
Deployment⑧
Retention

Institution
Teaching staff
Students
Quality and quantity

Recruitment
PublicPrivateHR management
Career path
Continuous
Education

MOH⑤
capability⑩
Monitoring⑥
Production④Finance③Legal framework②Health policy, HRH policy and plan
①Available human resources⑪
Coordination

図 4 House Model
出典 ： Fujita N, Zwi AB, Nagai M, Akashi H (2011) A Comprehensive Framework for Human Resources for Health System Development in Fragile and Post-Conflict
States. PLoS Med 8(12): e1001146. doi:10.1371/journal.pmed.1001146

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3. House Model とは

以下、 それぞれの構成要素について解説する。
① 保健人材の現状 （Available human resources）
国レベルでの保健人材に関する課題は、 政治
社会文化的な環境、 保健システムを構成する組
織や資源、 などによりさまざまである。 分析の出発点は現状把握から始まるが、 保健人材開発の場合も同様で、 どのような教育を受けた人材がどこで何人、 どのような状態で働いているのか、 という基本情報の把握から始まる。 特に、 紛争後国家の場合、国内に残っている施設機材や人材、どの程度の教育や保健サービスが提供されているのかといった保健資源に関する情報は断片的にしかえられないため、 復興支援の出来る限り早い段階で全国的に保健資源基礎調査を行うことが、政府や開発パートナーの方針を決定するために重要である。
② 保健政策 ・ 保健人材政策 ・ 保健人材開発計画 （Health policy, HRH policy and plan）
国の保健システムの枠組みや方向性を定めるもの。 世銀など開発パートナーの圧力もあり、 近
年多くの途上国は保健人材関連の重点政策や国家保健人材計画を策定している。
③

法 的 な 規 制 枠 組 み （Legal and regulatory
framework）
保健人材に関する法的な枠組みとは、 １） 保
健人材を定義し、 その教育方法 ・ 登録免許 ・ 保
健医療行為を規定する法規程が存在すること、
そして、２） その法規定を制度 ( 教育機関の認可、保健専門職の登録免許 ) として実施する仕組みが存在することをいう。 保健医療行為は国民の健康を守る一方で、 生命を危険にさらすこともあ
りうるため、 このような罰則も伴う規制によって保健人材の質を担保する必要がある。 日本の場合
は、 医師法や保健師助産師看護師法に基づいて保健専門職としての免許制度が機能している。
日本のように、 政府が規制枠組みを作り監督する

8機能を持つ国がある一方で、 プロフェッショナルとして独立性をもつ専門職カウンシルが法律を整備しこの制度を監督する国もある。 多くの途上国では保健人材の数の確保が優先課題になっており、人材の質となると教育内容や卒後研修などに目が行きがちで、 法的な規制枠組みによる人材の質の担保は忘れられがちである。
④ 財政 （Finance）
保健人材に関する財政の主たるものは保健人
材に対する給与や諸手当 （病院や診療所で働く
スタッフ以外にも教育機関や行政職事務職も含む） などの人件費があげられる。 しかし、 労務環
境や待遇改善にかかる必要経費、 保健医療施
設や教育機関の運営資金なども含めて考える必要がある。
⑤ 保健省の能力 （MOH capability）
現状把握 （①） を踏まえて、 家の土台となるのが②から④までである。 これには中央政府の関連省庁 （計画省、 財務省、 公務員省、 など）が関わるが、 中でも保健人材の Producer, User,
Manager, Coordinator である保健省が、 その中心的な役割を担う。 人材開発制度を構築していくためには、 政府内や関連団体との交渉も含めて保健省の能力がカギとなる場合が多い。
⑥ 養成 （Production）
ここでは初等中等教育修了後の人材を保健人
材として育てるために必要な基礎教育をさす。 教
育機関や教員・学生の数や質、 教育内容カリキュ
ラムなどがここに含まれる。
⑦ 配置 （Deployment）
学校を卒業した保健人材が、 公的 ・ 私的な診療施設や教育施設、 そして行政機関などに配属されることをさす。 教育年限の長い専門職 ( 医師
歯科医師など ) になるほど都市部に残りたがる点は途上国だけではなく先進国でも共通で、 郡部やテクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

3. House Model とは

へき地に配置され、 保健医療サービスを提供する保健人材の確保が課題となっている。
⑧ 定着 （Retention）
配置された保健人材が継続して働くことをさす。
現在、 世界の保健人材に関する大きな課題のひ
とつはへき地診療施設への配置と定着であり、 影響を与える因子としては給与やへき地手当、 子
女教育手当などの福利厚生、 施設機材薬剤などの労務環境改善、 住宅など生活環境改善、 継続教育による技能の維持、 キャリアパスや昇進、などが考えられ、 様々な対策が取られている。
国内 ( 公的セクターからプライベートや NGO へ ) ・
国外 （英語圏アフリカから南アフリカや欧米へ）への頭脳流出の課題の大きい国も多い。
保健ニーズに応じた保健人材システム（Human resource systems responding healthneeds）
保健課題も社会の変化とともに変化する。 限られた資源を有効に活用するためには保健の優先
課題に応じた保健人材システムを構築していくことを考える必要がある。 活用例にも示したが、 ア
フガニスタンやカンボジアでは妊産婦死亡削減に対して助産師に焦点を当てたシステムを作り、 これが他の職種や他の課題にも応用可能であることが示された。 母子保健の指標が改善し生活習慣病が課題となってくる国もあり、 栄養士や理学療法士など新たな職種や予防に関わる新たなサービス提供の形に対応した保健人材のシステムを考慮する必要が出てくるであろう。

析を繰り返すことで保健人材開発システムという「家」は形をなし、強固なものとして構築されていく。
このためにも保健人材情報システム構築と強化は
現在の課題の一つとなっている。
⑪ 関係者の調整 （Coordination）
国家予算以上に多くの予算を開発パートナーに頼らざるを得ない政府保健省関係者にとって、パートナーの投入を調整することは非常に重要な仕事である。 保健人材に関する関係者として国際機関や NGO などの他に忘れてはいけないのは、国内の関係者である。 保健省を中心に見れば、政府の関係省庁 ( 教育省、 財務省、 公務員省、計画省など )、 教育機関があり、 この他にも、 職
能団体、 労働組合など国内関係者との情報共有や調整が必要となる。

⑨⑩ 政策計画の実施モニター （Monitoring）
現状分析を踏まえて立案された保健人材政策
や人材開発計画 （Health Workforce Plan） を実施する際は、 保健人材に関する情報を定期的に把握し、 その推移を分析することが必要となる。
これが 「政策計画の実施モニター」 である。 保健の課題に応じて、 政策計画の実施 ・ 推移の分House Model は “保健人材開発システムという「家」 を建てる” イメージである。 家を構成する各要素、 あるいは積み木のどこかが弱い、 あるいは欠けていると家は強固なものにはならない。 また
積み木のつながりも考慮しないと、 少しの揺れで崩れてしまう。 特に家の土台となる部分（①―⑤）
は基本的には政府、 特に保健省の関わる部分であり、 この土台の上に養成 ・ 配置 ・ 定着といった人材開発のステップが柱 （⑥―⑧） として乗る。
しっかりした土台、土台とそれぞれがつながりをもった柱、 最終的なゴールとして保健ニーズに応じた
人材システムという屋根 （⑨） ができあがる。 庭の部分にはこれらのすべての要素を調整し、 家の完成具合をモニターしていくという機能 （⑩、 ⑪）がしっかりした家を建てるために必要である。 また
以下の活用例 （アフガニスタン） でも提示するが、往々にして投入や支援の集中する部分 ( たとえば養成 （Production） のみがクローズアップされて、それにつながる人材の配置や定着など、 忘れられがちである。

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3. House Model とはHouse model は 上 記 HRH Action Framework（図 3） と同様に包括的な分析フレームワークであり、 共通の要素をふくんでいる。 HRH Action
Framework に比べて House Model に特徴的な点
は、・ 包括的な保健人材開発管理システムの具体的な 11 の要素を提示したこと
・ 各要素の関連やつながりは重要であるが忘れがちであるためこれを強調したこと
・ 法的枠組みのように必要なのに注目されにくい要素を加えたこと・ 「家」 という象徴的なモデルを使い、 複雑な保健人材開発システムの概念を視覚的にもわかりやすく表現していることである。
以下、 House Model の具体的な活用例として、 保健人材開発制度アセスメント調査、 保健人材開発制
度の変遷の記録、 保健人材に関わる関係者分析への応用、 研修への活用、 を紹介する。

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4. House Model の活用例

4. House Model の活用例
1） 保健人材開発制度アセスメントとチェックリスト（資料 1， 2）
ある国で保健人材に関する特定の課題 （たとえば教育手法やカリキュラム、 あるいは卒後研修など） に関わる前に保健人材開発制度全体を分析評価する
ことは、 その課題が他の課題と比べてどのような重要性を持っているのか、 この課題に取り組むことへの妥
当性を確認する意味でも基礎情報として重要である。
House Model を用いた保健人材開発制度の包括的アセスメント （システムのスナップショット、 即ち、 ある時点におけるシステムの全体像を抽出する） の調査概
要、 チェックリストを紹介する。 わかりやすくいえば、 家を構成する各要素、 あるいは積み木のどこが弱いかあ
るいは欠けているか、 また積み木のつながりがしっかりしているかを調べる際に、 この方法が利用できる。
【目的】 保健人材開発システムの包括的な現状分析を行う【手法】文献レビュー、キーインフォーマントインタビュー。
分析フレームワークとして House Model を用いた。
【調査手順と留意点】
アセスメントのためのチェックリストは添付資料１に
示 し た が、 こ れ は A guide to rapid assessment of
human resources for health (WHO 2004)4） を改変し、House Model に基づいて項目を整理しなおしたものである。 House Model の要素ごとに網羅されている分、質問は相当数に上り、 政策レベルから現場レベルまで
質問の範囲も広く、質問の中には事実を確認するもの、
インタビュー相手の認識を確認するもの、 が含まれている。 このチェックリストはインタビューの際の質問票ではなく、 制度全体を見渡すために必要な情報のチェッ
ク項目のリストである。

査には時間的な制約もあるので、 目的に応じてどのチェック項目が重要か優先順位をつけながら情報収集していくが、 最終的にすべての項目をカバーできるとは限らない。 限られた時間と可能な範囲で得られる情報ではあるが、 全体を見渡したうえで House Model のどの要素が発達し、どの要素に強化が必要なのか、といった最終的な整理をして、 スナップショットとする。 例として別添資料 2 に 2009 年にカンボジアで実施した看護
助産分野の保健人材開発制度調査報告書を添付した。 実施当時の House Model は改良前のものであり、本テクニカルレポート執筆時のものとその構成要素や形は異なる。

手順として、 まずは政策文書や報告書など入手可
能な基本的な資料を入手し内容を確認し、インタビュー
相手を確認する。 チェックリストのすべての項目に答えられる人はいないため、 インタビュー相手により入手できそうな情報を絞り、 質問することが必要である。 たとえば保健省中央の保健人材関連担当部署から始めて、 教育機関関係者、 開発パートナーなどキーイン
フォーマントの範囲を広げながら、 関連資料をさらに入手できれば確認し、 質問項目の情報を埋めていく。 調テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

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4. House Model の活用例

２） アフガニスタンへの支援
アフガニスタンでは、 20 年以上続いた内戦の後、国際社会の支援を得て、 2001 年末より戦後復興に向けた取り組みが始まった。 2002 年の全国保健資源調査で明らかになったのは、 保健人材の絶対的な不足と、 期間も内容も統一されない保健人材としての教育の質であった。 特に世界的な妊産婦死亡の高さ （2000 年 MMR1900 （出生 100,000 あたり）） と
女性医療スタッフ特に助産人材の不足 （人口 50,000
人あたり助産師 1 名） が優先課題となり、 2003 年から保健省とドナーの総力を挙げて、 助産師教育標準カ
リキュラムの作成、 教員研修、 助産師教育の再開に取り組んだ。 しかし保健省およびドナー関係者が教育だけに集中した開始当初は、 都市部出身の卒業生は必要とされるへき地の保健センターへは就職したがらず、その結果、卒業生の就職率は 50％以下であった。
この反省から卒業後の就職や定着を考慮し、 へき地
出身の学生のリクルートと奨学金、 卒業後の出身地での就職先の契約制度を導入し、 2008 年には育成された助産師数は 3 倍に増え、 就職率も 74％と増加した。 助産師教育すなわち人材の＜養成＞ だけではな
く、 育成された人材の＜配置＞ から＜定着＞ へとつな
げて包括的に人材開発を見る （House Model の育成
配置定着の 3 つの柱をつなげる） ことで、 支援が有効なものに変化した例である 3）。

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4. House Model の活用例

HR systems responding
to health needs

３） カンボジアの人材開発制度の変遷<Production><Deployment><Retention>

MOH
capability

MoH(HRD) MOEYS
MoH(PD)
MoH(PD, DPHI,
Teaching institutes
CAR
HSD, NMCHC)
カンボジアでは内戦時代に保健人材を含む知識人
産師教育コースを増やすなどして数の増加を試みてい
UNFPA, WHO,
Civil Service
UNFPA, JICA, GIZの虐殺という特異な歴史 （1975－ 79 年）たものの、 2005 年には乳幼児死亡率に比べて妊産
JICA, AusAID,
GIZ, をもち、Commission
International &全国でほぼゼロに近くまで減少した保健人材の数の増
MDG 達成にWHO婦死亡率の停滞が課題として挙げられ、
local NGOs
加に取り組んだ。 80 年代からは教育年数の少ない初向け妊産婦死亡削減が保健省優先課題＜保健ニー
級看護師助産師 （1 年）、 准医師 （4 年） を育成し、ズ＞＜政策計画＞ となった 7)8) 。 助産師の数不足に郡部の病院保健センターへの配置が進められた。 90 <Finance>
ついては、
助産師教育コースの増加による新卒者増
MoEF
年代は国際社会の支援のもとに、 保健セクターリフォー
加＜養成＞ だけではなく、 様々な政策が次々と実施さ<Legal framework> MoH(HRD,
HSD), MOEYS<Monitoring>
ムなどの様々な取組みの一環として保健人材の数のれていった。PD,
それは、へき地出身の学生のリクルートと<Coordination>
MoH,
改善から質の改善への転換を行ってきた。
しかし保健
奨学金
・
卒後へき地保健センターへの就職契約制度
MoH,<policy and plan> MoH(DPHI, HRD, PD)
Relevant
Ministries,
Relevant Ministries
セクターリフォームによる保健施設数の増加、 80 年代＜配置＞ 、 公務員制度改革 （公務員削減）にもかUN, Bilateral,
Available
resources
UN, Bilateral, NGOs
初めの新規大量採用者の定年退職により、質への転 human
かわらず保健省は助産師のポストと給与を確保し＜配NGOs
換とうまく合致せず、 2000 年初頭には保健人材の中
置＞ 、 配置された新人助産師の技術的な支援などもでも特に助産師の不足が課題となっていた。 再度、 助
合わせて実施し＜定着＞ 、 2009 年には全国すべて

HR systems responding
to health needs<Production> <Deployment><Retention>

MOH
capability

Monitoring

Finance
Legal framework
policy and plan

Coordination

Available human resources

図 5 助産師関連の政策介入と House Model （カンボジア）

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4. House Model の活用例の保健センターに最低１人の助産師を配置し 24 時間
サービスを実現させた＜モニター＞ 。 保健センターを改修、 機材薬剤を確保し＜定着＞ 、 政府予算で病院
保健センターに分娩報奨金 （出産１人あたり 10-15 ドル） の給付を開始、 施設出産数増加が低給与のへき
地勤務の助産師たちの収入増加につながった＜財政＞＜定着＞ 。 対象を助産師に集中し、 House Modelのすべての要素を考慮し、 限られた資源を集中させた
包括的な対策が次々と実施されていった （図 5）。 こ
れは保健省の強いリーダーシップのもと、 財務省 ・ 公

務員省などの関連政府機関とドナーを巻き込んだ HighLevel Midwifery Taskforce を通じて実現したものである＜保健省の能力＞＜関係者の調整＞＜モニター＞ （図 6）。 へき地保健センターでの 24 時間助産サー
ビスの担保とともに、 外的な要因として治安安定 ・ 経
済発展 ・ 就学率の増加など社会的な要因もプラスに
働き、 技能職による出産介助へのアクセスは増加し、妊産婦死亡の改善につながったと評価されている （図7） 9）。

HR systems responding
to health needs<Production><Monitoring>

MoH,
Relevant Ministries,
UN, Bilateral,
NGOs

MOH
capability

MoH(HRD) MOEYS
Teaching institutes
UNFPA, WHO,
JICA, AusAID, GIZ,

<Deployment>
MoH(PD)
CAR
Civil Service
Commission
WHO<Retention>

MoH(PD, DPHI,
HSD, NMCHC)UNFPA, JICA, GIZ
International &local NGOs

<Finance> MoEF
<Legal framework> MoH(HRD, PD, HSD), MOEYS<policy and plan> MoH(DPHI, HRD, PD)

Available human resources

図 6 助産師関連の関係者マッピング （カンボジア）

14

HR systems responding
to health needs<Production> <Deployment><Retention>

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用<Coordination>

MoH,
Relevant Ministries
UN, Bilateral, NGOs

4. House Model の活用例

100%
90%
80%

MMR
437

70%

472 (95%CI=605-338)
89%
71%

60%
40%

55%

30%

38%
32%

10%

44%

206

(95%CI=288-124)

22%

20%

450
400

69%

50%

500

350
300
250
200
150
100

11%

50

% delivery by skilled
birth attendants% of delivery by skilled
birth attendants at
health facility
ANC coverage (at least
once by healthpersonnel)
Maternal mortality ratio
per 100,000 live birth

0

0%
2000

2005

2010

Data source: Cambodia Demographic and Health Survey 2000, 2005, 2010
図 7 サービスへのアクセスと妊産婦死亡の推移 （カンボジア）

一方で保健人材の質を担保するための規制の枠組
みとその基本となる保健人材の定義 ・ 教育 ・ 免許 ・業務を記した法規程類の整備が 2000 年代後半にいたるまで取り残されていた＜法的な規制枠組み＞ 。
2013 年現在、 ASEAN 相互認証協定 （MRA） による2015 年からの域内の保健人材の移動の自由を目指
してカンボジアでは国家試験と免許登録制度の整備が始まっており、 JICA プロジェクトを通じて、 NCGM はそのための基盤となる法規程制度整備支援に関わっている。 2000 年初めまで公立校と公立病院診療所が中心だったカンボジアにおいては、 House Model の土

台の中の Legal Framework の部分は人材開発政策の中でも優先順位は高くなく、 顧みる必要もあまりなかったと考えられる。 2000 年以降の社会の変化で教育 ・
保健サービスともにプライベートセクターが急速に発展し、 プライベートの保健医療人材育成学校や医療施設数が増加したことで、 教育やサービスの質をいかに担保するかが政府にとっての優先課題となってきたこと、 そして相互認証協定という外的要因の影響のため、Legal Framework に注目し、 強化する必要性が生じてきたという説明が可能かもしれない 9)。

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4. House Model の活用例

４） コンゴ民共和国の関係者分析調査（資料 3）
コンゴ民においては House Model をフレームワークとして用いて保健人材に関する関係者分析調査を実施した。 コンゴ民の場合、 まずは関係者の全体像の把握が必要であったため、 保健省、 関連省庁、 カウンシル
や労働組合、 開発パートナーや NGO、 教育関係者、など広く対象に House Model の構成要素の中の活動
分野、関心のある分野を同定し関係者マッピングを行った。 関係者マッピングから明らかになったことは、・ コンゴ民保健省が 4 つの柱とみなしている基礎教育、継続教育、定着、キャリア管理のなかでは、
継続教育への関心および関わりが他に比較して高い。
・ ハウスモデルの各要素への関係者の関わりを見ると、 協調 （72%）、 保健省の組織能力強化（69%）、 継続教育 （69%） に関わっている割合が高かった。 キャリア管理 （21%）、財政 （39%）に関わっている関係者は比較的少なかった。

ことが判明した。
この調査は保健省人材管理関連部局の担当者自らがチームを組みインタビューを行った。 面接者の選択
は、 「保健省人材局の考える」 関係者を選んでいるた
め、 プライベートセクターが少なくなっている。 本来であれば、 snow ball technique でインタビューを増やしていくのだが、 時間的制約もあり、 予め選んだ関係者のみのインタビューとなっている。 また、 政府関係者が聞くため利害関係者からの情報収集に関してはバイアスも考えられる。 一方で、 インタビュー実施、 結果の分析などを保健省人材関連局が実施しているため、 関
係者分析を実施しながら、 能力強化も同時に実施している。 また、 関係者分析を通して人材開発分野全体を俯瞰する考えも身に付きつつある。 今後、 分析結果の公表や関係者との共有など調査結果を活用する予定である。

また、 関係者の中でも特に人材開発システムの中核と考えられるキーインフォーマントたちに対しては、 横断的な現状分析とともに Retrospective およびProspective な時間軸の視点も加えて、 制度の変遷、将来の課題、 さらに深く意識調査を行った。 ここからわかったことは、・ Retrospective な視点からは、 質の高い保健人
材の配置は不十分で、 保健人材の養成も計画的ではなかったが、 国家保健計画、 国家保健
人材開発計画の策定、 保健に関する法整備が実施されてきた。
・ 保健セクターの様々なリフォームが実施された。
・ 保健省と高等教育省の連携および開発パート
ナー間の連携が開始された。
・ Prospective な視点からは、 保健省および保健
人材の能力強化、 保健人材データべース、 評
価 ・ モニタリングが必要である。
・ 保健セクターの予算、 保健人材への十分な給与、 政府の保健分野へのコミットメントが必要である。
以上の点を、 多くの関係者が共通して認識している
16

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4. House Model の活用例

５） 研修への応用JICA 仏語圏中西アフリカ保健人材管理研修
House Model を用いた研修の概要を以下に紹介する。
【対象】 仏語圏アフリカ諸国中央政府における保健人
材管理担当局および州政府における保健人材管理担
当局の局長級および課長級【期間】 約 3 週間 （2012 年 12 月実施）
【人数】 16 名【研修目標】 仏語圏アフリカ諸国の保健人材開発政策の改善により、 保健人材管理が強化され、 最終的には同地域の人々の健康改善に寄与する。
【研修目的】 研修員が、 仏語圏アフリカの関連政策の現状と問題点を把握するとともに、 保健人材管理の重要な要素についての議論を深め、 自国への適用策 ・改善策を計画できるようになる。
ここでは、 House Modelの中でも保健人材の＜定着＞に主眼をおいて研修を構成した例を紹介するが、 研修目的に応じ研修テーマを自由に選択する事が可能である。 House Model の構成要素のどの課題をえらぶ
場合も、 「House Model の構成要素を包括的にとらえる事」、 「House Model の構成要素の一つを独立した課題としてとらえるのではなく、 相互に関連している事」を強調することが重要と考えられる。

【研修コンセプト （研修のねらい）】(1) 本研修参加者は各国保健行政官であるため
保健システム全体を見据える役割を期待されており、 保健人材管理に関しては保健行政上の主な課題を包括的にとらえる事を 1 つ目の研修のねらいとする。 House Model を用い、 保健人材開発をその構成要素 （養成、 配置、 定着、 保
健省の能力、 財政、 法的な枠組み、 保健政策・
保健人材開発計画、 国内にいる保健人材、 モ
ニター、 調整） から概観し、 各要素が互いに密な関係性のなかにある事を理解し、 共有する。
(2) 本研修は、 保健人材管理の重要な要素である 「保健人材の定着」 に焦点をあて研修課題を設定する。 これに伴い、 仏語圏アフリカ諸国
における保健人材の定着とは、 1. 国内への定着、 2. 僻地への定着、 3. 公的機関への定着である事を共有するのが、 2 つ目の研修のねらいである。
(3) 保健人材の定着に関する講義や質疑等を通じ、 自国への適応策や改善策を計画できるようになることを研修目的としているが、 この際、 保
健人材の定着は独立した課題ではなく、 他の関連要素と共にこの課題を捉える事が重要である
事を共有するのが、 3 つ目の研修のねらいである。 具体的には、 養成 ・ 配置 ・ 定着が一貫した保健政策 ・ 計画の中で実施されることを理解することである。 当然の事ながら、 養成 ・ 配置 ・定着を考慮するうえで、 他の要素も関連している事を説明する必要がある。

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4. House Model の活用例

【研修構成例】
この研修コンセプト （3 つの研修のねらい） を基に、講義、 視察、 協議等で本研修を構成した。
単元

18

内容

形態

保健人材開発の枠組み

1. 保健人材開発分析フレームワーク 「House Model」
を紹介する
2. 保健人材開発分析フレームワークを使いながら、参加国の例を各自分析 ・ 紹介する

講義 ・ 討論定着に関する計画や政策

1. 課題の整理①国内への定着②へき地への定着③
公的機関への定着
2. 国、 都道府県、 大学、 保健医療施設における保健人材の定着に向けた日本の計画や政策を紹介する
3. 保健人材の定着に向けた参加国の計画や政策を紹介する
4. 財政的 ・ 非財政的インセンティブ等の対策を紹介
する 10)11)12)

講義 ・ 討論 ・ 視察定着を促進する保健人材の養成と配置

1. 国や都道府県等における対策
2. 大学や保健人材養成教育機関等の取り組みの紹介

講義 ・ 討論 ・ 視察

参加国の保健人材開発の現状を共有と課題分析 ・ 活動計
画案の作成

1. 参加国の定着に関する現状共有
2. 単元毎の学びを整理する
3. 課題を分析し、 解決に向けて実施されている、 効果のあった対策を共有する
4. 保健人材管理に関する問題点解決のための活動
計画案を作成する講義 ・ 討論

グループワーク
発表

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

4. House Model の活用例

【研修実施上の留意点】
各講義や視察開始時には、 House Model の構成要
素のどの部分に関する講義や視察なのかを研修員に明確に提示する工夫が必要である。 また、 研修期間
中に複数回の振り返りのセッションを設け、 受講した講義内容や視察が研修コンセプトにどのように関連しているのかを提示する。 同時に、 House Model の構成要
素全体をバランスよく概観する事が必要である。 以下に、 研修中に実施した振り返りの例を紹介する。

振り返り：〇月〇日 △△大学「日本の地域医療と△△大学（医師を中心とする養成配置定着システム）」

保健ニーズに応じた
人材制度<養成><モニター>
 地域医療教育ネッ
トワーク

 全寮制による関係
者の連帯感醸成
 地域実習重視
奨学金(総合医養成)<保健省のキャパシ
ティー>

<配置>
 出身地への配置僻地採用(出身地)<定着> 卒業生支援策の実 <調整>
省庁間
施
都道府県
地域
義務年限

<保健政策・保健人材開発計画><法的な枠組み><財源>
 都道府県支出<国内にいる保健人材>
 Community-based learning

この図を用いながら講義内容をレビューし、 構成要素の関連を視覚化する事で、 研修員の理解を深めることができる。 House Model を用いることで、 その構成要素を包括的にとらえたり、 構成要素の一つを独立した課題としてとらえるのではなく相互に関連している点を理解するには有効と考えられた。

【研修員の意見】研修対象が保健行政官であることから、 土台部分
である 「保健省の能力」 を玄関ととらえ、 保健人材開発の入口は研修員自身 （保健行政官） であると認識した、 という意見が聞かれた。

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5. House Model の活用と限界

5. House Model の活用と限界

これまでの活用経験から、 House Model をツールとして使い、 保健人材開発システムを包括的に分析すること、 システムが構築されていく過程を記述すること、構成要素の一つが独立した課題ではなく相互に関連している、 すなわちつながりの重要性を理解すること、 には有効と考えられた。 また崩壊した社会のシステムを立て直さなければいけない立場の政府保健省行政官、
あるいは現場で一緒に働く筆者らにとって 「家」 を建てるというイメージは、 シンプルであるが、 自らのものとして理解しやすく、 受け入れやすいようである。
House Model はあくまで全体を包括的に見ていくた
めの見取り図であり、 これですべてを説明できるわけではない。 たとえば人材開発システムの変遷や構築の過程での保健人材の質や質の変化について説明できるわけではない。 また研修実施を通じて、 House
Model に足りない要素も見えてきた。 その一つは Highlevel Political Commitment である。 House Model の中では言及していないが、 保健人材開発を包括的に概観し、 効果的に実践していく上で、 High-level Political
Commitment が 欠 か せ な い。 従 っ て、 House Modelの土台部分にある保健省のキャパシティで説明するか、 構成要素全体をオリエンテーションする機能としてHigh-level Political Commitment を盛り込んでもいいかもしれない。

20

この 「家」 は完成品ではなく、 国や地域の状況を見ながら使ってみて、 他にも必要な要素と思われるものがあれば加えればいいし、 不要であれば外せばいい、
常に改築中である。 たとえばコンゴ民では柱は養成 ・配置・定着の 3 つではなく、 基礎教育・継続教育・キャリア管理 ・ 定着の 4 つとなって使われている。 重要なことは、 保健人材開発を考えていく際には、 現在起こっていることや自分たちが行っている活動や支援が全体のどこに位置しているか、 常に全体を意識しながら包括的にみていくこと、 そして、 個々の要素だけではなく関連する他の要素とのつながりも注意を払うこと、 であろう。

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

参考文献

参考文献

1) WHO (2006). The World Health Report 2006 - working together for health http://
www.who.int/whr/2006/en/index.html
2) WHO (2010). Key components of a well-functioning health system 2010 http://
www.who.int/healthsystems/publications/hss_key/en/index.html
3) Fujita N, Zwi AB, Nagai M, Akashi H (2011) A Comprehensive Framework for Human
Resources for Health System Development in Fragile and Post-Conflict States.
PLoS Med 8(12): e1001146. Doi:10.1371/journal.pmed.1001146 http://www.
plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001146
4) WHO (2004). A guide to rapid assessment of human resources for health. http://
www.who.int/hrh/tools/en/Rapid_Assessment_guide.pdf
5) Joint Learning Initiative (2004). Human Resources for Health – Overcoming thecrisis. www.who.int/hrh/documents/JLi_hrh_report.pdf6) http://www.capacityplus.org/knowledge-library/all
7) WHO. The World Health Report 2005 - make every mother and child count. http://
www.who.int/whr/2005/en/index.html
8) Fauveau V, Sherratt DR, Bernis L. Human resources for maternal health: multipurpose or specialists? Human Resources for Health 2008. 6, 21.
9) Liljestrand J, Sambath MR. Socio=economic improvements and health systemstrengthening of maternity care and contributing to maternal mortality reduction
in Cambodia. Reproductive Health Matters 2012; 20(39):62-72 Doi: 10.1016/509688080(12)39620
10) Lehmann U, Dieleman M, Martineau T. Staffing remote rural areas in middle- andlow-income countries: A literature review of attraction and retention. BMC HealthServices Research 2008 8, 19.
11) Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Motivation
and retention of health workers in developing countries: a systematic review. BMC
Health Services Research 2008, 8, 247.

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

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参考文献

12) Fulton BD, Scheffler1 RM, Sparkes SP, Auh EY, Vujicic M, Soucat A. Health workforce
skill mix and task shifting in low income countries: a review of recent evidence.
Hum Resour Health. 2011 Jan 11;9(1):1.

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テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 1. 保健人材開発システムアセスメントチェックリスト

資料
1. 保健人材開発システムアセスメント
チェックリストテクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

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24

4

3

2

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

HRH

Definition of

保健医療人材戦略や計画の策定に誰が関わったか。

Who are involved in formulating HRH strategies and planning?

国には保健医療人材戦略や保健医療従事者計画があるか。それは定期的に改定されているか。

Does the country have a strategy for HRH or a health wokrforce plan ? Is it periodically updated?

保健医療人材政策は各レベルにあるか（国レベルから州県レベルまで）。

Are there HRH policies at each level (national to local, decentralized)?

保健医療人材は保健セクターより上位の開発政策(PRSP,MTEF)において承認されているか。

Is HRH acknowledged in broader development policies (PRSP, MTEF)?

国家保健人材開発政策はあるか。記述されているか。

ください。
Does the country have an HRH policy? Is it written down?

国家保健医療政策はあるか。策定過程、内容、最終改定日、他の関連課題を含めて簡単に述べて

update and other relevant issues.

Is there a national health policy? Briefly describe it, including the building process, content, last1

保健医療人材を定義した法規があるか（例えば、医師、看護師、助産師など）。

Do you have any legal document for defining HRH (i.e. physician, nurse, midwife, etc)?

療施設か、あるいはその他か。

その計画は、人材配置目標を含んでいるか。どの目標が使用されているか、対人口か、対保健医

health facility, or others?

*7 Does the plan include staffing targets ? Which target is used, target staffing per population, per

6

5

4

3

2

1

C. Legal framework

Planning

Policyプログラムアプローチ？

保健財政システムはどうなっているか（ユーザーフィーや医療保険制度など）。
What is the mechanism of partner support? Common fund? Program approach?

How is the system of health financing? (user fees or health insurance, etc.)

法規があれば入手、内容を確認する

国家保健人材開発計画を入手、確認する定過程や期間、保健省担当部署の関わりを確認する。

書として戦略文書を置いていった場合も多く、必要ならば策開発パートナーのコンサルタントが短期で調査を行い、報告

国家保健人材戦略、計画文書を入手、確認するている国があるので、確認する

地方分権に伴い、州や県レベルで保健人材政策や計画を持っ関連文書を入手、確認する

国家保健人材開発政策文書を入手、確認する

国家保健医療開発政策戦略文書を入手、確認する

同上

同上

関連文書を入手、確認するの有無、関連文書を入手し、確認する

ヘルスシステムの構造はどうなっているか。
What are the share of the government health expenditure in the total health expenditure?

全保健医療支出に占める政府の支出はどれくらいの割合か。

例えば、保健医療行政、リファラルシステム、民間セクター

How is the structure of the health system?

備考

1

開発パートナーによる支援メカニズムは何か。コモンファンド？
supportB. Policy and Planning

partners'

External

Health system

A.General information*"Questions with under line" represent Quantity aspects of Human Resource for HealthDimension ** "Questions of iItalic letter" represent Quality aspects of Human Resource for Health

Rapid assessment checklist of HRH system development

資料 1. 保健人材開発システムアセスメントチェックリスト

国家規定のほかに、地方レベルでの何か特別な規定があるか。

Besides the national regulations, are there specific regulations at local level?

養成校卒業から専門職として働き始めるまでのプロセスは何か。

What is the process from graduating school to starting practice as professional?

保健医療人材の法的な規制枠組みを実施する組織はどこか。

What are the main regulatory bodies in the area of HRH?

8unit for HRH

Responsible

2

1

E. MOH capability

21

民間診療所・伝統医療施設の開設基準や開設許可制度がある

ウンシルあるいは保健省に登録すれば実務可能な国もある

保健専門職の免許制度はなく、認可された学校を卒業し、カもある。

保健専門職として実務を行うための登録制度が存在しない国

は別に地方レベルでの規定があるか？

保健人材の資格、免許登録を州レベルで管轄する場合、国と学校卒業、国家試験、免許登録の流れについて確認する

保健省(担当部局）か、カウンシルか。

はあるか。

ヘルスケアを提供するシステムの各レベルにおいて、職員の主な職種の詳細な定まった業務内容

care delivery system?

Are there detailed job descriptions for the main categories of personnel at each level of the health

例えば、人材育成局など。ただし、ひつの部署が全ての責任

国家保健人材開発計画を入手、詳細を確認する

政府予算か。ドナー援助の場合は、財源は主にどこか。

ショナルレベル(州や県など）に責任部署があるか。

保健医療人材計画、モニタリング、育成、配置、維持、法的枠組み、財政、調整におけるサブナ

production, deployment, retention, legal framework, finance, and coordination ?

Does the country have an unit at subnational level responsible for HRH planning and monitoring,

署が保健省の中にあるか。

同上

予算は財政局、法的枠組みは治療局など）を担っているとは限らない。どの役割がどの部署にあるか、保健医療人材計画、モニタリング、育成、配置、維持、法的枠組み、財政、調整における責任部 部署のTORに照らして確認する。（計画は人材育成局だが、production, deployment, retention, legal framework, finance, and coordination ?

Does the country have an unit within the MOH responsible for HRH planning and monitoring,

ギャップは測定されているか。

保健医療人材計画実施は利用可能な資源とつりあっているか。もしも調和していない場合、そのmeasured?

Do HRH plan implementation correspond to the available resources? If not, has the gap been

保健医療人材政策や計画実施への財源はどこか。

Who are the main actors involved in funding HRH policies and plans?

関連文書があれば入手、確認する

for private and traditional providers to practice?
か？公的セクターと民間セクターでの実務に関する免許や登民間診療施設と伝統医療施設開設の認可制度はあるか。民間診療施設や伝統的保健医療施設にお録制度があるか？
いて保健医療サービス提供者が実践するための認可制度はあるか。

**7 What authorization is required for private and traditional facilities? What authorization is requiredorder to practice?
どの保健医療人材が実務のための登録が必要か（医師、看護師、助産師など）。
**6 What licensing requirements and procedures of HRH now exist? Are they adhered to?
保健医療人材の免許交付資格や手続きは何か。それは遵守されているか。

**5 What categories of HRH (i.e. physicians, nurse, midwife, etc.) are required to be registered in

4

3

2

D. Financing for HRH management

Job description

Regulations

資料 1. 保健人材開発システムアセスメントチェックリスト

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Students

staff

Educational

institutions

Educatinal

F. Production

主な保健医療人材の教育機関の基準はあるか。
Does any mechanism exist to link supply of professionals to demand (quantitative and qualitative)3

Is the migration of HRH teachers a problem ? In what sense?

教員配置や定着のための方策をとっているか。

Are there measures for deployment and retention of teachers?

教員養成システムはあるか。

Is there an educational system for teachers?

れるか。

最近の入学者数と卒業生数のデータはあるか。これらのデータは性別、年齢、資格別にも分けら

disaggregated by sex, age, and citizenship?

*14 Are data for total entrants and graduates available for recent years? Can these data be

現在の年次卒業生数は主な保健医療人材のニーズをカバーしているか。

教育機関の入学資格は何か。
*13 Does current number of yearly graduates cover the needs for the main categories of HRH?

12 What is the policy for admission to health professions school?

教員の仕事を評価するシステムはあるか。

**11 Is there a system for evaluating teachers' performance?

常勤職員（フルタイム勤務）の教員は十分か。

教員流出の問題はあるか。どのような意味で問題か。
*10 Are there enough full-time-equivalent teachers for the main HRH categories?

9

8

7

主な保健医療人材のスタンダードカリキュラムはあるか。

**6 Do you have a standardized curriculum for main HRH cadres?

保健医療人材の教育施設認可制度の内容は（認可基準、監査や立ち入り検査）。

**5 What is the accreditation system for health schools? (criteria, audit or inspection)

主な保健医療人材の教育研修施設はあるか。その数、どこか（公的と民間）。

Where are they? (private and public)?

*4 Does the country have education and training institutions for the main HRH cadres? How many?

専門職の供給と保健セクターの需要（質と量）の関連づけるメカニズムがあるか。

of the health sector?

Is there a standard of educational institute for main HRH cadres?

保健医療人材養成に関する国家戦略があるか。

Is there a national HRH education strategy?

上記部署は、適切な技術をもった十分な数の人員を兼ね備えているか。

Do the above units have enough personnel with adequate skills?

2

1

3

可能であればデータを入手、確認する

か？

卒業生の就職先に関する情報を把握しているか？指標がある

関連文書があれば入手、確認する関連文書があれば入手、確認する

ればそれを満たしているか、確認する

正規雇用の教員（フルタイム勤務）/学生数などの基準があ法を検討することも可能だが、詳細は別に譲る

面接者に対する一般的な質問。調査目的によっては、質問方確認する

ある場合、どのような仕組みか、確認するどのような方策かある場合、どのような仕組みか、確認する関連文書があれば入手、確認する。

署）はどこか？

関連文書があれば入手、確認する。認可制度の監督機関(部する

教育研修機関に関する情報や報告書などがあれば入手、確認

関する報告書など関連文書があれば、確認する

国家保健人材開発計画、保健人材情報報告、保健人材情報に関連文書があれば入手、確認する

国家保健人材政策の中で、養成に関する記述があるか、ど責任部署の人数と人材の背景（年齢、経験、教育背景）、な

資料 1. 保健人材開発システムアセスメントチェックリスト

/equity

Imbalance

Does deployment strategy fit with the needs of poor/vulnerable settings and people?

専門職配置の国内格差があるか。

Do you have a problem of mal-distribution of professionals in the country?

僻地や弱者のニーズに合う配置戦略があるか。

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

プライベートクリニックや病院における登録システムがあるか。

僻地への配置に関する何らかの対策があるか。
13 Do you have a registration systm for private hospitals and clinics?

*12 Do you have any measures for the deployment in rural and remote area?

人材は異なるタイプやヘルスサービスのレベルに応じて適切に配置されているか。

services (hospital, ambulatory, home, preventive, etc)?

保健医療サービスが危機的に行き届いていない場所があるか。
*11 Are human resources distributed appropriately among the different types and levels of health

10 Are there major segments of the population that are seriously underserved?

98

毎年の新卒採用者率のデータはあるか。

*7 Do you have a data of what share of graduates is recruited each year?

保健医療人材の勤務先や数に関するデータはあるか。（カテゴリー、場所、人数、年齢、性別）

how many, age, sex?)*6 Do you have a data for the number and workplace of health personnel (which category, where,

主な保健医療人材の登録システムはあるか。

Do you have a registration system for main categories of HRH?

sector5

国家公務員の配置戦略はあるか。

4

the public

Deployment in

What is the rule and procedures for recruitement and deployment?

採用や雇用に関するルールや手順はどのようなものか。
Is there a national staff deployment strategy?

3

採用に関する責任はどのレベル（国レベル、サブナショナルレベル）か。

What level (national, subnational) is in charge of recruitment of HRH?

2

sectorIs there a specific recruitment policy ?

採用に関して特別な戦略があるか。

1

the public

Recruitment in

G. Deployment**1 Is there a standardized final exam to ensure the qulaity of education?
6 教育の質の確保のために最終試験（卒業試験）の基準があるか。

最近の入学者数と実際の卒業生数の割合に関するデータはあるか。どれくらいの割合か。

years? What proportion?

*15 Do you have a data on the proportion of entrants who have successfully graduates, in recent

関連文書があれば入手、確認する

同上

同上

同上

同上

関する報告書など関連文書があれば、確認する

国家保健人材開発計画、保健人材情報報告、保健人材情報に同上可能であればデータを入手、確認する

同上関連文書があれば入手、確認する

同上

同上

関連文書があれば入手、確認する関連文書があれば入手、確認する

同上

資料 1. 保健人材開発システムアセスメントチェックリスト

27

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テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

incentives

Motivation /condition

Workingsalaries

Wages /

H. Retention

Private sector

労働者は過去12ヶ月間にストライキをおこしたか。

Did workers go on strike in the last 12 months?

公の労働時間と実際の労働時間は何時ですか。

What is the official and actual working hours?

職場に、水や電気、建物、薬、物品や機材の問題があるか。

Does work place have a problem of water, electricity, building; drug and materials, equipment?

あなたも含めて職員は、職場のセキュリティーの問題はありますか。

Does health staff (Do you) have a problem of security in the workplace?

保健ワーカーの住居や交通手段は働くために充分な状況か。

Is the living condition and transport of health workers adequate to work?

家庭の支出は、月平均いくらくらいですか。

How much is average monthly expense in your family?

あなたも含めた職員は、過去12ヶ月間に給与支払いが遅れた経験がありますか。

Did staff (you) experience delayed payment in the last 12 months?

（あなたは政府からの給与の他に他に収入があるか。）

保健医療人材の収入には、（政府からの給与の他に）何か他の形態があるか。

salary?)

職員は金銭以外のインセンティブを受け取っているか（物品や昇進など）。

11 Does health staff (Do you) receive non-monetary incentive (in kind, promotion, etc.)?

職員は金銭的なインセンティブを受け取っているか。

10 Does health staff (Do you) receive monetary incentive?

9

8

7

6

5

4

3

2

同上

同上

同上

同上

同上

同上

法を検討することも可能だが、詳細は別に譲る

面接者に対する一般的な質問。調査目的によっては、質問方

同上

同上

同上

法を検討することも可能だが、詳細は別に譲る

あなたの月給はいくらですか。
Do other forms of income exist for HRH? (Do you have any other income besides government

面接者に対する一般的な質問。調査目的によっては、質問方保健医療人材の各カテゴリーの月給はいくらか（手当等も含めて政府から）。

保健人材情報報告書など関連文書があれば確認する

family allowance, etc. ) ? Or What is your monthly salary?

What is the monthly salary of each category of HRH (from the government, include hardship or

プライベートセクターで働く保健人材の数は把握しているか。

*17 Do you have an idea of the number of health personnel working in the private sector?

1

法を検討することも可能だが、詳細は別に譲る

面接者に対する一般的な質問。調査目的によっては、質問方

関連文書、報告書などあれば確認する

面接者に対する一般的な質問。調査目的によっては、質問方
公的保健セクターを離れ、プライベートあるいは、保健以外のセクターに移る主な理由は何か。 法を検討することも可能だが、詳細は別に譲る

16 What are the main reasons for leaving the public sector for the private or non-health sector?

副業はよくあることか。

15 Is dual practice common in your country?

プライベートセクターにおける実際的な監査があるか。

14 Do you have a functional inspection system for private sector?

資料 1. 保健人材開発システムアセスメントチェックリスト金銭的・非金銭的なインセンティブが実施されているか？

スーパービジョンの計画と実施の責任はどこか。

は自分自身が受けたか？

実際にどのようなスーパービジョンを行っているか？あるい

越境が起こる主な要因は何か。

22 What are the main factors causing international migration?

越境する保健医療人材が、どの程度、保健医療人材格差を生み出しているか。

21 To what extent does international migration of staff create distributional imbalance on HRH?

主な保健医療人材のカテゴリーのうち外国人の割合に関するデータがあるか。

categories are not nationals?

20 For the total health workforce in the country, do you have a data on what share of the main HRH

毎年、越境する保健専門職（医師や看護師など）のデータはあるか。

year?

19 Do you have a data for the health professional (physician, nurse, etc.) who migrate overseas each

（保健医療人材の）越境移動は国内の大きな問題ですか。

18 Is international migration perceived as a major problem in the country?

Information

HRH

1

入手可能な保健医療人材情報やデータはあるか。

Do you have available HRH information/data?

I. Monitoring and evaluation

Migration**17 Is there a system of career path for major categories of HRH?
保健医療人材の主な職種においてキャリアパスシステムはあるか。

報告書などがあれば確認する

同上法を検討することも可能だが、詳細は別に譲る

面接者に対する一般的な質問。調査目的によっては、質問方同上情報が入手可能であれば確認する法を検討することも可能だが、詳細は別に譲る

面接者に対する一般的な質問。調査目的によっては、質問方する

可能であれば、主な職種のキャリアパスについて詳細を確認

法を検討することも可能だが、詳細は別に譲る

あなたの部下の保健スタッフ（あるいはあなたは）は過去12ヶ月間に継続教育の機会があった

educationか。

面接者に対する一般的な質問。調査目的によっては、質問方研修の機会がどのような形や頻度であるか？

topic?

16 Did health staff (Did you) have an opportunity for in-service training last 12 months? If yes, which

スーパーバイザーやマネージャー自身は、リーダーシップの研修を受けているか。

15 Are supervisors or managers themselves trained in leadership?

いるか？

パフォーマンスに応じた金銭的インセンティブ、非金銭的なインセンティ パフォーマンスの向上につながっているかどうか確認されてブどのようにパフォーマンスを向上させているのか。

non-pay incentive, )14 How are these mechanisms used to improve performance? (ex. performance based incentive,

スーパービジョンのスタンダードツールはあるか。）

どのようなスーパービジョンシステムか。（誰が誰に、どれくらいの頻度で実施されるのか。

etc)

13 What is the system of supervision? (by whom, to whom, how often, standard tool for supervision,

スーパービジョンシステムがあるか。

12 Do you have a system of supervision?

Continuous

Career path /leadershipSupervision /資料 1. 保健人材開発システムアセスメントチェックリスト

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

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保健医療人材の行政記録はあるか。

Are these available administrative records for HRH?

保健省は保健医療人材サーベイや保健センサスは実施しますか。ある場合、最終はいつか。

か。
Does MOH conduct HRHsurveys or health census? If yes, when was the last one?

国勢調査や労働調査を実施しているか。この情報源で保健医療人材情報を分析することは可能

possibel to analyse HRH information?

Does the country have population census or labour force surveys? Do these sources make it

保健医療人材情報は民間セクターも含んでいるか。

など）
Does HRH information cover the private sector?

保健医療人材の不足や過剰の問題があるか。

*11 Is there a problem of shortage or oversupply of HRH?

国には、保健システムの中でケアレベルに応じた施設タイプごとの職員配置基準はあるか。

*10 Does the country have staffing norms per facility type according to the levels of care?

保健医療人材の評価やモニターするための主な指標は何か。

65

職能カウンシルはあるか。その会員となる基準は何か。その構造は職員、活動は何か。

staffing, and activities?

What professional council exists? What are the criteria for membership? What is the structure,

structure, staffing, and activities ?
職能団体はあるか。その会員となる基準は何か。その構造は職員、活動は何か。

体、大学など）。
What professional association exists? What are the criteria for membership? What is the

保健医療人材に関して、国内ならびに国外の団体の関係者は誰か（保健省、他省庁、専門職団

partners

Who are the national and external stakeholders in HRH? ((MOH, other ministries, professional

associations, universities, etc)4and external

Stakeholdersはあるか？報告書などがあれば確認する

保健医療人材情報の流れ、頻度、保健情報システムとの関連

報告書や人材情報フォーマットなどがあれば確認する

同上関連文書があれば入手、確認するれる。

か聞く（雪だるま方式）を繰り返すと主要な関係者は網羅さ調査前に作ったリストをもとに、面接者に他に関係者がいる

面接者に対する一般的な質問。

同上関連文書があれば入手、確認する

例えば公務員の場合、公務員番号や雇用の記録、など

同上

同上

同上

保健医療人材情報はサブナショナルレベルにもあるか。あれば具体的にどのレベルか。（州、県 報告書などがあれば確認する

Is there information at subnational level? If yes, specify at what level (province, district, )保健医療人材情報をどのように収集するか。

別、年齢など）How is HRH information collected?

保健医療人材情報システムには何が含まれているか。（保健医療人材の分類、資格、職場、性

workplace, gender, age, etc.)

What are included in HRH information system? (category of HRH, levles of qualificaiton,*9 What are core indicators to monitor and evaluate HRH?

8

7

6

5

4

3

2

J. Stakeholders and coordination

management

資料 1. 保健人材開発システムアセスメントチェックリスト

K. Others

誰がメンバーか。

開発パートナーは、何に基づいて保健医療人材に関する活動を支援しているか。

4

3

2
幽霊労働者に関する問題があるか。

優先的保健プログラムに起因するポジティブ/ネガティブなインパクトがあるか。

Is there any positive/negative impacts due to the "prioritized Health Program(s)"?

タスクシフティングの事例があるか。

（給料は受け取っているが働いていない）
Is there any example(s) of "Task-shifting"?

working) ?

Is there any problem relating "Ghost workers" (which means staff receiving salary are not

欠勤に関する問題があるか。

Do you have any problem(s) about absenteeism?

いるか。

国の援助戦略やパートナーの調整メカニズムはあるか。ある場合保健医療人材の課題は含まれてinclude HRH issues?

11 Does a Country Cooperation strategies or partner cooridnation mechanism exist? If yes, does it

1

面接者に対する一般的な質問。調査目的によっては、質問方

国外の関係者が会合をもち情報共有などを行うことをさす。

この場合の、調整メカニズムとは保健医療人材に関わる国内

同上

は、質問方法を検討することも可能だが、詳細は別に譲る

いるか？面接者に対する一般的な質問。調査目的によって保健プログラムが保健人材に関する影響をどのように与えて疾病対策プログラムなどドナーの資金を選択的に受けている同上同上法を検討することも可能だが、詳細は別に譲る

面接者に対する一般的な質問。調査目的によっては、質問方整会合で保健医療人材が課題としてとりあげられているか？

における政府開発援助調整会合なども含む。これらの援助調

保健分野あるいは保健省レベルのみならず、マルチセクター

ナー独自の支援戦略など。関連文書があれば入手、確認する

たとえば、保健人材開発戦略や計画、あるいは開発パート

保健医療人材開発における国家戦略の策的や実施に、どの程度、開発パートナーが関わっている 法を検討することも可能だが、詳細は別に譲る

HRH development?

To what extent are stakeholders involved in formulating and implementing national policies for

関係者の調整メカニズムはあるか。

Is there coordination mechanism of stakeholders? Who are the members?

労働組合をもつ職種はどれか。

What categories of HRH have their own unions?

か。
10 On what basis to external partners support HRH activities?

9

8

7

資料 1. 保健人材開発システムアセスメントチェックリスト

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用31

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )2. 保健人材開発システムに関する調査報告書( カンボジア )人材開発システムに関する調査報告書（一部改編）

2009 年 6 月

JICA 地域における母子保健サービス向上プロジェクト

短期専門家

32

藤田則子

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )目次
略語表 … …………………………………………………………………………………………… 34
I) 調査目的…………………………………………………………………………………………… 35II) 調査方法 … ……………………………………………………………………………………… 35
Ⅲ ) 調査結果… ……………………………………………………………………………………… 36
1. カンボジア保健人材開発の現状………………………………………………………………… 36
Policy Framework… …………………………………………………………………………… 36
Legal Framework （法制度基盤）… …………………………………………………………… 40
Production( 育成 )… …………………………………………………………………………… 41
Deployment （配置）… ………………………………………………………………………… 43
Retention （定着）… …………………………………………………………………………… 43
2. 人材開発に関わる保健省担当部署や職能団体の役割とキャパシティ………………………… 451) 人材育成部 （Department of Human Resource）… ……………………………………… 452) 人事部 （Department of Personnel）… …………………………………………………… 46
3) 病院サービス部看護課 (Department of Nursing)… ……………………………………… 464) 職能団体… ………………………………………………………………………………… 46
3． カンボジア人材開発システムの優位点と改善点 … ………………………………………… 47
Ⅳ） まとめ……………………………………………………………………………………………… 48
収集資料文献リスト………………………………………………………………………………… 49
カンボジアの社会保健指標とその推移… ………………………………………………………… 50
National Health Coverage Plan… ………………………………………………………………… 50
公的セクターの保健人材数( 人口あたりの医師 ・ 看護 ・ 助産師数、 看護助産職 ・ 医師の比率）… …………………… 51
ドナー投入表… …………………………………………………………………………………… 52
保健人材全般の育成校 ・ コース名、 入学卒業制度… ………………………………………… 54

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用33

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )

略語表

34

ADM

Associated Degree of Midwife

ADN

Associated Degree of Nursing

HRD

Human Resource Department

HSP

Health Sector Strategic PlanHC

Health Center

IMCI

Integrated Management of Childhood Illness

MDG

Millennium Development Goal

MOH

Ministry of Health

NMCHC

National Maternal and Child Health Center

OD

Operational District

PHD

Provincial Health Department

PNS

Primary Nurse

RH

Referral hospital

PMW

Primary Midwife

RTC

Regional Training Center

SNS

Secondary Nurse

SMW

Secondary Midwife

TSMC

Technical School of Medical Care

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )I) 調査目的II) 調査方法

カンボジア看護助産分野の人材開発システムの現状分析を行い、 優位点と改善点を明らかにする

調査期間 2009 年 5 月 25 日―6 月 12 日
カンボジアにおける保健人材 ( 看護助産 ) 分野の保健省担当部署、 開発パートナー、 教育機関関係者、 他 27 名 の Stakeholder に 対 し、 別 添 チ ェ ッ ク
リストの質問項目を用いた半構造面接、 関連資料
収集、 既存の文献レビューを行った （収集資料文
献リスト）。 結果は人材開発システムの中の各要素（Policy Framework, Legal Framework, Production,
Deployment, Retention） ( 図１ 調査のフレーム ) から優位点と改善点に関して分析を行った。

図１．調査のフレーム

図１． 調査のフレーム

Policy framework
MOH Policy & strategy
Health workforce plan

Production

Deployment

Retention

Pre-service education
Accreditation of institutes
Teaching capacity

Allocation
Civil service (Public)

Continuous education(In-service training )Standard curriculum

PrivateSupport mechanism

Upgrading course
Monitoring mechanism

Financial、Technical
Administrative

Legal framework
Regulation,

Registration & Licensing of health personnel
Monitoring mechanism

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用35

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )Ⅲ ) 調査結果
1. カンボジア保健人材開発の現状

2)

Policy Framework
1)

保健政策と人材開発の位置づけ
現在の保健政策は Health Strategic Plan 200815 (HSP 2) としてまとめられている。 HSP 2 では人
材開発は保健プログラムの３つの分野 （RMNCH、
CDC、 non CDC) に横断的に関わる 5 つの保健シス
テムコンポーネント (Service delivery, Health financing, Human Resource for Health, Health information
system, and Health System Governance) のひとつとして位置づけられている。 現在の人材開発戦略としては、
・ 保健人材の技能の向上、・ ライセンス制度や職能団体強化を通じた専門職の確立、
・ 配置定着の促進 ( 助産師が優先）、
・ 人事院による公務員制度改革 （Civil Administrative Reform ： CAR） やユーザーフィや種々のインセンティブを通じた公務員給与の改善、が柱になっている。

人材開発計画
人材育成部 （HRD） により 1995 年に始めて人材開発計画が策定され、 引き続き Health Strategic Plan 2003-2007 (HSP 1) に基づいて Health
Workforce Development Plan (2006-2015) が 策定された。 結果的に現在の HSP ２と整合性をもつものとなっている。 カンボジアは 1997 年より National
Health Coverage Plan にもとづいて施設整備計画が進められ、 州 ・ 保健行政区 （OD） 以下の施設 （レファラル病院、 ヘルスセンター） における人材配置
基準 （最大 ・ 最小） が決められている （レファラル
病 院 の 基 準 は CPA （Comprehensive Package ofActivities）、 ヘルスセンターの基準 （MPA(Minimum
Package of Activities) とよばれる）。 国立病院 ・
国立センターには人材配置基準がないが、 現状のスタッフ数と CPA ・ MPA 基準をもとに HRD は各職
種の Workforce plan を作成している。 保健人材数
は表 1 のように増えてはいるが、 例えば、 2007 年の CPA/MPA 職員 （看護助産分野） の人材と数をみると助産師不足が問題であり、 表 2 のように国立病院を除く CPA と MPA 施設の人材基準と比べると、最小基準を満たすには 498 人、 最大基準を満たすには 712 人不足である。一方で都市部偏在も大きく、
2004 年には国内 963 のヘルスセンターのうち 229
が助産師不在であった。

表１ ： 1996 年から 2008 年までの保健人材の推移
MD

1996

1998

2000

2004

2006

2007

1,247

1,711

1,878

2,177

2,120

2,162

1,282

1,267

MA
SNS

3,979

4,384

4,268

4,521

4,758

PNS

4,430

3,993

3,892

3,563

3,327

SMW

1,706

1,830

1,771

1,813

1,822

PMW

1,515

1,482

1,257

1,113

1,113

( National Health statistics 2006, 2007, 2008, 資料２９を改変 )36

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

2008

5,186
3,464

3,534
1,844

1,339

1,478

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )表２ ： プノンペン ・ 州での保健人材数
PMW+SMWPNS+SNS( 助産師 )( 看護師 )

168

131

273

1822

4758

2935

8085

1921

4926

3066

8358

MA

MD

PMW

PNS

SMW

SNS

Phnom Penh
Municipality

123

105

32

105

99

Province

1282

2120

1113

3327

合計

1405

2225

1145

3432

MPA+CPA
人材最小基準

1952

960

1920

2604

4656

3564

6576

MPA+CPA
人材最大基準

2353

1920

1920

2858

5683

4778

7603

MPA+CPA 人材最小 ・ 最大基準は MPA、 CPA の施設数から施設ごとに配置される人材基準をもとに算出。
MD(Medical doctor), MA(Medical assistant)

図２． プノンペンと州の人材配置
Distirbution of health staff
SNS

SMW

PNS
Phnom Penh
Province
PMW

MD

MA

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

人材開発計画の実施にあたり保健省人材養成部（HRD）は「助産師数の増加」、「偏在解消と僻地のヘルスセンターへのスタッフの充足」を問題として認識しており、人事部と共に後述の配置を

37

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )人材開発計画の実施にあたり保健省人材養成部（HRD） は 「助産師数の増加」、 「偏在解消と僻地のヘルスセンターへのスタッフの充足」 を問題として認識しており、 人事部と共に後述の配置を踏まえた
学生リクルートや助産師再配置を進めていて 2008
年には国内の助産師不在ヘルスセンターは 79 に減少している。 カンボジアの場合歴史的な事情から公務員の年齢分布が特殊であり、 州ごとに違いはあるが職員の 20 － 30% が 50 歳台であり、 今後 5 －10 年で定年を迎える。 現在の Workforce plan はこの特殊性を踏まえた作り方になっていない。 過去数
年は助産師教育がさまざまに変化していたため学生数は一定しなかったが、 今年度の国内の助産師学
生総数は PMW 約 200 名、 SMW 約 600 名、 しかし定年退職者を差し引くと助産師数の増加は限定的である。 実際全体の助産師数は 2000 年と比べてほとんど増えていない。 また現在のヘルスセンター
数は計画にはまだ届かず、 建物のない HC に職員が勤務している場合も多く見られる。 このように人事部のもつ職員数と HRD のもつ学生数との比較、 計
画保健情報部による施設数 （建設予定数） などをつき合わせた定期的な調整もいない。 また、 防衛省管轄の Military School と Military hospital があり、 またプライベート病院診療所が増加しているが、これらのスタッフ数を保健省は把握していないため、
人材開発計画は保健省公的セクターのみが対象となっている。
3)38

保健予算 ・ 保健財政 （Health financing）
政 府 予 算 は 人 件 費 （ 公 務 員 給 与 ） と Central
Medical Store(CMS) の薬剤調達と配布に当てられ、
保健サービス提供に関わる行政 ・ 施設の運営費はほとんどがドナーからの外部予算によるものである。
WHO country profile （2005） によれば保健予算は
政府予算の 12.0％であり、 保健全体の予算の中で外部支援が 25.7％を占める。 一人当たりの総保健
支出は US ＄29 だが、 うち公的支出は＄7.0 と少な

く残りは out-of-pocket （79％） である。 公的施設
ではユーザーフィーが導入されており、 支援しているドナーや NGO が地域割りで貧困者対策のための基金 （Equity Fund） や Community Health Insuranceを導入しているが、 ドナー毎にばらばらであり統一されたものはない。
人件費に関して、 基本給はここ数年間毎年 10％程度増えているが、 それでも月 30 ドル程度であり生活費とは程遠い状況のため、公務員制度改革 （Civil
Administration Reform） が進行中である。 そのひとつとして今年から MBPI （Merit Based Performance
Incentive） が準備されている。 これは保健省や国立センター、 PHD などの中核のポストに対して資格と役職に応じた報酬が追加される （保健省局長クラスで月 US$ 450）。 後述の SOA の一環として 7 つの州保健局や管轄施設でも開始予定である。
4)

保健システム ・ 保健医療サービス
National Health Coverage Plan により保健行政 ・
診療システムは全国 24 州を OD と呼ばれる 76 の保健行政区に分けられている。 別添２のように人口に応じた公的保健施設設置基準がある。 レファラル
病院は病院診療機能が高いほうから CPA3， 2， 1と分けられサービス ・ 施設 ・ 人材 ・ 機材の基準が規定されている。 ヘルスセンターも同様に基準 MPAが存在する。 しかし現実は、 例えば帝王切開ができる病院は CPA3 レベルのみしかない、 CPA1 の病院の現在の機能はヘルスセンターと変わらない上にヘルスセンターよりも患者数が少ないこともある。 また
建物のないヘルスセンターは Non-MPA ヘルスセン
ターとよばれ、 看護助産師が勤務している。 これらの原因は人材 （数 ・ 質） 不足、 そして施設機材の不備とされている。 また首都プノンペンには７つの国立病院、 ９つの国立センターがあるが、 これらの施設基準 ・ 人材配置基準はない。
プライベート病院 ・ 診療所は保健省への届出制
度があり、 その施設長は公務員でないことになってテクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )いる。 実際のサービス提供の数や質、 勤務している
人材の種類や数は保健省も把握できていない。 公務員である保健人材は給与が低いこともあり、 同時にプライベート診療所 （定年退職者や非公務員が長として届出） で勤務し生活費を稼ぐ Dual Practiceが一般的である。
5)

保健人材の数と種類
保健省計画保健情報部は公務員保健人材の種
類と数を保健統計年次報告で出している。 これまでの推移は表１で、 人口当たりの医師 ・ 看護 ・ 助産
師数と看護職対医師の比は別添３に示す。

6)

主要ドナーの支援 （セクターワイドマネージメントと
人材開発分野のドナーの投入）
Health Sector Strategic Plan 2003-2007 では HSSP （Health Sector Support Project）1 と して Sector Wide Management(SWiM) が 実 施 さ れ、
ADB/WB （$50M）、DFID （$10M ）、UNFPA （$18M）が参加した。 この SWiM 内において、 Contractingと い う サ ブ シ ス テ ム が 11OD に お い て 実 施 さ れ た（ADB/WB 予算）。 NGO が保健予算を得て、 保健行政区と共に保健行政を運営し、 保健省人材が保健サービスを提供する形態であった。 NGO と保健行政区がサービスの量質を評価し、 それに基づく Performance Incentive が保健スタッフには支払われたのが特徴であった。 UNFPA は、 18OD に対して、 保
健年次計画 （AoP Annual Operational Plan） の母
子保健コンポーネントに対して予算をつけた。 平行
して 2007 年から GAVI － HSS が 10OD で Performance Incentive を含む Internal Contract を開始した。 BTC が 7 つ の OD で BTC 型 の Contracting を実施している。 複数のスキームにより、 援助方法を試す状態となった中で、 2007 年には Contractingの評価が行われた。 総体的には、 ドナーごとにやり方が異なるものの、国家予算と違って計画額と執行・OD へ到着する額に大きな差がなく （国から州 ODへ到達する段階での職員による抜き取りも原因のひとつとされる）、 援助資金が末端の OD 単位に届いていること、 OD のマネージメントが向上し、 Performance Incentive により職員の収入が増え、 サービ
ス提供量が増えていることが上げられている。 保健省はセクターワイド ・ マネジメント （SwiM） の継続を決定し、 SwiM に参加する援助団体も、 HSSP1 の際の 4 団体から、HSSP ２の 7 団体に増加している。
かつ、 支援スキームを標準化する方向である。 この形式として、 SOA （Special Operating Agency） が2009 年 5 月から実施予定とされている。 SOA は、
NGO ではなく OD が contractor となる。 実力がない
OD においては、 Technical Advisor （TA） を雇うことが出来ることとなっている。 HSSP2 では７ドナーがJPIG(Joint Partnership Arrangement Development
Partners Interface) としてプールファンドを結成し、SOA への資金援助を行うことになった。 これまでのContracting では、 資金が直接 OD に流れたことか
ら州保健局の責任と役割が不明瞭となることが懸念された。一方、SOA では PHD は commissioner として、
OD の監督者としての役割を持つ予定である。 またこ
れまでの Contracting では、 モニターは NGO に任されたため、 外部監査的にある一定のモニタリング機
能 を NGO 側 が 担 っ て き た。 Performance Based
Incentive においては、 サービスの質のモニターが肝要である。 インセンティブとして OD や施設スタッフで分けられただけでサービスの質の向上にはつながらない事例も他国で報告されている。 今後、 SOA において、 OD レベルでの TA 以外、 OD,PHD レベルでのモニタリングの外部実施者が不明瞭であり、 SOA
において誰がどのように、 州 ・ 保健局以下のレベルをモニターするのか、 中央保健省の役割をどうするか、 という点は今後の課題として関係者の聞き取りで挙げられた。 プールファンドに参加するドナーはセクターワイド以外にも個別に事業を予定 （DiscreteFund） しているが、 この７ドナーの内訳と現在コミット
している総金額は以下の通りである。

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用39

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )AmountNote

AfD

Euro 7,000,000

2008-2013

AusAID

Au$ 37,150,000

2009-2011

BTC

Euro 3,000,000

2009-2013

DFID

GBP 35,000,000

2009-2013

UNFPA

US$ 8,867,000

2009-2010

UNICEF

US$ 4,000,000

2009-2010

WB (IDA Credit)

SDR 18,500,000

2009-2013

JPIG （プールファンド） 以外の看護助産人材開発分野に関わるドナーの投入は別添４の通りである。
助産教育のカリキュラム作り、 卒後の継続教育実
施、 さまざまなスキームのインセンティブによる助産師活動支援にドナーが集中している。 一方で看護助
産教育の実施支援やモニター ・ 教員育成 ・ 人材
配置 ・ 人材制度整備に関わろうとしているドナーは少ない。 また現在の懸念事項として、 USAID の新たな資金の流入が挙げられる。 USAID は今後 5 年間
３つの NGO に対しそれぞれ年間約＄6M の支援を約束した。 （2008 年の保健分野 AoP の外部援助
団体からの予算は $56M で、 うち母子保健分野は＄5.9M である。 つまり、 これと同額を得る母子保健
分野 NGO が３つ存在することとなる）。 USAID パート
ナーの 3 つの NGO の支援は、 金額は大きいが、 対
象地域は、 全国ではなく、 10 州、 43OD に限定される。 さらに、 これらの対象州では、 ほかの援助ス
キームと重なる地域もあり、 対象地域は HSSP2 などと調整されているわけでなない。 この 3 つの NGO
は技術支援が中心となるが、 一部、 貧困者基金やPerformance Based incentive に使われる予定でもある。 しかし、 その資金の用途はまだ最終決定されていないためインセンティブとしてばら撒かれる可能
性もある。

40

また、 2005 年ごろから助産師関連が政策の優先課題となり、 保健省のみならず副首相、 人口開発国家委員会 （National Committee for Population
and Development） や公務員改革評議会 (Councilof Administrative Reform)、 主要パートナーを巻き込んだ政策対話の場 （High level midwifery Task
Force や Midwifery Forum） ができていて、 後述するようなさまざまな対策が比較的すばやく実施されていることは特記すべき事項である。
Legal Framework （法制度基盤）1)

保健人材に関する規定
日本の医師法や保健師助産師看護師法 （保助看法） にあたる専門職種の規定は省令のレベルでも存在しない。 一方で、 看護課 （病院サービス部の下にある） が 2003 年に作成した看護師の業務
分掌 （省令） があるが、 病院での看護ケアが中心
でヘルスセンターでの看護師の役割は記載されておらず、 医師やそのほかの職種との関係も不明瞭である。 医師、 助産師、 他の職種に関する業務分掌はない。 2000 年以降に策定された MPA や CPA ガイ
ドラインでは提供されるサービスの内容は記載されているが、 誰 ( どの職種 ) がそのサービスを提供するのかは記載されていない。 しかし Abortion Law など

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )サービス個別の法律や開業法など、 別の法的文書においては、 職種ごとの規定がある。 （例えば、 中絶に関する処置ができるのは Secondary Midwife か
医師に限る、 助産師はプライベート診療では産前産後健診を提供できるが分娩は提供できない、 等と記載されている。） 省内のさまざまな公式文書の中に断片的に業務内容が記載されているだけで、 統合された職種の規定は見当たらなかった。 また、 専門
職種の規定を作る責任部署について、 保健省関係
者 (Secretary of State) の中でも認識はさまざまで、Medical Council や Nursing or Midwifery Council、あるいは保健省 HRD との見解であった。 日本の場
合保健医療に関する法律は厚生労働省により策定され、 民法 ・ 社会法として憲法をもとに立つものであるが、 カンボジアは現在憲法を基に刑法 ・ 民法の策定中であり法律分野の JICA 技術協力プロジェクトがこれを支援している。
2)

保健人材教育施設に関する規定
2007 年 3 月 保 健 職 種 ( 医 歯 薬 ・ コ メ デ ィ カル ) と学校認可に関する規則が SubDecree21 （首相、 関連省庁大臣の承認による、 クメール語でAnukret） として制定された。 学位 ・ コース名、 学
生の入学資格、 学校認可制度を確立されること、国家試験を行うことなどが規定されている。 Council
Minister の元に Accreditation Committee of Cambodia (ACC) が設立され、 教育の質を担保する制度として増加する私立学校の認可制度が開始された。 現在保健従事者育成校として ACC から認可されているのは・ University of Health Science (UHS) ： 保健省下の独立法人 （Autonomous Body）
・ Technical School of Medical Care (TSMC) ： 国立
・ Regional Training Center (RTC): コンポンチャム、
バッタンバン、 カンポット、 ストントレンの４つ ： 国立・ 他に私立校 2 校 （International University、 Life
University）

保健省では学校設置基準 ・ 教育基準がすべてのコースに関して作られており、 学校施設 ( 教室他の設備や機材、 教員と学生数の比率、 教員の資格、 学生の入学資格、 卒業試験の基準 ) が記載されている。 公立校 （TSMC、 RTC） はこの基準に従い、保健省 HRD の指導のもと教育を実施しているが、私立校の教育の状況は学生数が把握されているだけで、 保健省 HRD がそれ以上の情報を得るのは難しいとのことであった。
3)

資格認定試験 ・ 免許登録制度
2003 年から土日だけの授業で医学教育を行う私立大学が参入し、 教育の質を担保するため、 2004
年に Council Minister のもとに委員会が結成されカリ
キュラムの標準化と共通入学試験制度が進められた （SubDecree21 として法的に名文化されたのは2007 年）。 保健科学大学 （University of Health
Science） の医歯薬学部と私立大学で 2008 年から共通入学試験が導入され、 2012 年には医歯薬学部共通卒業試験が計画されており、 実質上の国家試験に当たる資格試験が開始されることが期待される。 看護助産分野ではまだ共通試験の計画はな
く、 入学は保健省内の選考委員会でバカロレアの成績を元に決まり、 卒業試験すなわち資格取得となっている。 しかし卒業試験も共通問題から各学校が出題するなど標準化が図られている。 免許 ・ 登録制
度はない。

Production( 養成 )1)

教育制度
保 健 人 材 全 般 の 育 成 校 ・ コ ー ス 名、 入 学 卒
業の仕組みは別添５の通りである。 看護助産教育は 現 在 5 つ の 公 立 校 （ 首 都 の Technical Schoolof Medical Care: TSMC, 4 つ の Regional Training
Center: RTC）、 2 つの私立校で実施されている。 5つの公立校はカバーする州からの学生を受け入れ

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用41

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )て い る。 高 卒 後 3 年 教 育 の Associated Degreeof Nurse ( 以 前 の Secondary Nurse ： ADN), Associated Degree of Midwife ( 以 前 の Secondary
Midwife: ADM、 Direct entry) の他に、 特に僻地のヘルスセンターでの勤務を想定した Primary Nurse（PNS） , Primary Midwife （PMW） （高卒後 1 年の教育） が地方 4 つの公立校で実施中である。 またTSMC では 4 年の Bachelor of Nursing のコースが始まった。 またこれまでの助産師教育の変遷を経て、 助産師を増やすための臨時措置として始まっ
た ANS3 年＋助産師教育 1 年 （Diploma of Nurse
Midwife （DNM）。 通称３＋１コース） も継続中だが、HRD によればこのコースの位置づけは今後検討 （廃止あるいは Bachelor へ） とのことであった。 現在の助産師学生数は別添６の通りである。
2)

学校運営
４つの RTC は政府予算 （人件費 ・ 運営経費） とHSSP2 のプールファンドからの予算 （教員研修 ・ 調
整会議 ・ 実習病院へのモニター費用など） により運営されていて、 施設や教育機材はドナー供与や政府予算から支出されている。 学費は無料。 TSMC
は Autonomous となり運営は政府予算 （公務員給与） と学費収入 （一人年間 800 ドル） により運営されていて、 校舎や機材は日本の無償資金協力で建設された。 面接を行った２つの RTC 校長によれ
ば以前に比べて政府予算が増え RTC の運営はやりやすくなったとのことであった。

3)

標準カリキュラムとツール
看護助産分野では現在 3 年の助産師コース（ADM） の 2， 3 年目を除いたすべてのコースの標
準カリキュラムが策定され、 シラバスがある。 2000
年ころからこの活動が始まったが現在のカリキュラム
は外国人のアドバイザーが参加して作ることがほとんどであり、 英語で作られクメール語に訳され、 各
RTC に配布されている。

42

4)

教員の資格 ・ 待遇
教育基準によれば看護助産教員の資格は、 医
師看護助産などの有資格者かつ 3 年以上の臨床経験であり、 教員になるための育成コースはない。
（実態としては、 3 年以上の臨床経験のない教員も少なくない。） 近年の ADM 新カリキュラム導入で、主に助産師研修を担当している RTC 教員に対して、 2008 年後半―2009 年前半にかけて、 もともと保健省 HRD がもっている、 カリキュラムをどう使うか、 などといった、 既存の TOT 研修 （３週間） が、
WHO や ACCESS などの予算支援で実施された。 4
つの RTC のコアトレーナーグループが育成され、 彼らが全国 RTC の教員や実習教員を指導、 各 RTC
で 現 在 実 施 さ れ て い て い る。 そ の 他 に NGO や ドナーが持ちこむ断片的な TOT 研修に参加する程度で、 教員にとっての研修の機会は系統だったものはない。 教員は政府給与 （月約 30 ドル） のほか
小額の講師料 ( 現在一時間 0.5 ドル ) をもらうだけ
で、 HRD や校長たちによれば給与の低さがやる気の低さにもつながり、 優秀な教員は休職制度を利用して NGO に移動するため定着しないとのことであった。
現在 HRD は講師料基準を見直しており財務省に通ればプールファンドからの支出が可能とのこと ( 一時
間 2 ドル程度 )。 どの学校も教員の確保は課題であり、 特に助産師コースはコース数が増え、 学生数が増えているが担当の RTC 常勤助産師職員はどこも数名程度と不足は深刻で、 学生教員比の基準を満たせなくなることになる。 TSMC の場合は学費収入からの教員へのインセンティブがあり、 政府給与の他に月 120 ドル程度の報酬 （通称 School fee） が常勤教員の収入となる。 TSMC、 RTC （カンポット、
コンポンチャム） の現状は、 看護助産教員は科目により医師 ・ 看護師 ・ 助産師、 他のコメディカルが担当している。

5)

教育の現状に関するモニター制度
教育の標準化にあたり、 保健省 HRD と学校や州

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )保健局による定期会議などで標準カリキュラムの実
施徹底や現場の問題の解決が図られているが、 実際の講義や実習の状況に関しては各 RTC や教員任せとなっており、 教育の質に関するモニター制度は確立されてはいない。

ケアを改善する(3) 安全な出産へのアクセスを上げる （適切なレファ
ラルシステムや出産待機所、助産師インセンティ
ブの実施、 貧困者支援）(4) レファラル病院の機能強化（1）） により助産師育成配置に関してさらに注目度があがった。 当地では、 通称 “Re-allocatkon” といわれている。 具体的には保健次官 (H.E. Dr Te
Kuy Seang) のもと人材養成部 ・ 人事部 ・ 州保健局長による委員会が設置され、 助産師の配置転換やローテーション勤務 （RH から HC へ、 あるいは
HC 間で）、 新卒採用枠の中で MW 増加と HC への配置が始められた。 今年は新卒 800 人採用のうちADM69 名、 PMW234 名で州保健局の状況に応じてヘルスセンターに配属、 来年は新卒 850 名のうち 300 名以上は助産師 （PMW あるいは DNM） の予定である。 既存の助産師の配置転換を進めていることから、 新規助産師育成を待たずに、 今年 9月に目標達成は可能としている。 しかし当座の数合わせはできても、 Fast Track は MW の定着や、 配置された MW の能力やパフォーマンスまで言及しているわけではない。

Deployment （配置）
MPA 基準はあるものの現実には都市部以外のヘルスセンターは看護師 （男性） が施設長と EPI や
小児診療 （IMCI） と結核やマラリア、助産師 （女性）が母と新生児保健を見る形が一般的である。 都市部への保健人材偏在解消のために設けられた PNS、
PMW コースの学生は入学時に州保健局と RTC に対して卒後僻地のヘルスセンターへの就職の契約を結ぶ制度がストントレン RTC で 2003 年に始まった。
その結果人材定着につながったことから 2006 年から他３つの RTC でも始まり、 この制度は現実に機能していた。 ADN と ADM は空席のポストに新卒業者が応募する形をとるが、 助産師の場合ほぼ全員就職可能、 看護師の場合は成績により就職できないこともある。 応募には年齢制限があり助産師は 30 歳
以下、 看護師は 28 歳以下。 また助産師の公務員
給与の等級を看護師より 2 段階格上げるなど助産師確保の努力が継続されている。 医師の場合、 卒
業後公務員とならず、 プライベートセクターで勤務する学生もいる。 看護助産とも、 いずれの学校、 保
健省 HRD、 人事部も卒業後の就職率や学生の就
職先のデータをもっていない。
2008 年 9 月新大臣就任後、 MDG 達成に向けて母子保健、 特に妊産婦死亡削減が優先課題として挙げられ、 Fast Track Intervention が施政方針として上げられた。 それによれば(1) すべてのヘルスセンターに最低１名の助産師を配置する (2009 年 9 月までに )、(2) リプロダクティブ母子新生児小児保健件の継続

Retention （定着）1)

配置された保健スタッフの支援メカニズム
経済的支援 （インセンティブ） ： 現在、 実施されている多様な援助スキームには、 サービスの数( 例えば妊婦検診 ) に応じてドナー毎に異なるさまざ
まな仕組みのパフォーマンスインセンティブが組み込まれている。 ガイドラインもなく、 標準化もされておらず、 収集がつかない状況となっている ( 別添８)。
また施設分娩推進のために 2007 年より政府より分娩インセンティブの支払いが開始された （一分娩あたりレファラル病院で 10 ドル、 ヘルスセンターで 15ドル）。 これは導入に当たり保健省から僻地勤務の助産師に対する僻地手当ての導入として財務省にテクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用43

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )交渉したところ、 議論の中で施設分娩インセンティブにすりかえられてしまったという経緯がある ( 原因は不明 )。 現行 JICA 地域における母子保健サービス
向上プロジェクトの調査によればこのインセンティブは施設内のスタッフで分配され、 スタッフの収入向上に役立ち、 サービスの数の向上にはつながっているようである。 しかしインセンティブを獲得するために実際に助産師以外の職員が助産師が行うべきサービスを行っていることも多く観察され、 サービスの質に関する問題は取り残されたままである （別添９）。 また同プロジェクトの調査によると Contracting や NGO
支援のない地域では国家予算からヘルスセンターに至る過程で予算は目減りし、 ヘルスセンターに到着
する運営経費はゼロに等しい。 現在のカンボジア保健省は、 国家予算の流れをあるべき形にしようとするのではなく、 外部資金をインセンティブとして使い人件費の上乗せを続けている状態である。 僻地手
当ては現在経済財務省と交渉中とのことであった。
技術支援 ： 現行 JICA 母子保健サービス向上
プロジェクトによれば配置された新卒 PMW が 「妊婦検診や安全な出産介助、 新生児ケア」 ができるよ
うになるために NMCHC で 2 ヶ月の追加実習が必要であった。 通常の助産師は 1 ヶ月の研修で十分であるところ、 最低限の技能レベルに達するまでに 2 ヶ月を要したことより、 新卒 PMW が卒前研修で習得している技能レベルが低いことが明らかとなった。 これを踏まえて、 同プロジェクトで実施中の PHD/OD
レベル母子保健行政官と RH 助産師によるヘルスセ
ンター助産師の支援制度モデル作りが進んでいて、その成果も見られている。 他にも技術支援が可能な
NGO はヘルスセンター助産師のスーパービジョンを行っているが、 保健省 （HRD） レベルではまだ助産師の配置までしか考えられていない。 NMCHC （国家リプロダクティブヘルスプログラム） は自分たちの役割として配置された人材の提供するサービスの質を確保するためにいかに支援していくかは今後の検討課題と認識している。
44

2)

継続教育としての卒後研修
助産師は現在の話題の中心であることもあり、 妊
娠 ・ 出産 ・ 産後 ・ 新生児 ・ 乳幼児 ・ 家族計画など In-service training は、 5 つの国家プログラムと、 NGO やドナーがそれぞれに研修を実施している （別添 4）。 助産師対象の包括的な 2 種類のIn-service training コ ー ス （NMCHC １ ヶ 月 コ ー ス、
RACHA LSS コース） については、国家リプロダクティ
ブヘルスプログラムは標準化を試みてはいるが困難
な 状 況 で あ る。 Comprehensive Midwifery Reviewによれば技能に焦点を当てた比較的長期の卒後研
修 2 種類（NMCHC1 ヶ月コース、RACHA LSS コース）
のみについては研修直後だけではなくその後も技能は定着し効果があることが示されている。 しかし、 研
修で学んだ内容が実際に実施されるためには、 薬剤機材があること、 施設や部門の長が新しく学んだ知識や技術を使うことを認めることが必要であるが、これらに焦点をあてたフォロアップはほとんど行われていない。 これらの卒後研修がどこまでサービスの改善につながっているか十分には検証されていないのが現状である。

3)

看護職のキャリアパス
現 在 保 健 省 HRD は PNS、 PMW が SNS、 SMWになるコース （Bridging program） を計画中である。
現在の基礎教育以外には高等教育 （修士 ・ 博士）のコースはまだなく、 計画段階にもない。

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )2. 人材開発に関わる保健省担当部署や職能団体の役割とキャパシティ
1)

人材育成部 （Department of Human Resource）
人材育成部 （HRD） の組織図と人材配置は別添
１０の通り。 部長、 副部長 2 名、 卒前 ・ 卒後 ・ 資
格登録の 3 部門に分かれている。 スタッフは 15 名、うち 2 名が国外長期留学中。 実質の活動は、 看護助産を中心とした卒前教育制度の確立と教育の実施に多くの時間と人材が割かれている。
卒前教育部門は看護・助産・臨床検査・放射線・理学療法のコースをカバーし、 教育機関 （TSMC と４つの RTC） を指導監督する役割を持っている。 実
際、 看護助産カリキュラムの内容やチェックリストな
どのツール、 から試験監督まで HRD が参加し、 教育の標準化を HRD 主導で実施している。 2000 年
以降標準カリキュラム以外にも学校設置基準や入学卒業規定など教育制度の確立が進んだ。 HRD 担
当者自身 「コースカリキュラムの見直しは学校の役割との認識はあるものの現在は自分たち HRD 側が進めていかないと進まない、 将来は RTC に任せるべきである」 と認識している。 また一年の看護助産コース （PNS や PMW） は僻地への人材配置のための短期的な戦略で長期的には 3 年コース （AND や
ADM）、 そして 4 年の Bachelor に発展すべきであるという長期的な視点を持っている。 教育のモニター
ツールは作成したものの、 スタッフが 2 名しかおらず HRD が直接教育の現場を訪れる形でのモニターは実施できていない。 2002 年から開始された RTC
や TSMC による四半期会合で相互の連絡は改善しており、 この会合はモニターの機能も果たしている。
HRD として今後は卒前教育 （公立 ・ 私立） のモニ
ター機能を強化すべきと考えているが、 実施方法は検討すべきであろう。
卒後教育部門は予算を確保し HRD が実施することになった研修をアドホックに実施し、 国外の研修の窓口が主な活動である。 多くの卒後研修が国家プ

ログラムにより実施されている中でこの部門の役割が明確ではない。 資格登録部門は人材データベースの入力 （GTZ により 2000 年に導入、 全国保健人材登録と受講した研修が記録されている） 以外の仕事はほとんどなく、 データベースが利用されたことは、 ほぼない。 HRD 全体としては卒後部門の 4 人、資格登録部門の 6 人、 卒前部門の 2 名は出勤しているものの建設的な仕事をしている様子はあまり見られない。 対外交渉も含めて HRD の仕事のほとんどは部長と 2 名の副部長で実施している状況である。
HRD はサウスウェールズ大学 （オーストラリア） から技術支援を受けて 2006 年に人材育成計画を策定した。 Workforce plan は保健情報計画部 （Department of Planning & Health information） や人事部 （Department of Personnel） と調整し、 実際の配置 （スタッフ数） を見ながら中長期的に学生数を見直す必要があると HRD は認識している （が実施されていない）。 また PMW/PNS の配置を見越した学生受け入れが始まったころから人事部との情報共有が進むようになった。 育成コース（特に助産師）の変遷を見ると、 助産師育成の方向性の方針決定
が人材開発計画、 Workforce plan、 現状の職員数
や学校のキャパシティなどの現状分析、 将来の展望に基づいて決められていたとは考えにくいほど場当たり的である。 実際現在の助産師 3 年コース（ADM）
は政治家の鶴の一声で開始が決まり大慌てで開始
した、 退職助産師の契約職員としての雇用継続がほとんど議論のないままに助産師フォーラムの結論として決まった、 などという経緯がある。
人材制度の法的な制度整備 （保健人材の規定・
免許 ・ 登録、 など） はほとんど進んでいないが、 保
健省がどこまで管轄するのか、 省内のどの部署が担当するのか、 どこまでが HRD の役割か明確ではな
いことも影響しているようである。

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用45

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )2)

人事部 （Department of Personnel）
部長以下スタッフ 30 名。 TOR は、 データベース
による保健省スタッフの登録管理、 給与 ・ 転勤などの管理、 公務員新人オリエンテーション、 など。 年に一度、 新卒就職後に状況を確認するために 2 －3 名で州保健局を巡回する。 HRD のデータベースと人事部のデータベースは連携しておらず、 入力が主で、 データを利用する、 HRD と連携して育成と配置をつなげて考えるところまではいかないようである。
現在 WHO と GTZ が 2 箇所のデータベースをつなげ、データの利用についてアドバイスを始めたところである。

3)

病院サービス部看護課 (Department of Nursing)
病院サービス部の下にあり、 課長とスタッフ 2 名。
96 年から WHO が、 その後 French Cooperation が支援、 そのときに看護師の業務分掌を作った。 現
在アドバイザーはいない。 主な活動は病院の看護サービスを巡回指導する、 Regional Nursing Committee( 全国６つ、 病院看護部長会議を指導 ) が中心。 昨年から HSSP の支援で予算がつくようになったが、 スタッフがいないので 3 ヶ月に一度程度、 州病院を巡回し、 病院の記録を確認、 衛生状況を見ている。 現在は分娩インセンティブの実施状況モニ
ターの指示があり、 施設内の分配方法や記録類をチェックしている。 課の人数が少ないこと、 TOR と活動が病院レベルのみに限られていて、 看護助産職
全体を見渡す活動は難しいようである。

4)

職能団体
Cambodia Midwifery Association （CMA 助 産 師協会）, Midwifery Council は存在し、 役員も決まっている。 役員は病院勤務の助産師たちが主体で、 専
属職員はおらず、 実質的な活動はあまり行われていない。 最近の助産師に対する注目が大きくなったことから、 助産師協会は資金を得て、 助産師デーな
どの催しものを実施しているが、 この 2 団体の役割

46の違いを関係者は認識できておらず、 アドボカシーの面でも技術面でも弱体である。 Medical Council、
Nursing Association, Nursing Council についての情報は時間の制約上入手できなかった。 助産師に関連して、 UNFPA の技術アドバイザーの考えとしては、 Midwifery Council は、 助産師業務のスタンダー
ドの定義、 ライセンスや Accreditation について責任があり、CMA は、卒後研修、他の職能団体との連携、他国の助産師協会との連携、 助産師の職能の向上に責任があると考えている。 一方、 保健省上層部を含め、 保健省関係者すべて、 これらの団体の役
割や活動の方向性については明瞭ではなかった。

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )3． カンボジア人材開発システムの優位点と改善点
優位点

改善点

人材開発が保健政策の中でプログラムを横断する 人材開発計画の実施にあたりWorkforce plan 修正と実施のために人事部 ・ 計
優先課題として位置づけられている
人材開発計画が存在し、 優先課題 ( 助産師、 人 画情報部との連携が強化される必要がある
プライベートセクターや内務省 （military） の保健
材の偏在 ) と対策が明確である
人材に関する情報が少ない
政策 ・ 保健システム 公務員制度改革が進行中である
３次施設 （国立病院 ・ センター） の人材配置基
人材に関するアドボカシーの機会がある
準がない（助産師フォーラム、 など）
人材データベースが計画策定や政策決定に利用されていない
法制度

保健人材教育施設基準と認可制度がある

保健人材に関する規定、資格・免許登録制度がない統合された職種の業務分掌がない

育成

標準カリキュラムが作られ、 それに沿った教育が ( 長期の ) 教員育成コースがない
教員 ・ 実習教員の能力が不十分
実施されている
実習体制が未整備
HRD と RTC のネットワークが強化された
教員の待遇が悪い
教育実施に関するモニター制度が未整備

配置

卒後の僻地への配置を考慮した学生との契約制 人材が都市部に偏在 ( 助産師のいないヘルスセン
度がある
ターがある )
助産師の再配置 ・ 雇用の増加 ・ 基本給増加などで 低給与や教員ポスト数が少ないため教員の配置が難しい
助産師のいないヘルスセンターが減少している

定着

インセンティブにより僻地スタッフの収入が増え、 基本給が低い
さまざまなインセンティブのスキームが混在
サービスの増加につながっている
NGO や国家プログラムにより卒後研修 （国内外） インセンティブ取得のため、 専門職以外のスタッフがサービスを提供しているの機会がある
支援メカニズムとしての新スーパービジョンがモデ 卒後研修が標準化されていない
再配置された助産師の提供するサービスの質がモルとして実施されている （JICA プロジェクト）
ニターできていない
職能団体が弱体である

保健省人材養成部

やる気と能力のあるスタッフが少ない
組織図と TOR がある
卒前教育の実施に HRD の多くの活動が裂かれてRTC ・ TSMC との報告連絡体制が確立した
HRD と人事部の情報共有が進み人材配置と学生 いる。
人材政策 ・ 法制度面での仕事が進んでいない
リクルートがつなげられるようになった

ドナーの投入助産教育のカリキュラム作り、 卒後の継続教育実 看護助産教育の実施支援やモニター ・ 教員育成 ・施、 さまざまなスキームのインセンティブによる助 人材配置 ・ 人材制度整備に関わろうとしているドナーは少ない。
産師活動をドナーが集中して支援している。

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用47

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )Ⅳ）まとめⅣ） まとめカンボジアにおいて保健人材は保健政策の中で常に中核に位置づけられ、助産師の不足と保健人材の偏在という課題を解決するために国家人材開発計画も存在する。特に２００２年以降、業しサービスを提供する助産師に比べてほとんどなさ
カンボジアにおいて保健人材は保健政策の中で常看護助産を中心としたコメディカルの育成制度が確立し、実施する
TSMC/RTC と監督するHRD とれていない。
に中核に位置づけられ、助産師の不足と保健人材のの連絡調整が改善した。また人事部との連携がよくなり、人材育成と配置が同時に検討され、配これらを調査のフレームまとめると、 Policy Frame偏在という課題を解決するために国家人材開発計画も置につながる人材育成が進んだ。特に分娩インセンティブやさまざまなパフォーマンスインセンテ
work は改善点を抱えてはいるものの形を作りつつあり、存在する。 特に２００２年以降、 看護助産を中心としィブなどの支援制度がスタッフの定着を促進した。それに比べて保健人材の法制度面での整備
Production-Deployment-Retention は政策としての優たコメディカルの育成制度が確立し、実施する TSMC/（人材の規定、免許・資格・登録）が遅れている。また教員も同様に育成配置定着が必要であるが、先性からここ数年保健省を超えて政府内、 公務員制
RTC と監督する HRD との連絡調整が改善した。 また
その対策は卒業しサービスを提供する助産師に比べてほとんどなされていない。
度改革委員会による決断が下りさまざまな取り組みが人事部との連携がよくなり、
人材育成と配置が同時にこれらを調査のフレームまとめると、Policy Framework は改善点を抱えてはいるものの形を作り実施されていて、 成果を上げつつある。 しかしそれに検討され、 配置につながる人材育成が進んだ。 特につつあり、Production-Deployment-Retention は政策としての優先性からここ数年保健省を超え比べて人材制度の基盤となる保健人材の規定、 資格
分娩インセンティブやさまざまなパフォーマンスインセンて政府内、公務員制度改革委員会による決断が下りさまざまな取り組みが実施されていて、成果
認定 ・ 免許登録制度といった、 国民へ保健医療サーティブなどの支援制度がスタッフの定着を促進した。 そを上げつつある。しかしそれに比べて人材制度の基盤となる保健人材の規定、資格認定・免許登ビスを提供する保健人材の質を確保するための制度がれに比べて保健人材の法制度面での整備 （人材の規録制度といった、国民へ保健医療サービスを提供する保健人材の質を確保するための制度が存存在しない点が今後カンボジアの人材制度構築に向け
定、 免許 ・ 資格 ・ 登録） が遅れている。 また教員も在しない点が今後カンボジアの人材制度構築に向け改善すべき点と考えられる。
改善すべき点と考えられる。
同様に育成配置定着が必要であるが、 その対策は卒Policy framework
MOH Policy & strategy
Health workforce plan

Production

Deployment

Retention

Pre-service education
Accreditation of institutes

Allocation

Continuous education

Teaching capacity
Standard curriculum

Civil service (Public)
Private(In-service training )Support mechanism

Upgrading course
Monitoring mechanism

Financial、Technical
Administrative

Legal framework
Regulation,

48

Registration & Licensing of health personnel
Monitoring mechanism

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )資料． 収集資料文献リスト
1. MoH, Cambodia.Health Sector Strategic Plan
2003-2007.
2. MoH, Cambodia. Health Strategic Plan 20082015
3. MoH, Cambodia. Second National Health Workforce Development Plan 2006-2015
4. MoH, Cambodia.National Health Statistics 2006.
5. MoH, Cambodia.National Health Statistics 2007.
6. World Bank Cambodia Health PETS (Public Expenditure Tracking Survey Report) 2008.
7. MoH, Cambodia. Guidelines on Minimum Package of Activities for Health center development
2008-2015.
8. MoH, Cambodia. National guidelines on Complementary Package of Activities for Reproductive
Health development 2006-2010
9. MoH, Cambodia. Prakas on Identification of Roleand Responsibilities of Nurses. 2003
10.MoH, Cambodia. Roles and responsibilities ofnursing manager of national and regional levels,
Director of hospital, and chief of ward. 2003
11.Royal Government of Cambodia. Sub decree on
Health Training. 2007
12.MoH, Cambodia. Minimum Standard Associate
Degree in Nurse Midwifery (ADNM) Curriculum
2007.
13.MoH, Cambodia. Minimum Standard Associate
Degree in Midwifery (ADM) Curriculum (3-year)
2008.
14.MoH, Cambodia. Guidelines on Primary Midwife
and Primary Nurse Curriculum 2006
15.MoH, Cambodia. Curriculum of Diploma of Nurse/
Midwife 2nd Edition, 2006
16.MoH, Cambodia. Guidelines for Diploma of Nurse/
Midwife Curriculum, 2006
17. MoH, Cambodia. Curriculum of Primary
Nurse-Midwife for North Eastern Region 2003

18. MoH, Cambodia. Indicators of the Quality Assurance Program (QAP) in Education for Health
2008
19.JICA project for Improving Maternal and Child
Health service in rural areas of Cambodia. Performance-based Financing of Maternal and Child
Health Services: Financial and Behavioral Impacts
at the Field Level in Kampong Cham Province.
2009
20.MoH, Cambodia. Curriculum: Midwifery Training
Program for CPA level referral hospitals 2005.
21.MoH, Cambodia. Evaluation of training courses at
National Maternal and Child Health Center 2007
22.JICA The Development Study on Strengthening
MCH service performance in the Kingdom of
Cambodia (Interim report) 2007
23.JICA The Development Study on Strengthening
MCH service performance in the Kingdom of
Cambodia (Final report/draft) 2007
24.GTZ/EPOS Report on staffing and training needs
assessment in Kampong Thom and Kampot
Provinces 2008
25.JICA Project for Improving Maternal and Child
Health Services in Rural Area s in Cambodia.
26.MoH, Cambodia.. Report of needs assessment of
Public Midwifery education institutions and theirclinical practice sites in Cambodia. 2009
27.MoH, Cambodia. Report of Comprehensive Midwifery Review in Cambodia 2006
28. 鈴木里美 カンボジアの助産師継続教育の変遷と今後の課題 2005
29. 国際協力機構 カンボジア国地域における母子保健サービス向上プロジェクト 事前評価 ・ 実施協議
報告書 2007

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用49

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )カンボジアの社会保健指標とその推移
2000

2005

2007

2008

乳児死亡率 （出産 1000 対）

95

66

5 歳未満死亡率 （出産 1000 対）

124

88

妊産婦死亡率 （出生 100,000 対）

437

472

合計特殊出生率

4.0

3.4

妊婦検診カバー率 （最低 1 回）

37.7%

69.3%

68%

81%

施設分娩率

11%

21%

25.5%

39%

SBA がカバーする出産率

32%

44%

46%

58%

DPT3 カバー率

43%

76%

DPT3-HepB カバー率

87%

90%

IMCI を実施しているヘルスセンターの割合

58%

69%

低体重児 （－２SD） の割合

39.5%

安全な水へのアクセス （都市部 / 郡部）

28.4%
67%/54%

一人当たり国民総生産 （US$） ＊

300

460

550

HIV 有病率 (15-49 歳 ) ＊

1.6

1.0

0.8

初等教育完了率 ＊4785

人口 (Census 2008)

13,388,910

都市部人口 (Census 2008)

19.5%
181,035 Km2

面積

Data source ：Demographic Health Survey (2000, 2005);
Progress report HSP taskforce program area 1 RMNCH (2007, 2008)＊ World Development Indicators database＊＊ General Population Census of Cambodia 2008

National Health Coverage Plan
Operational District: OD( 保健行政区 ) の標準サービスと施設数 （2009 年 5 月現在）
診療施設

主なサービス

カバー人口

施設数

Referral hospital

CPA3 （CPA2 ＋血液銀行、 眼科耳鼻科）
CPA2 （CPA1+ 外科 ・ 手術室）
CPA1 （内科小児科産婦人科、救急外来、臨床検査放射線、 薬局）

60,000 － 200,000

CPA3 （21）CPA2 (39)
CPA1 (16)Health center

MPA （妊婦検診、 出産、 新生児、 乳児、
EPI、 結核、 マラリア、 健康教育など）

8,000 － 12,000960 （＊）（＊） 建物のある MPA ヘルスセンター、 建物がないがスタッフがいる non-MPA ヘルスセンターを含む

50

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )公的セクターの保健人材数 ( 人口あたりの医師 ・ 看護 ・ 助産師数、 看護助産職 ・ 医師の比率 )2007
Medical Doctor

2,162

Medical Assistant

1,267

2008

Secondary Nurse or ADN

5,186

Primary Nurse

3,534

Secondary Midwife or ADM, DMN

1,844

Primary Midwife

1,478

総数

人口 1000 人
当たり

医師
3,429

0.25

看護師
8,720

0.65

助産師
2,322

0.17

看護助産 /
医師

3.22（National Health Statistics 2007 & 2008）
Total population ＝ 13,388,910 （Census 2008） を総人口として用いた

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用51

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )ドナー投入表看護助産関連の人材育成へのドナーの投入状況
Policy framework

Production

Deployment

Retention

その他

データベースを元に MW Council 設 立 助産師教育カリキュラム HRD と Person- WHO 技術ガイド
Workforce plan 詳 支 援、 Regulation、 作 成 支 援、 WHO 技 術 ガ nel に あ る デ ー タ ラインの配布な
細 の 支 援 （ ア ド バ Registration 支援は イドラインの配布など
ベースの活用支 ど
イ ザ ー 長 期 2009 可能 ( 投入は未決
援、 Personnel の年 4 月から 2 年）、 定だが）MBPI、 SOA 準 備
HLMWTF ・ TWGH
支援 （アドバイザーなどメンバー
長期 2009 年 4 月から 2 年）UNFPA

HLMWTF ・ TWGH MW Council、 MW 助 産 師 教 育 カ リ キ ュ ラ 学生リクルートのた PHD/OD か ら 現 在 の カ ン トなどメンバー
Association 支援？ ム ・ ツ ー ル 作 成 印 刷 支 め の TV や ラ ジ オ の AOP の 中 の リ ー プ ロ グ ラ
援、 RTC/TSMC に 教 広報、 公務員への RMNCH コンポー ム は 2010 年
育 機 材 ( モ デ ル な ど 計 オリエンテーション ネ ン ト ( 研 修、 ま で RMNCH、＄200,000） 供 与 ( 供 の費用を支援 ( 実 ス ー パ ー ビ ジ ョ 人 材 育 成、
与先は未決定）、 HRD に 施は Personnel）
ンなど） への資 HSSP の 3 分
よ る RTC モ ニ タ ー 支 援、
金支援 （24OD) 野。 2011 －TOT な ど HRD か ら の リ ク
15 年 を 現 在
エストに応じ研修費用支作成中だが大援、 RTC 教員に対するイ
きな変更はなンセンティブ ( 講師料 （一いだろうとのこ時間 2 ドル程度） の支援、と。 HSP2 の財務省の許可が下りれば実質リーダー
プールファンドからの支出
的存在
が可能）

GTZ/EPOS

HLMWTF ・ TWGHなどメンバー

Aus AID

52

Legal frameworkWHO

看護プレセプター研修カリ HRD データベース HC、 RH の MW
キュラム作成支援、 チャ に関する技術支援 対象の研修 ( カム ・ カンポット ・ バッタン
ンポット、 コンポ
バ ン RTC 対 象 に 研 修 実
ントム 2 州） に施。 ３つの RTC への機材
対 し RACHA 委供与など。
託して LSS を実
DED(JOCV にあたる ) によ施。 研 修 後 はる OJT（チャム・カンポット・
州 の MCH チ ーバッタンバン州病院に配ムによるフォロ
属され実習教員の指導。
アップ支援、 同時に HC に必要な機材供 .
TSMC 助産教員と実習教
員強化、 実習体制整備のための技術アドバイザー（2009 年 後 半 よ り 2 年 ）2名テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

プールファンド、 UNFPA ・GAVAI への拠出

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )RACHA/USAID

TWGMCH メンバー

助産師教育カリキュラム ・ツ ー ル 作 成 支 援、 RTC
教員 ・ 実習教員の育成、
RTC の 改 修 や 機 材、 実
習先 （RH や HC の開拓と実習体制づくり）URC/USAIDHLMWTF ・ TWGHなどメンバー

象 州 ・ OD の 運 A c c e s s /営 強 化 （HIS 含 JPHIEGO と のむ ）、 RH/HC の 連携が検討中
質管理とスタッフ
へのパフォーマ
ンスインセンティ
ブ、 Equity fnud、

RHAC/USAIDHLMWTF ・ TWGHなどメンバー対 象 州 ・ OD 対象州およびスタッフへのパ プ ノ ン ペ ン にフ ォ ー マ ン ス イ あ る RHAC ク
ンセンティブリニックによるRMNCH サ ービス提供、 家族計画のディ
マンド増加のためのコミュニ
ティ動員活動FrenchCooperation

TWGH などメンバー

ACCESS/
UNICEFHLMWTF メンバー

対 象 州 OD のRH ・ HC に 対する LSS 研修、
PHD/OD に よ る
スーパービジョン （資金） 支援、
RH/HC スタッフ
へのパフォーマ
ンスインセンティ
ブ、

TSMC 助 産 コ ー ス に AV
機材供与 ( ＄20,000）
対 象 州 ・ OD の 他国で導入しHC や RH の 新 た 「産後出血生 児 ケ ア ト レ ー 予防のためのニング実施。
地域 TBA による Misoprostol
使用」 を提案
したが MOH 倫
理委員会で却下された。

USAID はこの３つの NGO に、 5 年間で各々約＄３０M の資金支援。 6. 対象地域は 10 州、 43OD （プルサット、 バッタンバン、 バンテミンチェイ、 シエムリアップの全州、 コンポンチャム、 プレイベン、 ココン、 シアヌークビル、 コンポンスプー、 プノンペンの一部の OD）。 これらは USAID 州 （OD） となり、 RACHA、 RHAC がヘルスセンターとコミュニティをつなぎ、 MNCH 分野で活動。
黄色部分は、 支援がないことが確認できた部分である。

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用53

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )保健人材全般の育成校 ・ コース名、 入学卒業制度
保健従事者の教育システム (As of June 2009)
１． 育成コース、 資格
Higher Education （Bachelor を取得）
Public university

Private university

Medical Doctor
DentistPharmacist

University of Health Science (UHS)International University (IU):
Phnom Penh

Bachelor of Nursing

University of Health Science (UHS):TSMCInternational University (IU):
Phnom Penh
Life University: Sianouk Ville

Secondary Education （Diploma 他を取得）
Qualification

Duration

TSMC

RTC
Kg, Cham

RTC
Kampot

RTC
Batambang

RTC
Stung Treng

Secondary NS（Associated Degree of
Nursing）

3 years

○

○

○

○

○

Primary NS

1 year○○○○Secondary MW（Associated Degree ofMW）

3 years

○

○

○

○

Primary MW

1 year

○

○

○

○

○

○

○

Diploma NS/MW○

4 years(NS 3 + MW1)○

Laboratory technician

3 years○

X-ray technologist

3 years○

Physiotherapist

3 years○

Bachelor of Nursing

4 years○

54

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

Medical Doctor
DentistPharmacist
Bachelor of Nursing

University of Health Science (UHS)International
Phnom Penh

University of(UHS): TSMC

University(IU):
International
Phnom
Penh 2. 保健人材開発システムに関する調査報告書 ( カンボジア )資料
Life University: Sianouk Ville

HealthSecondary Education （Diploma 他を取得）
Qualification
Duration
TSMC
Secondary NS（Associated Degree of
Nursing）
Primary NS
Secondary MW（Associated Degree ofMW）
Primary MW
Diploma NS/MWLaboratory technician
X-ray technologist
Physiotherapist
Bachelor of Nursing

Science

University(IU):

3 years○

RTC
Kg, Cham○

1 year
3 years

○

○
○

○
○

○
○

○
○

○
○

○
○

○
○

○

○

1 year
4 years(NS 3 +
MW1)
3 years
3 years
3 years
4 years

RTC
Kampot○

RTC
Batambang○

RTC
Stung Treng
○

○
○
○
○

２． 入学 ・ 卒業
２．入学・卒業
1) Medical Doctor, Pharmacist, Dentist, BcNS

1) Medical Doctor, Pharmacist, Dentist, BcNS
12 grade + Bac
National Entry Exam↓Foundation year (1 year)↓
Medicine
Pharmacy Dentistry Bachelor of Nursing↓
National Exit Exam↓
Diploma of Medicine, Pharmacy, Dentistry, Nursing
signed by MOE and approved by MOH

SMW と SNS の学生数は州人口により決められ各
RTC に割り振られる (Quota system)。 PMW と PNS
は僻地 HC での職員であり PHD からの不足人員の報告を元に割り振るが、 入学時に PHD/RTC と卒業後の就職先に関する契約を結ぶ。 学生は自分の住所の属する RTC 以外の RTC には入学できない。
カバー州
TSMC

Phnom Penh, Kandal, Kg Chhnang, Kg Speu

RTC Kg Cham

Kg Cham, Kg Thom, Svay Rieng, Prey Veng

RTC
Battambang

Battambang, Siem Reap, Pursat, paillin,
Bantemeanchey, Odymeanchey,

RTC Kampot

Kampot, Takev, Koh Kong, Sianouk Ville, Kep

National Entry Exam ( 国 家 入 学 共 通 試 験 ) は
RTC
Stung Treng, Kuratie, Preah Viher, Mondolkiri,
2008 年より開始、 National28Exit Exam （資格取得のStung Treng
Ratanakiri,
ための国家試験に相当） は 2012 年実施を目指している。 Council Minister (Sok An 副首相 ) が長とな以前に比べて TSMC や RTC は人気が高くなり、り National Examination Committee が 試 験 を 準 備 運
Bac のスコアにより選抜で落ちる学生もでてきた。
National Entry(国家入学共通試験)は2008 年より開始、National
Exit Exam （資格取得のた
営Exam
してい
る。 メ ン バ ー は Council
Minister, Secretary
TSMC は PNS/PMW コースを実施していないので、めの国家試験に相当）は 2012 年実施を目指している。Council Minister (Sok An 副首相)が長とな
of State (MoH and MoE), representatives of ACC,PNS/PMW と 希 望 す る Kandal の 学 生 は RTC Kg
り National Examination Committee が試験を準備運営している。メンバーは Council Minister,
professionalboard(Medicine,
Pharmacy),
DeanofCham に、 Kg Speu の 学 生 は RTC Kampot、 Kg
Secretary of State (MoH and MoE), representatives of ACC, professional board (Medicine,
UHS ofand
IU,andと IU,
HRD/MoH。
Pharmacy), DeanUHSと HRD/MoH。
Chhnang は RTC Batambang に入学する。
Diploma NS/MW (4 year) は助産師不足解消を
2) Nurse, Midwife, & other comedicals
2) Nurse, Midwife, & other comedicals
目的として 2003 より開始。 SNS の有資格者に対し1 年の助産師教育を提供し助産師となる。 しかし看
12 grade + Bac
護師と助産師の給与スケールが同じだったため希望
Entry exam↓↓Entry selection
TSMC
RTC
者が少なかった。 最近の助産師優遇政策で助産師
Final exam
Final examの給与スケールが看護師に比べて上がったため希↓望者も前よりは増えているとのこと。 HRD は今後このDiploma signed by MOH
コースをどう整理するか今後検討するとのこと （廃止、 BcMW とする、 など）•
RTC の入学試験
・ RTC の入学試験 RTC の各コースに応募、MOH にある National Committee (HE高卒・バカロレア受験後、学生はDr. Tey Kyu Sien、HRD,
RTC)により学生が選抜される。基準は年齢、住所、バカロレアの点数
高卒 ・ バカロレア受験後、学生は RTC の各コー
・ RTC の卒業試験（生物、数学、化学）で、選抜後各学校に配置される。
スに応募、 MOH にある National Committee (HE Dr.
HRD/MOH と RTC/TSMC は卒業試験標準問題
SMW と SNS の学生数は州人口により決められ各 RTC に割り振られる (Quota system)。PMW
Tey
Kyu
Sien、
HRD,
RTC)
により学生が選抜される。
集を作成、 毎年各 RTC はこの中から問題を選び卒と PNS は僻地 HC での職員であり PHD からの不足人員の報告を元に割り振るが、入学時に基準は年齢、住所、バカロレアの点数（生物、数学、臨床実習も標準評価用紙 ( チェック
PHD/RTC と卒業後の就職先に関する契約を結ぶ。学生は自分の住所の属する RTC業試験とする。
以外のRTC には入学できない。
化学） で、 選抜後各学校に配置される。
リスト ) を作成、 教員がこれに基づき学生の技能を
TSMC
RTC Kg Cham
RTC Battambang
RTC Kampot

カバー州
Phnom Penh, Kandal,
Kg Chhnang,
Kg Speu
vol.04 保健人材開発システム分析モデルと開発途上国における活用
テクニカル・ レポートKg Cham, Kg Thom, Svay Rieng, Prey Veng
Battambang, Siem Reap, Pursat, paillin, Bantemeanchey,
Odymeanchey,
Kampot, Takev, Koh Kong, Sianouk Ville, Kep55

資料 2. 保健人材開発システムに関する調査報告書 ( カンボジア )評価する。 卒業試験の正解率は RTC により 40％－ 80％と差があるが、 卒業＝資格取得であり、 国
家試験はまだ予定されていない。
・ TSMC の入学卒業試験
TSMC は Autonomous （2006 年より） となった
ため、 入学卒業試験は上記標準問題集とチェックリ
ストを使い TSMC が独自に実施している。 学生の約25％が学費免除の学生、 残り 75％が年間 800 ド
ルの学費を払う。

56

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

3. Study Report on Stakeholder Analysis in the Developmentof HRH in the Democratic Republic of the Congo
THE DEMOCRATIC REPUBLIC OF THE CONGOMINISTRY OF PUBLIC HEALTH
SECRETARIAT-GENERAL

GENERAL SERVICES AND HUMAN RESOURCES DEPARTMENTSTUDY REPORTANALYSIS OF STAKEHOLDERS IN THE DEVELOPMENTOF HUMAN RESOURCES FOR HEALTH IN DRC

Study financed by the Japanese International Cooperation Agency (JICA) and the
National Center for Global Health and Medicine (NCGM)

By ZANDIBENI KAKU Jacques
Consultant.

October 2012

This report was originally written in French and translated in English

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用57

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

TABLE OF CONTENTSTHANKS……………………………………………………………………………………………………………………………………… 59
ABBREVIATIONS AND ACRONYMS………………………………………………………………………………………………… 60
LIST OF TABLES…………………………………………………………………………………………………………………………… 62
LIST OF FIGURES…………………………………………………………………………………………………………………………… 63
SUMMARY…………………………………………………………………………………………………………………………………… 64
1. INTRODUCTION………………………………………………………………………………………………………………………… 66
1.1. Context and justification…………………………………………………………………………………………………………… 66
1.2. Conceptual framework……………………………………………………………………………………………………………… 68
1.3. Objectives………………………………………………………………………………………………………………………………… 68
2. STUDY METHODOLOGY…………………………………………………………………………………………………………… 69
2.1. Type of study……………………………………………………………………………………………………………………………… 69
2.2. Site of study……………………………………………………………………………………………………………………………… 69
2.3. Population of study…………………………………………………………………………………………………………………… 69
2.4. Variables, indicators and expected results………………………………………………………………………………… 70
2.5. Sampling…………………………………………………………………………………………………………………………………… 70
2.6. Data collection techniques………………………………………………………………………………………………………… 71
2.7. Data processing and analysis……………………………………………………………………………………………………… 72
2.8. Timetable of activities ……………………………………………………………………………………………………………… 73
2.9. Ethical considerations………………………………………………………………………………………………………………… 75
3. STUDY RESULTS………………………………………………………………………………………………………………………… 76
3.1. STRUCTURAL ANALYSIS OF STAKEHOLDERS………………………………………………………………………………… 76
3.1.1. Characteristics of the sample………………………………………………………………………………………………… 76
3.1.2. General information on stakeholders.……………………………………………………………………………………… 77
3.1.3. Characteristics concerning HRH……………………………………………………………………………………………… 85
3.1.4. Interest of stakeholders in the HRH development process ……………………………………………………… 89
3.2. RESULTS OF QUALITATIVE ANALYSIS…………………………………………………………………………………………… 96
3.2.1. RETROSPECTIVE VIEW OF SYSTEM…………………………………………………………………………………………… 96
3.2.2. PROSPECTIVE VIEW OF SYSTEM…………………………………………………………………………………………… 102
4. DISCUSSION OF RESULTS……………………………………………………………………………………………………… 107
4.1. Lessons learned……………………………………………………………………………………………………………………… 107
4.2. Congolese House of Development for HRH……………………………………………………………………………… 112
4.3. Study limitations …………………………………………………………………………………………………………………… 113
5. CONCLUSION AND RECOMMENDATIONS……………………………………………………………………………… 114
BIBLIOGRAPHIC REFERENCES…………………………………………………………………………………………………… 115
ANNEXES:………………………………………………………………………………………………………………………………… 116
58

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

THANKS
The content of this report is the product of input from multiple persons: the officials and managers of
the Ministry of Public Health, namely those of Central departments responsible for human resources, theofficials and managers of other Ministries visited, key informants and focal points of stakeholders andpartners of the Ministry of Health with an interest in the question of human resources for health in the
DRC.
Convinced of this work, they gave up their time, dedication, availability, ideas and experiences; namely,
their best to ensure its realization.
We trust that in reading these words, they will also understand our expression of gratitude to all of them.
Dr. Jacques ZANDIBENI KAKU

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用59

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

ABBREVIATIONS AND ACRONYMS
MA
AHAM
NANC
AMPS/GHWA
ADB
DOMW
WB
DPSD
Monkole/CSTS
NMC
BTC
UCK
HD
HO
TCC
DSP
OM
KHD
PDIH/Kinshasa
CCC/SANRU
ESP/UNIKIN
AFDRC
EDF
GAVI-Alliance
IHSDG
IMS
NIS
HIPCI
Monkole/HIN
HITMS
JICA
KOICA
MIHUE
MICS
PMI
LDHZ
MPA
60

Managerial administrator
Association of Health structure Managerial administrators
National Association of Nurses of the Congo
Global Health Workforce Alliance
African Development Bank
Diocesan Office for Medical WorksWorld Bank
Department of Population Sciences and Development.
Monkole Center of Studies and Training Support
National Medical Council
Belgian Technical Cooperation
University Clinics of Kinshasa
Head of Division
Head of Office
Technical Coordination Committee
Department of Studies and Planning
Office of Migration
Kimbanguist Health Department
Provincial division/inspection of Health of Kinshasa
Church of Christ in the Congo/Sant? en Milieu rural (Rural Healthcare)
School of Public Health of Kinshasa University
Armed Forces of DRC
European Development Funds
Global Alliance for Vaccines and Immunization
International Health Sector Donors’ Group
Institute of Medical Studies
National Institute of Statistics
Heavily Indebted Poor Countries Initiative
Monkole/Higher Institute of Nursing
Higher Institute of Technical Medical Studies
Japan International Cooperation Agency
Korea International Cooperation Agency
Ministry of Higher Education and University
Multiple Indicator Cluster Survey
Provincial Medical Inspector
Lead Doctors in Health Zone
Ministry of Public Administration

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

MPH
MPH/D12
MEWSW
NCGM
NTCI
OCM
WHO
NEO
NGOD AFRO BENELUX
NHWO
GSP
NPHD
HHRNDP
UNDP
SH
PRGC
HRH
CNRT
SG
MGS
NSHI
NUD
NUDS
NUPC
NUEAESSHSRS
PHC
UNIKIN
UCL
FUB
USAID

Ministry of Public Health
Office in Charge of MPH Partnership (12th Office)"Ministry of Employment, Work and Social Welfare"
National Center for Global Health and Medicine
New Technology of Communication and Information
Observatory of Congolese MediaWorld Health Organization
National Employment Office"No-Governmental Organization of the Congolese Diaspora of Belgium,
Netherlands and Luxembourg."
National Health Workforce Observatory
Governance Support Project
National Plan of Health Development
Human resources for health National Development Plan
United Nations Development Programme
Stakeholder
Project to Reinforce Governance Capacities
Human Resources for Health
Congolese National Radio & Television
Secretariat-General
Minimum Guaranteed Salary
National System of Health Information
National Union of Doctors
National Union of Dental Surgeons
National Union of Pharmacists of the Congo"National Union of Executives, Agents and Employees of Service Sectors"
Health Sector Reinforcement Strategy
Primary Health Care
University of Kinshasa"Catholic University of Louvain, Belgium"
Free University of Brussels
United States Agency for International Development

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

LIST OF TABLES
Table 1
Table 2
Table 3
Table 4
Table 5
Table 6
Table 7
Table 8
Table 9
Table 10
Table 11
Table 12
Table 13
Table 14
Table 15
Table 16
Table 17
Table 18
Table 19
Table 20
Table 21
Table 2262

Number and percentage of stakeholders per category
Description of mandates/missions and priority areas of Ministries and Central departments
visitedDescription of mandates/missions and priority areas of Specialized state services visited
Description of mandates/missions and priority areas of Training institutions visited
Description of mandates/missions and priority areas of departments Medicaux de religious
orders visited
Description of mandates/missions and priority areas of orders and
Health professional associations visited"Description of mandates/missions and priority areas of partners,"
Donors and NGOs visited
Description of mandates/missions and priority areas of other stakeholders visited
Frequency of the scope of services offered throughout the provinces
Types of information offered by stakeholders on HRH
Seniority of stakeholders visited by age ranges
Existence of provincial branches among the stakeholders visited
Spread of stakeholders according to the number of provincial branches owned
Distribution of frequencies of services to be provided by types
Spread of stakeholders according to their interest expressed in the 4 sectors of the HHRNDP
Spread of stakeholders according to the specific NHWO function of their mandate
Volatile events having influenced the changes in HRH
Socioeconomic events having influenced the changes in HRH
Factors having encouraged the changes observed in HRH
List of partners having contributed to changes
Areas of institutional commitments of key informants
List of opportunities cited by key informants

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

LIST OF FIGURES
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure10
Figure11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16"Conceptual model of HRH development, “Organizational model”"
Stakeholders and key informants interviewed?
Distribution of frequency of stakeholders according to the spread of their service scope in
the health system
Types of information offered by stakeholders on HRH as percentage (see annex)
Activities performed by stakeholders concerning the HRH as percentage
Seniority of stakeholders in the work on HRH (see annex)
Level of intervention in the health system as percentage
Percentage of stakeholders having provincial branches (see annex)
Services to be provided at MPH concerning the HRH
Priority areas of stakeholders for the HHRNDP
Frequency of choice for each function of the Observatory as percentage
Frequency of choice of the specific function to the mandate of stakeholders
Areas of commitments in HRH development organization
System of HRH development: Congolese organizational model"Areas of engagement of orders, unions and associations of professionals"
Areas of commitments of partners

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

SUMMARY
People are the core at the center of the operation of any organization; considered as a form ofcapital which adds value to all other resources by
allowing them to become socially useful products.
In its 2006 World Health Report, the World HealthOrganization condemns a crisis of human resources for health which has beset the world for someyears; no continent immune to the problem.
However, this crisis is particularly acute in African
nations. This report highlights in particular how
Human resources for health (HRH) are one of thebottlenecks which prevent international aid frommaterializing into improved health outcomes indeveloping countries.
The DRC, like most developing countries, faces
multiple problems concerning human resources
for health (HRH). These include: inappropriate
production not taking any planning into account,unfair distribution among provinces, inappropriate
retention measures, lack of coordination among
national and international actors and the lack of areliable system of information on HRH, including
production of substandard health workers.
Since 1998, the country has been implementing
a HRH development system. In 2006, with the accession of the Health System Reinforcement Strategy (HSRS), the process was accelerated, finishingin 2010 with the creation of the National HRH
Development Plan (HHRNDP, 2011-2015) which,in turn, is an integral component of the National
Plan of Health Development (NPHD) to obtain theMillennium Development Goals.
To facilitate the implementation of the HHRNDP,
64

a project to support the development of HRH (PSDHHR) was initiated by the Management in chargeof HR at the Ministry of health (D1) supported by
the Japanese International Cooperation Agency(JICA). The flagship activities of the project, namely clarifying the content of actions of national andinternational partners in the HRH area and sharing
information among stakeholders in the National
HRH Observatory were cited as priorities.
It was necessary to analyze stakeholders via a survey to map out the latter as a key tool for the organizing authority to coordinate the interventionsof all actors implementing the HRH development.
The overall objective of this analysis is to establish
a Status Report of stakeholders in HRH development in the DRC.
In specific terms, 6 objectives were chosen:
1.Analyze stakeholders monitoring their missions and respective priority areas in HRH in
the DRC.
2.Analyze stakeholders according to their HRH
activities and their areas of engagement in the
HRH development process.
3.Compare stakeholders according to their areasof interest in this process.
4.Map out details of all stakeholders in the development process of Human resources forhealth.
5.Analyze the HRH development system of the
DRC via the key informants.
6.Formulate recommendations.
From a methodological perspective, it involves across-sectional study with descriptive intention. It

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

was initiated primarily utilizing qualitative methods for collecting data, namely interviews centering on focal points of stakeholders and semi-structured interviews with the key informants. In total,
31 stakeholder structures were visited and 10 key
informants interviewed.
Main study results:•The areas of interest and engagement for
stakeholders concerning the National Development Plan of Human resources for health wereidentified. In fact, the study points out that the
4 sectors of HHRNDP, namely career management, basic training, continuous training andretention, are of interest to all stakeholders.
However, their interest seems stronger in thearea of continuous training compared to othersectors.
•As for areas of engagement in the HRH development process, according to “the housemodel”, apart from consultation, which is ofinterest to almost all parties (72%), continuous training (69%) and reinforcement of institutional capacities (69%) headed the field interms of interest of stakeholders; while there
was much less commitment to career management (21%) and funding (39%) of HRH. Nevertheless, there are specific features of interestor commitment according to the categories of
stakeholders.
•The lack of commitment among stakeholders
to fund the agenda of the HHRNDP was cited.
In fact, this analysis shows that only around
13% of stakeholders offered funding to MPH as
opposed to 81% which were ready to offer it
expertise.

•In qualitative terms, the study results corroborate the situational analysis of the HRH
performed in 2010; which shows that the implementation of the HHRNDP is still lagging
behind.
•Other partners, previously unknown in termsof their interest in the HRH issue, were discovered, and can be capitalized with a number ofopportunities.
• Finally, other considerations not mentioned in
the HHRNDP such as strategies to sustain thecurrent gains of countries in terms of HRH development were discussed with the key informants.
•In sum, the analysis allowed mapping of the required data for the HRH National Observatory
and facilitated the coordination of stakeholders in HRH development by the Management
responsible for HR within the MPH.

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

1. INTRODUCTION
1.1. Context and justification
In all nations in the world, Human Resources represent the key element of any organization, sinceover and above their economic impact, it is they
which add value to other resources by allowing
them to become socially useful products. (1, 2).
In its 2006 World Health Report, the World HealthOrganization condemns a crisis of human resources for health which has beset the world for someyears; no continent immune to the problem. However, this crisis is particularly acute in African nations. In fact, according to this report, 57 countries
are affected worldwide, 36 of which in Sub-Saharan Africa, with a cumulative lack of 4.3 million
health workers and 1 million in the African continent alone (3). As regards the glaring inequalities
observed in quantitative and qualitative terms,
firstly between developed and developing countries, and secondly between rural and urban areas, especially in Africa, this Report clearly showsthat Human resources for health (HRH) are one of
the major bottlenecks preventing international aid
from materializing into improved health outcomesin developing countries. (3, 4).
Developing human resources is thus the mainstay of efforts to ensure the adequate operationof a health system. In fact, “Human resources,
alongside material resources and infrastructure,
constitute the factors for establishing care in ahealth system” (Kashala1, 2008). “Given their importance in the organization and especially in theimplementation of healthcare to benefit the com-munity, it is crucial for countries to strive for a sustainable development perspective of these humanresources for health” (Youssouf Ould Limam)2.
HRH development transcends the administrative
management function of health professionals;
rather, it is a more strategic approach of assessment and recognition of the latter as compellingand irreplaceable human capital for the provisionof quality healthcare, the sole guarantee of attaining the Millennium Development Goals in thehealth field. This makes it the benchmark and thecatalyst for the adequate operation of a healthsystem. (5).
The DRC, like most developing countries, faces
multiple problems in terms of human resources
for health (HRH). These most commonly involve:
inappropriate production not taking any planning
into account, unfair distribution among provinces,
inappropriate retention measures, lack of coordination among national and international actors
and the lack of a reliable system of information on
HRH, including production of substandard healthworkers.(6,7).
In 1998, initial discussions on HRH developmentin the DRC were held during the country’s participation in the HR development strategy for the
WHO region formulated in Lome, Togo. Regarding
this strategy, the DRC set out its first document on
HR development policies, but no implementation
followed. In fact, the country suffered from a lethargy due to armed conflicts up until 2006, the year
prescribed by the WHO to health workers.

1

Kashala : First Professeur Noir of human resource management lessons, at the School of Public Health of the University of Kinshasa/DRC. In “course module on
human resource management, Academic Year 2008-2009” .
2
Youssouf Ould Limam provided the preface for the Development Plan of the RHS of the Islamic Republic of Mauritania ; he is in charge of the Computer-aided
HR Management Office at the Ministry of Health and Social Affairs in this country.

66

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The participation of countries in international forums on human resources, particularly in Douala(with the preparation of the Douala plan in 2008)
and in Kampala (notification of the Declaration of
Kampala), allowed the DRC to identify the major
weaknesses which assailed its human resources
for health system, namely the lack of a reliable
information system on HRH(1, 2). Instead, without
available data on human resources, workers will
be raised without planning and coordination, andwith no guarantee of the quality of training. (8).
This situation prompted the country, via a multisectoral committee, called “Commission of human resources for health”, in collaboration with
development partners, GAVI and cooperation
agencies namely JICA, to set up a National Development Plan of Human resources for health,
HHRNDP for short, since November 2010. This
plan fits into the general framework of the Health
System Reinforcement Strategy and the National
Plan of Health Development of the country, which
retained HRH development as one of the strategic
priorities to support the development of ZS. In
fact, the development of human resources is oneof the key aspects of the health system reinforcement strategy (5,7).
Moreover, the HHRNDP-DRC, for its part, retained
the reinforcement of the intra- and inter-sector
partnership in the HRH sector as a strategic priority.
It commences, among other things, with the creation of a framework for dialog with all stakeholders (MESU, users, unions, orders and professional
associations...) (1,6).

In view of the implementation of Planning, aProject of the Ministry of Health initiated by theManagement responsible for Human Resources(D1) partnering the Japanese International Cooperation Agency (JICA) entitled: “Project to Support
the Development of Human resources for health(PSDHHR)” was established. The main activitiesof the project, including clarifying the content ofactivities performed by national and international partners intervening in human resources forhealth and sharing information between stakeholders were retained as priorities (9).
To ensure feasibility, a process to set up the National Observatory of Human resources for health(NHWO) was launched within the Ministry of
Public Health thanks to technical support provided by the WHO. This set up should proceed instages, the most important of which consists of
the identification, analysis and involvement of all
stakeholders involved in the HRH issue. The first
sector of this stage was completed since August
2011, with the adoption of job description by the
NHWO, involving preparation of the list of stakeholders committed and allocation of roles for eachof them to play in this process.
This should lead to the second sector, which
consists of analyzing stakeholders to clarify thecontent of their respective activities related tothe development of human resources for healthwith a view to improved involvement. Therefore,
it proved necessary to embark on a study, in theform of a survey, initiated among all stakeholders
to facilitate analysis and preparation of efforts tomap stakeholders. This is the context to the present study report.

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

1.2. Conceptual framework

1.3. Objectives

The analysis of stakeholders for the development
The objectives pursued in this study are given beof Human resources for health in the DRC, waslow:conducted withregardtotheelementsofthe1.2. Conceptual framework
Human resources for health development systema) General objective:
The analysis of stakeholders for the development of Human resources forsuch as illustrated in the conceptual model below:
health in the DRC, was conducted with regard to the elements of the Human resources for(House Model)
Establish an inventory of stakeholders inhealth development system such as illustrated in the conceptual model below: (House Model)
volved in the development of human resources for health in the DRC.
b) Specific objectives:

Figure 1: Conceptual model of HRH development ” House Model” (10).

Figure 1: Conceptual model of HRH development ”House Model”(10).
conceptual framework
aboveshows showsa health asystemwhich responds
TheTheconceptual
framework
above
healthadequately tosystem
the needswhichof the population
the frameworkan organization
respondslike
adequately
tooftheneeds of which must
be constructed on a cornerstone of available human resources, of high quality and in sufficientthe population like the framework of an organizaquantity.

tion which must be constructed on a cornerstone
To achieve human
this, the HRH
development
be builtand
on its three mainof available
resources,
ofmusthighitself
quality
pillars, namely production, deployment and retention. Those, in turn, must be founded on anin sufficient quantity.
effective policy and planning, a consistent and well-adapted judicial and regulatory
achievethesystem
HRH development
must itself
framework, To
a reliable
andthis,concreteof funding and institutions
with reinforced
bearchitecture
built onconstructed
its threeinmain
pillars,
namelyproduccapacities. All
this mannershouldbe supported
by a coherent andfunctional coordinationand dialog mechanism
involving all Those,stakeholders.
tion, deployment
and retention.
in turn,must be founded on an effective policy and planning, a consistent and well-adapted judicial andregulatory framework, a reliable and concrete
system of funding and institutions with reinforced
1.3. Objectives
capacities. All architecture constructed in thismanner
The objectives
pursued inshould
this studybe
are supported
given below: by a coherent andfunctional coordination and dialog mechanism ina) General objective:
volving all stakeholders.

1. Analyze stakeholders, monitoring theirmandates/missions and their respective
priority areas in HRH in the DRC.
2. Analyze the stakeholders according totheir activities in HRH and their areas ofengagement in the HRH development process.
3. Compare stakeholders according to theirareas of interest in this process.
4. Map out details of all stakeholders in the
Health Human Resource development
process.
5. Analyze the HRH development system of
the DRC via the key informants.
6. Formulate recommendations.

Establish an inventory of stakeholders involved in the development of humanresources for health in the DRC.
68 objectives:
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2. STUDY METHODOLOGY
The methodology followed in this analysis is thesame as that used for qualitative studies. In fact,
it comes into its own when used for an analysis ofstakeholders as a tool to identify the needs, issues
and/or interests of the various parties concernedby what is often too wide a question, based on themodel of the development of human resources forhealth. The goal here is to improve understandingof the areas of interest and mutual perceptions
for the development (11, 12). Nevertheless, before proceeding with the qualitative analysis,
some qualitative data were also collected with theintention of measuring simple indicators.
The SD 21000 standard (Sustainable development
for the 21st century) defines the “relevant parties
or stakeholders ” as “any individual or group which
may affect or be affected by, directly or indirectly,
in the short- or long-term, by strategies, actions,messages (and their consequences), that the organization implements to attain its objectives ”.
More recently, the ISO 26000 standard on societal
responsibility invites companies to identify their“stakeholders”: “The stakeholders are the organizations or individuals which have one or more interest/s in a decision and any activities performedby an organization ”. They may also provide genuine development opportunities for the organization (13).
2.1. Type of study
It is a cross-sectional study with descriptive intention primarily based on qualitative methods.

2.2. Site of study
The study concerns all three levels of the healthpyramid of the DRC. However, this report centerson collected data mostly in Kinshasa, provincial
city and capital of the DRC. In fact, this first section of the analysis of stakeholders focused initially on Kinshasa; based on the idea that startingwith Kinshasa, which is at the center of the healthsystem and which encompasses almost all head
offices of official institutions active in the country,
this would allow information on most stakeholders
operating in the country to be obtained. Lessons
learnt from the survey in Kinshasa could allow
the scope of the analysis to be extended to otherprovinces subsequently.
2.3. Population of study
The population of this study constitutes all stakeholders involved in the area of human resources
for health.
At a central level, the study targeted the Ministryof Public Health (MPH), namely the Secretariat-General, as the administrative authority and twoother central divisions, namely that responsible
for studies and planning (D7) and that responsible
for partnership (D12). The three Management
arms of MPH directly involved in HRH, namely
the Management of General Services and Human
Resources (D1), the Management of the Teachingof Health Sciences (D6), and the Management ofContinuous Education (D11), as integral components of the research and/or analysis team, were
not targeted by the analysis.

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

The other Ministries involved in HRH were also
targeted, namely, the Ministry of Higher and University Education (MIHUE), Ministry of the Civil
Service, Ministry of Labour, Employment andSocial Benefits, Ministry of Planning, Ministry of
Finance and Ministry of the Budget.
Furthermore, the other stakeholders, particularly
the training institutions, the private and religious
sector, the orders, unions and associations ofhealth professionals, development partners, andsome NGOs were also involved in this analysis.
2.4. Variables, indicators and expected results
In the course of this study, some variables of interest were analyzed, including:•Categories of stakeholders involved in HRH development in the DRC.
•Levels and priority areas of stakeholders in thehealth system.
•Areas of interests of stakeholders in the HRH
development process;•Nature of available resources for stakeholders
to support the HRH development process.
•Level of interest of stakeholders in the HRH development process.
Indicators:
The analysis allowed us to measure certain indicators; such as:•Number of stakeholders involved in the HRH
Development process.
70•Proportion of stakeholders by level of intervention in the health pyramid.
•Proportion of stakeholders by areas of intervention.
•Nature of information on HRH available fromstakeholders.
•List of main actions of stakeholders by level ofintervention.
•Existence of mapping of stakeholders implementing the HRH Development.
Main study results:•Mapping of information on HRH linked to the
prepared NHWO.
•Mapping of stakeholders: localization, seniority
and areas of interest in the HRH, available.
•Qualitative analysis of the HRH development
system implemented.
2.5. Samplinga. Sampling technique:
Based on a previously drawn-up list of stakeholders having participated in the preparatory
workshop of the National Health Workforce
Observatory (NHWO), the research teammembers used brainstorming to complete thelist, while ensuring all categories of stakeholders involved in the issue of human resources
for health were represented. In fact, given themultisectoral nature of the structures involvedin human resources for health, it was a matterof ensuring all sectors could at least be represented in the sample analyzed, namely, thepublic sector, private sector, religious, civil so-

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congociety as well as development partners.
The ideal was to list up the stakeholders visited using the snowball sampling technique but
constraints of time, namely just two weeks
in which to collect data, did not allow sorting
to proceed. In other words, the sampling was
performed out of convenience, made up according to professional networks.
b. Choice of key informants.
In the course of the workshop for adoptionof job discription of NHWO, each stakeholder structure designated a focal point, which
would represent it within this forum. The latter
was officially identified as a target to respondto a questionnaire concerning its holding structure.
For stakeholders not having participated in thisworkshop, the contact person was the manager of the targeted structure or similar aroundthe same, who guided the investigator on the
ground.
As regards key informants for the qualitative
analysis of the HRH development system, thiswas chosen based on a profile: their knowledge, experience and responsibility in the research, training and/or management of humanresources for health. A shortlist of 14 informants was compiled, 10 of which were foundand 4 were unavailable.
c. Size of the sample
In total, the scope of this analysis included

meeting with 41 stakeholders, 31 of whom
responded to the questionnaire survey targeting their structures as stakeholders and 10
key informants who were interviewed in depth
about the HRH development system of thecountry.
Among these stakeholders, two were portrayed using two types of tools via two different respondents, namely, one focal point
having responded to the questionnaire survey
as a structure stakeholder, and a key informant
who was passed on to the interview guide. (seediagram of stakeholders grouped according to
the tool used to collect the data, lower, in the
results section). From here, a difference is seenin the addition, namely 39 stakeholders, in the
mapping of annexed data.
2.6. Data collection techniques
As already detailed above, the data used for thisanalysis were collected by two main techniques,
namely, documentary review and questionnaireinterviews and by an interview guide based ontarget informants.
The documentary review allowed a summary of
the background to the evolution of the development process of human resources for health in
the DRC as well as the major challenges it faces atthis time. To do so, a certain number of normativeand other documents were reviewed and the information within was summarized and used in the
introductory section of this report.
The directed interviews, meanwhile, were conducted using a pre-established questionnaire sur-

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

vey, intended for the structural analysis of stakeholders for the observatory of HRH. This tool is set
out in the annex of this report.
The conversations or semi-structured interviews
with key informants were conducted using an interview guide. (See tool in annex).
To guarantee the quality of the collected data byinterviews, interviewers were briefed for two dayson the methodology of how to conduct interviews(qualitative method) and on the data collection
tools; this briefing also allowed supervisors toensure that all interviewers had the same understanding of the importance weighted on different
questions based on role-playing games in theclassroom with feedback. Finally, the tools werepretested with the intention of perfecting theirformulation.
Aiming to maximize the potential information
provided by the key informant, each interview
was conducted by three interviewers, namely one
main interviewer and two note-takers. The study
did not use recordings to avoid any misunderstanding on how such recorded information would
be used on the part of the interviewees.
In total, the data collection lasted two weeks andwas performed by a team comprising 12 interviewers divided into 4 groups of 3 interviewers bywork team. The 3 initial teams were tasked withcollecting data from stakeholders with the questionnaire survey, while the fourth team was earmarked to conduct the semi-structured interviews
with the key informants. The interviewers wereaccompanied on the ground by a team of supervi72

sors, including two Central managers of MPH anda JICA consultant.
2.7. Data processing and analysis
After having collected data on the ground, theinterviewers should consult at the end of the day
to compile the notes for the interviews completed
and/or duly complete the questionnaire survey.
These field notes should be entered before being
passed on to supervisors, who should validatethem before passing them onto the consultant forcompilation.
Once all the entered questionnaires have beencollected, all data of the structural analysis were
centralized in a summary matrix, bringing together
the main questions and their responses for eachstakeholder. This file, which was created in Excel,
was debugged to reduce typing and transcription
errors as far as possible and then used as the base
document for analyses performed on the collected data. Moreover, the quantifiable information
was summarized using the cited statistical methods: frequency, percentage, etc. to calculate therelevant indicators.
The data collected via semi-structured interviews
with key informants, meanwhile, was subject tomanual qualitative analysis.
In fact, an analysis team comprising 7 persons
was assembled, including interviewers having collected the specific data in question (namely, the3 interviewers of group 4), D1, and three publichealth experts, of which 1 short-term Japanese
consultant, the head of the PSDHHR project and 1

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Congolese consultant.
Following a careful reading through all the interview notes, the team proceeded to the identification of concepts, and labeling, coding and grouping the same before the analysis in real terms got
underway.
The information thus compiled allowed the maintendencies of the points made by informants tobe aired, also by category, from which useful lessons could be learnt. Nevertheless, attempts werealso made to respect the terms, points and key
words or verbatim responses used by respondents
to preserve the original flavor of the same.

collection tools as well as a combined timetable ofactivities. This preparatory period lasted nearly 3
months; from September to November 2011. The
activities summarized in the timetable are thoseincluded with effect from the finalization of the
protocol and the data collection tools until thesubmission of the final study report. (see timetable of activities below).

Moreover, to create schematic representationsof the qualitative analysis results, the Mindjet
Mind-Manager 9 software package was used.
In absolute terms, all the information analyzed allowed the results of this analysis to be presented
in the form of a narrative report, summary tables,graphics, and finally mapping of stakeholders in
relation to the conceptual framework of the study.
2.8. Timetable of activities
The activities performed as part of this study were
initiated from August 2011, with the assemblingof the research team and the preparation of thedraft list of stakeholders to visit.
This is followed by the recruitment of a consultant
who should support the team already assembled
by members of the Ministry of Health and thoseof JICA, to prepare the study protocol, the data
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73

74

D1 andConsultant

Processing andanalysis of thedata
Editing ofprovisional
reportSharing andfeedback of theteam
Submission ofprovisional
reportValidation
workshop withpp
Submission of
the final report

7

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12

11

10

9

8

Compilation of
the data

6

Consultant

D1 and JICA

Consultant

Consultant

Consultant

Research teamConsultant

Supervisors
andinterviewers
5 Entry of the data Interviewers

Briefing ofsupervisors andinterviewers
4 Collection of thedata

3

Finalization
Research teamprotocol andtools and manual
2
Obtaining of
D1
authorizations

1

TIMETABLE OF ACTIVITIES
No. ACTIVITIESINCHARGE
S3

S4

Dec. 11S1

S2

S3

January 12
S4

S1

S2

S3

February 12
S4

S1

PERIOD BY WEEKSS2S3March 12
S4

S1

S2

S3

April 12

May 12, toS4 bedetermined

Observation

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

2.9. Ethical considerations
Given that this analysis started with the collection of data from human subjects, primarily byinterviews, ethical considerations were taken into
account, in this case, those concerning the 3 fundamental principles of respect for the individual,
respect for benefaction and for justice.

would be the prime beneficiaries of adjustment
measures resulting from this analysis.

In fact, reflecting our respect for human rights,
we obtained the verbal and voluntary consent ofinterviewees to respond to the study questions.
Their right of refusal to respond to our interview
was respected. Furthermore, they were assured ofconfidentiality of the information provided to us
as follows: “the names of interviewees will neverbe associated with their contacts and will not be
included in any report of this analysis”. Moreover,to provided even more reassurance of confidentiality, it was decided to avoid using recorders whencollecting information for this study since the results of the analysis will not be used for reasons
other than those cited in the context, namely,
those facilitating coordination of the actions ofstakeholders harmoniously in terms of alignment,
efficacy and efficiency of interventions made aspart of National Development Planning of humanresources for health.
The principle of justice was respected for selecting
all the categories of stakeholders and administering them all with the same questionnaire.
In addition to taking into account these three fundamental ethical principles, interviewees were
reminded that the study did not involve any significant ethical risk. Furthermore, the stakeholders
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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

3. STUDY RESULTS
3.1. STRUCTURAL ANALYSIS OF STAKEHOLDERS

The study results in “analysis of stakeholders in
HRH development in the DRC” are collected in two
sections based on the tool used to obtain them.
The first section known as the “structural analysisof stakeholders” summarizes the results of structures analyzed via the questionnaire survey. The
second section presents the results of the qualitative analysis of the HRH development system,
scanned using in-depth interviews with key informants.

3.1.1. CHARACTERISTICS OF THE SAMPLE
The stakeholders visited are presented in table1 below, which shows their spread by category.
Based on the group to which they belonged, thestakeholders were divided into seven categories
namely:- The Ministries/Central ministry departments;- Specialized state services;- Training institutions;- Medical departments of religious orders;- Orders, unions and Professional associations;- Partners, Donors, NGOs and others.

In the first section below, apart from the characteristics of the sample, the study results arepresented in three sections, namely general information, the characteristics of stakeholders concerning the HRH and finally their interest in the
HRH development process in the DRC.
A.Table 1: Number of stakeholders surveyed by category
No. Categories of stakeholders

Percentage

1

Ministries/Central departments of Ministries.

10

25.60%

2

Specialized state services

512.80%

3

Training institutions

6

15.40%

4

Medical departments of religious orders

3

7.70%

5

Orders/unions and Professional associations

7

18.00%

6

Partners, Cooperations,
Donors and NGOs

6

15.40%

7

Others

2

5.10%

Total

39

100%

The table shows that the those responding to
the study came from 7 structural categories of
stakeholders. These are Ministries, their Generalsecretariats and/or Central departments (25.6%),
Specialized state services (12.8%), Training insti76

Numbertutions (15.4%), Medical departments of religious
orders (7.7%), Orders and Health professional associations (18%), development partners, donors
and NGOs (15.4%), and others (5.1%).

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B. The distribution of stakeholders based on the tool used for collecting the data.
B. The distribution of stakeholders based on the tool used for collecting the data
Figure 2: Stakeholders and key informants interviewed
Figure 2: Stakeholders and key informants interviewed
Key
informants

Stakeholders
DSP (MPH)
D12Min. Plan
Min. Budget
Min. FinanceMin. ETPS
ESP/
UnikinNISOMNEOAFDRC /health
CNRT

CSTS/
MonkoleSG/MPH
SG/MPA
DSP/MIHEU
WHO/RDC
DPS/KIN
DOMW
NMC
UCK

CCC/SANRU
KHD
NUD
NUPC
NUDS
NUEAESS
NANC
AHAM
BTC
JICA
UNFPA
USAID
Benelux Afro-Center
OCM

DPSD/
UnikinHIN/
Monkole3.1.2. GENERAL INFORMATION ON STAKEHOLDERS

HITEM

In this paragraph, some general information isprovided on stakeholders visited. This information
primarily concerns their mandates and/or missions in the DRC, their priority areas or those ofinterest in general as well as the spread of their
The above diagram illustrates the spread of respondents according to theservice scope nationwide.
tool used to collect the data. In total, 31 entities were surveyed via a questionnaire targeted at
The above diagram illustrates the spread of retheir structures, and 10 were questioned with an interview guide in the capacity of key
spondentsthe
accordingthe toolused to collect3.1.2.1.with
Areas
intervention
and interest of
informants. Moreover,diagramtoshows
2 stakeholders
who were targeted
two of
types
of
the
data.
In
total,
31
entities
weresurveyed
via
stakeholders
bycategory
tools simultaneously. These are two training institutions: the School of Public Health of thequestionnairetargeted atand
theirand Center of Monkole (CEFAUniversity ofa Kinshasa(ESP/UNIKIN),
thestructures,
Training Support10
werequestioned
withaninterview
guidein
Before specifying the activities performed by
Monkole).
the capacity of key informants. Moreover, thestakeholders directly linked to HRH, there was adiagramshows
2
stakeholders
who
were
targetneed to explore their areas of priority or of gener3.1.2. GENERAL INFORMATION ON STAKEHOLDERS.
ed with two types of tools simultaneously. These
al interest in the DRC. Table Nos. 2, 3, 4, 5, 6 andare twotraining
institutions:
the Schoolof Publicis provided
7 givedescription of the main areas of priority
In thisparagraph,some general
information
on astakeholders
HealthoftheUniversityofKinshasa(ESP/UNIKIN),
andinterest
categories
visited. This information primarily concerns their mandates and/or missions in the by
DRC,
their of stakeholders, such as
the Training
SupportCenterof Monkole(CE- of theirreceivedinterviewees on the ground.
priority areasandor thoseof interestin general
as wellas the spread
servicefrom
scope
nationwide. FA-Monkole).
3.1.2.1. Areas of intervention and interest of stakeholders by category.

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

Before specifying the activities performed by stakeholders directly linked toHRH, there was a need to explore their areas of priority or of general interest in the DRC.
Table Nos. 2, 3, 4, 5, 6 and 7 give a description of the main areas of priority and interest by77

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Table 2: Description of missions and priority areas of Ministries and Central departments visited
No.

Stakeholder
DSP/
MPH(D7)

1

2

3

4

5

78

Areas of intervention or
general interest

Missions DRC

1.Prepare a macroeconomic diagnosis of the health sector; ・ Planning
2.Prepare, monitor and evaluate macroeconomic and sec- ・ Studies
toral policies, strategies and plans, projects and health ・ Reform・ Mobilization of resources.
programmes
3. Prepare and/or update legislation on procedures to prepare the framework law and the Hospital Act...;4. Promote the partnership for the mobilization of resources.

M a n a g e m e n t o f 1. Manage partners administratively and technically.
Partnership/MPH(D12)・ External partnership (cooperation agencies and international NGOs;
・ Internal partnership/national NGOs;
・ Intersectoral collaboration

Ministry of the ESU/ The Ministry of the ESU has a triple role:
・ Higher and university eduSecretariat-General 1. Teaching,cation2. Research (fundamental, operational, applied) and・ Research
3. Service for the community (which includes professional ・ Services to the community
support for young graduates).
Ministry ofPlanning

1. Planning of socioeconomic development of the DRC (the ・ Intersectoral coordination
main mission);・ Investments and devel2. Technical coordination of all interministerial committees o p m e n t p ro j e c t s / p ro working in the development sector;
grammes.
3. Monitoring and evaluation of all development projects. ・ Monitoring/evaluation

Ministry of
the Budget

1. Preparing the State budget
2. Preparing and monitoring the budget.

・ Identiﬁcation of number of
executives and state officials;
・ Preparation of budget envelopes.

6

Ministry of Finance 1. Management of public State ﬁnances in various forms: ・ Finances.
mobilization of receipts, exchange rate, currency monitoring, framework for expenditure, etc."

7

Ministry of the La- 1.The Ministry deals with national policy for employment ・ Employment
・ Social security
bour, Employment and beneﬁts or social security.
and Social Beneﬁts

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NB: The official duties of all Ministries of the DRC are stipulated in Ordinance No. 08/074 of 24 December,2008. (see Official journal of the DRC).
Table 3: Description of missions and priority areas of Specialized state services visited
No.

Stakeholders

Missions in the DRC

Areas of intervention or
general interest

National Institute 1. Produce and distribute encrypted data (statistics) in the ・ Production of statistics
01 of Statistics (NIS)
DRC
2. Train personnel in statistics.
National Employ- 1. Produce statistics on workers (as an adviser to the State). ・ Employment
ment Oﬃce(NEO) 2.Manage databases concerning jobseekers, employee
needs or employment markets and possible resulting job
placements."
02
3.Dealing with unemployed (jobless): Receiving offers of
employment; Intervention in social security (health andeducation); recommendation from Employers as required)
4. Certifying contracts from employers.
Department of Mi- 1. Management of national frontiers (main mission);・ Safetygration (OM)
2. Control of stays of foreigners/expatriates; Issuing visas to ・ Education, training
foreigners;
・ Health03
3.Management of repatriated refugees (in tandem with
the High Commission for Refugees);
4.Collaboration with Interpol or International Police (as amember).
H e a l t h S e r v i c e s 1. Help improve health and food safety of servicemen by ・ Basic training of A2 nursBranch/AFDRC
reducing morbidity and mortality and physically and es and combat stretchmentally boosting troops, particularly during military op- er-bearers.
・ Readying troops for com04
erations.
2. Facilitating reconciliation between army and public by bat.
relief actions for the population in the event of catastro- ・ Relief for the population.
phes.
Congolese National 1. Inform, train, educate and entertain the Congolese pub- ・ Audiovisual press
・ Communication broadcast
Radio and Televi- lic
05
and television
sion(RNTC)

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Table 4: Description of missions and priority areas of training institutions visited
No.

Stakeholders

Missions in the DRC

Areas of intervention or
general interest

Department of
1. Teaching of population sciences (Demography) and of ・ University teaching;・ Research in all areas linked
Population Sciences development (Economics, etc.):
and Development a. Methods of collecting, monitoring and evaluating proj- to the population.
(DPSD)/UNIKIN
ects and programmes, analyses of sociodemographic
data;
b. Analysis of sociocultural, environmental and economic
factors aﬀecting the population and analysis of inﬂu01
ences of the various demographic components ondevelopment;
2. Research:a. Fundamental research covering varied themes andb. Applied research targeting the service to the community (Preparing policies in the area of population,
Evaluation of programmes and projects, Consultations, sub-contracting, etc.).
School of Public
Health of the
02 University ofKinshasa(ESP/UNIKIN)

1. Training of health workers of the DRC and elsewhere
・ Training;
2. Research into health;・ Research;
3. Assistance to the community (reinforcing the capacities ・ Social intervention.
of the MPH in areas combating HIV, monitoring avian ﬂu
and Monkey-Pox; etc.).

Kinshasa University 1. Provision of tertiary care,
Hospitals (BTC)
2. Basic training and training courses for students studying
03
medicine and at the ISTM;
3. Training during employment.
Higher Institute for 1. Train quality nursing staﬀ (multi-skilled nurses and mid- ・ Training of HRH in the caresector.
04 Nursing Services wives);
2. Contribute to the ongoing training of nurses.
(ISSI)

80

Higher Institute of
05 Medical TechnicalTeaching (HITMS)

1. The training of nurses at secondary level (A2), higher ・ Training and follow-up oflevel (A1) and laboratory technicians.
pupils and students in hospitals.

Center deFormation and06
Support Sanitaire(CEFA) Monkole

1. Ensure ongoing training of health professionals based at ・ Coordination of medical
the Monkole Hospital Center;training activities;
2. Ensure post-university training of nurses, lab technicians, ・ Fight against sickle cell;・ Practical laboratory work.
etc.

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Table 5: Description of missions and priority areas of medical departments of religious orders visited
No.

Stakeholder

Diocesan Oﬃce ofCatholic Medical
01
Work (DOMW).

Missions in the DRC

Areas of intervention or
general interest

1. Coordinate health services in line with national and pastoral policy of the Catholic church.
2. Promote access to healthcare to the poorest sector of
the population in Kinshasa and its surrounding area

Church of Christ in 1. Restore the health of the Congolese public
the Congo/Project02
Health Rural (CCC/
SANRU)

・ Health of the population
by PHC with three mainareas: malaria, HIV andvaccination.

Kimbaguist De1. Participate in the State health campaign
partment of Health
03
“KHD”

・ Basic training (ITM andmedical faculty);
Setting up hospitals andhealth centers.

Table 6: Description of missions and priority areas of orders and associations of health professionals visited
No.

Stakeholder

National Union of
01 Doctors (NUD)

Missions in the DRC
1. Defend the interests of all member doctors;
2. Protect the medical profession against charlatans;
3. Organize cultural activities for doctors.

Areas of intervention or
general interest
・ Socioprofessional aspectsof doctors (remuneration,
working conditions).

Order of doctors/ 1. Including doctors in the order before engaging in profesNational council ofsion (requirement of the Law);
the Order of doc- 2. Ensuring compliance with medical deontology; the order02
tors (NMC
has the power to sanction doctors either by apportioning blame, temporary suspension, suspension or striking
them oﬀ.
National Union of 1. Defend the interests of the pharmaceutical profession/ ・ Constitution of the union
Pharmacists of theprofessional union.
in federations according toCongo (NUPC)
institutional aﬃliation
03
・ Continuous training
・ Partnership for ongoingtraining
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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

National Union of
Dental Surgeons04 (NUDS)

1. Defend the social beneﬁts of members;
・ Ongoing work training for
2. Monitor changes in membership numbers;
members;
3. Check diploma qualiﬁcations (authentication of academ- ・ Verification of academic
ic titles).
title before posting by the
Ministry.

National Association of Nurses of
the Congo (NANC)

1. Gather together nurses in their capacity as professionals ・ Sectors of care in pediatric,
and ensure their awareness of professional, deontologi- surgery and obstetric carecal and ethnic issues;etc.;
2. Oﬀer training during employment, seminars and studies; ・ Inter ventions for HIV/3. Establish partnerships with national and international AIDS, and other infectiousorganizations.
diseases (malaria, TBC..)
4. The main mission involves protection of the nurse’ s in collaboration with partjob.
ners;
・ Interventions in the zoonosis in collaboration withFIS (Federation In Health).

National Union of
Executives, Agents
06 and Employeesof Service Sectors(NUEAESS)

1. Defend its aﬃliates, collectively and individually;
・ Working and social condi2. Protect their employment and promote their sociopro- tions in view of the retenfessional and moral interests aiming to constantly im- tion of unionized employprove their working conditions and standing in life.
ees.

05

Association des As- 1. Contribute and help facilitate intellectual and social pro- ・ Actions on members who
sociation of Healthmotion of members.
are Management Admin07 structure Manage- 2. Lead members;
istrators of health institurial administrators 3. Defend the interests of members.
tions.
(AHAM).

Table 7: Description of missions and priority areas of partners, Donors and NGOs visited
No.

Stakeholder

Missions in the DRC

World Health Orga- Institution of the United Nations, having a support man01 nization/DRC-Kin- date at the Ministry of Health: “We are so to speak, an adshasa (WHO)viser of the MPH, and provide it with logistical support” .

82

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Areas of intervention or
general interest資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

02

Belgian TechnicalCooperation (BTC)

The BTC is an agency for funding bilateral cooperation in ・ The BTC intervenes in arthe form of projects in various sectors not for proﬁt.
eas of health, agriculture,roads, bridges, ferries,
teaching and good governance projects.

Japanese Interna- 1. Cooperation: bilateral,・ Public health (HRH andtional Cooperation 2. Technical cooperation: non-refundable financial aid, health establishments)
Agency (JICA)
construction of infrastructure; training courses in Japan ・ Professional training
for Congolese in multiple areas, and other modalities of ・ Road infrastructures (urban
03
funding or refundable loans.
roads),・ Urban water supply,・ Safety: support for trainingof police and judiciary;・ Environment.
United Nations
Population Funds(UNFPA)04

1. Promote the rights of each woman, man and child to live ・ Universal access to healthwith good health and enjoy equal opportunities;
in the area of reproduc2. Assist countries which use data relating to population tion, including family planto devise policies and programmes for eﬀorts to reduce ning and sexual hygiene;
poverty and help ensure that each pregnancy is wanted, ・ Support for population andeach childbirth is safe, young people do not contract development strategies;
HIV/AIDS, each girl and woman is treated with dignity ・ Promotion of awarenessand respect.
of problems of populationand development;
・ Advocating the mobilizationof resources and Political
will to succeed in this area.

United States Agen- 1. Promotion of peace and stability in the DRC;
・ Training
cy for International 2. Contribution to establish viable democratic institutions ・ Research;
Developmentin the DRC;
・ Intervention to beneﬁt the(USAID)
3. Macroeconomic growth and stability ;population;
4. Intervention in social security (basic social services: ・ Peace and security (social
health and education);stability);05
5. Intervention in humanitarian crises (epidemics, volca- ・ Health (70% of the budget);noes...);
・ Economic growth;
6. Diplomatic ﬁeld; etc.
・ Social protection(vulnerable groups)
・ Education (primary andsecondary).

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Benelux Afro-Center
06

1. Ensure support for the reform of the HRH management ・ Health;with the expertise of the Congolese diaspora;
・ Social area (eﬀorts to com2. Ensure support for computerization of the health sector;
bat the digital divide).
3. Ensure institutional reinforcement of health NGOs;
4. Ensure reinforcement of the role of civil society organizations in the health sector;
5. Ensure eﬀorts to combat the digital divide in the social
sector.

Table 8: Description of missions and priority areas of other stakeholders visited
No.

Stakeholder

Observatory ofCongolese Media
01 (OCM)

Missions in the DRC

Areas of intervention or
general interest

1. Self-regulation of media with the role of:・ Media: Pedagogical role of
2. Helping enrich the public with educational programmes
journalists.
3. Helping journalists do their jobs professionally;
4. Policing the media (while ensuring compliance with thecode de deontology of Congolese journalists).

Provincial division 1. Intermediary level of the health system, responsible for
02 of health/Kinshasa
technical and logistical support… on a peripheral level(ZS) in the provincial city of Kinshasa.

To depict the actual scope of the field on which
this analysis is based via the structures visited, figure 3 below shows the distribution of frequencyof stakeholders according to the spread of theirservice scope nationwide.

inces the services of the stakeholder structure
were offered? Table 9 below summarizes the information.

3.1.2.2. The service scope of stakeholders visited
throughout the provinces.

Spread of the oﬀer via theFrequency
national provinces

The study focused on specifying the scope of services offered by stakeholders visited in Kinshasa,
aiming to obtain a relatively precise overview ofthe scope of data collected by reports nationwide.
Therefore, the question was raised to determine,
as of the day of the survey, in which national prov84

Table 9. Frequency of the scope of services offeredthroughout the provinces
Percentage

All provinces

22

71

Some provinces

9

29

Total

31

100

The table above shows that of the 31 stakeholders visited, 22 (71%) offered their services in all

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

national provinces including the provincial cityof Kinshasa, against 9 (29%) of whom, who onlyoffered services in some provinces as well as Kinshasa. The details on the provinces covered byeach of the stakeholders are listed in the annexedsummary table of mapping.
3.1.3. CHARACTERISTICS CONCERNING HRH
As regards human resources for health (HRH), thesurvey explored multiple elements of stakeholders.
Among other things, areas covered included thetypes of information at their disposal concerning
HRH, the activities each of them performed andtheir seniority in the work for human resources
for health .
The analysis also sought to specify the current level of intervention and/or the activity of stakeholders in the health system of the country; whether
they encompassed provincial branches capableof offering equivalent services to their central offices/services in Kinshasa and finally, the services
they offered for the Ministry of Public Health concerning the ongoing reform of human resources
within this Ministry.
The results corresponding to all this information
are listed in tables 10, 11, 12, and 13 below.

3.1.3.1. Information available from stakeholders
on HRH
Table 10: Types of information offered by stakeholders on HRH
Types of information
offeredFrequency

Percentage(n=31)On training

26

83.9

On use17

54.8

Others

16

51.6

None

2

6.4

The table above shows that the stakeholders visited had more information on HRH training itself(83.9%) rather than its actual use (54.8%). This
also reflects the far greater interest in training
compared to that for its use. However two stakeholders visited (6.5%) declared that they did nothave any information concerning the HRH, namely
the OCM and the Min. of the Budget. In fact, theobservatory of Congolese media as well as the
Ministry of the Budget did not engage in any activity directly targeting HRH.
Apart from these two types of information, morethan half (51.6%) of the structures visited indicated that they also had other information, detailsof which are listed in the summary tables of information concerning the NHWO in annex. Nevertheless, for information, here is a summary of someother information available from stakeholders:
uInformation on staff numbers in various categories of HRH and the different promotionsof degree-qualified health workers since
1984 (USAID, ESP)
Informationon unmet needs for qualified
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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

personnel in Bandundu (DPSD);
uStatistics on the categories and movementsof nurses (ISSI);
uBank of data concerning human resources
applying for employment in all categories
combined (NEO);uMigratory movements of HRH (OM);
uInformation on active and deceased pharmacists (NUPC)
uInformation on the job profile to facilitate
the selection of civil service officials (BTC);Au databank on HRH of the Congolese Diaspora (BENELUX AFRO CENTER) etc.
3.1.3.2. HRH activities performed by stakeholders

3.1.3.2. HRH activities performed by stakeholders

The graphic
shows
that
HRH, visited
The graphicabove
above showsthat intermsinof terms
HRH, theof
stakeholders
engaged inthe
morestakeholders
activities concerning
trainingengaged(64.1%) thanconcerning
usage (46.2%).
visitedinthosemore
activities
It also transpired that apart from the activities concerning training and usage, other types ofconcerning(64.1%)
than thoseconcerning
activities were
performed training
by nearly 77%
of stakeholders,summarized
in the paragraphs
below: usage (46.2%). It also transpired that apart fromthe activities
concerning
usage,
other
1° Activities
concerning thecontrol of staff:training
inventoriesandof active
personnel(SG/MPH andWHO),types
HRH staff
active in the were
catholicperformed
religious network
the registrationofof activitiesby (DOMW),
nearly 77%
ofdoctors in the table of the order (NMC), number of unionized employees among healthstakeholders, summarized in the paragraphs below:

network (DOMW), the registration of doctors
in the table of the order (NMC), number ofunionized employees among health service executives and officials (NUEAESS), etc.
2° Activities concerning the viability of HRH
training establishments and programmes: Survey of viability of secondary and superior leveltraining establishments performed with the
JICA support (SG/MIHUE), project to support
the training programme of the midwife branchwith the UNFPA and USAID (DSP/MIHUE).
3° Activities concerning the reinforcement of
HRH capacities by specialization, recycling, andrefresher training courses and/or the awardingof grants for doctorate (USAID, UNFPA, ESP/
Unikin, BTC) and training of ZS executives andcommunity liaisons in PHC (CCC/Sanru, KHD ).
4° The partnership for HRH development: cooperation contract with MPH/Human resources department for collaboration with HRH of
the diaspora (Benelux Afro-Center), partnership for the training of executives (General
Health Service Management of AFDRC) andpartnership for ongoing training of pharmacists (NUPC).
5° Other specific activities of certain stakeholders, particularly the recording movements in of
HRH (OM), recording of jobseekers and applicants placed among HRH(NEO), etc.

service executives and officials (NUEAESS), etc.

2° Activities concerning the viability of HRH training establishments and programmes:
1° Activities concerning the control of staff:
Survey of viability of secondary and superior level training establishments performed withinventories
ofproject
activepersonnel(SG/MPH
the JICA support(SG/MIHUE),
to support
the training
programme andof the midwife
branch with WHO),the UNFPAHRH
and USAID
staff (DSP/MIHUE).
active in the catholic religious
3° Activities concerning the reinforcement of HRH capacities by specialization, recycling,
and refresher training courses and/or the awarding of grants for doctorate (USAID,UNFPA,
BTC)
and trainingof ZS executives
and community liaisons in PHC
vol.0486 ESP/Unikin,
テクニカル・ レポート
保健人材開発システム分析モデルと開発途上国における活用(CCC/Sanru, KHD ).
4° The partnership for HRH development: cooperation contract with MPH/Human
resources department for collaboration with HRH of the diaspora (Benelux Afro-Center),partnership for the training of executives (General Health Service Management of
AFDRC) and partnership for ongoing training of pharmacists (NUPC).

Table 11: Seniority of stakeholders visited by age ranges.
Age range/number Frequencyof years

Relativefrequency

0 toin9 the Democratic
929.0 of the Congo
資料 3. Study Report on Stakeholder Analysis in the Development of HRH
Republic
10 to 19
20 to 29
30 to 39
40 to 49
50 and more
ND*3
Total

8
6
4
1
2
1
31

26.0
19.5
13.0
3.0
6.5
3.0
100.0

The table shows that of the 31 stakeholders visited, only 9 (29%) had less than 10 years ofseniority, while 1 (3%) did not specify seniority. In contrast, all others (21) had seniority ofmore than 10 years in their work for human resources for health, among which, 2 for morethan 50 years.
The data received shows significant variation in the seniority of
stakeholders involved in HRH work. The average age is 19.2 years, peaking at 52 years andwith a minimum of 0.7 year (namely 8 months). It was seen that among MPH partners, theUSAID (external partner) and religious orders (internal partners) already have a history of
more than 30 years spent involved in HRH work in the DRC.
The response to the question posed to determine the level at which thestakeholders visited actually intervened in the health system of the country in terms of HRH isshown in figure 7 below.

3.1.3.3. Mapping of stakeholders according totheir seniority involved in HRH work
Table 11: Seniority of stakeholders visited by age
rangesAge range/number ofyears

Frequency

Relativefrequency

0 to 9929

10 to 198

26

20 to 296

19.5

30 to 394

13

40 to 491

3

50 and more

2

6.5

ND*3

1

3

Total

31

100

3

The table shows that of the 31 stakeholders visited, only 9 (29%) had less than 10 years of seniority, while 1 (3%) did not specify seniority. In
contrast, all others (21) had seniority of more than
10 years in their work for human resources forhealth, among which, 2 for more than 50 years.
The data received shows significant variation in theseniority of stakeholders involved in HRH work. The
average age is 19.2 years, peaking at 52 years andwith a minimum of 0.7 year (namely 8 months). It
was seen that among MPH partners, the USAID (external partner) and religious orders (internal partners) already have a history of more than 30 years
spent involved in HRH work in the DRC.
The response to the question posed to determine
the level at which the stakeholders visited actuallyintervened in the health system of the country interms of HRH is shown in figure 7 below.

The figure shows that most stakeholders visitedintervened at all 3 levels of the health system at atime (58%), others intervened in at least 2 levels,
including the central level (nearly 39%); only 3%(one single stakeholder) who only intervened at
an intermediary level.

ND* : not done= pas des données.

3.1.3.4. Stakeholders with offices throughout theprovinces
Table 12. Existence of provincial branches among
the stakeholders visited
Stakeholders

Staff

Percentage

With provincial branches

20

64.5

Without provincial
branches

11

35.5

Total

31

100

The table above shows that of the 31 structures visited, 20 declared that they had provincial branches
capable of providing services equivalent to others
at a central level, namely nearly 65%, compared to11(35%) who did not. Related details are listed intable 12 below, bringing together by category the
stakeholders with and without provincial branches.

3

ND* : not done= pas des données.

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Table 13. Spread of stakeholders according to thenumber of provincial branches owned
Categories of
stakeholders

With provincial Without
branchprovincial
branchMinistries/Central D12, PLAN,
Divisions
BUDGET,
MEWSWSpecialized stateservices

NIS, NEO, OM,
AFDRC/HealthTraining
institutions

ISSI/Monkole,
CEFA, HITMS

Medical/religious
services

CCC/SANRU,
KHD

Orders andProfessional
associations

NUD, NUDS,NUPC,NUEAESS,
NANC, AHAM.

External partners,
Donors and NGOs

UNFPA

Others

3.1.3.5. Types of services to be provided at the
Ministry of Public Health

14. Distribution
ofdonors
frequencies
of services
to issue, along
UNFPA, the Table
main development
partners andwith an interestin the HRH
the lines of USAID, JICA,
BTC…,
currently
lackprovincial
representations
capable ofbe provided by types
completing tasks equivalent to their Central departments in Kinshasa.

Types of services Frequency ofPercentage
DSP/health,3.1.3.5. Typesto
of beservicesto be provided
at the Ministry of Public
Health.
provided
responses(n=31)MIHUE,
Finance
Expertise25
80.6

Table 14. Distribution of frequencies of services to be provided by types

CNRT

Finance

DPSD/UNIKIN,
ESP/UNIKIN

4

Types of services to Frequency
Material
support 5 of responses
be provided
Expertise
Others18 25
Finance4
Material support
5
Others18

13

Percentage
16.1(n=31)
80.6
58.1
13.0
16.1
58.1

The table above shows that most of the stakeholders visitedprovideto MPHbut to MPH
The table aboveshows thatmost of expertisethe stakeholders
visited(80.6%);
provide expertise(80.6%); but areare lacking
in terms
of material
support (16.1%)
and funding(13 %) for HRH
lackingin terms
of material
support(16.1%)
development. The graphic below better illustrates this result.
and funding (13 %) for HRH development. The
graphic below better illustrates this result.
USAID, BTC,JICA,
BENELUX- AFROOCM

The table above reveals that all Medical departments of religious orders as well as Orders and
Health professional associations, have provincial
branches which can perform work equivalent totheir central divisions in Kinshasa. Furthermore,apart from the UNFPA, the main development
However,apartapart fromthree
types typesof services
detailed above, other
However,
fromthethe
three
of services
services on offer were cited by stakeholders (58%), including:partners and donors with an interest in the HRH
detailed above, other services on offer were cited
issue, along the lines of USAID, JICA, BTC…, cur- Contribution
to planning and(58%),
studies (DSP/MIHUE),
by stakeholders
including:rently lack provincial representations capable of Preparation of a plan of advocation by partners (Min. Plan)
to reflections on reform, research and in-depth analyses of HRH (ESP
completing tasks equivalent to their Central de- Contribution
to planning and studies (DSP/
uContribution
and DPSD/Unikin);partments in Kinshasa.
MIHUE),

88

 Contribution to enhance the visibility of research work by publication via their web
uPreparation of a plan of advocation by partsite (CEFA/Monkole).
 Provide various information on HRH in the form of data banks or databases(MEWSW, OM, NEO, NIS, CEFA and ISSI Monkole, HITMS, etc.);
 Contribution to basic training and ongoing lessons of HRH (UNFPA, ESP/Unikin,
CEFA/Monkole, KHD, etc.).
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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congoners (Min. Plan)uContribution to reflections on reform, research and in-depth analyses of HRH (ESPand DPSD/Unikin);uContribution to enhance the visibility of research work by publication via their web site
(CEFA/Monkole).
uProvide various information on HRH in theform of data banks or databases (MEWSW,
OM, NEO, NIS, CEFA and ISSI Monkole,
HITMS, etc.);
uContribution to basic training and ongoing
lessons of HRH (UNFPA, ESP/Unikin, CEFA/
Monkole, KHD, etc.).
uAssistance from MPH to control staff (NUEAESS), to assess each profession and improve retention (NUPC), to promote theavailable quality of HRH in the DRC (AHAM);uReinforcement of the capacities of the MPH
through technical cooperation and construction of the IMS as part of the HHRNDP(JICA).

3.1.4.1. Priority areas of stakeholders compared to
HHRNDP
Table 15. Spread of stakeholders according to theirinterest expressed in the 4 sectors of
HHRNDP
Priority areas

Frequency of
responses

Percentage(n=31)

Continuous
education

25

80.6

Basic education

17

54.8

Careermanagement

16

51.6

Retention

16

51.6

The table above points out that all 4 sectors ofthe HHRNDP involve the stakeholders since thedata on responses in each of the 4 sectors exceeds
50%; although the key interest is in continuous
education (80.6%).
The figure below better illustrates this result.

3.1.4.Interest of stakeholders in the HRH development process
As stated above, the analysis of stakeholders primarily aims to map and give a perspective of theiractivities and particularly their areas of interest in
HRH development. Following are the results concerning the interest expressed by stakeholders in
the 4 sectors of the National Development Planfor Human resources for health (HHRNDP 20112015), the functions attributed to the National
HRH Observatory and the HRH development pro-3.1.4.2. Key functions for the HRH National Observatory.
cess in general such as illustrated in “the organizaFaced with the crisis involving health workers, which is a global problem
tional model” stated above.
and particularly acute in African nations, the World Health Organization has recommended
that all countries establish National HRH Observatories. The DRC, as one of the signatories
to the Declaration of Ouagadougou, on Primary Healthcare and health systems, made thecommitment, along with all other African countries, to meet this recommendation. Therefore
since June 2010 up to the present, the country has been in the process of setting up theテクニカル ・ レポート vol.04NHWO.
保健人材開発システム分析モデルと開発途上国における活用 89
In addition, in August 2011, the Ministry of Public Health organized ameeting with the stakeholders to adopt the terms of reference of this forum. In the course ofthis workshop, 11 main functions were attributed to the NHWO. Including:資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

3.1.4.2. Key functions for the HRH National Observatory

HRH development;
9. Development of collaborative links for the collection and storage of data as well as sharing;
10.Contribution to the mobilization of resources
for the HRH agenda;
11.Sharing of available strategies on the retention
and equitable distribution in HRH.

Faced with the crisis involving health workers,
which is a global problem and particularly acutein African nations, the World Health Organization
has recommended that all countries establish National HRH Observatories. The DRC, as one of the
In the course of this analysis, it was a matter ofsignatories to the Declaration of Ouagadougou, on
the stakeholders confirming their interest in idenPrimary Healthcare and health systems, made thetifying the functions which particularly interested
commitment, along with all other African counthem and in which they could be involved as parttries, to meet this recommendation. Thereforeof theIn effective
implementationof oftheObserva-confirming
since June 2010 up to the present, the country has
the course of thisanalysis, it was a matterthe stakeholders
theirinterest
inidentifying
thefunctionswhichparticularlyinterested
themand intory. The figure below shows us the frequency
ofwhich they
been in the process of setting up the NHWO.
could be involved as part of the effective implementation of the Observatory. The figure
choiceof stakeholders
for the 11
In addition, in August 2011, the Ministry of Publicbelow shows
us the frequencyof choice of stakeholders
forfunctions.
the 11 functions.
Health organized a meeting with the stakeholders
to adopt the terms of reference of this forum. In
the course of this workshop, 11 main functions
were attributed to the NHWO. Including:
1. Sharing of experiences and information onplanning for HRH development;
2. Analysis of tendencies of the HRH situation in
the DRC;
3. Support for research/study activities to facilitate evidence-based decision-making;4. Redynamization of the information system byimproving the quality and coverage of the data
This figure
shows that
all functions
attributed attributed
to the NHWO are
This figure
shows
that
all functions
tosignificant
on HRH;for the stakeholders but to differing extents. The most significant is the first function, whichNHWO
forXIthestakeholders
but while the
5. Improvement of the quality of tools and datacomprisedthenearly81% of are
votes,significant
followed by theand VIIIfunctions (64.5%);
least
popularchoicewastheVIfunction(35.5%).
Given
theimportanceof managing
to differing extents. The most significant is the firstcollection mechanisms;
networks of expertise in the HRH area, this function must be scrutinized more closely by thewhich comprised nearly 81% of votes,
6. Support for management of networks of ex-organizingfunction,authority.
followed by the XI and VIII functions (64.5%);
pertise in the HRH area to reinforce national
Moreover, to further refine the choice of functions of interest by
while
leasttopopular
wasfunction
the VIbased
function
capacities;
stakeholders,
they thewere asked
identify thechoice
most specificon their mandate.
straw(35.5%).
graphic and Giventable 10 below
respectively represent
the frequency ofchoice of thetheimportanceofmanaging
net7. Reinforcement of national capacities for moni-The
most specific function and the details of stakeholders based on the chosen specific function.
works of expertise in the HRH area, this function
toring and evaluating HRH;
must be scrutinized more closely by the organizing
8. Availability of reliable information for national
90

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congoauthority.
Moreover, to further refine the choice of functionsof interest by stakeholders, they were asked to
identify the most specific function based on theirmandate. The straw graphic and table 10 below
respectively represent the frequency of choice ofthe most specific function and the details of stakeholders based on the chosen specific function.

According to the choice made by interviewees togo for one specific function or the other, it emergesthat two functions of the NHWO seem non-specificto any stakeholder visited; namely functions II andIV.
Table 16 below shows the spread of stakeholders
based on their choice of one NHWO function, identifying them as the ones which were most specificto their mandate or the mission of their organization.

According to the choice made by interviewees to go for one specificfunction or the other, it emerges that two functions of the NHWO seem non-specific to any
stakeholder visited; namely functions II and IV.

Table 16: Spread of stakeholders according to the specific NHWO function in their mandates

Table 16specificbelow shows
the spreadof stakeholders based on theirchoice ofNo. MostfunctionchosenStakeholders
one NHWO function, identifying them as the ones which were most specific to their mandateor the mission
organization.
I of their
Sharingof experiences and information on
DSP/MPH, SG/MIHUE,

planning for HRH development?

HITMS,AFDRC/health, CNRT,
Stakeholders
BTC, UNFPA, OCM
DSP/MPH, SG/MIHUE, Includes all categories ofTable 16: Spread of stakeholders according to the specific NHWO function in their mandates.
No.
I

II
III
IV
V
VI

Comments

Most specific function chosen
Sharing of experiences andinformation on planning for HRH
HITMS,
stakeholders, except orders,
II Analysis of tendenciesof the HRH situation
development
AFDRC/health, CNRT, unions and religious orders
BTC, UNFPA, OCM
in the DRC
Analysis of tendencies of the HRH
Function not identified as
for research/study activitiesspecificto faciliESP/UNIKIN,
CEFA/
situation III
in the Support
DRC
in the mandate
by anystakeholder
tate evidence-based decision-making
Monkole,Support for research/study activities to ESP/UNIKIN,
Significant function, primarily
facilitate evidence-based decisionCEFA/Monkole,for training and research
makinginstitutions, higher level
IV Redynamizationof the information Function
systemnot identified as
Redynamizationof the information
system by improving the quality andspecific in the mandate by any
byimprovingthequalityandcoverageof thecoverage of the data on HRH
stakeholder
on HRH?
Improvement ofdata
the qualityof tools
DPSD/UNIKIN, NIS
Function conforming to theand data collection mechanisms
mandates of these 2 institutions

Support for management of networks
of expertise in the HRH area toreinforce national capacities
VII Reinforcement of national capacities
for monitoring and evaluating HRH

D12

Of specific interest for the
management of partnershipComments
Includes all categories of stakeholders,
except orders, unions and religious
ordersFunction not identiﬁed as speciﬁc inthe mandate by any stakeholder
Signiﬁcant function, primarily for training and research institutions, higher
level
Function not identiﬁed as speciﬁc inthe mandate by any stakeholder

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

JICA
AHAM, NUD,
OM

A more specific function forpartners with technical expertisein monitoring/evaluation of
HRH

37

91

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the CongoV

Improvement of the quality of tools and data DPSD/UNIKIN, NIS
collection mechanisms

Function conforming to the mandatesof these 2 institutions

VI Support for management of networks of ex- D12
pertise in the HRH area to reinforce national
capacities

Of speciﬁc interest for the management of partnership

VII Reinforcement of national capacities formonitoring and evaluating HRH

A more speciﬁc function for partners
with technical expertise in monitoring/evaluation of HRH

JICA
AHAM, NUD,OM

VIII Availability of reliable information for nation- Min. of Planning, Min.
al HRH developmentof the Labour, Employment and Social Beneﬁts, ISSI/Monk, KHD,
NANC,

Almost all categories of stakeholders
included, except external partners

IX

Development of collaborative links for collection, storage and sharing of data

Function not very speciﬁc to the mandates of stakeholders involved

X

Contribution to the mobilization of resourc- Min. Budget, Min. Fies for the HRH agenda
nance, USAIDXI Sharing of available strategies on the retention and equitable distribution in HRH

NEO

Relevant function of the speciﬁc responsibility of the State and partners

NUPC, NUDS, NUEAESS, More signiﬁcant function for the
CCC/SANRU,
unions, religious orders and NGOs
Benelux Afro-Center

This table shows us that based on their respective
mandates, no stakeholder visited could identifyfunctions II and IV of the NHWO as specific totheir institutional mandate. It is thus incumbent
on the organizing authority to take all responsibilities for organizing activities which may help implement these actions within the NHWO.

92

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

for collection, storage and sharing of
data
X
XI

Contribution to the mobilization of
resources for the HRH agenda

mandates of stakeholders
involved
Min. Budget, Min.
Finance, USAID

Relevant function of the specificresponsibility of the State andpartners of HRH in the Democratic Republic of the Congo
資料 3. Study Report on Stakeholder Analysis in the Development
Sharing of available strategies on the
NUPC, NUDS,
More significant function for theretention and equitable distribution in NUEAESS,
unions, religious orders and
HRH
CCC/SANRU,
NGOs
Benelux Afro-Center

This table shows us that based on their respective mandates, no stakeholder visited could
identify functions II and IV of the NHWO as specific to their institutional mandate. It is thus
incumbent on the organizing authority to take all responsibilities for organizing activities
which may help implement these actions within the NHWO.

3.1.4.3. Spread of stakeholders according to the areas of engagement in HRH development
organization.
3.1.4.3. Spread of stakeholders according to the areas of engagement in HRH development organization.

The graphic shows that the stakeholders are clearly committed to all stages of the HRH development process. Nevertheless, as for the 4 sectors ofthe HHRNDP, apart from consultation, which is ofinterest to almost all parties (nearly 72%), continuous education (69%) and reinforcing institutional
capacities (69%) still hold the record in terms of

stakeholder commitment; while little commitment
38
is shown by the same for career
management(21%) and funding (39%) of HRH.
These results are best shown by reporting themwithin “the Congolese house” of HRH development reconstructed in figure 14 below.

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用93

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

The graphic shows that the stakeholders are clearly committed to all stagesof the HRH development process. Nevertheless, as for the 4 sectors of the HHRNDP, apartfrom consultation, which is of interest to almost all parties (nearly 72%), continuous
education (69%) and reinforcing institutional capacities (69%) still hold the record in terms of
stakeholder commitment; while little commitment is shown by the same for career
management (21%) and funding (39%) of HRH.
These results are best shown by reporting them within “the Congolese
house” of HRH development reconstructed in figure 14 below.

Figure14: HRH development system; Congolese organizational model.

Figure14: HRH development system; Congolese organizational model.
NB: In questions corresponding to the conceptual organizational model, for career
NB : In
questions corresponding
to thecame
conceptual
addition(recruitment
to this overalltendencyin the andresults,
management,
two components
to light: theInposting
anddeployment)
organizationalmodel,
forcareermanagement,
revealedof
arecommitment
specific tendencies
within catepromotion (progress in grades). In each case, thealso
percentage
of stakeholders
two components
cametolight:
theposting(regories
ofstakeholders,
as
can
be
seen
in theoftwo
was 21%. Moreover, as well as the components summarized in the model, other areas
cruitment
and deployment)
and promotion
graphics below,
which respectively
illustrate theengagement
were highlighted(23%) (progsuch as coordination,
supervision,technical assistance,
ress conflictin grades).
In
each
case,
the
percentage
of
areas
of
engagementoforders,unionsandofpromanagement, follow-up of internal and external HRH movements and monitoring
commitmentof stakeholders
was 21%. Moreover,fessional associations and those of development
the implementationof NHWO.
as well as the components summarized in thepartners.
model, other areas of engagement
highlightIn addition wereto thisoverall tendency in the results, also revealed are specificed (23%)suchascoordination,
supervision,tech- as can be seen in the two graphics below, which
tendencies within categories of stakeholders,
nical respectively
assistance, conflict
management,
follow-up
illustrate the areas of engagement of orders, unions and professional associationsof internal
andexternal
HRH partners.
movements andand those of development
monitoring of the implementation of NHWO.
94

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

The graphic shows that the main areas of engagements for the orders, unions

The graphic andshowsthat the main areas of engageregulatory framework, continuous education, conassociations of health professionals appear to be the legal and regulatory framework,
The graphic
shows that of
the main sultation
areas of engagements
for the orders, unions of HRH.
ments for theorders,unionsandassociations
thenofthemonitoring/evaluation
continuous education, consultation then the monitoring/evaluationHRH.
andassociationsofhealthprofessionals
appear
to
be
the
legal
and
regulatory
framework,
health professionals appear to be the legal andcontinuous education, consultation then the monitoring/evaluation of HRH.

The areas of engagement of development partSince the main results of the mapping of stakeThe
areasof
engagementofdevelopment
partners
to be themainlyners appear to be mainly reinforcing institutional
holders havebeen appear
presented,
purpose of thereinforcing institutional capacities followed by support for basic education, continuus
capacities followed by support for basic education,
following
sectionistoindicate
outlinesof theeducation and finance.
continuus education and finance.
results of thequalitativeof the HRH deThe areas of engagement of development
partners
appearanalysis
to be mainly
systemthanksreinforcing institutional
capacities
followedbyvelopment
supportbasic performed
education,
continuus
All other
specific featuresof thesepoints canforbeexploredin the mappingof to in-depth
the datafeatures
which
will
annexedto thisreport.
andfinance.
All other education
specific
of be
these
pointscanbeinterviews with key informants pre-identified
explored in the mapping of the data which will be
among the stakeholders.
Since
thespecificmain resultsof themappingof stakeholders
have beenotherfeaturesof thesepointscan be exploredin thepresented,
mapping ofannexed to this report. Allthebefollowing
is to indicate outlines of the results of the qualitative
thethedatapurpose
which ofwill
annexed section
to this report.

analysis of the HRH development system performed thanks to in-depth interviews with key
informants pre-identified
the stakeholders.
Since theamong
main resultsof the mapping of stakeholders have been presented,

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

the purpose of the following section is to indicate outlines of the results of the qualitative
analysis of the HRH development system performed thanks to in-depth interviews with key
informants pre-identified among the stakeholders.

95

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

3.2. RESULTS OF QUALITATIVE ANALYSISThe in-depth interviews completed with key informants generally targeted a comprehensive analysis of the HRH development system of the country
through specific questions focusing on the pastand future. From here, we distinguish the two
sectors in terms of the results presented in thissection.
3.2.1. RETROSPECTIVE VIEW OF SYSTEM
Six fundamental questions allowed analysis of the
HRH development system in terms of the retrospective plan; namely:•what major changes were observed in the last
5 to 10 years?
•what events influenced these changes?
•what were the main contributory factors?
•who were the key players involved in thesechanges?
•what main partners contributed to it? and•what results were obtained thanks to thesechanges?
The responses obtained to these questions are
summarized in the paragraphs below.
A.MAJOR CHANGES IN TERMS OF THE HRH.
In response to the question of determining the
major changes which have marked the DRC overthe last 5 to 10 years, in terms of HRH development, three major trends emerged in the responses from respondents; a minority thoughtthat there was no significant change: “not much
96

change; nothing at all in qualitative terms”. but
the vast majority acknowledged that major changes had indeed effectively taken place. The latter
were observed in four main areas: policies, governance, training and service delivery.
In terms of policies, the following positive changes were noted:- The political will which enabled effective
collaboration between the Ministry of Public Health and that of Higher and University
education;- The key place earmarked for Nursing as national policy.
Nevertheless negative change was also noted:“unregulated exploitation of human resources forhealth”, with disorderly appropriation not always
taking account of needs.
In terms of governance, numerous positive changes were noted; primarily including:- The reform of Human resources deployedwithin the MPH- The determination and monitoring of an
MGS for the remuneration of health professionals;- The special status of doctors prescribed by
Ordinance law- The risk premium of doctors;- Completing inventories of the health sector- Management autonomy accorded to public
hospitals; and- The special status of other health professionals.

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As for negative changes in terms of governance,
key informants deplored the following:- The catastrophic management of HRH,
- Appropriations not taking into account basic
needs expressed;- Substandard conditions of living “and working”, not appealing for health workers inrural areas;- Many executives trained in public healthworking outside the health system;- The hospitals and ZS served are managed byyoung doctors without experience.
In terms of training, the positive changes signaled
were:- The training of health professionals by
stakeholders involved with national strategies or standards;- The change in qualification of nurses from
A3 to A2 level, by reinforcing their capacities using a short-term training programme;- The reform of Higher and University Education with the uniformization of medical faculty programmes; and the introduction of adegree course in Nursing Sciences.
- The training of the 3rd cycle of central level
executives in Public Health ensured by the
School of Public Health of the University ofKinshasa.
Nevertheless, in terms of training, some negativechanges were also noted:- Lack of specialists in health structures: “toomany generalists, very few specialists”.
- Not enough pharmacists- Many executives trained in Public Healthworking outside the national health system.
In terms of service delivery finally, a single positivechange was cited, namely the introduction of thecommunity sector in all health-related activities.
B.WHAT MAJOR EVENTS INFLUENCED CHANGES?
In response to this question, the informants
briefed the research team by citing certain events
sorted into two main sectors: health and socioeconomic-political. The cited events included
those which could be classed both positively andnegatively.
In the health sector, tables 17 and 18 below summarize events cited by key informants:
Table 17: Sectoral events having influenced thechanges in HRH
No. Positive events

No. Negative events

01 The accession of the
NPHD and HHRNDP

01 The poor HRH
management

02 The setup
of technicalcommittees within
the MPH

02 Lack of planning for
HRH management

03 The reform of health 03 Many agents in
sector funding
health institutions at
all levels- The disorderly production of HRH, bothquantitatively and qualitatively;
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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

04 "The Health reportcard of the country
established basedon surveys/studies(EDS, Inventories,
reports etc.)"

04 Theunderqualification of
personnel

05 The support andaccompanimentof JICA for the
MIHUE and MPH
collaboration

05 The lack ofdescription of jobs
and tasks

03 The national andglobal economiccrisis04 Striking by doctors in 04 The social discontent
an attempt to gain aspecific status

C.FAVORABLE FACTORS:In posing the question of determining the factors which encouraged the changes observed inrelation to the HRH, multiple responses were received. Analysis allowed them to be categorized
and grouped, as shown in table 12 below:

06 The support ofdevelopment
partners
07 The onset of Global
Funds

Table 19: Factors having favored the HRH changes observed

08 The orientations of
the WHO: MDG and
HRH development
pillars

In socioeconomic and political sectors, the cited
events are listed in the following table:
Table 18: Socioeconomic events having influenced the changes in HRH

98

03 Internationalization
andglobalization

No. Positive events

No. Negative events

01 The dialog between
the State andProfessional
associations

01 Political instability

02 The political will of
the Government tocreate the School of
Public Health

02 "The events in the
EAST of the country(war, humanitariancatastrophes…), andshift of partners of
Kinshasa toward the
EAST"

Factors

Positive

Negative

Internal
institutions

Political will of the Situation of
government
political, social,economic andfinancial crises of
the country
Awareness within
the MPH

Problem of good
governanceTransition offoreign teachers
by nationals to
the ESP (adequatetransfer ofcompetences)

Abuse noted in
HRH management:
career poorly
defined (MPH)

Openness to other Substandard
public and private working conditions
institutions
Based on youngteachers

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External
institutions

D.KEY PLAYERS AND PARTNERS.

Reinforcement ofprocedures of the
Global Funds

As for the question of determining who were thekey players involved in the changes respectively
and which main partners supported these developments, the informants identified the main actors involved and the partners.

The IHSDG (InterDonor Group of
the Health Sector)
Contribution ofdevelopment
partners
People/individuals

In terms of the main actors involved, these include:

Engagement ofActorsAvailability ofinterested experts
Capacity to takeinitiatives
Surge in demand
for medical
candidates

Socialfactors

Pressure of
professional
associations

Demographic
growth withinsufficient
infrastructure

Increased demand Cost of living
for healthcare
Dynamism ofCongolese people(willingness tostudy)
ScientificfactorDevelopment of
ScienceTechnology
factorTechnologicaldevelopment

1) The Government.
The Congolese government, via the Ministries
directly concerned by the HRH issue, namely
the MPH, MIHUE and MPA, were identified as
key players in the development inventory of human resources for health.
Moreover, within the Government, some individual entities were cited for their personal involvement in these developments; namely the
Minister of Public Health, the Secretary-Generalfor health, and some Central Directors of MPH;
Governors of provinces and head doctors of the
Health Zone.
2) The community or civil society
Civil society includes all active social structuresin the community which are involved one way
or the other in the production, use or consumption of services involving human resources for health (beneficiaries of health services);
including: churches, schools, companies, unions
and associations of professionals, non-governmental organizations and private profit-making
bodies.

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

3) The development partners
The results of interviews clearly show that thecountry benefits from the support of multiple
partners in sectors implementing HRH development, which include an impressive number ofexternal partners and some local partners.
All, in general terms, are involved in the activ-

ities respecting the HRH development processbuilding on support in the process of planning,
basic training and during employment, including reinforcing institutional capacities (logistical,
technical and financial support) up to retention.
The list of partners collected according to their affiliation is shown in the table 20.

Table 20: List of partners having contributed to changes observed(No-exhaustive)
UnitedNations
SystemBilateral and multilateral
partners

BanthatFund

NGO, External universities

Local partners andstakeholders

WHO,
UNICEFUNFPAUSAID,
BTC,
UE,
JICA,
DFID,
CORDAIDWB

CBM (German NGO),CARITAS Spain, MISEREOR(Spanish NGO)...

Government/DRC(completion point PPTE
initiative)

FM GAVI
Bill Gates

Handicap International
CICR (Red Cross
International)
CEMUBAC

Catholic and protestantchurches
Unions

UNDP/GSP Chinese cooperation Indian
project
cooperation
French cooperation,
Spanish cooperation, Italiancooperation.
Swedish cooperation
Canadian cooperation
SAR (South African Republic).

World Medical Association
UCL FUB

E.MAIN RESULTS OBTAINED.
In posing the question of determining the main
results which were obtained thanks to changes
mentioned above, most respondents oriented
their responses in three ways in which, according
to them, despite some tangible results; a minority
believe that to date, there has been no notable
100

result yet.
1) Results in institutional terms.
- Reform underway within the MPH, whichaccording to a respondent, should be interpreted “more as an indicator than a result,given its sectoral character”;

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo- The HHRNDP is available within the MPH;
- Retaining directions of HRH and Teaching of
Health Sciences despite the reform within
the MPH;- The effective collaboration between the MIHUE and MPH- The effort to clean up the Health Education
Establishments within the MIHUE- The restructuring of public hospitals with“collaboration and complementarity” of
doctors-nurses- The Kinshasa University Hospitals equippedwith the latest materials and equipment
thanks to the support of partners (Japanese
Cooperation, Indian cooperation, Belgian
universities etc.);- Reinforcement of capacities of health workers- The significant boosting of remuneration ofState doctors.
- The return of certain doctors toward structures of State.
2)Results in terms of training- Post-university training of health workers(ESP/BTC);- More than 1000 health executives trained
for the 3rd cycle by the Kinshasa ESP;
- Relaunch of the IMS as a Pilot training
school with JICA support;- Existence of ITM for nursing training of A2
quality level, managed by private religious
partners, like DOMW.

NB: Concerning the 3rd cycle training of healthexecutives at the ESP, this institution reveals anegative result, based on the fact that the primary objective set, namely to train 5 executives tooperational level by ZS (LDHZ, MA, Pharmacist,
Sanitation engineer and nurse supervisor) remains
a distant goal. In addition, numerous trained executives remain outside the health system.
3)Results in terms of the delivery of care
- Construction of more than 50 CS and 1 HGR
by the DOMW in Kinshasa to provide localized care according to the national policy of
primary healthcare.
F.CONSTRAINTS AND DIFFICULTIES ENCOUNTERED.
The entire development process has always been
confronted with constraints or difficulties; thiscertainly also applied to the experience of establishing the current gains in the area of HRH development in the DRC.
As for determining the nature of the main constraints or difficulties encountered in establishing the current gains on HRH, the respondents
blamed the following elements:
D.ifficulties linked to governance:- Lack of clear vision of the government on
HRH management- Lack of specific orientations on HRH reform- Quality of HR in the management responsible for HRH at MPH poses problems;- No HR management specialists in the DRC- No estimated management mechanism of
HRH (planning,…);テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用101

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo- Correct management constraint of resources (difficulty in managing correctly);- Inappropriate and/or disorderly frequency
of appropriations- Inadequate work tools (materials, equipment, conditions, infrastructure,…);- No-compliance with contractual clauses
agreed with the State;- Enormous needs (in the sector);- Lack (or weak) engagement of local authorities;- Threats faced of the hierarchy (by the lower
level);- Failure indicated by the retirement of personnel in the other ministries;- Aging of personnel: replacement, learningand innovation become difficult.
- Lack of capacity of directors.
Financial difficulties or constraints:- Low State budget for health- (Many) budgetary constraints- Limited duration of support from partners- Strike of health workers following poor
working conditions;- Self-funding of hospitals due to a lack ofsubsidies from the State;- No leave taken by personnel, due to a lackof holiday pay.
Constraints linked to HRH production:- Function of ITM left to be tackled by parents- Nursing training having become a commercial matter- Reduction in the quality of the basic train102

ing: ITM, ISTM, Medical faculty…).
- Limited number of entrants to ESP/year(limited number of grants).
Social constraints:- Low socioeconomic level of the population.
3.2.2. PROSPECTIVE VIEW OF SYSTEM
As for the retrospective sector above, the prospective sector of the analysis of the HRH development
system of the DRC covered specific questions, theresults of which are presented in paragraphs, tables and illustrations below.
A.THE MAIN PRIORITIES.
As for determining the main priorities for HRH development in the DRC in the next 5 to 10 years according to the opinion of interviewees, the latter
indicated multiple priorities, which were grouped
into four categories below:
1)Priorities for HRH development:
Implement the HHRNDP
n Ensure strong management of HRH within
the MPHn Modernize the HRH
n Control numbers of health workers
n Establish an inventory of personnel by servicen Identify personnel eligible for retirement
and retire themn Identify deceased officialsn Prepare the job description for personnelnテクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Appropriate HRH logically according toneeds and competencesn Covering personnel
n Sense of responsibility and transparent
management of personnel at MPH
n Accountabilityn Computerization of HRH managementn Fitting-out BTC with adequate infrastructureand equipmentn Ensuring good health and good working
conditions for agentsn Define a good salary scale.
n Regularly evaluate the assigned objectives.
n2)Priorities for training
Identify personnel training needs
n Improve the quality of basic training
n Create reference ITM and ISTM
n Promote the training of specialists
n Promote the training of (quality) nurses
n Promote moral education and correct training of personnel.

B.INSTITUTIONAL COMMITMENTS.
Regarding the cited priorities, key informants
were asked to determine the areas in which theirrespective institutions could commit or continue
to be committed with fulfillment of these priorities in mind. The following table summarizes themain areas of commitment of each institution
concerned.
Table 21: Areas of institutional commitments of
key informants
Institutions

Areas of priority commitments

Comments

MPH

・ Re-evaluate HD and HO
to the first direction
・ Transparency in HRH
management
・ Accountability at all levels
・ Sense of responsibility

Via these 4priorities, theMPH commits
itself to good
governance

MPA・ Take into account theassets of HRH reform of
the MPH (remuneration,
promotion, and progress).

The FP has asignificant rolein the reformof HRHMIHUE・ Continuous training, indialog with MPH, to evaluate the real need;・ Initial training responding to quality criteria;
・ Creating reference establishments with theaccompaniment of partnersn3)Priorities for service delivery
Improve the tools of work, namely working
conditions (for personnel)
n Provide ease of access to healthcaren Reduce maternal mortality.
n4)Priorities for social issues:n Develop social and psychological assistanceresourcesn Develop social security.

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

WHODRCESP/UNIKIN

BTC

・ Controlling numbers of
personnel
・ Setting up the HRH Observatory
・ Encouragement for performance
・ Contractualization withHRH

As adviserof the MPH,
the WHO is
deployed to
do what thelatter asks

・ Training of health workers and・ Identification of overallneeds, by research activities

Government
and key
Ministries(forces)

CEFA/・ Provide ongoing training
Monkole in nursing, medicine andethics・ Basic and continuous
training
Institutional
develop・
ment: supervision, monitoring…

Order of ・ Ensure the quality of thedoctors
training of health service
providers (doctors).
DPS/Kin- ・ Retirement of eligible
shasa
official s
・ Ensuring a reliable HRH
database

The solution
would be to
apply decentralizationaced with development priorities of human resources for health in the DRC, multiple opportunities can be taken according to key informants; thisis covered in the following paragraph.

104

Two main groups of opportunities were identified:those originating from Government and key Ministries (actually, the forces) and those offered by
the presence of external and local partners of theMPH. They are summarized in table 22 below.
Table 22: List of opportunities and/or forces cited(No-exhaustive)

・ Planning first; then,・ Basic and continuous
training

DOMW

C.KEY OPPORTUNITIES TO SUPPORT HRH DEVELOPMENT.

External and local External
partners
conditions

Political will of Presence of
the Government multiple partnersof the MPH

Social peace

Political will of Presence andthe government support of WHO:to introduce
definition of HRH
NTCI
pillars

Introduction of
the NTCI (on aninternational
level)

Reform ofIntervention of
the judicial
JICA for HRH
framework/
general status ofState personnel
Attaining thecompletion
point of the
PPTE initiative

Bilateral
cooperation fromSouth Korea(KOICA)The existence of Bilateral Indian
the NPHD
cooperationand theimplementationof the HHRNDP

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The presence of AMPS/GWHA
experts in the 2
key ministries:
MPH and
MIHUE
Result-based
funding andBarem deMbudi4Global Funds

The existenceof the School of
Public Healthfor training
and research;
Academic
personnel
available

Presence ofpressure groups:
unions andcorporationsof healthprofessionals

Need for
HRH renewal(perceived at a
local level)

As regards results-based funding, this strategy has
not yet been applied in the public state-managed
institutions. However, according to a high-level official of the Ministry of Health, the successful trackrecord of this strategy elsewhere means it shouldbe imported for use within the MPH.
As for the implementation of the HHRNDP, one
informant thought that this would be an opportunity provided that “this implementation was compliant and correct, respecting all other legislativeand regulatory material drawn up”; this is the only

way in which, he added, “things will run smoothly”.
To demonstrate the importance of compliancewith judicial legislation, another informant insistently stated that: “the reform of the judicial
framework or the general status of personnel ofthe administration of State officials and civil servants, remains the obligatory path for any reform,
and as long as this framework is ignored, reform
will be blocked”.
D.THE SUSTAINABILITY OF RESULTS.
The objectives of the dialog with informants included asking them about the strategies needing
to be implemented to ensure the sustainability of
the current gains of the country in the area of HRH
development. The responses obtained to this issue are listed in the form of actions to implement,with the level of responsibility shared between
the key players: the government and its partners(stakeholders in general).
The responsibilities of the government:- Acknowledge its role as the organizing authority;- Increase the budget allocated for health;- Pay good salaries to health professionals;- Apply positive and negative sanctions;- Promote general reform of the civil service;- Ensure compliance with regulation andstandards;

4

The Mbudi accord, or Mbudi social contract, is an accord signed on 12 February, 2004 in Mbudi, a suburb to the west of the capital Kinshasa, between thetransitional Government of the DRC, represented by the former Vice-président Z’Ahidi Ngoma responsible for social and cultural matters and the trade unionistsof the public administration which provided for the payment of 208 USD to bailiffs and 2080 USD to the Secretary-general, by applying a salary scale going from
1 to 10. The Mbudi scale should be applied progressively in three tiers, over a period of eight years. To date, eight years on, this scale has still not been applied.

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo- Ensure the continuity of NPHD and HHRNDP
activities;- Ensure effective planning of HRH deployment and the setting-up of bodies;- Implement (make functional) the framework for consultation;- Maintain active collaboration between MIHUE and MPH;
- Assign a key place to training of nursing personnel in the reform;- Ensure the stability of personnel involved in
the reform and the implementation* of thesame.
As regards the stability of personnel involved in
the reform, and the retirement of eligible officials,
one informant declared: “we have to save personnel involved in the reform of HR; no disorderly
forced retirement as in 2009, 2010 ”; while another, discussing the HHRNDP continued as follows:«… because, its success depends on the mobilization of funds and the stability of personnel involved in its implementation ”. A latter went evenfurther in declaring: “a permanent minister would
perpetuate reform”.

of competences.
- Create good working conditions, by improving the working tool, ensuring a good atmosphere and innovation in the employment
field.
Responsibilities of Partners:- Demand competences from promoters of
training schools, to ensure the quality ofbasic training.

NB. It is also necessary to underline the fact that,
according to an informant, there is a need to initially develop gains before considering how to sustain them, since according to him, to date, there
had not been “any clear gains yet in HRH development in the DRC”.

The shared responsibilities of the Government(MPH) and its partners:- Advocate to support gains- Administer the HHRNDP budget- Exercise good management of resources- Ensure compliance with mutual commitments- Develop a reference system for successful
experiences- Promote sharing of knowledge and transfer
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4. DISCUSSION OF RESULTS
Given that it involves an initial analysis concerning
the stakeholders involved in the issue of humanresources in the DRC, the discussion of the resultsof this analysis will focus mainly around the threefollowing points: the lessons learnt from the study
results, the proofreading of the conceptual “Housemodel” in the HRH development process in the
DRC with regard to HHRNDP and finally, the study
constraints.
4.1. Lessons learned
The analysis of the results of this study allowed
us to make discoveries from which we could learnsome lessons.
4.1.2. The discoveries
The results of the structural analysis of stakeholders and those of the qualitative analysis of
the HRH development system in the DRC allowed
some discoveries to be made.
a) Identification of the areas of interest of partners concerning the HHRNDP.
It is noted at this point that all four pillars of HRH
development are of interest to stakeholders, including basic education, career management,
continuous training as well as retention. The same
applies to areas of engagement, as specified in
the conceptual organizational model. In fact, thestakeholders all showed real commitment with anacceptable balance in all areas, which is evidenceof the ample interest of stakeholders in all aspectsof human resources within the Ministry of Health.
Nevertheless, some differences came to light interms of the sector of interest chosen by stakeholders, some details of which are listed in thefollowing point.
b) The tendencies of interest of key players forcontinuous education.
In fact, the results show that overall, the stakeholders show more interest in continuous education (80 %) than all other sectors of the HHRNDP,
with average interest around 53%. This reality is
not a one-off, since it is also reflected with reference to activities performed by partners favoring
HRH, namely that training on the job has always
been given preferential treatment in budgetary
terms compared to other aspects of HRH development.
In its Global Health Report, the WHO speaks of
the rocketing training on the job (WHO 2006).
Over and above the real needs to reinforce thecapacities of health professionals faced with ever-growing innovations due to the evolution ofhealth science, a system of motivation for personnel by performance premiums and a per diem system during training activities is at the heart of thisepidemic. This explains the multiple distortions
observed within the health system of the country(multiple absences due to training, fees for service, contradicting the overall approach advocatedby national health policy of Primary Health Care,a shift toward activities financed by performance,etc.)(14).
Moreover, in terms of activities of stakeholders
concerning HRH, the results show that they engage in more activities concerning training in gen-テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用107

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congoeral (64.1%) than those concerning usage (46.2%),
the scope of which includes activities of recruitment, appropriation, career management and retention.
In fact, apart from the weaknesses linked to thesampling effect which could be used to explainsuch a result in quantitative terms, the reality
emerging from qualitative analysis is that “thetraining of health professionals has become acommercial matter in the DRC”, explaining theproliferation of training establishments and theincreasing decline in training quality, since it often
takes place without any prior planning (7). This
could be easily explained from one perspective,
namely the fact that stakeholders have more information on training of health professionals thantheir usage. Set against the background of a lackof resources, usage being more constraining, interms of the duties and responsibilities of the employer, whether public or private, HRH production
seems more significant for stakeholders.
This clearly reflects what has been observed forsome decades, namely the fact that the DRC produces human resources for health, but has no
idea how to use them; or even less retain them.
In fact, multiple health professionals, especiallyin the teaching profession, tend to emigrate toneighboring countries and the north, hoping tofind employment, and a better situation in socioeconomic and safety terms and improved working
conditions. This situation is likely to have significantly contributed to impairing the quality of careand the tertiary training in the country (15). Whilethe country itself lacks sufficient qualified humanresources for health especially in remote areas
108(5, 7). In addition to the economic losses linked tothe costs of training such qualified professionals,
the country experiences an outflow of its humancapital, which it needs to provide healthcare toits population. This phenomenon of an exodus ofskills: “brain drain”, although a global problem, is
especially acute on the African continent (16, 17).
Furthermore, while considering the areas of commitment in the HRH development process andmonitoring the organizational model, the sametendencies can also be seen. In fact, putting aside
the specific interest in consultation noted (72 %)and in reinforcing institutional capacities (69%),
continuous education still holds more interest(69%) comparatively than other areas.
Accordingly, there is a need to indicate that theauthors of the conceptual framework model proposed in response to the global issues concerning
HRH, that reflections on the development of thesystem must be made within a more global andholistic framework going beyond solely traditional
considerations, where the initial training is emphasized, during employment, to cover the management of training and personnel (10).
Fuijita and her colleagues believe that the HRH
development system in post-conflict countries
like the DRC, require all other components of theorganizational model to be taken into account, up
to sociocultural aspects and that the collaborative
links between them must be guaranteed, giving all
those involved the opportunity to work together
and harmoniously in a well-coordinated system(10). The interest shown by stakeholders in consultation suggests their tendency to favor a frame-

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work for proposed consultation within the MPH.
In contrast to what is recommended, however,
it is noteworthy that stakeholders, the Government and development partners in general, focus
more on certain components of the system, suchas reinforcing the institutional capacities; while
the teaching institutions converge their efforts on
training, while neglecting other aspects, like thejudicial, policy and planning framework etc. (18).
c) Weak commitment of stakeholders to fund theagenda of the HHRNDP
Regarding the results concerning the services tobe provided at MPH and the areas of engagementof stakeholders, there is undeniably a lack of commitment of partners and interventionists in general in funding of the HHRNDP.
In fact, while two years have already passed
since the MPH gained the HHRNDP 2011-2015,
it is clear that the implementation is still making
no headway. Moreover, this analysis shows that
only around 13% of stakeholders offered funding
to MPH against 81% which were ready to offer
expertise; Moreover, in areas of engagement for
HRH development, less than 40% (38.5%) madefinancial commitments. Furthermore, as with thecategory of development partners, cooperations,
Donors and NGOs visited, funding commitments
were only made by 4 of the 6 parties.
This situation is at odds with the recommendationof the WHO which, in its 2006 World Health Report, namely recommends development partners
to adopt a “50:50 approach” whereby 50% of

external aid is dedicated to reinforcing the healthsystem, half of which for human resource development strategies” and to orient their financial andinstitutional support toward supporting the healthsystem and implementing policies. However, thescope of this analysis did not extend to analyzing
the budget allocated to the HRH development system, but to assess the willingness of partners tofund the activities of the HHRNDP.
A look at literature shows that some decades ago,
Development Partners and Donors hardly funded
HRH. For example, while most projects funded by
the World Bank include activities linked to HRH,
they would only have equated to 10% of budgets
allocated between 1970 and 2002 and mainly
focused on specific training activities rather thanoverall plans to reinforce HRH (19). However,there are signs that despite the change of course
since 2007 with its new strategy for Health, Nutrition and Population centering on Reinforcementof health systems, “human resources will only be
one of many points”(20, 21).
Faced with a lack of commitment of stakeholders
to fund HHRNDP, there is a need to plan more activities to advocate the mobilization of resources,
local as well as external, for the implementationof this Plan. In fact, regionally as well as globally,
the lack of financial resources dedicated to healthremains a major cause of the shortage of HRH (3,20).
d) Specific commitment of technical and financial
partners to reinforce institutional capacities.
Despite the reduced number of development

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congopartners visited, it was nevertheless clear fromthe results that all are engaged in reinforcing institutional capacities. This engagement should becapitalized on as far as possible to further reinforce the central level, where the weaknesses stillpresent in the management body overseeing HRH
are still all too obvious. In fact, reinforcing institutional governance and the leadership of bodies incharge of HRH development, is one of the major
strategic objectives of the HHRNDP.
Furthermore, there are very few development
partners engaged in working to retain and monitor/evaluate HRH. Only the BTC commits to funding the retirement of eligible personnel, while thisis a key priority for the Government. Moreover, it
is involved in ongoing reform within Public Administration in the sense of rationalizing human resources; it also accompanies bodies compared tothe selection of profiles responding to position (jobdescription) as part of its institutional support. As
for the WHO, it commits to the implementation of
the NHWO.
e) The availability of stakeholders to support the
NHWO
The majority of stakeholders visited expressed
their full support for the process of setting up andoperating NHWO in the DRC. In fact, the results
show that a significant proportion (nearly 81%)of stakeholders are interested in the first function
attributed to this forum, namely that of sharing
experiences and information on planning for HRH
development. Nevertheless, a significant function
attributed to this forum does not seem to takesufficient account of the interest of stakeholders,110

namely the support for management of networks
of expertise in the HRH area to reinforce national
capacities (35.5%). It is noteworthy, nonetheless,that this function seems to be specific to the mandate of the Central Management of the MPH responsible for partnership (D12).
f) Availability of information needed for the coordination of partners.
Important information has been made available
thanks to this analysis: the stakeholders involvedin the HRH issue and their respective activities are
identified; the information and other resources
on HRH which they have are detailed; the services
which they could potentially provide at MPH are
identified; the localization and spread of activities
performed by these latter in the health system of
the DRC are clarified, etc. All this information haveallowed mapping of the latter variables to a certain extent, which is a key tool provided to the organizing authority to coordinate the interventions.
For the qualitative portion of the analysis, as wellas what was discovered, lessons were also learnt.
g) Comparison of study results for the situational
analysis of HRH of 2010.
One key question was raised in the course ofanalyzing the results of this analysis. Namely“What link can be made between the study andsectoral diagnosis made in 2010? Since according
to the questioner, the problems identified in thisstudy are the same as those cited in 2010, which
prompted the establishment of the HHRNDP.

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The discussion of the points around this question
led to the finding that this study, despite having
differing goal and objectives from those involvedin analyzing the situation preceding the processof drawing up the HHRNDP, can be considered anevaluation of the process in some ways and could
allow for some adaptation of the actions to be implemented based on actual events.
In fact, the study results corroborate the sectoral
diagnosis used to draw up the HHRNDP and are
perfectly aligned with the same. This provides reassurance that despite the fact that the situational
analysis of 2010 was not implemented in the formof a study, it still managed to target real problems
and it is on this basis that strategic priorities weredeveloped in the HHRNDP 2011-2015. This correlation is in addition to the common vision between the MPH and other stakeholders on questions of HRH. Moreover, it also shows that theimplementation of HHRNDP is still taking time. In
fact, two years after the validation of the HHRNDP
by the Government and its partners, the pictureof HRH remains almost unchanged even now.
h) Compliance with MPH policy by certain local
partners
One of the key discoveries made in the course ofthis analysis was that of the application and approval of the national policy for Primary Healthcare by certain local religious partners and theirinvolvement in training of health workers in the
management of PHC.

The retrospective sector of analyzing the HRH development system allowed identification of someconstraints which would have to be taken into
account when implementing HHRNDP to avoid potential hindrances. These would primarily include
poor governance, budget shortfalls for health, alack of control over production and decline in thequality of health professionals trained and finally,
the general poverty of the population.
j) Identification of some strategies for sustainability of gains
The prospective sector of qualitative analysis allowed key informants to determine some tried
and tested strategies to ensure the sustainabilityof the current gains of the HRH development process in the DRC.
In fact, sustainability is only possible given effective and responsible involvement by the State andits partners. Using the proposed strategies, theleadership of the State is again highlighted in thesense of awareness of its role as an organizing authority and to increase the budget to be allocatedto health. Moreover, the State must also ensure it
channels the reform of the MPH in the shape of ageneral reform of public administration. Moreover,in terms of the choice of strategies and actions, it
is easier to promote experiences which have already proven successful instead of reinventing thewheel, which underlines the need for a frameworkfor dialog and to promote the sharing of experiences and information through the NHWO.

i) Identification of constraints which could hinder
the implementation of the HHRNDP
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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congok) Discovery of other partners with an interest in
the HRH issue

consequence of the reform triggered withinpublic administration.

Studying its qualitative aspect allowed us to identify some key partners for which the nature of interventions for HRH development were not wellknown. These subsequently became potential
partners to support the implementation of the
HHRNDP.

- Certain informants, discussing opportunities
to be taken concerning the National Plan of
HRH development indicated between the
Government of the DRC. It is clear that the
government, which is the internal and main
player of the action cannot simultaneously
be an opportunity in the form of external
factors which can be exploited to reinforce
the system. It is therefore more a strengthand not an opportunity.

l) Some points to be clarified.
Among the points made by informants, some require further clarification.
- Among the major changes cited concerning
HRH, apart from the special status of doctors among the public services of the State,
the special status of other health professionals was underlined. However, it should
be noted that at this time, the special statusof other health professionals remains an
ongoing project within the MPH.
- It was also signaled that the reform of HR
at MPH would represent a jump start totrigger reform in all other Ministries of Public Administration. Considering the scopeand speed of health reform, it is quite easy
to understand although expressed by the
informant in these terms. However, the reality is that the reform of Public Administration came before that of the MPH. In fact,
the South African Republic, which championed support for reforming the public administration, preceded partners which support health; hence health reform is more a112

4.2. Congolese House of Development for HRH
The National Plan of HRH development in the
DRC describes 4 sectors in this process, the development of which was based on 4 cornerstones.
These are career management, basic education,
continuous education and retention. However,the conceptual framework of HRH development
according to the organizational model referred toin this analysis, represents 3 pillars on which theprocess should be constructed, namely production, as the equivalent of basic education, posting
which could correspond to the management career (recruitment, distribution, promotion…) andretention which includes continuous education,
working conditions and incentives.
The organizational model, as its authors state, “offers a symbolic opportunity to reconstruct key elements in the health system, while underlining theoverall functions required to respond effectively
to the needs of the community and highlighting
the manner in which the components supporting

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congothe model must slot in and reinforce each other, if
a durable structure is to be established”(10).
Therefore to better measure the progress fromthe perspective of activities outlined in the 4 sub–plans of the HHRNDP, it was crucial to reconstruct
the HRH development organization while monitoring the Congolese model; the latter of which includes 4 pillars instead of 3 listed in the Japaneseorganizational model.
With this result, in this analysis, all components ofthe conceptual framework were taken in isolationin the areas of commitment of stakeholders involved in the HRH development process.
4.3. Study limitations
The results of this study do not reflect the factthat the situation observed for some stakeholders
showed a less than representative selection. In
fact, as well as the study being limited to Kinshasa,
and the limited number of observations, the sample observed did not list all categories of stakeholders, since there is a key lack of internationaland national NGOs. Moreover, the profit-making
private sector was not cited, especially among
HRH users.

for the National HRH Observatory. With this inmind, we cannot be sure that they are those bestplaced to give us the precise answers to all thequestions posed.
In all cases, the tendencies revealed by the resultsof this analysis are worthy and likely to inform decision-makers when coordinating stakeholders in
HRH development.
Furthermore, the huge field of human resources
for health and the limited resources available toconduct this study limited what could be achievedin this initial phase. Moreover, since the process ofanalyzing stakeholders happens dynamically overtime, extending the scope of this analysis should
be envisaged to sectors not yet covered as well as
facilitating periodic updates.

Another limit was exposed in the choice of respondents. In fact, apart from the qualitative portion, for which key informants were selected considering well-established criteria by those seeking,the respondents for the quantitative portion were
not chosen taking into account carefully chosen
selection criteria. In fact, as indicated above, thisconcerned focal points delegated by their bodies
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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

5. CONCLUSION AND RECOMMENDATIONS
Based on what precedes, the following conclusions are drawn from the analysis:uuu

The HRH issue is of interest to multiple
stakeholders in the DRC, but none have yet
become involved in the HHRNDP process.
The clarification, thanks to this analysis involving mapping of stakeholders in termsof their missions, activities and areas ofengagement for the HRH in the DRC, is obtained for the existing coordination bodies
within the MPH for the effective organization and coordination of interventions on
HRH in the sense of the HHRNDP.
The persistent nature of problems linked to
HRH highlighted in this study and resembling
those described in the situational analysis of2010 underlines the urgency of the implementation of the HHRNDP. This also highlights the need to proceed with reinforced
advocation and marketing among stakeholders to accelerate the implementation.

To achieve the advocated development in the HRH
area in the DRC, and with regard to the resultspresented and discussed above, some recommendations should be formulated. They are all
expressed in the form of proposals for optimal useof the results of this analysis.
u

114

There have been persistent problems concerning the HRH illustrated from 2010 to date, anda lack of commitment of stakeholders to fundthe HHRNDP, It is imperative that the MPH reinforce advocation activities; starting with the

publicity of the study results via all possible
channels and in the short term, organizing a
restoration at the major TCC forum.
u

u

u

u

u

The MPH must also organize a round table
meeting of stakeholders to discuss the implementation of the HHRNDP (PAO 2012)and provide specific orientations using constraints clarified in this analysis.
The Management responsible for HRH
within the MPH must use the results of thisanalysis to reinforce the coordination mechanisms of stakeholders via
m The HRH commission and reinforcement of its capacities (CNPSS).
Accelerate the process of setting up aframework for dialog between the key ministries and the NHWO for all stakeholders.
The need to engage in interventions to accelerate the training of specialists in thearea of health in general, and those in HRH
management in particular within the MPH.
Briefly, with all stakeholders, collaborate totransform all the negative points cited inthis report into positive situations or objectives to be achieved with the intention of
approach the desired level of development;
which would achieve quality HRH for the
DRC, with sufficient manpower, sufficiently
motived and equally distributed targeting
theMillennium Development Goals.

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BIBLIOGRAPHIC REFERENCES
1. DRC, MPH, National HRH Development Plan
2011-2015, december 2010, pp 11.
2. Ngumbu M, “Expérience of the DRC vers le
HRH development”, presentation à the Atelier on la management of human resources
for health in Africa francophone, -information system of HRH and observatory of
HRH-, of the 25 january 2011.
3. WHO, “Travailler ensemble for the health”,
World Health Report, Genève, 2006.
4. JLI, 2004, “Human resources for health:overcoming the crisis”, Boston, Harvard University Press.
5. Ministry of Planning, Document of the strategy de croissance and de reduction of thepoverty (DSCRP), juillet 2006.
6. DRC, National Plan of Health Development
2011-2015.
7. DRC, MPH, Stratégy de reinforcement of thehealth system, version revisée 2010.
8. Noriko.F, “Analyse of the situation of the system de development des human resourcesin the DRC”, juillet, 2009.
9. MPH, Human resources department enhealth, cadre logique of the Project to support the HRH development.
10. Noriko F., Anthony B. and al. “A Comprehensive Framework for Human Resources for
Health System Development in Fragile andPost-Conflict States” 2011. PLoS Medicine/www.plosmedicine.org. HYPERLINK “http://
www.crisisgroup.org/en/Key-issues/research-resources/conflict-histories/dr-congo.aspx” http://www.crisisgroup.org/en/
Key-issues/research-resources/conflict-historys/dr-congo.aspx.
11. Borgès G., Qualitative Research: anothertype of action and communication, ReGiven
medicale of the assurance maladie, vol.32
No. 2, avril-juin 2001.
12. Boutigny E., “Vers un renouvellement of thedemarche qualitative en sciences de management?”, management &amp; Avenir,
2005/2 No. 4, p. 59-69.
13. Kyberd I., Breillat J., 2010, “analysis of partners”
http://jacques.breillat.fr/?p=2181
14. Nathalie R. and Macq J., “RContributionof the first mission of the GRAP-PA Healthin the DRC, Inventories”, Mars-April 2010;
pp33.
15. Wembonyama S. and col. ”medicine andhealth en République democratic of theCongo: of the independence à la 3rd République”, Medecine Tropicale. 2007.67.5;
pp.451-452.
16. Mboungou V., “la fuite des cerveaux: lecoût for the pays d’origine”, of the 22March
2011; hptt/Africaexpansion.com.
17. Talansi M., “fuite des cerveaux africains”:
un livre de Gaston-Jonas kouvibidila; mis àjour le 23.February 2010; in journal, Africa
redaction, February 2010.
18. Narasimhan V, Brown H, and al. (2004),“Responding to the global human resources
crisis”. Lancet 363: 1469–1472. ).
19. E. Elmendorf & K. Larusso (2006), “Human
Resources for Health and World Bank operations in Africa”. A Review of Experience,
Africa Region Human Development Working
Paper Series No. 110, June 2006.
20. Caroline G., “The human resources forhealth in developing countries”, ReGiven

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用115

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congobibliographic, Solthis – Sciences Po., january 2010. http://solthis.org/plaidoyer-r164.
html.

21. World Bank (2007), Healthy Development
The World Bank Strategy for Health, Nutrition, and Population Results, April 24, 2007.

ANNEXES:
Annex 1: Questionnaire survey from stakeholders
DEMOCRATIC REPUBLIC OF CONGO/MINISTRY OF PUBLIC HEALTH/SECRETARIAT GENERAL/HEAD OF HUMAN RESOURCESANALYSIS OF STAKEHOLDERS IN THE DEVELOPMENT OFHEALTH HUMAN RESOURCES IN DRCQUESTIONNAIRE SURVEY

0. WORK TEAM
1. Number of the questionnaire:………………………………………………
2. Date of the interview:………………………………………………………
3. Interview start time:……………H…………MIN……………
4. Province/district/town/city: ……………………………………………………
5. Work team:Members
Interviewer
Note-taker
Supervisor
Data inputter

116

Surname and given name

Date

Signature___/____/2012___/____/2012___/____/2012___/____/2012

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Code資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

I. IDENTIFICATION OF THE STAKEHOLDER
No.

Questions

Responses

Q1

Denomination of the
stakeholder

Q2

Localization of the office

1. Street:..........................................
2. No.:.............................................
3. Commune:.................................
4. City:.........................................
5. Province:...................................

Q3

Identification of the
respondent/focal point?

1. Name:..........................................
2. Sex: 1. M 2. F
3. Telephone No.:..............................
4. E-mail:.........................................
5. Function:......................................
6. Seniority:...................................

Q4

Address/contact details

Code

II. GENERAL INFORMATION:No.

QUESTIONS

Q5

What is the mandate/ missionof your institution/structure?

Q6

What are your areas ofinterventions or of interest in
the DRC?

Q7

For how long has your yourinstitution/body existed in the
DRC?

RESPONSES

CODE..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Q8

Currently, in which national
provinces are your services
offered?

Q9

When exercizing your mission,
do you think you have a roleto play in the development of
human resources for health?

Q10..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................
1. Yes
2. No
If Q9= 1, ask Q10.
If Q9=2, proceed directly to Q11.

If yes, at what level of the
1. Central level
health system of the DRC do you 2. Intermediate level (province/district)currently intervene?
3. Peripheral level (ZS)

III. INFORMATION ON HUMAN RESOURCES FOR HEALTH

118

No.

QUESTIONSRESPONSES

Q11

What type of information do
you have on human resources
for health?

1. Information on training
2. Information on usage
3. Other information (please specify)..........................................................................................
..........................................................................................
..........................................................................................

Q12

What are the main activities
1. Training
performed by your institution
2. Usageconcerning human resources for 3. Other (please specify)
health?
..........................................................................................
Interviewer: Only suggest the ..........................................................................................
answers opposite if required.
..........................................................................................
..........................................................................................

Q13

Have you already been
1. Yesapproached by the Ministry of 2. No
Health to help resolve problems 3. If yes, how did you proceed?
of human resources for health? ..........................................................................................
Instruction: interviewer, do..........................................................................................
not ask this question if the..........................................................................................
stakeholder is par t of the MPH. ..........................................................................................
..........................................................................................

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CODE

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Q14

Do you have an office, service
or cell capable of providing
information on or resolving
a problem linked to humanresources for health?

1. Yes
2. No
3. If yes, which?
..........................................................................................
..........................................................................................
..........................................................................................

Q15

Do you have provincial branches 1. Yes
which can accomplish the same 2. No
tasks as those in Kinshasa?
3. If yes, specify which provinces (and in the province:
town or city)?
..........................................................................................
..........................................................................................
..........................................................................................

Q16

For how long have you been..........................................................................................
working for HRH development? ..........................................................................................
..........................................................................................

IV. INTEREST IN THE PROCESS OF DEVELOPMENT OF HRH.
No.

QUESTIONSRESPONSES

Q17

The Ministry of Health wishes
to involve you (more) in thedevelopment process of Human
Resources, which service(s) can
you offer?

a) Expertiseb) Financec) Material supportd) Other to be specified..........................................................................................
..........................................................................................
..........................................................................................
..........................................................................................

Multiple responses possibles.
Do not suggest responses.
Q18

In the development of humanresources for health, there are
4 main sectors. Which of these
sectors interest your service?

CODEa) Career managementb) Basic trainingc) Continuous trainingd) Retention
Instruction: check the box corresponding to the
response.

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Q19

In August 2011, the Ministry of
Health organized a workshop
on the observatory of humanresources for health. 11
functions were retained as partof this observatory - which areof interest to you?

(Instruction: suggest functions
to the interviewer; multiple
responses possibles).
Circle the number(s)corresponding to the chosen
function.

120

1. Sharing of experiences and information on planningfor HRH development
2. Analysis of tendencies of the HRH situation in the DRC
3. Support for research/study activities to facilitate
evidence-based decision-making
4. Redynamization of the information system byimproving the quality and coverage of the data on
HRH
5. Improvement of the quality of tools and datacollection mechanisms
6. Support for management of networks of expertise in
the HRH area to reinforce national capacities
7. Reinforcement of national capacities for monitoringand evaluating HRH
8. Availability of reliable information for national HRH
development
9. Development of collaborative links for collection,
storage and sharing of data
10.Contribution to the mobilization of resources for the
HRH agenda
11.Sharing of available strategies on the retention andequitable distribution in HRH

Q20Among the functions cited
above, which is the most specific ..........................................................................................
compared to your mission?
..........................................................................................

Q21

Please help us identify the activities performed by your institution concerning HRH more
specifically by assessing them in the areas of engagement listed below. Please identify
them in increasing order of priority and estimate the percentage of time that you spend
on this activity during a working week.

No.

Area of engagement

01

Basic training

02

Appropriation (recruitment anddeployment)

03

Retention (career management/
promotion)

04

Retention (incentives/working conditions)

Check theactivity

Order ofpriority

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05

Continuous training

06

Policies and planning

07

Legal and regulatory framework

08

Finance09

Monitoring/evaluation

10

Concertation

11

Reinforcement of institutional capacities

12

Other (please specify)............................
.........................................................

Interview end time: ….....H………minutes.
THANK YOU FOR YOUR CONTRIBUTION.
Annex 2: Interview guide from key informants
DEMOCRATIC REPUBLIC OF CONGO/MINISTRY OF PUBLIC HEALTH/SECRETARIAT GENERAL/HEAD OF HUMAN RESOURCESANALYSIS OF STAKEHOLDERS IN THE DEVELOPMENT OFHEALTH HUMAN RESOURCES IN DRC
In collaboration with the Japanese International Cooperation Agency (JICA).
INTERVIEW GUIDE

0. WORK TEAM
1. Number of questionnaire:………………………………………………
2. Date of the interview:………………………………………………………
3. Interview start time:……………H…………MIN……………
4. Province/district/town/city: ……………………………………………………
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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Members
Interviewer
Note-taker
Supervisor
Data inputter

Surname and given name

Date

Signature

Code___/____/2012___/____/2012___/____/2012___/____/2012

I. INTRODUCTION:
Nous sommes entrain d’essayer de comprendre le development of human resources for health in the DRC
and to identify the main problems and the priorities for son development futur.
Il would be bon, for nous, de commencer by recevoir des explications on your mission in the DRC and particularly your engagement in the area of human resources for health. Nous allons for cela, we entretenirwith vous en vous posant some questions.
Notre interview comprend two parties principales; la first section includes des questions on the past (partie
retrospective) and the deuxième, des questions concerning the future (partie prospective) of the development process of human resources for health in the DRC.
Following avoir collected all information utiles, we allons rediger un report qui rendra available the resultsof this survey.
Notre conversation with vous pourra prendre around 45 minutes.
SVP, Mr...............................................................; pouvons- nous commencer maintenant?

122

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No.

Questions

1°

Identity of the respondent2°

Capacity of the respondent?

3°

Current function

4°

Denomination of his/her
associated institution

Responses

Code

III. INTERVIEW TOPICS:
Q1. Could you tell us more about the main activities performed by your institution related to human resources for health?
Q2. Please help us identify the activities performed by your institution concerning HRH more specificallyby assessing them in the conceptual framework of our analysis (HRH development organizational body).
Please identify them in increasing order of priority and estimate the percentage of time that you spend
on this activity during a working week.
No.

Activities deployed01

Basic training

02

Appropriation (recruitment and deployment)

03

Retention (career management/promotion)

04

Retention (incentives/working conditions)05

Continuous training

06

Policies and planning

07

Legal and regulatory framework

08

Finance09

Monitoring/evaluation

10

Concertation

11

Reinforcement of institutional capacities

12

Other (please specify)............................
.........................................................

Check theactivity

Order ofpriority%

Q3. In your opinion, which major changes have marked our country over the last 5 to 10 years, concerning HRH development?

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資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

Q4. What are the major events which have influenced these changes?
Q5. Who were the key players behind these changes?
Q6. What were the key factors having encouraged these developments?
Q7. Who are the main partners having supported these developments?
Q8. What have been the main results obtained thanks to these changes?
Q9. Which constraints or major difficulties have beenencountered? ..........................................................................................................................
Q10. In your opinion, which are the key priorities for HRH development in the DRC in the next 5 to 10
years?
Q11. Among the main priorities of HRH development you have just cited, in which areas does yourinstitution continue to be engaged or still intends to engage? Please explain and give details of the scope ofyour engagement.
Q12. In your opinion, what are the key opportunities which could encourage HRH development in the DRC?
Q13. At this time, who are your main partners in HRH activities?
Q14. In your opinion, what are the specific features of the health system of the DRC in general and its
human resource system in particular compared to other pays with which you are famliar? Please make aparallel comparison, indicating the differences and common areas?
Q15. Considering all the gains made in the area of developing human resources for health in the DRC, how
do you think we can make them sustainable?
Q16. Is there anything else concerning your experience on HRH in our country which you would like toshare with us?
Q17. As regards the the HRH issue, do you know anyone else whom you could suggest to us as an interview
candidate?
THANK YOU VERY MUCH FOR YOUR CONTRIBUTION.
Interview end time:.............H...........min.
SUMMARY TABLE OF MAPPING. (See below).

124

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用No.

MPH (DSP/D7)

MPH(D12)

DSP/MIHUE

MESU(SG)

Plan

3

4

5

6

MPH (SG)

Stakeholders

2

MINISTRIES/CENTR 1
AL DEPARTMENTS
OF MINISTRIES.

Categories

The MIHUE isnational, with noprovincial bodies.
These establishments
are found at a
provincial level.

In all 11 provinces

All provinces (theDSP is nationwide)

Since 1978.

Since 2004,
namely, since I
have taken
charge.

Since 1999.

Since when has
this body
worked in
DHHR?
The MPH is present in Since its creation
all provinces: DPS

To what extent is it
localized into thehealth system?

In 1979, with the
In all provinces. There Since 1985.
creation of theis a provincial
Commissioner of Plan. (regional) division ofplanning.

Since independence

Since 1999, butfunctional in 2005

Since 5 September
2001. (but the DSP
existed as the Studies
Office since 1982).

Since when existingin the DRC?

a) Career
management b)
Basic training c)Continuous trainingd) Retentionb) Basic training c)Continuous trainingd) Retentionb) Basic training c)Continuous trainingd) Retentionc) Continuous
trainingd) Retentiona) Career
management b)
Basic training c)Continuous trainingd) Retention

Sectors of interestin
DHHR/HHRNDP

4) Retention (incentives/working
conditions); 5) Continuous training
6) Policies and planning 7) Legal andregulatory framework 8) Finance; 9)Monitoring/evaluation 10)
Conciliation;11) Reinforcement of institutional
capacities

1) Basic training, 4) Retention(incentives/working conditions)6) Policies and planning,7) Legal and regulatory framework,
10) Conciliation, 11) Reinforcementof institutional capacities;6) Policy and planning;7) Legal and regulatory framework;
8) Finance;9) Monitoring/evaluation;10) Conciliation;11) Reinforcement of institutional
capacities.
4) Retention (incentives/working
conditions)5) Continuous training
6) Policies and planning7) Legal and regulatory framework
8) Finance9) Monitoring/evaluation
10) Conciliation
11) Reinforcement of institutional
capacities
12) Other: Coordination
5) Continuous training;7) Legal and regulatory framework; 9)Monitoring/evaluation;10) Conciliation;11) Reinforcement of institutional
capacities
1) Basic training; 7) Legal andregulatory framework; 6) Policy andplanning; 3) Retention(incentive/working conditions); 11)
Reinforcement of institutional
capacities; 10) Dialog and 12)
Inventories.

Areas of engagement in the
DHHR/organizational model

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

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125

126

TRAINING
INSTITUTIONS

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The School of
Public Health(ESP/UNIKIN)

Kinshasa
University

13

Ministry ET/PS

10

12

Civil Service

9

Department ofPopulation
Sciences andDevelopment(DPSD)/UNIKIN

Finance811BudgetPlan

MESU(SG)

7

6

5

The MIHUE isnational, with noprovincial bodies.
These establishments
are found at a
provincial level.

Since 1978.

Since 1984

Since 1973

Since 1960 (with Mr.
Charles Kisolekele as
Minister).

Since the accession of
the country to
independence.

Since 1987.

This sector wasproperly taken
into accountfrom 2001.

Since theexistence of theministry; in1960.

Since theaccession of thecountry to
independence.

Since 1987.

Nationwide (including Since 1988
externally)a) Volet Teaching: invirtually all
universities (BasCongo, Equateur,
Kinshasa) b) Volet
research: nationwide

All provinces

All provinces

In all provinces, they
are provincial
divisions of Financeand in Kinshasa, thecentral Financemanagement division.

In all provinces of the
DRC

In 1979, with the
In all provinces. There Since 1985.
creation of theis a provincial
Commissioner of Plan. (regional) division ofplanning.

Since independencea) Career
management b)b) Basic training c)Continuous traininga) Career
management; b)
Basic trainingc) Continuous
trainingd) Retentiona) Career
management c)Continuous trainingd) Retentiona) Career
management.

a) Career
management b)
Basic training c)Continuous trainingd) Retentiond) Retentiona) Career
management b)
Basic training c)Continuous trainingd) Retentionb) Basic training c)Continuous trainingd) Retention

1) Basic training
5) Continuous training
6) Policies and planning 9)
Monitoring/evaluation 11)
Reinforcement of institutional
capacities
1) Basic training, 6) Policy andplanning; 7) Legal and regulatory

1) Basic training
4) Retention (incentives/working
conditions; 5) Continuous training
9) Monitoring/evaluation; 10)
Conciliation 11) Reinforcement ofinstitutional capacities.

6) Policy and planning 7) Legal andregulatory framework 10)
Conciliation;11) Reinforcement of institutional
capacities
2) Appropriation (recruitment anddeployment)
4) Retention (incentives/working
conditions); 5) Continuous training
6) Policies and planning 7) Legal andregulatory framework 8) Finance9) Monitoring/evaluation 10)
Conciliation
11) Reinforcement of institutional
capacities.

1) Basic training
10) Conciliation
11) Reinforcement of institutional
capacities
7) Legal and regulatory framework 8)
Finance; 10) Conciliation
11) Reinforcement of institutional
capacities

4) Retention (incentives/working
conditions); 5) Continuous training
6) Policies and planning 7) Legal andregulatory framework 8) Finance; 9)Monitoring/evaluation 10)
Conciliation;11) Reinforcement of institutional
capacities

1) Basic training, 4) Retention(incentives/working conditions)6) Policies and planning,7) Legal and regulatory framework,
10) Conciliation, 11) Reinforcementof institutional capacities;

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the CongoSERVICESSPECIALISES DE
The ETATTRAINING
INSTITUTIONS

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18

NEO(Office
National d the
Employment)

NIS (Institut
national desstatistics)

CEFA/MONKOL
E

16

17

HITMS

15

Kinshasa
University
Hospitals (BTC)

13

ISSI MONKOLEThe School of
Public Health(ESP/UNIKIN)

1214Department ofPopulation
Sciences andDevelopment(DPSD)/UNIKIN

11

127

Since 2003

The 3 october 1978, laloi de 1978 consacre
the NIS like company
publique à caractère
scientifique. la reformdes companies
publiques de 2009,consacre the NIS likeestablishment public.

For 10 years (2002)

Since 1992.

For 15 years

Since 1984

Since 1973

This sector wasproperly taken
into accountfrom 2001.

Since sa creationin 1978.

For 10 years(2002)

Since 1998

For 12 years

Katanga, Bandundu,
Since 2008
Nord and Sud-Kivu,
Province Orientale andIn les national
provinces à theexception desprovinces of theManiema and NordKivu.

Our services areoffered in theprovincial city ofKinshasa and KasaïOccidental, more
specifically in Luiza.
In Katanga, KasaïOriental, Bas-Congoand Kinshasa

In Kinshasa and Au
Katanga, where a cell
is focused oncontinuous training.

Nationwide (including Since 1988
externally)a) Volet Teaching: invirtually all
universities (BasCongo, Equateur,
Kinshasa) b) Volet
research: nationwidea) Career
management.

b) Basic training c)Continuous trainingb) Basic training c)Continuous trainingb) Basic traininga) Career
management b)
Basic training c)Continuous traininga) Career
management b)
Basic training c)Continuous trainingd) Retentionb) Basic training c)Continuous traininga) Career
management; b)
Basic trainingc) Continuous
trainingd) Retention

4) Retention (incentives/working
conditions) 7) Legal and regulatory
framework 10) Conciliation 11)1) Basic training
4) Retention (incentives/working
conditions); 5) Continuous training
6) Policies and planning 7) Legal andregulatory framework 9)
Monitoring/evaluation; 10)
Conciliation 11) Reinforcement ofinstitutional capacities
12) Others: assistance technique1) Basic training
5) Continuous training11) Reinforcement of institutional
capacities

1) Basic training

1) Basic training 4) Retention(incentives/working conditions); 5)
Continuous training
6) Policies and planning 7) Legal andregulatory framework 8) Finance; 9)Monitoring/evaluation 10)
Conciliation; 11) Reinforcement ofinstitutional capacities

1) Basic training
5) Continuous training
6) Policies and planning 9)
Monitoring/evaluation 11)
Reinforcement of institutional
capacities
1) Basic training, 6) Policy andplanning; 7) Legal and regulatory
framework
2) Appropriation (recruitment anddeployment),3) Retention (career
management/promotion), 4) Retention(incitation/working conditions), 11)
Reinforcement of institutional
capacity6) Continuous training, 8) Finance; 9)monitoring and evaluation; 10)
Dialog .

1) Basic training
4) Retention (incentives/working
conditions; 5) Continuous training
9) Monitoring/evaluation; 10)
Conciliation 11) Reinforcement ofinstitutional capacities.

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NEO(Office
National d the
Employment)

OM (Ministry of
the Interior and
Decentralization)

Health Services
Branch/AFDRC

CNRT

18

19

20

21

DOMW

NIS (Institut
national desstatistics)

CEFA/MONKOL
E

17

MEDICAL, PRIVATE 22
AND RELIGIOUS
SECTOR.

SERVICES
SPECIALISES DE
The ETAT

16

Since the signature of
the Presidential
ordinance in 1981

Since 17 April, 1964

Since the Colonial
periodSince 2003

The 3 october 1978, laloi de 1978 consacre
the NIS like company
publique à caractère
scientifique. la reformdes companies
publiques de 2009,consacre the NIS likeestablishment public.

For 10 years (2002)

Since sa creationin 1978.

For 10 years(2002)

Since the end of2007:
establishing thegeneralmanagement ofhealth services
within the
Ministry of
Defense.

a) Career
management b)
Basic training c)Continuous trainingd) Retention

Since la creation c) Continuousof thetraining
organization; and d) Retention
since 2002 (wehave our own
Center of health).

a) Career
management.

b) Basic training c)Continuous trainingb) Basic training c)Continuous traininga) Career
management b)
Basic training c)Continuous trainingd) Retention

Throughout the
For 1 year (2011) a) Career
country, with a station
management c)(branch) in eachContinuous training
province and a substation in some
districts.

At a central level(Kinshasa) andintermediate level inall military regions

In all provinces

Katanga, Bandundu,
Since 2008
Nord and Sud-Kivu,
Province Orientale and
Bas-Congo. Kasaï
Occidental will soon
be involved.

In les national
provinces à theexception desprovinces of theManiema and NordKivu.

Occidental, more
specifically in Luiza.
In Katanga, KasaïOriental, Bas-Congoand Kinshasa

1) Basic training; 2) Appropriation ; 3)
Retention (career management); 4)
Retention (incentives); 5) Continuous
training; 6) Policy and planning; 7)Legal and regulatory framework; 8)
Finance; 9) Monitoring/evaluation;5) Continuous training 9)
Monitoring/evaluation; 10)
Conciliation.

1) Basic training; 2) posting(recruitment and deployment); 3)
Retention (management carrière); 4)
Retention (incentives..) 5) Continuous
training
6) Policies and planning; 7) Legal andregulatory framework 9)
Monitoring/evaluation; 10)
Conciliation; 12) others: Etats deneeds en HRH en cas humanitaire.

2) Appropriation (recruitment anddeployment); 3) Retention (career
management/promotion)4) Retention (incentives/working
conditions); 5) Continuous training
6) Policies and planning 7) Legal andregulatory framework 8) Finance; 9)Monitoring/evaluation 10)
Conciliation; 11) Reinforcement ofinstitutional capacities.

4) Retention (incentives/working
conditions) 7) Legal and regulatory
framework 10) Conciliation 11)
Reinforcement of institutional
capacities

1) Basic training
4) Retention (incentives/working
conditions); 5) Continuous training
6) Policies and planning 7) Legal andregulatory framework 9)
Monitoring/evaluation; 10)
Conciliation 11) Reinforcement ofinstitutional capacities
12) Others: assistance technique1) Basic training
5) Continuous training11) Reinforcement of institutional
capacities

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the CongoORDERS/UNIONSANDPROFESSIONALASSOCIATIONS

Order of doctors

NUD

NUDS

26

27

KHD

CCC medical

DOMW

CNRT

25

24

23

MEDICAL, PRIVATE 22
AND RELIGIOUS
SECTOR.

21

Since 1987

Since le 07. 11.1990

Created in around1960

Since 1963

Since the signature of
the Presidential
ordinance in 1981

Since 1974 for
HRH productionof secondary
level and in 1995
for universitylevel

The organization
Since 1987
operates in 11 national
provincesd) Retentiona) Career
managementa) Career
managementa) Career
management b)
Basic training c)Continuous trainingd) Retention

Since its creation b) Basic training c)
in 1963
Continuous trainingd) Retention

In all provinces and in Since 1987
all districts

In all provinces of thenational territory

In all provinces of thenational territory.
Palu: coverage in 11
provinces (119 ZS),
HIV: coverage in 5
provinces (BC, BDD,
2 KASAI,KATANGA)a) Career
management b)
Basic training c)Continuous trainingd) Retention

Throughout the
For 1 year (2011) a) Career
country, with a station
management c)(branch) in eachContinuous training
province and a substation in some
districts.

2) Appropriation (recruitment anddeployment); 3) Retention (career
management/promotion)4) Retention (incentives/working
conditions); 5) Continuous training
7) Legal and regulatory framework
10) Conciliation

1) Basic training;7) Legal andregulatory framework; 9)Monitoring/evaluation; 11)
Reinforcement of institutional
capacities. 12) Registration in
Doctors’ Register2) posting (recruitment anddeployment); 4) Retention (incentives
and working conditions); 6) Policies
and planning; 7) Legal and regulatory
framework 9) Monitoring/evaluation;10) Conciliation;

1) Basic training
4) Retention (incentives/working
conditions), 5) Continuous training
6) Policies and planning 7) Legal andregulatory framework 8) Finance; 9)Monitoring/evaluation 10)
Conciliation; 11) Reinforcement ofinstitutional capacities

1) Basic training 4) Retention(incentives/working conditions); 5)
Continuous training 9)
Monitoring/evaluation; 10)
Conciliation 11) Reinforcement ofinstitutional capacities

1) Basic training; 2) Appropriation ; 3)
Retention (career management); 4)
Retention (incentives); 5) Continuous
training; 6) Policy and planning; 7)Legal and regulatory framework; 8)
Finance; 9) Monitoring/evaluation;10) Dialog;11) Reinforcement ofinstitutional capacities;12) Others: supervision.

5) Continuous training 9)
Monitoring/evaluation; 10)
Conciliation.

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129

130

PARTNERS,COOPERATIONSAND DONORS

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

NANC

AHAM

30

31

WHO

Union healthprofessionals(NUEAESS)

29

32

NUPC

NUDS

NUD

28

27

26

Practically in all areas
where the Provincial
Council of the Orderof Pharmacists exists,
the union is alongside.

Since 1964

Our services areoffered in allprovinces

Since 1965, initially
We offer our services
known as AIZA
throughout all national(Association of nurses provincesof the Congo Zaïre)from 1965 to 1971.
Then, from 1971 to
the present, NANC.
We have beenworking on HRH
development for
8 months.

Since engaging
in the process ofreform and HRH
workshops;
namely, since
2008.

Since 1992. (ayear after thecreation of theOrder ofpharmacists, in1991).
Since its creationin 1991.

The organization
Since 1987
operates in 11 national
provinces

In all provinces and in Since 1987
all districts

Created on 18 April
In all provinces of the1991, and recorded by national territory
the Ministry of Workand that of the civil
service in 1992.

Since 1992. (one year
after the creation of
the Order ofpharmacists, in 1991).

Since 1987

Since le 07. 11.1990a) Career
management d)Retentiona) Career
managementb) Basic training c)Continuous trainingd) Retentiona) Career
management b)
Basic training c)Continuous traininga) Career
management c)Continuous trainingd) Retentiona) Career
management c)Continuous trainingd) Retentiona) Career
management

1) Basic training, 7) Legal andregulatory framework; 9)monitoring/evaluation (monitorage ofHRH), evaluation of the Assurance
quality); 10) Conciliation; 11)
Reinforcement of institutional
capacities;

3) Retention (career management andpromotion); 4) Retention(incentives/working conditions); 5)
Continuous training; 6) Policy andplanning.

1) Basic training; 4) Retention(incentives/working conditions) 5)
Continuous training
6) Policies and planning 7) Legal andregulatory framework 8) Finance; 9)Monitoring/evaluation 10)
Conciliation; 11) Reinforcement ofinstitutional capacities

3) Retention (career
management/promotion); 4) Retention(incentives/working conditions) 5)
Continuous training
7) Legal and regulatory framework
10) Conciliation

5) Continuous training;7) Legal and regulatory framework 9)
Monitoring/evaluation; 10)
Conciliation.

2) Appropriation (recruitment anddeployment); 3) Retention (career
management/promotion)4) Retention (incentives/working
conditions); 5) Continuous training
7) Legal and regulatory framework
10) Conciliation

2) posting (recruitment anddeployment); 4) Retention (incentives
and working conditions); 6) Policies
and planning; 7) Legal and regulatory
framework 9) Monitoring/evaluation;10) Conciliation;

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the CongoOTHERS

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

Benelux Afrocenter

37

Since 2007 (namely
for around 5 years).

Since the 1980s.
Subsequently closed
following looting in
1991, then re-opened
in 1998.

For 31 years (namely
in 1981)

JICA office open in
the DRC since July
2007. However, there
has been diplomaticcooperation (embassy)
since 1970.

For 11 years

OCM (Observatory Since 2005of media)

USAID

36

38

UNFPA

JICA

34

35

BTC

33

The first programme
developed initially(from 2007 to 2009)
was a centralized
approach. Actually(from 2010 to 2012),
this approach waschanged to favor
decentralization, with
4 provinces involved
up to that point: BasCongo, Bandundu,
Nord-KiGiven andManiema.
In each province, there
is a provincial branchwhich operates if there
is funding of partners.
but in Kinshasa, itworks at a centrallevel.

Since 2011:
Restructuring to
improve efficacy in 3
decentralized offices:
Katanga (forKatanga); Nord Kivu
(for NK, SK,
Maniema and Uturi)
and Kinshasa (forKinshasa, BDD, andBC). In 8 provinces intotal.
Nationwide. As forhealth, in 4 provinces(the Kasaï, Katanga
and Sud-Kivu).

At a central level (inKinshasa only up to2013). but from 2014,
expanding into
provinces.

Our services areoffered in allprovincesc) Continuous
trainingd) Retentionb) Basic training c)Continuous trainingb) Basic training c)Continuous traininga) Career
management b)
Basic training c)Continuous trainingd) Retentiona) Career
management d)Retention

The OCM hasc) Continuous
never worked for training
HRH
development.

Since 2010
(around 2 years
ago).

Since the 1980s.
(with major
projects:
SANRU, PSND,PEV etc.).

Since itestablished itself
in the DRC, in
2002.

Since December
2008.

For 11 years12) Sharing of experiences.

1) Basic training;4) Retention/incentives and working
conditions; 5) Continuous training.
11) Reinforcement of institutional
capacities

1) Basic training
4) Retention (incentives/working
conditions); 5) Continuous training
8) Finance; 9) Monitoring/evaluation
10) Conciliation; 11) Reinforcementof institutional capacities

1) Basic training
5) Continuous training
6) Policies and planning8) Finance10) Conciliation
11) Reinforcement of institutional
capacities

1) Basic training,6) Policies and planning 8) Finance;11) Reinforcement of institutional
capacities; 12) others: bilateral
cooperation with UNICEF for
vaccination and healthy village
project.

All tasks concerning BTC; especiallyfunding and HRH training (secondary
level teaching).

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo131

OTHERS

OCM (Observatory Since 2005of media)

Provincial divisionof health/Kinshasa.

38

39changed to favor
decentralization, with
4 provinces involved
up to that point: BasCongo, Bandundu,
Nord-KiGiven andManiema.
In each province, there
is a provincial branchwhich operates if there
is funding of partners.
but in Kinshasa, itworks at a centrallevel.

132b) Basic training c)Continuous trainingd) Retention.

The OCM hasc) Continuous
never worked for training
HRH
development.

1) Basic training; 4) Retention(incitation/working conditions); 5)
Continuous training; 6) Policy andplanning; 12) Others: Conflict
management in hospitals; andnotification of personnel on theapproval committees.

12) Sharing of experiences.

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

BTC
Functions of the NHWO significant for development
partners and donors and others
I
Sharing of experiences and information on planning for HRH x
development
II
Analysis of tendencies of the HRH situation in the DRC
III
Support for research/study activities to facilitate evidencebased decision-making
IV
Redynamization of the information system by improving thequality and coverage of the data on HRH
VImprovement of the quality of tools and data collection
mechanisms
VI
Support for management of networks of expertise in the HRH
area to reinforce national capacities
VII Reinforcement of national capacities for monitoring andevaluating HRH
VIII Availability of reliable information for national HRH
development
IX
Development of collaborative links for collection, storage
and sharing of data
X
Contribution to the mobilization of resources for the HRH
agendaXI
Sharing of available strategies on the retention and equitable x
distribution in HRH

No.

x

x
x

x

x

x

x

x

x

x

x

x

x
x

x
x

USAID
x

UNFPA
x

x

x

JICA

x

x

x

x

Benelux
Autre
Afro
(OCM)
x
x

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

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133

134

x

x

Redynamization of the information systemby improving the quality and coverage ofthe data on HRH

Improvement of the quality of tools anddata collection mechanisms

Support for management of networks ofexpertise in the HRH area to reinforce
national capacities

Reinforcement of national capacities formonitoring and evaluating HRH

IV

V

VI

VII

VIII Availability of reliable information for
national HRH developmentx

Support for research/study activities tofacilitate evidence-based decision-making

III

x

x

x

Analysis of tendencies of the HRH situation in the DRC

II

Functions of the NHWO significant
DSP
for Ministries and Special State
healthNo.
Services visited
Sharing of experiences and information on xIplanning for HRH development

x

x

x

x

D12
MPH

x

x

x

x

x

x

SG
MIHUE

x

x

x

x

x

x

x

x

Min.
plan
x

Min.
Budget

x

x

x

x

Min.
Finance

X

X

X

X

X

Min.
ETPS

x

x

x

x

x

x

x

x

NIS

x

x

x

x

x

x

NEO

x

x

x

x

x

x

OM

x

x

x

x

x

AFDRC

x

x

CNRT

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用

x

Sharing of available strategies on theretention and equitable distribution in HRH

XI

x

x
x

x

x

x
x

x
x

x

x
x

Redynamization of the information system by improving the quality and coverage of thedata on HRH
Improvement of the quality of tools and data collection mechanisms
x

Support for management of networks of expertise in the HRH area to reinforce national
capacities
Reinforcement of national capacities for monitoring and evaluating HRH
xAvailability of reliable information for national HRH development

Development of collaborative links for collection, storage and sharing of data

Contribution to the mobilization of resources for the HRH agenda

Sharing of available strategies on the retention and equitable distribution in HRH

IV

VI

VII

VIII

IX

X

XI

x

x

x

x

x

x

Support for research/study activities to facilitate evidence-based decision-making

III

x

x

V

X

X

X

x

x

x

x

DPSD/ ESP/ISSI/UNIKIN UNIKIN MONKOLE HITMS
x
x
x
x

x

x

Analysis of tendencies of the HRH situation in the DRC

x

x

x

II

Sharing of experiences and information on planning for HRH development

Functions of the NHWO significant for Training institutions visitedx

Contribution to the mobilization of
resources for the HRH agenda

X

No.
I

x

Development of collaborative links forcollection, storage and sharing of data

IX

x

x

x

x

x

x

CEFA/
MONKOLE
x

x

x

x

x

x

x

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

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135

136

XI

X

IX

VIII

VII

VI

V

Contribution to the mobilization of resources for the HRH
agendaSharing of available strategies on the retention andequitable distribution in HRH

Support for research/study activities to facilitate evidencebased decision-making
Redynamization of the information system by improving
the quality and coverage of the data on HRH
Improvement of the quality of tools and data collection
mechanisms
Support for management of networks of expertise in the
HRH area to reinforce national capacities
Reinforcement of national capacities for monitoring andevaluating HRH
Availability of reliable information for national HRH
development
Development of collaborative links for collection, storage
and sharing of data

III

IV

Analysis of tendencies of the HRH situation in the DRC

II

No.
I

Functions of the NHWO significant for religious
medical departments, unions and associations ofhealth professionals
Sharing of experiences and information on planning for
HRH development

X

X

X

X

X

CCC/
SANRU

x

x

x

KHD

x

x

x

x

NUD

x

x

x

x

NUPC

x

x

x

x

x

x

x

NUDS

X

X

X

X

X

X

X

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

NUEAESS NANC AHAM

資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the Congo

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 3. Study Report on Stakeholder Analysis in the Development of HRH in the Democratic Republic of the CongoRESEARCH TEAMInterviewers tasked with data collection by stakeholders:Study coordination:
No. Surname and given name(function)

Institution

1

Dr. LOKADI Pierre (SecretaryGeneral)

MPH

2

Mr. NGUMBU Epiphane(Directeur 1st Department,
and coordinator of PSDHHR
project)

MPH

3

Dr. SHIMIZU (Head of PSDHHR
project)

JICA/NCGM

4

Dr. NORIKO FUJITA (short-term
consultant)

JICA/NCGM

5Dr. ZANDIBENI KAKU Jacques(consultant)

JICA

No. Surname and given nameInstitution

1

A.G. MBAYO

MPH

2A.G. NGOLE

MPH

3Mr. EMELEMEKA

MPH

4A.G. MATAMBA

MPH

5

Mme BITANGILAYI

MPH

6

A.G. MUSENGA

MPH

7

Mr. KIYOKO

MPH

8A.G. KAPAFULE

MPH

9Mr. KINGOMBE

MPH

Interviewers tasked with in-depth interviews with
key informants
No. Surname and given name1

Members of the working teamNo. Surname and given name(function)

Institution

1

Dr. ILONGA BOMPOKO(Directeur 11th division)

MPH

2

Mr. KOMBA DJEKO (Directeur 6th MPH
division)3

MA MATOKO NICAISE (HD RH)

3

Dr. MUFWAYA RAYMOND (head JICA
of health programme health)4

Mr. MUKUNU GUY (Technicalassistant)

JICA

5

Mme KAYO KANEKO

JICA

2
3

MPH

st

MPH

Mr. MAMBU (HD, 6 division)"A.G. ABABA (HO, 1 division)"stInstitutionth

Mr. KASONGO (1 division)

MPH

MPH

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用137

資料 4. Glossary

4. Glossary

138

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 4. Glossary

Glossary by World Bank
http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/EXTHSD/0,,contentMDK:20190578~menuPK:438351~pagePK:148956~piPK:216618~theSitePK:376793~isCURL:Y,00.html(Accessed 26Februayl 2013)[Balanced distribution]
Refers to appropriate allocation of health personnel, geographically and among levels of care andtypes of services, to ensure equitable provision ofquality health services to all.
[Brain drain]
Outflow of health professionals to other countries,
or from the public to the private sector withina country, or out of the health sector, usually insearch of more employment opportunities, andbetter working and living conditions.
[Capacity building]Continuing process of strengthening existing capacities and introducing more efficient technologies and systems in order to address a problem ina more effective manner. UNDP defines capacity
building as “the process by which individuals,
groups, organizations, institutions and societies
increase their ability to (1) Perform core functions,solve problems, define and achieve objectives and(2) Understand and deal with their development
needs in a broad context and in a sustainable
manner.”
UNDP, Capacity Development, Technical Advisory
Paper II. In: Capacity Development Resource Book.
Management Development and Governance Division. UNDP, 1997.
[Career]
The movement of individuals from one job or

position to another job or position which has different (usually higher) levels of authority, income
and or skills/requirements.
[Career structure]
Planned set of differentiated steps, posts or jobs
through which one can progress professionallywithin a specific position or across positions along
time to ensure the continued effectiveness of anorganization.
[Career management]
Process of setting goals, identifying specific skills,
capabilities, interests, and implementing a careerplan. Providing career management assistance is
one of the strategies employed to retain healthprofessionals (see Retention of staff)
World Health Organization, Public Services International (PSI) Terms of Employment and Working
Conditions in Health Sector Reforms: Points fordiscussion, 2001. In: Workshop on Global Health
Workforce Strategy. Annecy, France, 9-12 December 2000. Retrieved 03/18/02.
[Competences]
Knowledge, skills and attitudes which an individual possesses. Competencies are accumulated anddeveloped through education and training and experience.
[Continuing professional development]
Process of systematic learning that allows healthprofessionals to continue to meet the needs ofthe population being served by updating and enhancing their skills, whilst addressing health professionals’ career and educational aspirations.
[Coping strategies]
Approaches employed by health personnel toovercome unsatisfactory remuneration or working
conditions in order to fulfill professional and material expectations. Examples of coping strategies

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資料 4. Glossary

are: (1) undertaking extra duties to supplement
income (see fragmentation of work), (2) migrating
to private practice or out of the health sector (seebrain drain) and (3) being in a payroll without providing services (see ghost worker).
Ferrinho P, Van Lerberghe W, Providing health care
under adverse conditions: Health personnel performance & individual coping strategies, Studies in
Health Services Organisation & Policy, 16, 2000.
[Deployment]
Refers to the process of allocating personnel
among types and levels of services and among
regions and sub-regions of a country. (Dussault
G,1999)[Discipline]
A generic term covering the process and methods
in an organization through which the conduct/behavior of the workforce is managed.
[Education; basic, specialization, continuing]
Education – development of competencies, or theprocess by which the appropriate number of eachcategory of providers is produced and equippedwith the knowledge, skills and attitudes needed
to produce the kind of performance necessary toachieve health services objectives.
Basic - acquisition of fundamental professional
competencies by new personnel. Provision of basic education is usually under the responsibility ofprofessional schools and universities.
Specialization – process of acquiring specific competencies in addition to basic education.
Continuing education – all educational experiences, activities and resources engaged by a healthprofessional after completion of professional
training.
[Employment status: full-time, part-time, temporary, permanent]
140

Full-time (whole-time) – employment for or working for the amount of time considered customaryor standard.
Part-time – employment for or working for lessthan the amount of time considered customary or
standard. The trend towards part-time or temporary employment with lower salaries is attributed
to attempts by employers to develop more flexible
employment practices, but can also be used positively as a way of retaining workers who wish towork reduced hours.
Permanent – Employment contracted for an indeterminate period.
Fixed term – employment contract for a fixed period of time
Temporary – short-term contracts or “casual”
work, either for a definite period or for a specificactivity.
[Feminization] –Process by which number of female workers proportionately increases in specific occupations.
[Flexibility]“Flexibility in the use of labor can be of two types:
time-based, to match staffing to workload (useof different shift patterns, working hours etc.); or
contract-based, for organizational flexibility (useof temporary staff and fixed-term contract staff,
and even contracting-out whole sections of theservice).“ (Martineau, Martinez, 1997). Flexibility
can also cover pay flexibility and skill flexibility as
well as other aspects.
[Fragmentation of work, multi-employment][Roenen et all 1997]
Process by which health personnel seek alternative ways to increase income by undertaking otherforms of paid employment either after or during
official working hours. (Machado, 1997)   テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 4. Glossary[Gender]Socially defined aspects of being male or female.
Gender roles refer to those activities considered
by a given culture to be appropriate to a woman
or a man. When applied to human resources inhealth, gender refers to an understanding of thesignificance of gender in (1) employing people in
the health sector workforce, (2) recognizing how
gender affects occupational choices, career patterns and working practices and (3) considering
the non-institutional care of the sick, usually carried out by female family members (see Gender
Imbalance). (Dussault, 1999)
World Health Organization, “Public Services International (PSI) Terms of Employment and Working
Conditions in Health Sector Reforms: Points fordiscussion”, 2001 In Workshop on Global Health
Workforce Strategy. Annecy, France, 9-12 December 2000. Retrieved 03/18/02.
http://www.who.int/health-services-delivery/human/workforce/papers/PSI.pdf
Moser C, Tornqvist A, Bronkhorst B, Mainstream
gender and development in the World Bank: progress and recommendations, World Bank Report,
Washington, DC, 1998
[Ghost Worker]
Personnel formally on payroll but providing noservice (See coping strategies)[Grievance]
A generic term covering the processes and methods through which members of the workforce
may express disagreement with the conditions of
employment.
[Human capital]
The stock of accumulated skills, experiences andpersonnel that make workers more productive.
Or

Human skills and capabilities generated by investments in education and health. (WHO)[Human resources development]
Human resource development (HRD) refers tofunctions involved in planning, managing andsupporting the professional development of thehealth workforce within a health system, both at
the strategic and policy levels (Martineau,Martinez, 1997). HRD aims at getting ‘the right people
with the right skills and motivation in the rightplace at the right time’. (Hornby, 1980)
Hornby P, Ray D, Shipp P, Hall T, Guidelines forhealth manpower planning: a course book. World
Health Organization, Geneva: 1980.
Or
Systematic effort, within the limits of what a country is prepared to spend, to maximize the effective
utilization of the workforce in the health sector(Dussault, 1999)[Human resources management]
Process of creating an adequate organizational
environment and ensuring that the personnel perform adequately using strategies to identify andachieve the optimal number, mix and distributionof personnel in a cost-effective manner (Martineau, Martinez, 1997)[Human resources planning]
Process of estimating potential requirements forhuman resources in health and of designing waysof fulfilling those requirements (see Workforce
planning).
[Human Resource Policies] Guidelines and directions that regulate the utilization of workforce
both within the health sector and within the wider
context (socio/political/economic)
Martineau and Martinez, 1997.
[Imbalances: regional, service, occupational, gen-テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用141

資料 4. Glossaryder] An imbalance occurs when there is shortage
or surplus of health personnel as a result of a disequilibria between demand and supply for labor.  
In the health sector, imbalances can be of thefollowing types: (1) Profession/specialty imbalances, related to a disparity in various health professions, such as doctors or nurses, as well withinprofessions, for example, a shortage of one typeof specialist, (2) Geographic imbalances, whichrefers to urban-rural and poor-rich regions disparities of health personnel, (3) Institutional and services imbalances, related to differences between
health care facilities, as well as between services,(4) Public/private imbalances, associated with differences in human resources allocation between
the public and private health care system, and (5)Gender imbalances, which refers to disparities
in the female/male representation in the healthworkforce.
Zurn P, Dal Poz M, Stilwell B, Adams O, Imbalances in the health workforce: Briefing paper, World
Health Organization, Geneva, 2002.
[Industrial action]
Collective activities of workers to pressure management into agreeing to some demands. It can
include strikes, demonstrations and other formsof expression of discontent.
[Job analysis]
Process of identifying the requirements and defining roles of specific tasks.
[Job equivalence]
The weighted values of the skills requirements
and work conditions of a particular job that allow
comparison to other jobs in an organization, mostnormally used to determine career development
and pay.
[Labor legislation]
142

Policies and guidelines regulating the labor market. Laws and regulations that govern the functioning of the labor market.
[Labor markets]
Institutions and processes through which employment and wages are determined, affecting
the supply and demand for labor. Labor markets
can be divided into regional, occupational or skills
segments. Health labor market is the segment
concerned with human resources in the healthsector. Factors affecting health labor market are
imbalances, mobility, and migration.
Mehmet O, The emerging global labor market:
some implications for international health, report
prepared for WHO Consultation on Imbalances inthe Health Workforce in Ottawa on 10-12 March
200. WHO, Geneva.
[Job analysis]
Process of identifying the requirements and defining roles of specific tasks.
[Job equivalence]
The weighted values of the skills requirements
and work conditions of a particular job that allow
comparison to other jobs in an organization, mostnormally used to determine career development
and pay.
[Labor legislation]
Policies and guidelines regulating the labor market. Laws and regulations that govern the functioning of the labor market.
[Labor markets]
Institutions and processes through which employment and wages are determined, affecting
the supply and demand for labor. Labor markets
can be divided into regional, occupational or skills
segments. Health labor market is the segment
concerned with human resources in the health

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 4. Glossary

sector. Factors affecting health labor market are
imbalances, mobility, and migration.
Mehmet O, The emerging global labor market:
some implications for international health, report
prepared for WHO Consultation on Imbalances inthe Health Workforce in Ottawa on 10-12 March
200. WHO, Geneva.
[Labor relations, bargaining, conflicts]
Labor relations – relations between management
and employees in relation to collective bargaining
and maintenance of contract.
Bargaining – negotiation over the terms and conditions of an agreement or contract.
Conflicts – opposition or disagreement between
parties that calls for an agreement or a contract.
[Lay-off, downsizing, redundancies]
Staff reductions resulting from organizationalchanges or budget cuts; form of termination of
employment without negative evaluation of performance.
[Management of change, change management]
The concept of change management encompasses three basic definitions: (1) the task of managing change, referring to (a) making changes inan organization in a planned and systematic way,or (b) “responding to changes over which the organization exercises little or no control”, such as
legislation, social and political upheaval, changing
economic situations, etc; (2) “an area of professional practice,” referring to experts or firms engaged in planning and managing change for theirclients; (3) a body of knowledge, consisting of “models, methods and techniques, tools, skills andother forms of knowledge that go into making
up any practice.” (Nickols,2002) http://home.att.
net/~nickols/change.htm[Migration]

Process of movement of people from one country,
region or place to settle in another. In the healthsector, when related to movement of health workers, this process is also referred to as brain drain.
[Mismatches]
A bad match, a discrepancy, or a lack of correspondence between the competencies of a person
and the requirements of a job, or an imbalance
between required numbers/skills of staff and staff
available.
[Mobility]
The capacity or facility of movement of personnel
between positions, organizations and regions.
Mobility of health care personnel is an important issues in the allocation of personnel withina health care system (see deployment and brain
drain).
[Motivation, satisfaction]
Motivation – individuals’ degree of willingness tosustain efforts towards achieving certain goals.
(See System of Incentives)
Satisfaction - Contented state of mind that affects
or motivates behavior. (See Systems of Incentives)[Outsourcing, Outcontracting]
To obtain goods or services (sometimes alreadyprovided by the staff of the organization, thus
implying a process of transfer) by contract from asource outside an organization or are.
[Payment mechanisms]
Methods and systems through which health careservice providers are reimbursed. Examples of
payment mechanisms are fee-for-service, capitation, bonus payment and case payment.
Hicks V, Adams O, Pay and non-pay incentives,
performance and motivation, prepared for the
Global Health Workforce Strategy Group. World
Health Organization, Geneva, December 2001.

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資料 4. Glossary

Performance management, evaluation]
Performance Management – Process of optimizing
productivity and quality of work of the workforce.
This includes designing or adapting performance
management and performance appraisal systems.
Martineau and Martinez, 1997)
Evaluation - assessment process that provides
feedback to workers on their performance andensures the quality and effectiveness of services
provided.
[Personnel information system]
National and/ or local information system thatprovides, analyses, evaluates and distributes information needed to support decision-making andhealth personnel management and practices.
[Productivity]
Refers to outputs extracted from given inputs,
such as patients seen per doctor, number of procedure per provider, and so on.
[Psychological contract]
Describes a reciprocal relationship which may be
defined as the mutual expectations of the individual and the organization with each other. The
psychological contract is often unwritten and unspoken, but nevertheless represents each party’s
expectations for the relationship’s continued existence . Adams, O., Hicks, V.:Pay and Non-Pay Incentives, Performance and Motivation, Prepared
for WHO’s December 2000 Global Health Workforce Strategy Group, Geneva.
[Recruitment]
Process of searching for personnel to enter a particular job or position.
To strengthen or increase the supply of personnel
to perform services.
[Regulation of practice: certification, licensing,accreditation, professional discipline monitoring144

and dealing with professional errors)]
Regulation of Practice – Formal recognition granted by a representative body (usually at national
level) to an individual or group to verify thatcertain predetermined educational requirements
and/or professional standards have been met.
Such mechanisms are implemented to ensure
maintenance of standards and the quality ofhealth care services provided. In some systems
there will be a requirement to re-certify or re-accredit at specified time intervals.
Accreditation – approval of an educational program or an institution by a governmental or voluntary body.
Certification – process by which a non-governmental agency grants recognition to an individual
who has met certain qualifications.
Licensing – (of health personnel): governmental
authorization of a person to engage in a healthprofession occupation.
Registration - (of official recording of the names of
persons who have certain qualifications to healthpersonnel); practice a profession or occupation.
World Health Organization. HUMAN RESOURCES
FOR HEALTH: A Toolkit for Planning, Training andManagement, WHO, Geneva, 2001
[Remuneration]
Payment of an equivalent to a person for a service
or expense.
[Retention of staff]
Maintenance of health personnel by offering adequate opportunities for re-training and career
management assistance (see career management).
[Skills mix]
Refers to the mix of posts in the organization, themix of employees in a post, the combination of

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用資料 4. Glossary

skills available at a specific time, or it may also refer to the combinations of activities that compriseeach role, rather than the combination of different
job titles. Skill mix is a strategy used to ensure themost cost-effective combination of roles and staff.
Buchan J, Ball J, O’May F, Skill mix in the healthworkforce: Determining skill mix in the healthworkforce: guidelines for managers and healthprofessionals, WHO working paper no.
[Staffing]
Process of recruiting, allocating and retaining
staff or personnel, in terms of mix and number of
personnel (the right combination of categories of
personnel and adequate numbers per category),
and its deployment, of its distribution by region(including internal migration pattern), by level ofcare, by type of establishments, by gender, in order to meet the service objectives.
(Martinez and Martineau, 1997)[Stock]Quantity of accumulated productive assets. In
workforce planning, “stock” refers to the current
composition of the workforce. In budgetary terms
it can refer to mobile clinics as well as fixed assets
are part of the capital stock of the health care system.
[Stress : occupational stress]
An individual may perceive stress related to theiroccupation or job because of the interaction between personal factors and workplace characteristics; especially specific job role demands. Occupational or job-related stress adversely impacts
productivity, absenteeism, worker turnover, andemployee health and well-being (Reissman, D.;
Orris, P.; Lacey, R.; Hartman, D.: Downsizing, Role
Demands, and Job Stress. Journal of Occupational& Environmental Medicine. Volume 41(4) April

1999 pp 289-293)[Substitution]
Process of delegating tasks to less qualified personnel with the goal of improving cost-effectiveness.
[Systems of incentives]
Sets of rewards and sanctions to improve staff
performance and motivation by providing financial
and non-financial benefits such as flexible working
schedule and training, education and career development opportunities.
[Teamwork]
Work done by a group formed by associates withdifferent skills and backgrounds, with each doing apart but all subordinating personal prominence tothe efficiency of the whole (see Skills Mix)
[Training: in-service]
Training – maintenance and adaptation of thecompetencies of existing personnel within thecontext of their current position.
[Unemployment, underemployment]
Unemployment – The condition in which personnel available for work in a labor market are not
employed.
Underemployment - The condition in which personnel available for full-time work in a labor market is (1) employed at less than full-time or regularjobs or (2) in jobs where their full skills are notutilised, or are inadequate for economic needs.
[Trade unions, Unions]Representative bodies of personnel that act toprotect and defend the legal rights and interestsof their members. Unions influence the contents
and the pace of implementation of reforms agendas, especially in issues involving conditions ofpay, terms of employment or job specifications.  
[Work organization]

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資料 4. Glossary

Process of defining arrangements of work in an
organization, coordinating tasks and assigning
responsibilities. Coordination of clinical departments in hospitals, which brings together professionals from different disciplines, is one example
of work organization. (see Teamwork)[Workforce dynamics]
The way the stock changes through movement
into (entry of newly trained individuals, immigration, re-entry) and out (retirement, death, emigration, exit of the occupation) of the workforce.
[Workload]
The amount of work expected or assigned to a
specific position or to one person (can also be atechnical term related to “measures” of activity byindividuals or teams.).
[Workforce planning: needs, supply and demand,
surpluses, shortages]
Comprehensive process to provide a frameworkfor staffing decision-making based on an organization’s mission, strategic plan, budgetary resources,
and a set of desired workforce competencies. It
incorporates an analysis of present workforce toidentify competencies needed in the future andpossible gaps and surpluses, preparation of plansfor building workforce (See Capacity building), andevaluation process to assure objectives are being
met. (See Performance Management and Human
Resource Planning)[Working conditions, terms of employment, benefits]
Working conditions - Characteristics of the environment in which a person is expected to work.
Includes terms of employment, benefits, physicaland social climate.
Terms of employment - Conditions that regulate
and define employment contracts (See Job Analy146

sis)
Benefits - Advantages that a person is entitled tosuch as maternity leave and health insurance (SeeSystem of Incentives)Thanks to the contribution of the following individuals: Dr. James Buchan (Queen Margaret
University College, Edinburgh), Dr. Paulo Ferrinho(Department of Health, Lisbon, Portugal), Dr. Peter Hornby (Keele University), and Dr. Felix Rigoli(Paho), for their valuable comments and suggestions.

テクニカル ・ レポート vol.04 保健人材開発システム分析モデルと開発途上国における活用テクニカル ・ レポート vol.04 作成協力者
清水孝行 （NCGM 国際医療協力局派遣協力課）
園田美和 （NCGM 国際医療協力局派遣協力課）
田村豊光 （NCGM 国際医療協力局派遣協力課）
永井真理 （NCGM 国際医療協力局派遣協力課）
橋本麻由美 （NCGM 国際医療協力局派遣協力課）
藤田則子 （NCGM 国際医療協力局派遣協力課）
阿部貴美子 （Queen Margaret University, U.K.）
Anthony Zwi (University of New South Wales, Australia)
Arie Rotem(University of New South Wales, Australia)

テクニカル ・ レポート編集元
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2013 年 3 月 発行

このテクニカル ・ レポートは厚生労働省国際医療開発研究費 22 指 8 「紛争後国家や脆弱国家における保健人材開発制度の確立に関する研究」 の研究成果、 および独立行政法人国際協力
機構 （JICA） カンボジア地域における母子保健サービス向上プロジェクト、 コンゴ民主共和国保健人材開発支援プロジェクト、 仏語圏アフリカ保健人材管理集団研修の経験をもとに作成された。
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147཯ᇌᘍ૎ඥʴ‫׎‬ᇌ‫׎‬ᨥҔၲᄂᆮ⇡∙⇥∞‫׎‬ᨥҔၲңщ‫ޅ‬ἘἁἝỽἽὉἾἯὊἚ vol.

04

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᧏ႆᡦɥ‫↚׎‬ⅹↀ↺෇ဇHouse Model-User's guideNaonal Center for
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