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EXTENDED EXECUTIVE SUMMARY     18



                 However, based on the comprehensiveness of the underlying factors that are taken into
                 account in estimating HRH requirements, and the belief that one of the objectives of a health
                 system must be to address the health care needs of its population, the needs-based approach
                 was judged the most appropriate approach to be used. This study is the first study that
                 used a needs-based approach in projecting HRH workforce supply and requirements in the
                 Malaysian context. This study also is the first study that used System Dynamics (SD) simulation
                 modelling approach, instead of using MS Excel tool, to develop and integrate the supply and
                 the needs-based requirements projection models. SD is known to be a dynamic and flexible
                 method, widely used for modelling complex problems. It has been used in many workforce
                 planning studies in Canada and the United Kingdom (Birch, 2007; CfWI, 2013b, 2013c, 2014b).

                 The following sections provide, in a more detail, the modelling methods and processes
                 carried in this HRH workforce modelling and projection study.


                 2.1    The HRH Workforce Supply Modelling: The In-and-Out Flows Approach



                 The supply or availability of HRH is conceptually simpler to estimate and project.
                 The supply projection model is devoted to identifying how many HRH are or will be
                 available  to  deliver  health  services  to  the  population.  It  requires  careful  calculation  of
                 the  numbers  of  new  entrants  into  the  health  workforce,  the  capacity to  produce  more
                 or fewer health workers in the future and recruit them into the health services industry,
                 and the loss rates through retirement, emigration, death or pre-retirement leaving. This
                 way of supply calculation may be called formally, as the In-and-Out Flows approach as
                 illustrated in Figure 6. The inflows may include the graduated workforces from local and
                 overseas universities, and in-migrations workforce and the outflows are workforces who
                 leave the system due to complete retirement, change in profession, emigration or death.


                         Figure 6: The In-and-Out Flows approach for HRH workforce supply projection







                                Inflow                 Stock of Health        Outflow
                                                          Providers
                                                                            Retire
                                                                            Change
                             Education
                             Immigration                                    profession
                                                                            Emigration
                                                                            Death

























                                                             SUPPLY AND NEEDS-BASED REQUIREMENT PROJECTIONS OF MALAYSIAN HUMAN
                                                                RESOURCES FOR HEALTH USING SYSTEM DYNAMICS APPROACH 2016 - 2030
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