Endorsements by THIS Monday please: G8 statement on health
worker crisis
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Dear All,
A quick reminder for those of you who are interested in endors-
ing the statement (copied below) to the G8 on the health worker
crisis, please get your signatures in as soon as you can! While
we are accepting signatures (health workers, NGOs, and govern-
ment officials; religious leaders also welcome) through June 20,
we will be issuing a press release THIS Monday, June 13, and
will include this statement and a preview of the signatures. The
health worker crisis issue has not been getting much attention
throughout all the talk and media surrounding the build-up to
the G8, so we are speeding up our earlier plans. Please help get
the health worker crisis the attention it needs!
If you would like to sign, best is if you can sign through our
website: http://www.phrusa.org/campaigns/aids/g8message/. Please
e-mail me with any questions. And please forward to colleagues!
Please note an addition to the preamble, placing this call in
the context of need for more aid, debt cancellation, fair trade,
and achieving 3 by 5.
Peace,
Eric
Eric A. Friedman
Physicians for Human Rights
1156 15th Street, NW, Suite 1001
Washington, DC 20005, USA
Tel: +1-202-728-5335 ext. 303
Fax: +1-202-728-3053
mailto:efriedman@phrusa.org
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Statement for Group of 8 meeting in July 2005 on actions needed
to support human resources for health to achieve the Millennium
Development Goals
We are nurses and doctors, pharmacists and laboratory techni-
cians, medical assistants and community health workers. We are
non-governmental organizations. We are [members of] govern-
ment[s]. We are people with HIV/AIDS. Some of us sit in govern-
ment ministries, some of us work in rural health facilities, and
some of us work wherever it is we find people in need. We share
in common a deep concern for the health and well-being of the
members of our communities and citizens of our own and other
countries. Yet despite our best efforts, health systems in many
developing countries are in crisis, and millions of people whose
lives we could save and whose health we could preserve are dying
and becoming seriously ill.
Health workers are at the core of these health systems. Health
systems collapse where there are too few health workers, or
health workers without proper training, supervision, and manage-
ment and support structures, or health workers who are separated
from their community structures and needs, or health workers who
are themselves ill and dying and working in unsafe conditions.
Yet this is the situation many of our countries face. Annual
health budgets that are often $10 or less per capita, the exodus
of health professionals, failure to prioritize human resources,
and the HIV/AIDS pandemic, both through the disease burden it
creates and its impact on health workers themselves, have com-
bined to create a crisis. Until we surmount this crisis in human
resources for health and health systems, preventable death and
suffering on a massive scale will continue.
Overcoming this crisis will require the joint efforts of your
countries and ours. We will take the lead, but require coopera-
tion and support in what must be a global response to a problem
of global proportions. Together, we must develop and implement
sustainable and greatly expanded responses that address underly-
ing causes to the health worker crisis, that improve health sys-
tems, and that dramatically improve access to quality health
services for people in underserved areas.
Everyone has the right to the highest attainable standard of
health. Fulfilling this right requires addressing the crisis in
human resources for health and in health systems. The efforts of
our countries alone will not be enough to resolve this crisis
and secure for every person the dignity she deserves. We there-
fore urge your governments to meet your obligations under the UN
Charter and other human rights law to join us in taking the ac-
tions required to resolve this crisis.
The investments required to overcome the health worker crisis
are central to achieving the Millennium Development Goals, but
they are far from the only ones required. Accordingly, along
with the required investments in human resources, as detailed
below, we strongly urge greatly increased investment by the G8
to promote health and education, development and women's equal-
ity. Specifically:
* The G8 and other wealthy nations are legally and morally
obliged to meet the internationally agreed upon target of in-
vesting at least 0.7% of GNP in official development assistance.
We call upon all your nations to commit to rapidly reaching this
target, including by immediately doubling aid to Africa.
* We call upon you to agree to 100% multilateral debt cancella-
tion for impoverished nations to enable many of our own coun-
tries to significantly increase investments using domestic fi-
nancial resources in poverty reduction and human development.
* We call upon you to provide an immediate infusion of funds to
enable the 3 by 5 initiative to succeed in bringing AIDS treat-
ment to 3 million people by the end of 2005. In its December
2004 progress report, the World Health Organization estimated a
shortfall of $2 billion for 2005.
* We call upon you to remove trade barriers to agricultural and
other goods produced in poor countries.
To enable our countries to have the health workforces we require
to meet our people's health needs and achieve the Millennium De-
velopment Goals, we urge the members of the G8 to make the fol-
lowing commitments:
1. Strengthening national health systems
1.1 We urge you to support African and other developing coun-
tries that are experiencing crises in human resources for health
by providing the necessary financial and technical support to
enable our countries to develop and fully implement national
strategies on human resources for health as a central part of
any overall plan to improve service delivery and strengthen na-
tional health systems so as to achieve or exceed the Millennium
Development Goals.
1.2 We urge you to ensure that through your efforts and those of
others, the resources required to fully fund these strategies
are available.
1.3 We urge you to coordinate your investments and those of
other donors and organizations with those of regional communi-
ties and developing country governments, and to use local tech-
nical resources where possible.
1.4 Strategy development should be led by national authorities
with broad stakeholder participation that engages civil society
and responds to local needs.
1.5 Assistance in the development of strategies should not delay
the provision of urgently needed financial assistance and other
technical assistance.
2. Supporting and enlarging health worker capacity
2.1 We urge you to support, with financial and technical assis-
tance, national efforts to create conditions that facilitate
health worker retention and deployment to underserved areas, in-
cluding adequate compensation; improved health worker manage-
ment, planning, and information systems; incentives; continuous
learning opportunities; and; safe working environments for
health workers through universal precautions and other forms of
infection prevention and control, universal access to post-
exposure prophylaxis, and workplace HIV treatment and prevention
programs.
2.2 We urge you to support models of education and care that re-
spond to national circumstances and priorities, providing qual-
ity health care to the maximum number of people and expanding
health services in underserved areas. The models of care will
often include the development of high quality mid-level and com-
munity health worker cadres, effective competency-based training
strategies, and policies, training, supervision, and adequate
compensation to enable nurses to engage in advanced nursing
practices. We urge you to further support the development of ca-
reer pathways for mid-level and community health worker cadres,
permitting competence- and skills-based movement up the hierar-
chy of the health system.
2.3 Community members, including people living with HIV/AIDS,
have a vital role in supplementing the care provided by health
professionals. We urge you to support local, regional, and na-
tional efforts to empower community health workers and caregiv-
ers, including by enabling them to have the compensation, train-
ing, accreditation, supervision, and support structure required
to maximize their effectiveness. We urge you to support local
efforts to increase community awareness and capacity to partici-
pate in a comprehensive scale-up of prevention, care, and treat-
ment programming through activities such as treatment prepared-
ness, treatment literacy, and treatment adherence support.
2.4 We urge you to support expanded capacity of health profes-
sional training institutions including through incentives and
other support for faculty, expanded physical space, and creation
of new training institutions as needed, and to support these in-
stitutions in reviewing curricula to assure that the skills are
relevant to required public health needs and competencies.
2.5 We consider it a tragic irony that many of the same coun-
tries facing enormous human resources deficits have in our midst
large numbers of unemployed health care workers.
We urge you to take all necessary steps, working with our gov-
ernments and other parties, including international financial
institutions, to enable their rapid re-engagement.
3. Overcoming macroeconomic challenges
3.1 We urge you to seek agreement with the International Mone-
tary Fund and other international financial institutions, fi-
nance, health, and other ministers, and central banks to in-
crease fiscal space for expanded funding from external and do-
mestic sources, including debt cancellation, for health and
other forms of human development. Civil society must have a
voice in this process. Macroeconomic challenges should not and
need not impede the flow of the required resources.
3.2 We urge you to ensure that new and existing developing coun-
try agreements with the IMF and other international financial
institutions do not require or lead to freezes in health worker
recruitment, prevent payment of wage levels required to retain
health workers, or prevent the hiring of unemployed health work-
ers. Programs critical to public health should be exempt from
budget and wage ceilings contained in such agreements.
3.3 Long-term, sustainable economic growth requires investments
to reduce poverty and hunger, improve health and expand educa-
tion at all levels, empower women, and ensure environmental sus-
tainability, including through improving living conditions in
rural and slum areas and universal access to clean water and
sanitation.
3.4 We urge you to commit to providing your assistance in a
long-term and predictable manner, including for both bilateral
and multilateral mechanisms, such as the Global Fund to Fight
AIDS, Tuberculosis and Malaria.
4. Addressing health worker needs in high-income countries
4.1 We urge you to meet your country's own health care needs
without reducing the capacity of developing countries to meet
our health needs.
4.2 We urge you to meet your obligations under World Health As-
sembly Resolution 57/19, "International migration of health per-
sonnel: a challenge for health systems in developing countries."
4.3 We urge you to evaluate the recruitment practices of public
and private health providers in your country, and implement
strategies that will protect the health human resource base of
our countries. The strategies may include ending active recruit-
ment from certain countries and working with developing country
governments and regional and international organizations to de-
velop satisfactory policies on recruitment, such as through man-
aged migration with mutual benefits to both source and destina-
tion countries.
4.4 We urge you to take the necessary measures to increase your
country's supply of domestically-trained health care workers.
5. Supporting international organizations
5.1 The technical capacity and normative role of the World
Health Organization gives it a special role in addressing the
human resources for health crisis. We urge you to provide WHO
the additional funding it requires to support expanded and ac-
celerated large-scale technical assistance in this area; to
build its own capacity at headquarters, regional, and country
levels, including through interdepartmental collaboration and
nationally led teams, and; to enhance national capacities to de-
velop and implement strategies to meet Millennium Development
Goals, including effective development and management of the
health workforce. We further urge you to ensure that WHO has the
funds to develop and sustain a human resources for health obser-
vatory in Africa. All funding to expand WHO capacity should be
in addition to the funding WHO requires to support anti-
retroviral therapy scale-up.
5.2 The Global Fund to Fight AIDS, Tuberculosis and Malaria sup-
ports health system strengthening, including human resources. We
urge you to ensure that the Global Fund is fully funded, includ-
ing so that it can renew all deserving proposals from previous
rounds, fully fund Round 5, and launch Round 6 in a timely man-
ner. We further urge you to make available technical support to
help applicants develop ambitious proposals in the area of AIDS,
including treatment, tuberculosis, malaria, and health system
strengthening.
5.3 We urge you to support regional health and development or-
ganizations in their effort to address the human resources for
health crisis through regional and sub-regional interventions.
6. Ensuring soundness of donor programs
6.1 We urge you to ensure that your own funding mechanisms and
programs strengthen, and do not weaken through resource diver-
sion or other means, public health systems and their human re-
source capacities. Bilateral programs should help build local
capacity and utilize and catalyze local capacity wherever possi-
ble.