HIFA2015: Priorities in Human Resources for Health - Background information
Global conversation starts Monday 9th September, through September and October, sponsored by the Global Health Workforce Alliance
Join here: www.hifa2015.org
The text below is intended to provide a brief introduction to some of the issues in Human Resources for Health. Please keep it as a reference for the discussions over the coming weeks. It is based on a GHWA fact sheet, available here: http://www.who.int/workforcealliance/media/KeyMessages_3GF.pdf
THE GLOBAL HEALTH WORKFORCE IS IN CRISIS.
Billions of people are denied access to safe, effective healthcare as a result of workforce shortages and lack of support to teh existing workforce. Here are just a few of the consequences:
- 48 million women give birth each year without a skilled health worker present
- 6.9 million children under 5 die from treatable & preventable diseases every year
- Ninety percent of all maternal deaths and 80 percent of stillbirths happen in just 58 countries. These countries have only 17 percent of the worlds midwives and physicians.
Below are some of the cross-cutting issues of the Global Health Workforce Crisis. All of these issues need to be addressed to realise progressively the GHWA vision: Every person everywhere will have access to an informed,
supported and motivated health worker. For further reading, please use the links below, or browse the GHWA Knowledge Centre, a collection of resources on HRH issues, organised by theme:
http://www.who.int/workforcealliance/knowledge/en/
HIFA members and others are invited to share their experience and expertise on any of the issues below, or indeed any other issue that you perceive to be important. Let us know what you think have been the Human Resources for Health achievements of the past 10 years, globally and in individual countries. Such achievements may be in any domain: research, policy, and/or implementation. What have been the failures or disappointments of the past 10 years? Are we making progress or are we falling behind? What can be done to improve the situation, globally or in individual countries, over the next 10 years. Please send your messages to: hifa2015@dgroups.org
1. URGENT ACTION IS NEEDED: Global commitments to the health-related Millennium Development Goals and efforts to increase access, coverage and equity of health services will not be met unless action is taken now to increase human resources capacity in health services. Addressing shortages and inequitable distribution so that the right health personnel will be in the right place at the right time must be made a global health priority.
Further reading:
Human resources for health: critical for effective universal health coverage. (GHWA, 2013)
http://www.who.int/workforcealliance/knowledge/resources/hrhforuhcpost2015/en/index.html
2. THIS MUST BE RECOGNISED UNIVERSALLY AS A GLOBAL CRISIS: More than a quarter of the worlds countries do not have enough health workers. The world needs 4 million new health workers to address global workforce shortages. The urgency to address the health worker crisis is a challenge for all high-, middle- and low-income countries alike. Health worker shortages affect Germany and the USA, just like they affect India or Uganda. Western countries import workers from developing countries, because they are also short of trained health workers. Aging populations are exacerbating the problem.
3. IMPROVE URBAN/RURAL DISPARITY: The acute shortages and inequitable distribution of health workers within countries are also major barriers to increasing coverage of health interventions to those most in need. Fifty percent of the worlds population lives in rural areas, but 75 percent of doctors and 62 percent of nurses serve urban populations. For instance, the capital city of Cameroon, Yaounde has 4.5 times more health workers than the poorest province in the country.1 Approximately 80 percent of the Malawian population lives in rural areas, yet only 30 percent of the countrys health staff work there.
Further reading: How to Recruit and Retain Health Workers in Rural and Remote Areas in Developing Countries (World Bank Guidance note, Health,
Nutrition and Population Discussion Paper)
http://www.who.int/workforcealliance/knowledge/resources/wb_retentionguidancenote/en/index.html
4. MANAGE MIGRATION: Developing countries lose some of their most valuable health workers to richer countries. For example, 75 percent of doctors trained in Mozambique now work abroad. The majority work in Portugal (1,218) and the rest work in South Africa (61), US (20) and UK (16).2 When significant numbers of doctors and nurses leave, the countries that financed their education lose a return on their investment. Geographical and financial barriers that prevent
people from accessing a health worker when they need care must be removed.
Further reading: WHO Global Code of Practice on the International Recruitment of Health Personnel (2010)
http://www.who.int/hrh/migration/code/full_text/en/
5. IMPROVE RETENTION: Effective management of trained health workforce is fundamental. To expand coverage of essential interventions to those who need them the most, health workers must be incentivized with improved working conditions (adequate equipment, facilities, supervision, opportunities for advancement and fair remuneration) to retain them to serve in their home countries/regions or undeserved areas. In Zambia, health workers receive an extra 25% recruitment and retention allowance to their basic monthly salary; those that serve in rural areas receive an additional 25% rural and remote hardship allowance. These policies have been effective in decreasing the migration of nurses.
Further reading: Rapid Retention Survey Toolkit: Designing Evidence-Based Incentives for Health Workers
Health worker retention toolkit (Dec 2012, PDF 3Mb):
http://www.who.int/workforcealliance/knowledge/resources/retentiontoolkit/en/index.html
6. USE A HOLISTIC APPROACH: Countries must develop innovative solutions for strengthening their health systems, based on priority health needs and concrete strategies for achieving better health outcomes. Adopting a holistic approach to the crisis, recognizing the inter-dependence and the inter-connectedness of the different areas of health workforce development is critical. Stand-alone interventions will not be effective, nor sustainable. Strengthening health systems means not just making changes within individual or vertical disease-specific programs but extending that change across the system. For instance, when an investment is made in training new health workers, parallel efforts must be made to ensure that adequate resources, management systems and incentives are put in place so to ensure that the new graduates can find employment in the health sector.
Further reading: Third Global Forum: new template for eliciting HRH commitments (2013).
http://www.who.int/workforcealliance/en/
7. SCALE-UP TRAINING: Countries must work to increase the quantity of health workers while maximizing the potential of existing health workers, including community health workers who play an important role in reaching remote and excluded populations. Government-wide support is critical in order to strengthen health workforce policy, planning, financing, management, monitoring and reporting. Through the Ministrys implementation of the Emergency Human Resource Plan (EHRP 2004-2010), Malawi extended the health workforce by 53%, from 5,453 in 2004 to 8,369 in 2009 across 11 priority cadres.
Education and training of health workers is an immediate priority, bearing in mind that training a doctor, for example, requires 5-8 years, so the
effects of actions taken today will not be felt instantly. The health workforce must be responsive and respectful to the populations they
serve, taking into account socio-cultural needs. This means educating the health workforce, ensuring an appropriate gender balance and skills mix and having oversight, supervision and regulatory mechanisms. Building capacity to enable countries to retain and absorb newly trained health professionals is also crucial.
Further reading: Scaling Up, Saving Lives (2008)
http://www.who.int/workforcealliance/knowledge/themes/training/en/index.html
8. INTRODUCE TASK SHARING where appropriate. While initially driven by the urgency of conquering the HIV/AIDS epidemic, task sharing holds the potential of enabling countries to build sustainable, cost-effective and equitable health care systems, thus moving closer not only to the MDGs, but also the Universal Health Coverage goal. It is safe and effective for health workers in communities to carry out a variety of healthcare tasks if they receive training which emphasis a team based approach to the delivery of care, supported by the necessary regulatory frameworks that authorize them to operate within the full scope of their profession.
Further reading: WHO Recommendations Optimizing health worker roles for maternal and newborn health
http://www.optimizemnh.org/
9. FOSTER LEADERSHIP: An effective response to the health workforce challenges entails collaboration among multiple sectors of Governments (including health, education, finance, labour, science and research), and multiple constituencies including also the private sector, professional associations, international organizations, development partners, foundations and civil society.
Further reading: Governance and human resources for health (Article in Human Resources for Health journal, 2011)
http://www.who.int/workforcealliance/knowledge/resources/hrhgovernance/en/index.html
10. INCREASE FINANCING: Funding must be long-term and sustainable if it is to contribute in a sustainable and effective manner to strengthening national health systems. Financing is not just about raising funds, but also about how the funds are used to increase efficiency, effectiveness, and equity ("making the money work"). Every country with critical shortage of health workers should develop and implement a budgeted, national health workforce strengthening plan, integrated in the national health strategy. This plan should include a special focus on covering the poor and most excluded segments of society, and strategies to train and retain skilled health workers as well as maximize health worker productivity and performance. Development partners should maintain and increase health resources and technical support to respond to countries demand, while national governments should strive to sustain and increase domestic health spending and use resources effectively to move towards UHC.
Further reading: "More money for HRH: more HRH for the money" (Global Health Workforce Alliance, TOPIC BRIEF: Financing Human Resources, 2012)
http://www.who.int/workforcealliance/knowledge/resources/hrhfinancingbrief2012/en/index.html
11. WORK TOGETHER. Partnership is critical to success. Cross-government support and partnerships must ensure that health workers have the necessary skills, competencies and incentives to provide an effective service. There should be mechanisms to measure, reward and sustain high-quality service provision. Within governments, responses to this cross-sectoral problem should involve national Ministries of Health, Labour, Education, Public Service and Finance .The only way forward is to work together--North and South, East and West, rich and poor. Everyone has a part to play in the solution to this crisis.
Further reading: Third Global Forum: new template for eliciting HRH commitments (2013).
http://www.who.int/workforcealliance/en/
With thanks,
HIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA2015 campaign and co-director of the Global Healthcare Information Network. He is also currently chair of the Dgroups Foundation (www.dgroups.info), a partnership of 18 international development organisations promoting dialogue for international health and development. He started his career as a hospital doctor in the UK, and has clinical experience as an isolated health worker in rural Ecuador and Peru. For the last 20 years he has been committed to the global challenge of improving the availability and use of relevant, reliable healthcare information for health workers and citizens in low- and middle-income countries. He is particularly interested in the potential of inclusive, interdisciplinary communication platforms to help address global health and international development challenges. He has worked with the World Health Organization, the Wellcome Trust, Medicine Digest and INASP (International Network for the Availability of Scientific Publications). He is based near Oxford, UK.
www.hifa2015.org
mailto:neil.pakenham-walsh@ghi-net.org