One of the critical barriers for low resource countries to make progress towards achieving the health millennium development goals (4, 5 and 6) is a crippling shortage in the health workforce. This issue was first highlighted in the 2006 World Health Report which called attention to what had become a crisis. As cited in a recent speech by WHO Director General Margaret Chan , it is now recognized that the structural adjustment policies enacted in the 80s severely constrained manpower resources in countries with high debt burdens. WHO has established a target minimum ratio of 23 health professionals (typically made up of a combination of doctors, nurses and midwives) per 10,000 inhabitants as necessary for achievements of the health MDGs. Many countries, particularly in sub-Saharan Africa, are way below this number even when factoring new cadres, such as clinical, medical or health officers with varying competencies to provide preventive and curative care. Furthermore, many countries have also relied on task shifting to community health (extension) workers. These human resource innovations show promises and would be further reinforced through ensuring that regulatory frameworks are in place and performance management systems, compensation and supervision, are reinforced. Of course for these strategies to work, workers also need the right equipment, drugs and supplies to carry out the tasks they are mandated to perform.
Given that the critical period of vulnerability for newborns in the day of birth and in the first week thereafter, and some of the interventions that would enhance their survival depend on well-trained health professionals, critical shortages in their numbers (and particularly those skilled to attend births) limit the abilities of countries to scale up effective life-saving newborn health interventions.
On the international front, the attention to health workforce issues has come to fore since the 2006 report and been part of high level meetings of the G8, G20 and African Union. A separate international conference was held in Kampala in 4-7 March 2008 under the aegis of the Global Health Workforce Alliance (GHWA), whose secretariat is at WHO in Geneva. The momentum has led to the development and approval by the WHO General Assembly last May of a new Code of Practice on the International Recruitment of Health Professionals. This is meant to address another root cause of the health workforce crisis, the extensive migration of health professionals from low resource countries to higher resource countries, particularly in the Middle East and the West. The code marks a significant step forward in that it was unanimously approved at the General Assembly, a rare feat. On the down side, it presents a voluntary code of practice and does not have an enforcement component.
What is exciting about the Code of Practice is that Article 6 and 7 in particular calls on nations to gather comparable data, establish human resource information systems, exchange information and conduct research on health workforce issues. It specifically calls on triennial reporting of key HR indicators to WHO. Hopefully, this will be accompanied with resources from donor countries to poorer countries to establish these systems. Given that data on human resources for health in general, and migration specifically, is very difficult to obtain, this is a welcome development.
WHO has also released a new set of global policy recommendations for encouraging health professionals into rural areas (“Increasing access to health workers in remote and rural areas through improved retention”, WHO 2010 – may require membership into knowledge gateway). While this is a 79-page document, it includes an interesting set of tables in Chapter 4 about the quality of the evidence for the various recommended interventions.
The GHWA is also working on an HRH appendix to the United Nations Secretary General Joint Action Plan for Women’s and Children’s Health whose draft is being circulated for comment.
While HRH issues are often not the focus of the HNN community’s attention, they are often very much in the minds of those policy makers to whom we seek to advocate. Thus, dear network member, doesn’t it makes sense to gain some understanding of important developments in this area? How else is newborn survival linked to HRH issues?