Midwives studying in Somalia, image (c) WHO
The World Health Organisation is making a strong move to tackle a common and vital theme in all its global health initiatives, an issue which, if ill-managed, would jeopardise even the best intentioned and best planned projects: human resources for health. The effective recruitment, education, support, deployment and distribution of human resources is a key factor in achieving the goal of universal health coverage.
In a wide-angle, varied and internationally inclusive report by Mozart Sales, Marie-Paule Kieny, Ruediger Krech and Carissa Etienne the WHO links together its on-the-ground research, the wider policy governing global health human resources and the issues which arise when attempting to fulfil policy in practical terms in diverse settings. They identify some fundamental ingredients of effective human resources in this field, starting with the fact that there should be enough practitioners, who are talented, well educated, respected, valued and (consequently) motivated.
However, they raise questions about whether enough workers will be available to meet the need that exists in terms of numbers and locations of patients worldwide; to put in the time investment required to ensure significant health gains; to make an applied study of different contexts' health needs; to train the right numbers of healthcare workers to a good standard and ensure long-term support for them; and to establish long term health practices for communities and found permanent healthcare systems which deliver long into the future.
From 10th - 13th November 2013 the Third Global Forum on Human Resources for Health will be meeting in Brazil to map out context-sensitive and workable plans and also work on ensuring political leadership and advocacy to ensure that the issue is seen, rightly, as a high priority necessitating action.
As the authors affirm,
Health workforce development is partly a technical process and, as such, it requires expertise in human resource planning, education and management. It is also, however, a political process requiring the will and the capacity to coordinate efforts on the part of different sectors and constituencies in society and different levels of government.
The alliance of healthcare expertise, solid education, political will, smart planning and
management is not some kind of impossible health Grail, as evidenced by successful initiatives in Brazil, Sudan, Cameroon, Thailand, Ghana and Indonesia (referenced at the end of the original bulletin). Concrete measures to address all aspects of the healthcare system have resulted in measurable improvements in health, with each location being assessed and then 'treated', so to speak, according to its specific needs. However, strong leadership endorsement and a holistic view are necessary, otherwise measures are bitty, short term and do not ensure either the longstanding health of the populations being treated or the long term development of a viable and competent health workforce.
There are many factors which can affect the policy, provision and practicality of developing strong human resources for health. The authors isolate certain issues which must be taken into consideration: an understanding of market forces; the particular needs which arise when developing health workers for long term roles in rural areas; the international migration of health workers; utilising the expertise which "mid-level and community-based health workers" have, which may in some cases be equivalent to the treatment doctors could give, and meeting their needs; the issue of decent, respectful and liveable pay for health workers; the ways in which emerging technologies can be harnessed to support both educational and systemic elements of human resources for health; and the challenges to existing systems and skills of the movement towards universal healthcare.
As the report authors state, this "ambitious and transformative agenda .... places citizens' right to health at the heart of development policies and ... treats progress in the area of human resources for health as a key driver of broader health system development."
This will require investment and, in some countries' cases, outside financial support which must be utilised in a targeted way, based on close research instead of assumptions or generalities. The authors provide an abundance of research which shows the diversity of issues playing into the vision of universal healthcare, from the distribution of healthcare workers in Brazil, the training and employment of midwives in Ethiopia and Somalia, emergency measures to improve health care in Cameroon and working with a "fragmented" workforce in Sudan.
These examples demonstrate in their variety and detail the necessity for the world community to move towards the implementation of universal healthcare while providing strong advocacy and leadership from the top; applying rigorous and context-aware analysis at the mid level of research, agenda setting and policy development; establishing practical systems which have breadth, flexibility and longevity with strong distribution in both rural and urban settings; and, when it comes to dealing with health workers themselves, ensuring that individuals are well trained, well supported, well remunerated, well respected and able to use their skills in a manner which ensures that they, their patients and the wider healthcare system in which they meet can all grow, change and flourish in the long term.