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In the absence of skilled health workers many people around the world will continue to die and suffer unnecessarily. With 57 countries identified by the World Health Organization as having a health workforce crisis, the global shortage of health workers remains a critical obstacle to achieving the Millennium Development Goals, as well as the global health goals of the US government’s Global Health Initiative (GHI).
Where Is the Health Worker in the GHI?
Launched in 2009, the GHI is designed to expand on existing collaborations with partner countries that strengthen health systems, provide high-quality health services, and prevent and treat infectious diseases, with a particular focus on women and children. “It is impressive that President Obama announced the GHI in May 2009, fewer than five months after entering office, and proposing a new initiative that would bring additional resources and also truly build on the US government’s investments in health system strengthening, including human resources for health,” says Maurice Middleberg, IntraHealth’s vice president for global policy.
The GHI includes expansion and appropriate deployment of the health workforce among its goals. However, the GHI has yet to define a clear approach for achieving its health workforce aims to ensure sustainable impact. As Middleberg emphasizes, “The GHI can be achieved only if health workers are present.”
Key Elements of a Strategy
To contribute to the conversation about the GHI, Middleberg has authored a strategic approach to the health workforce challenge that would support implementation of the GHI. Saving Lives, Ensuring a Legacy: A Health Workforce Strategy for the Global Health Initiative proposes that the US set a goal of increasing the global health workforce by 232,000 by 2014 and 580,000 by 2020. Key elements of the strategy include:
- A five-part technical approach that includes building the constituency for human resources for health; optimizing policies, plans, and management systems; strengthening workforce development; increasing workforce effectiveness; and fostering gender equity
- A focus on 25 countries that have a health workforce crisis and in which the US is already making a substantial investment to improve health
- An organizational structure that provides the necessary leadership, expertise, and coordination.
A New Series on Health Workforce Policy
Middleberg’s paper builds on the research literature and IntraHealth’s experience in leading CapacityPlus and other USAID-funded projects in human resources for health as well as from lessons learned from many other organizations’ work.
“Our goal is to advance both thinking and practice about human resources for health,” notes IntraHealth president and CEO Pape Gaye. “This paper marks the first of a series of global health workforce policy papers, and I hope they will engender a lively discussion and debate to move this pressing issue forward. We would love hear what our colleagues and readers think.”
Excerpts from the paper
Click on the titles to go to the referenced section.
| Foreward Because health workers save lives. This is the central credo of IntraHealth International and the impetus behind the Global Health Workforce Policy Papers, which are being launched with this edition. IntraHealth’s mission is to enable health workers to serve communities most in need . . . . |
Abstract The health workforce crisis is widely recognized as a critical obstacle to achieving the Millennium Development Goals, as well as the global health goals of the United States Government (USG). The Obama Administration’s Global Health Initiative recognizes this problem and includes . . . |
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| Because Health Workers Save Lives In 1993, I was on assignment in Pursat, Cambodia. My colleagues and I entered a small, one-room, rural health post. Lying on the floor was a heavily pregnant woman suffering from eclampsia, a dangerous condition of pregnancy-induced hypertension. Without treatment . . . |
Where Is the Health Worker in the GHI? It is now widely acknowledged that systemic deficits in human resources for health (HRH) pose a major barrier to the achievement of the Millennium Development Goals. The World Health Organization (WHO) has identified 57 countries that have a human resources crisis . . . |
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| Key Elements of an HRH Strategy This paper proposes a strategic approach to HRH that would help support implementation of the GHI. The key elements of the proposed approach are as follows: 1. Setting a global goal for increasing the health workforce, 2. Identifying a set of priority countries for . . . |
HRH Objectives for the the GHI "As currently formulated, the HRH goal in the GHI is Increased numbers of trained health workers and community workers appropriately deployed in the country" (Implementation of the Global Health Initiative: Consultation document n.d., 13). This rather vague formulation . . . |
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| Technical Approach Goals and objectives must be supported by a coherent, evidence-based approach. This paper touches on only the highlights of what the technical approach to an HRH strategy for the GHI should include. The proposed technical approach includes the following elements . . . |
Assessing Progress Like other aspects of health systems, HRH has been the subject of widespread debate and discussion of appropriate indicators for monitoring and evaluating progress. There are multiple dimensions to the health workforce issue. There has been controversy over issues of . . . |
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| Evaluation, Research, and Learning The parsimonious set of indicators proposed in Table 2 are intended only as a core set that the USG can track systematically across a set of countries. These can and should be complemented by other studies that feed into a larger effort to generate lessons learned from . . . |
Cost Physicians for Human Rights has estimated the average per-capita cost of training new health workers using WHO data from the report of the High Level Taskforce on Innovative International Financing of Health Systems (HLTF) (Eric Friedman, personal communication . . . |
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| Leadership and Management of the HRH Program One of the reasons that the GHI lacks an HRH strategy is that no person or office in the US government has responsibility for oversight and coordination of the US response to the health workforce crisis. It’s hard to imagine how the USG can muster a coherent response to HRH when . . . |
The Human Cost of Inaction The abstract language of “health workforce crisis” and “human resources for health” obscures the suffering of people in need who cannot reach a trained, supervised, and supported health care provider. A woman dies in labor. A child succumbs to pneumonia. A farmer is . . . |