Empowering patients and strengthening communities for real health workforce and funding targets

Abstract

The setting of ambitious targets for expanding the health work force and improving its quality, efficiency and equitable service delivery is a task long overdue. It has been nearly one decade since the minimum needed density of physicians, nurses and skilled midwives – 2.28 workers per 1000 inhabitants – was established, but without attention to other health worker cadres. Furthermore, the estimate was based on only two areas of health worker activity – skilled birth attendance and measles immunization – that represent a minuscule fraction of people’s health-care needs. 1 As a result, it grossly underestimated the health workforce needed in low- and middle-income countries to respond effectively to the pandemics of human immunode ficiency virus infection (HIV), tuberculosis and malaria; the burden of neglected tropical diseases; unmet needs in child, maternal and sexual and reproductive health; and the growing prevalence of noncommunicable diseases. In addition to being unsuitable for responding to epidemiological trends and other contextual variables, the established worker density target was minimalistic and non-dynamic, for it conveyed the impression that meeting only the most rudimentary needs of health systems would suffice to alleviate the crisis in the area of human resources for health. No aspirational goals were set for progressively expanding and strengthening a health workforce to meet a population’s broad-spectrum health needs. Cometto & Witter 2 are correct in asserting that much has been learnt about the value of properly trained mid-level 3 and community health workers 4 in improving health service coverage and efficiency. Work is still being conducted to determine the best skill mixes and workforce ratios for different countries and to establish good practice models for health workforce training, task sharing and teamwork. Although simplification, combined with equity and quality, is the overall goal, the path is laborious given the headwinds of bureaucratic intransigence, chronic underfunding and persistent brain drain. To overcome these headwinds, it is crucial that health workers be paid living wages and given incentives to work in neglected areas. 5