Progress patchy on health-worker crisis

Abstract

Hundreds of health experts met in Bangkok last week for the second global conference to tackle the worldwide shortage of health workers. Patralekha Chatterjee reports from the meeting. With a bomb blast in Moscow's airport, political turmoil in Egypt, and shock waves rippling through global markets last week, the crippling shortage of health workers worldwide stood little chance of grabbing headlines. But the key message from the second Global Forum on Human Resources for Health, held in Bangkok recently is troubling: national and global leaders are not treating the health-worker crisis, most dramatically evidenced in sub-Saharan Africa, as one of the most pressing issues of our times. At risk are the lives of the millions of people who need medical assistance every year and global development goals. Worldwide, there is a shortage of nearly 4·3 million health workers. But 57 countries (39 of which are in Africa), which have fewer than 23 health workers for every 10 000 people, are at a crisis point, WHO's World Health Report noted in 2006. Crisis or priority countries also include some of Asia's burgeoning economies—eg, India and Indonesia. But the health-worker crisis is not just about numbers. It is also about the unequal distribution of workers, lack of training, and international migration from poor countries to rich countries. The declaration made at the first Global Forum on Human Resources for Health, held in Kampala, Uganda, in March, 2008, flagged the urgent need to act on six interconnected strategies to shore up the health workforce. These relate to strengthening leadership, better use of evidence, scaling up training, improving retention of health workers, managing international migration, and increasing investments for health workers. What has happened since the Kampala Declaration and the Agenda for Global Action (AGA)? The progress report released in Bangkok last week by the Global Health Workforce Alliance (GWHA) offers a mixed picture. There are national action plans and signs of promise but less measurable action on the ground. Of 57 countries afflicted by the health-worker crisis, six had not responded to the questionnaire used for the survey. “The data is not perfect. There were no baseline surveys. The answers have been in the yes-no format. But despite these limitations, the report provides a good snapshot of policies on human resources for health [HRH] and gives an idea of governance in the priority countries. This is the first attempt to track progress in implementing the Kampala Declaration and the AGA”, says Mubashar Sheikh, executive director of the GHWA, which convened the meeting alongside Prince Mahidol Awards Conference, WHO, the Japan International Cooperation Agency. Indeed, despite the gaps, the report offers important insights into political will to tackle the health-worker crisis within a country. Of 51 countries which took part in the survey, 44 had a Human Resources for Health (HRH) plan but only 29 had started implementation. 33 countries said they had a national coordinating committee for HRH, most with some degree of representation beyond the ministry of health, but only 22 had a mechanism to inform policy making through data sharing. Among the report's most revealing findings are those relating to community-health workers. Despite the much-talked about pivotal part such workers play in scaling up essential health services, this group still does not get adequate support. Most countries reported high enrolment in training programmes for doctors, nurses, and midwives (53% to 69%) but for community-health workers, the proportion was less than a third. The Bangkok Forum showcased many inspiring country case studies. For example, Malawi used salary supplements as an emergency measure to address HRH issues in its public health sector. Meanwhile, Ethiopia has nearly halved its child mortality since 1990, despite a low overall density of doctors, physicians, nurses, and midwives. The key to Ethiopia's success story has been the innovative use of community-based health extension workers. Donor funds helped train Ethiopia's extension workers and, in total, 39 of 51 crisis countries reported getting donor support to implement their HRH plans. But with the future funding climate unpredictable, so is progress on the health-worker crisis. As Brook Baker from the international non-governmental organisation, Health Gap, points out there are “no firm, new commitments of cash”.