Health workforce

Technical cooperation for the development of human resources for health in Portuguese-speaking countries of Africa (PALOP)

Meeting funded by the European Union [EC Project 9.ACP.MTR.04]

8–12 December 2008, Praia, Cape Verde - WHO coordinated an intercountry meeting to review the current situation and discuss strategies to improve the national and regional ability to develop and implement policies of human resources for health (HRH). The meeting also aimed to identify future activities and actions, at the national as well as the international level, including the Health Cooperation Strategic Plan (PECS) for the Community of the Portuguese Speaking Countries (CPLP).

Participants were:

  • Representatives of the Human Resources Directorates of Ministries of Health of Angola, Cape Verde, Guinea Bissau, Mozambique and São Tome and Principe;
  • Representatives of the Government of Angola responsible for the management of the project for PALOPs;
  • WHO Representatives and technical advisers in human resources for health or health systems in the countries and technical advisers` on HRH from Brazzaville and Geneva;
  • WHO ePORTUGUESe platform coordinator from Geneva;
  • Representatives of key partners in PALOPs, such as the Oswaldo Cruz Foundation, Brazil and the Institute of Hygiene and Tropical Medicine, Portugal;
  • World Bank Technical Adviser in human resources and health systems for the PALOPs.

The participants identified the needs and opportunities for HRH technical cooperation and agreed on the national and sub-regional interventions and technical support activities. They also agreed on the priorities for technical cooperation and activities to be implemented at national and sub regional levels, based on the project 9.ACP.MTR.04 of PIR-PALOP.


The importance of human resources for health is widely recognized as a cornerstone of health systems development and Millennium Development Goals (MDGs) achievement. The crisis in HRH is global, but particularly acute in sub-Saharan Africa, where the magnitude of the problem has reached critical levels. The situation was widely described in the World Health Report 2006, which estimates that there is a global deficit of approximately 4.3 million health workers in the world, mainly medical doctors, nurses, and midwives. Taking account the global analysis set out in the Report, the European Commission (EC) General Affairs and External Relations Council (GAERC), adopted conclusions on the European Union (EU) Strategy for Action. The Council called on the EC and its Member States to develop a coordinated EU response in support of country level efforts to address the HRH crisis. The Council adopted an EU Consensus Statement on the Crisis in Human Resources for Health, stating that: “Europe is committed to supporting international action to address the global shortage of health workers and the crisis in human resources for health in developing countries”.

Of the 57 countries that suffer from a critical deficit of HRH, 36 are in Africa, of which three are Portuguese-speaking countries (PALOP), e.g. Mozambique, Angola, and Guinea Bissau among them. The other two also face serious HRH challenges. Although all these countries have committed to addressing the HRH problem, and almost all have developed plans and strategies for HRH development, they face tremendous challenges to implement them. Some of these plans need to be updated and revised, and adjusted in function of the financial, political, and technical capability to implement them.


The general objective of the EC project is the improvement of the population health conditions in the PALOPs by improving access and quality of the health services. A strategy to achieve this objective is to improve the national and regional capacity for the HRH development.

The project aims at meeting the needs for HRH development identified through an extensive process of analysis of the HRH situation in the five PALOPs. This approach expresses the countries' and partners' willingness to undertake these interventions, insuring the creation of a network among PALOPs, promoting dialogue and synergy among them and with regional and other appropriate platforms.

The main stakeholders involved in the project are the national directorates responsible for HRH. When appropriate, the consultation or participation includes the ministry of education, finance and public administration and other relevant stakeholders, reinforcing the renewed emphasis of strengthening primary health care through enhanced intersectoral collaboration.

The training, research and documentation institutions are appropriate and natural partners in the implementation and/or beneficiaries of the proposed activities. These institutions, whose participation modalities will be reconfirmed in the start-up phase of the project, will be involved in the implementation of activities that can be decentralized, in order to strengthen ownership of the project by the beneficiary countries.

A component of the programme related to the information and documentation activities has been developed between the WHO (Brazzaville and Geneva) and ECAid (Brussels and Luanda). The project formulation process was concluded in mid 2008 and the approval and final signatures by the participating agencies were obtained in August 2008.

The expected results of this technical cooperation process are:

  • Strengthening of the national capability of PALOPs for development and implementation of HRH policies;
  • Development and strengthening HRH information systems in PALOPs, including mechanisms of exchange and cooperation among countries and the HRH observatories in Africa;
  • Evaluation of the educational and training systems followed by development of technical cooperation programmes;
  • Strengthening access to information and knowledge in health, in Portuguese language, throughout the institutions in PALOPs (ePORTUGUÊSe).

Next steps

Responsibility of national teams

  • Each country will finalize the list activities and detailed costing at the national level and send to WHO the cost estimates to be integrated in the Global Action Plan (end of January 2009)

Responsibility of WHO

  • Establishing the costs for regional activities (AFRO);
  • Finalizing the Global Action Plan by end March 2009;
  • Discussing the Global Action Plan with the EC Project Administration Unit in the National Planning Directorate in Angola;
  • Convening a meeting with the directors of HRH, the Project Administration Unit, and all stakeholders interested to finalize the Global Action Plan.

Responsibility of the Project Administration Unit, Angola

  • Contract the group that will be the Project Management Unit, until the end of March 2009. The Unit is going to manage the budget programme implementation;
  • Follow up the implementation of the activities in countries.