Words into deeds: 2009 a critical year for progress on the health workforce crisis

Persepctives from Dr Sigrun Møgedal, Chair, Global Health Workforce Alliance and Ambassador for HIV/AIDS and Global Health Initiatives, Norway and Dr Mubashar Sheikh, Executive Director, Global Health Workforce Alliance.

*An abridged letter version of this piece was published in the The Lancet, Volume 373, Issue 9660, Page 300, 24 January 2009. (see link below)

FRIDAY 23 JANUARY 2009 -- 2008 was an exceptional year for the response to the global health workforce crisis. Never before have there been such levels of political commitment to resolve the chronic shortage of health workers around the world.

The global community has clearly recognized that the health workforce is the very heart of functioning health systems, and that without greater quantity and quality of motivated, equally distributed health workers, progress towards health and development goals will not be possible.

The endorsement of the Kampala Declaration and Agenda for Global Action[1] in March 2008 signalled a milestone in this response. Adopted at the first ever Global Forum on Human Resources for Health convened by the Global Health Workforce Alliance (GHWA) in Kampala, Uganda, these agreements provide strategies to help close the health worker gap over the next decade.

In their 2008 Declaration[2], the G8 recognized the importance of the Kampala documents in driving forward the response, and pledged to address the chronic shortages, by working towards increasing the health workforce and supporting efforts - such as those of the Alliance - in developing robust health workforce plans and establishing specific, country-led milestones and formulating effective workforce policies.[3]

Specific donor commitments from the UK, the US and Japan to train new health workers - including through PEPFAR - have boosted this response. At the UN High Level Meeting on the MDGs (September 2008), resolving the health workforce crisis was underlined as central to the achievement of the health-related targets. A new taskforce on Innovative Financing for Health was launched, the mandate of which includes finding solutions for funding over 1 million additional health workers by 2015.

All of this is extremely promising, but now the challenge is to transform these pledges into concrete action in the context of an unprecedented global financial crisis. Accelerated efforts will be required to make sure that the opportunity currently available to resolve the global health worker shortage is not missed. There is much to do.

The approach needed is one of collective responsibility. Donor countries must live up to, increase and sustain their commitment of resources, while low-income countries too must find ways of to increase resources while also using available resources more effectively and efficiently. Ambitious health and development plans should not be postponed. At country level, all national stakeholders with their external partners must together identify critical gaps and country specific barrier, in order to focus joint effort and agree on a framework for immediate and long term action, monitoring and mutual accountability.

This is to everyone’s benefit, since supporting the general health of populations contributes to the economic health of nations and thus to the global economy. Expanding and improving the global health workforce makes financial as well as humanitarian sense. The Global Health Workforce Alliance, under its newly-confirmed Chair, Dr. Sigrun Møgedal of Norway, has developed a three-year framework of strategies and priorities to face this time of challenging opportunity. With the targets set by the Kampala documents as its objective, and informed by wider health and development goals such as the MDGs, Health for All, and the revitalization of primary health care[4], GHWA will continue to be a catalytic force, accelerating action in countries by building synergy between Alliance partners, increasing advocacy; brokering knowledge and monitoring progress.

2009 is crucial in a number of key areas. Country HRH plans are being developed, but these must be costed needs-based and fully funded if we are to move beyond rhetoric. Global health initiatives such as the International Health Partnership and the Global Fund must collectively and individually take active steps to ensure that adequate funding is allocated for health workforce strengthening within their programmes. Issues such as migration and task shifting will be on the table.

In January, the World Health Organization will present the International Code of Practice for the international recruitment of health personnel to its Executive Board. With health worker migration one of the fundamental issues needing to be addressed for the resolution of the health workforce crisis, the Alliance is encouraged to see accelerated action being taken by WHO in these negotiations, as recommended in the Kampala Agenda for Global Action.

In the end, mutual mobilization and responsibility is critical. Every single Alliance member, partner and stakeholder has a role to play. GHWA will be monitoring progress and reporting back at its next global Forum.

Governments, including members of the G8 and other development partners, international organizations, civil society, the private sector, academia and others must maintain momentum and work together to ensure that the exceptional work of 2008 moves from words to deeds, resulting in concrete progress on the ground in 2009.

[1]The Kampala Declaration and Agenda for Global Action. Global Health Workforce Alliance / World Health Organization. http://www.who.int/workforcealliance/Kampala%20Declaration%20and%20Agenda%20web%20file.%20FINAL.pdf viewed on 09.12.2008
[2] G8 Hokkaido Toyako Summit Leaders Declaration, Hokkaido Toyako, 8 July 2008, http://www.g8summit.go.jp/eng/doc/doc080714__en.html viewed 09.12.2008
[3] Ibid.
[4]Moving forward from Kampala: Strategic directions and priorities 2009-2011 adopted at the 7th GHWA Board meeting held in Brazil at the end of 2008.