Countries and partners call for a multisectoral response to human resources for health at the meeting in Ghana
For the first time, over 170 delegates from fourteen African countries and development partners gathered in Accra, Ghana, for a meeting on "Good Practices for Country Coordination and Facilitation."
The meeting brought together delegates from Ethiopia, the Gambia, Ghana, Kenya, Lesotho, Liberia, Mozambique, Nigeria, Sierra Leone, Sudan, Uganda, Tanzania, Zambia and Zimbabwe. Partners attended include the African Development Bank, DFID, GAVI, Global Fund, JICA, PEPFAR, USAID, UN Agencies, the World Bank and regional bodies (West African Health Organization and East, Central and Southern Africa Health Community).
The meeting aimed to spur a dialogue among countries and partners around a guiding document - Human Resources for Health: Good Practices for Country Coordination and Facilitation (CCF). The document was drafted basing on the Kampala Declaration and Agenda for Global Action. It includes a set of good practices for effective coordination among all stakeholders involved in and or affected by the need to strengthen the health workforce.
The draft CCF document proposes that for success in coordination, country coordination mechanisms or 'national alliances' can be set up involving all partners working on HRH issues in the country. In countries, where such mechanism or 'national alliances' exist, they can be further developed to ensure that all partners collaborate with one comprehensive HRH plan, consistently implemented by all stakeholders, including a unified monitoring and evaluation framework.
Here are some of the messages the countries and partners shared at this meeting:
Karima Saleh, World Bank
As much as or over 60% of the budgets of the health ministries are allocated for HRH matters. Therefore, resolving the crisis requires evidence-based analysis on labour market dynamics which will enable defining the needed monetary and non-monetary incentives for human resources and required government interventions. The World Bank has been working on a programme with 7 focus countries to develop such evidence with support from the Gates Foundation and the Government of Norway. The Governments of Ethiopia, Rwanda and Ghana are taking advantage of the programme. From a meeting in Bamako in 2009, the World Bank and partners are working to set up a community of practice (CoP) on HRH. Partners and civil society organizations are working to set up the CoP aimed to facilitate a more effective exchange of information on HRH policy and programme development and implementation.
Joseph Amuzu, Health Adviser, Commonwealth Secretariat
The Commonwealth Secretariat is one of the first institutions bringing HRH to the global agenda. In 1998, we recognized the situation that many health workers were being 'poached' from developing countries to developed countries. We decided that the best approach would be to develop a code for recruitment for health workers in developed countries, which is not to discourage migration of health workers from developing countries, but to ensure good ethical recruitment. In 2003, we developed the code which was officiated at a ceremonial launch. In the Commonwealth, countries do not vote or sign but all countries support the code and we make sure that they bind with the code. We are collecting evidence on how effective the code has been to regulate the problem. And, as we agree on the multisectoral response, I urge that countries and partners advocate to the highest level of decision-makers to keep up with their promises on health workforce issues.
Fayrouz Mohammed Abdalla, Federal Ministry of Health of Sudan Ishraga Mohammed A. Albashir, Al Zaiem Al Azhary University, Member of the Nursing and Midwifery Association, Sudan
In Sudan, we have good coverage of health workers in urban areas with some deficiencies in under-served districts. Our main problem is in the distribution of health professionals and skill mix. The Academy of Health Sciences was launched in 2005 with a mandate for production of nurses, midwives and medical assistants. We are now working on the national strategy for HRH for 2010-2015, which will also help us understand existing gaps and projections for health workers needed. A national HRH committee was set up in 2009, including National Council of Training, Medical Specialization Board, the Police department, and Ministries of Education, Labor and Defence, among other stakeholders, working to develop a multisectoral plan for HRH by December 2009. On the nursing side, like many other countries speaking here, Sudan is faced with severe shortages of nurses. All health services are centred around a few urban areas, therefore, we need to urgently scale up training and production of more nurses and medical assistants for rural regions. In unstable regions, such as Darfur, skeleton health workforce remains, but given harsh conditions many health workers move to NGOs that offer better salaries and working conditions, since it is mainly humanitarian NGOs that are providing health care in those regions.
James Campbell, DFID, UK
Responding to the question on the successful case of Malawi health worker program, we should note that this is a country-led and country-designed initiative supported by partners. The Malawi initiative set out an innovative 5-year program with specific targets and a strong costed plan. The necessary information was there and the risks described in the earlier country presentation were mitigated. The program had strong funding support from the Global Fund and DFID and majority of partners were very comfortable. The program focussed not only on scaling up health worker production but also to ensure that future graduates are recruited. An independent evaluation of the Malawi programme has been commissioned by DFID and will be available next year.
Picking up on the point from my colleague at the World Bank, it is worth noting that we have 7 IHP+ countries present at this meeting. A recent review by Tom Pearson from the London School of Hygiene and Tropical Medicine noted that only 1 in 4 of the current Country Compacts has a specific HRH component and only half of the annual stocktaking reports have a dedicated section on HRH. Country coordination for HRH must ensure that it impacts on the broader coordination efforts in the health sector including the IHP+ processes and the PEPFAR Partnership Frameworks where these apply.
Dr Invocaviths, Ministry of Health, the United Republic of Tanzania
In Tanzania, we have a HRH working group under the technical sub-committee for SwAP. We have a human resource strategic plan that is well costed. This coordination mechanism includes all relevant line ministries, including the HRH unit of the Ministry of Health that is in the driver's seat taking direction for policy and guidance. Membership in the working group is flexible, which means that many partners join in depending on the activities. The working group is chaired by both public and private institutions. We are seeking more adequate representation of civil society and professional associations.
Ikuo Takizawa, Regional Project Formulation Advisor for Health, JICA
Following the 2008 G8 Summit, Japan made a commitment to train 100 000 health workers and set up 1000 health facilities. In working to materialize these goals, we are working in 15 African countries to combine technical assistance with support to infrastructure, scaling up training for health workers and providing support to policy management. We are working with Tanzania on the development of Human Resources for Health Strategy. This is a country-led process, spearheaded by the Ministry of Health that established a good coordination mechanism with all partners through a HRH working group. Also as a lesson, we would call all countries and partners to better disseminate their experiences, as we often find that so many previous studies have been done but results have not been circulated.
Efua Amissah-Arthur, African Development Bank (AfDB)
The African development bank's programs for the health sector starts from country's national strategy. We agree on priorities with the countries. Most of the country health programs include human resources components. But we noticed that when there are funding shortages, it is often the human resources' components that get slashed. Therefore, we call on the countries to move the issue up the priority scale. Also we have a newly set-up fragile states' unit, which will have a focus on capacity building. Countries are encouraged to apply for funding under this program for improving human resources for health.
George Sserunjogi, Ministry of Finance, Uganda
In the process of scaling up training and education for health workers, we faced with a some difficulties between the Ministry of Health and Education. The training of health workers is a mandate of the Ministry of Education. By developing a joint coordination mechanism involving all stakeholders, major ministries were able to overcome such difficulties in defining health sector priorities and allocation of resources. The Ministry of Finance has undertaken many measures to allocate funds to improve recruitment, salary enhancement for health workers. However, more improvements are still needed mainly in the areas of management and leadership in terms of prioritizing needs for the health sector and improving transparency and accountability.
Hon. Punchu L.Bernard, Civil Service Agency, Liberia
Liberia is posed for recovery and development following long lasting civil war. The country is following a two year transition plan as an emergency response to sustain the country's health services due to departure of humanitarian NGOs. The country is faced with extremely low ratio of health workers per capita: 0.2 health worker per 1 000 persons. There are 1972 health workers on regular payroll, 1860 paid by donor funding and another 2000 working in the private sector. A senior Human Resources Director and ten expat specialists have been hired through the Civil Service Agency to fill in the capacity gap in the HRH sector. A higher salary and incentives have been granted to health workers willing to work in rural areas. In 2008, the Government developed a comprehensive national health strategy, with policy, guidelines and a component on HRH.