Launch of the Merlin 'Hands up for Health workers' campaign
Dr Mubashar Sheikh, Executive Director, Global Health Workforce Alliance
Distinguished colleagues, partners and friends
I would like to thank our hosts Merlin for inviting the Global Health Workforce Alliance to participate in this important launch of the 'Hands Up for Health Workers' campaign.
This leadership shown by Merlin is exactly the kind of positive proactive action we are advocating through the Alliance towards resolving the health workforce crisis.
In too many countries, people live and die without ever having seen a health worker.
The shortage of health workers – which the World Health Organization (WHO) estimates globally to be more than 4 million– is impairing provision of essential, life-saving interventions such as childhood immunization, safe pregnancy and delivery services for mothers and access to treatment for AIDS, tuberculosis and malaria.
It is one of the most fundamental constraints to progress in health and development – and reaching international targets such as the Millennium Development Goals.
Let me give you a vivid reminder of what this means in practical terms.
At eighteen years old, Fatmata from Sierre Leone was 1 year into her marriage and happy to be pregnant. However, the day of her delivery she had to be rushed to the hospital -
The hospital to which she was taken was described as being the country's best although the doctors there describe it as the place of last resort. There are only 2 specialists in obstetrics and gynecology in this 130 bed hospital where patients from all over the country are sent. Patients’ families have to buy their own medication and materials including gloves for doctors and nurses.
Needless to say, Fatmata never made it out of that hospital. She bled to death after giving birth to a baby boy. In the ill-equipped and understaffed facility, she was unable to get the care she needed.
Fatmata’s story is sadly, far from unique. A mother dies in pregnancy or childbirth every minute. One child under the age of 5 dies every 3 seconds. Nearly 7,000 people are newly infected with HIV every day. Life expectancies are collapsing in some of the poorest countries.
All these issues are compounded by critical shortages of health workers within weak health systems.
Unless this workforce shortage is overcome, international health goals will not be met, and quality of life of populations will further degenerate.
The health workforce crisis has developed before our eyes.
Chronic and long-term underfunding of health services, fiscal constraints for countries, and insufficient numbers of health workers trained in almost all countries have led to this tragic situation.
This has been exacerbated by upsurges of new and old pandemics in low-income countries as well as aging populations and increased demand for care in developed countries, which has led to significant migration of health workers from low-to high-income countries.
The figures tell the story:
- 57 countries are experiencing 'critical' shortages; 36 of these in Africa.
- Sub-Saharan Africa has 25% of the global burden of disease, but only 3% of the world's health workers.
- The UK and the Democratic Republic of Congo have roughly the same population figures (around 60 million). But the UK has over 1/3 more physicians and 25 times more nurses than the DRC. Given the current crisis situation in DRC, its likely these ratios will widen even further.
- In Ethiopia, there are under 2,000 doctors for the entire country of 75 million - and tragically, only 651 midwives in the whole country.
- On average, one in four doctors and one nurse in 20 trained in Africa is working in 'high-income' countries.
- In sub-Saharan Africa and some Asian countries, the monthly wage for a public sector physician can be less than $100; in some high-income countries it can exceed some $14 000 per month.
- And despite the crisis concentration in certain countries, this is truly a global crisis - affecting everyone - rich and poor, north and south, east and west. Developed countries are themselves also facing shortages - due to population aging and increase demands of care - which are only expected to worsen with time.
Nevertheless - there is hope. We are at an exciting time - perhaps the most opportune moment - to transform the global health worker shortage.
The past year has shown signs of real progress.
March this year saw the endorsement of the Alliance's Kampala Declaration and Agenda for Global Action which provided a global framework to develop human resources for health over the next decade.
In May, the Alliance launched the report of its international task force on scaling up education and training – co-chaired by Lord Nigel Crisp - with critical recommendations for countries in both poor and high-come countries on how and where to act immediately.
Since then, important new political and financial commitments to strengthen the health workforce have been made. Notably, the United Kingdom has proved a leader through commitments and action.
- The G8 2008 pledged to address the critical shortages of health workers across the world as a fundamental component for progress in health, recognizing the Kampala Declaration and Agenda for Global Action as the 'roadmap' documents to help guide the response to the health workforce crisis.
- There were specific donor commitments from the UK, US and Japan to train new health workers in Africa - including through PEPFAR.
- Most recently in September, at the UN High Level Meeting on the MDGs a number of new commitments were announced, including:
- The UK government pledge to provide £450 million over three years to support national health plans, including training more nurses, midwives and doctors, in eight of the world’s poorest countries.
And we are seeing real progress on the ground - countries implementing successful models are reaping improvements in the health status of their populations.
These advances and commitments are extremely important and welcomed.
Now comes the difficult task of ensuring pledges and commitments are transformed into concrete action on the ground - rapidly.
We have more to do than ever - particularly in light of the global financial crisis, which we know inadvertently poses a real threat to progress on health and development. This has happened previously in the past and would be a devastating blow.
It is essential therefore to learn from past mistakes and counter this period of economic downturn by increasing commitment and investment in health and the social sector - and ensuring a strengthened global workforce.
On this issue, UK Prime Minister Gordon Brown recently stated that "there can be no worse time than this to turn back'' and that ambitious health and development plans should not be postponed. We at the Alliance agree wholeheartedly, and reiterate that now more than ever we must maintain, sustain and enhance investment in health and the health workforce and ensure this is translated into immediate action.
Because the reality is that unless action starts today, we will not be able to reach the health-related MDGs and millions, perhaps billions, of people will continue to suffer.
Our global challenge is to train, manage and retain the largest expansion of health workers in history.
The Kampala Declaration and Agenda for Action outlines the Alliance’s vision of six interconnected strategies for action, these are:
- Leadership - nationally, regionally and globally - the fundamental component for progress in countries.
- Training – to ensure more health workers at every level of health service delivery, depending on country context and needs
- Retention – including efforts to ensure adequate equipment and facilities; quality supervision; decent wages and professional development
- Financing – increasing both international and domestic funding and addressing economic constraints. Addressing health worker migration to manage the pressures of the international health workforce market.
- Evidence-based capacity building to ensure models of best practice are replicated and adapted within country and regional contexts.
This cannot be achieved overnight. Neither can this be a temporary measure.
Increasing the quality and quantity of health workers to the levels needed is a long-term commitment that needs sustaining throughout an individual’s entire training and working life.
For all of this – long-term commitment and predictable, sustained financing for the health workforce is fundamental.
And no single entity can solve this crisis alone.
The Alliance was set up to address exactly this, and act as a platform for joint action.
A partnership of national governments, civil society, international agencies, finance institutions, researchers, educators and professional associations, the Alliance is dedicated to identifying, implementing and advocating for solutions to the health workforce crisis - accelerating action in countries through increased advocacy, convening partners, brokering knowledge and monitoring.
Because as partners, we can achieve so much more.
This is why we at the Alliance are excited and encouraged by the ‘Hands Up for Health Workers’ campaign . The campaign embodies the kind of innovative, proactive commitment and leadership that is vital to the future progress of this response.
We are impressed by the dedication and motivation around this campaign, and we will strive to support and partner with Merlin for the its forward implementation and success.
Because, as I have stated, in this time of global economic crisis, sustained and concrete financial commitments for health and development are more critical than ever.
It is our mutual responsibility to build on current momentum, 'unlock' progress on health and ensure this is sustained over the long-term.
I urge you to seize the opportunities available to make a difference and save the lives of Fatmata and others like her, for the sake of all our futures and our children's futures.