Jim Campbell a, Gilles Dussault b, James Buchan c, Rüdiger Krech d, Giorgio Cometto e
a Instituto de Cooperación Social Integrare (ICS Integrare), Barcelona, Spain
b Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Portugal
c Queen Margaret University, Edinburgh, Scotland
d World Health Organisation, Geneva, Switzerland
e Global Health Workforce Alliance, Geneva, Switzerland
The Third Global Forum on Human Resources for Health in Recife, Brazil starts tomorrow, Saturday 9th November, 2013. Co-hosted by the Global Health Workforce Alliance (the Alliance), World Health Organization (WHO), Pan American Health Organization (PAHO) and the Government of Brazil, the Forum anticipates more than 1,500 participants in the pre-Forum (09 Nov) and main proceedings (10-13 Nov). For Twitter followers expect a high-volume of photos, commentary and more at the hash-tag #3GFHRH
The Forum’s objectives and outcomes are clear: reinforce the linkages between the health workforce, the Millennium Development Goals, universal health coverage (UHC), and the post-2015 development agenda, and; elicit new HRH commitments from governments, donors, development partners, the private sector, and civil society to improve the availability, accessibility, acceptability and quality of health workers and health services.
The rationale for new HRH commitments and their implementation is grounded in a compelling evidence base. From the 2000 World Health Report to the 2013 report of the independent Expert Review Group (and many other flagship reports and publications before and between) the evidence is consistent: health systems are only as strong as the health workers within them, and the absence of a fit-for-purpose health workforce is the biggest barrier to improving health outcomes (e.g. the attainment of the MDGs). The latest edition of the Bulletin of the WHO – “From evidence to policy and action: new insights on human resources for universal health coverage” – further strengthens this evidence base with new research and analysis. The collection of papers sets the stage for discussion and agreement in Recife, including calls to “get real”, support “fundamental changes” and create a “paradigm-shift”. All of which is to be accompanied by “international solidarity, multilateral collaboration and mutual accountability”.
Additional evidence will be presented in Recife, including the Forum’s technical report: ‘A universal truth: no health without a workforce’. The report is the outcome of research across 36 low-, middle- and high-income countries, from all six geographical regions of the WHO, conducted by ICS Integrare, IHMT and Save the Children under the guidance of the Alliance, WHO, and a Technical Working Group of HRH experts chaired by the World Bank. Marie-Paule Kieny (WHO), Tim Evans (World Bank), Jim Campbell (ICS Integrare) and Gwendoline Malegwale Ramokgopa (Deputy Minister of Health, South Africa) will be discussing the report, its findings and implications at a launch on Monday 11th November in Recife. Electronic copies of the report and translations (French, Portuguese and Spanish) of the Executive Summary will be available for download at the Alliance’s Forum page to coincide with Monday’s launch.
The focus of the report is the role of human resources for health to Attain, Sustain or Accelerate Progress towards UHC. This is the ASAP challenge for HRH – one that must be addressed as soon as possible. The 36 country case-studies, new analysis of workforce data from WHO’s Global Health Observatory and modelled estimates of potential workforce deficits (for midwives, nurses and physicians) by 2035 make clear that the ASAP challenge is a global agenda; as evident in supporting documents for the 2013 World Health Assembly that describe a global, multidimensional challenge. The UHC agenda goes beyond the language of the 57 ‘crisis’ countries in the 2006 World Health Report. All countries, at whatever stage of economic development, are faced with complex drivers of change that have a profound impact on the investment in, and education, governance and management of the health workforce. Health budgets and resources are being squeezed in many countries. Effective coverage is at threat and yet the expectations inherent in the UHC agenda (and potentially in the post-2015 agenda), to progressively expand quality health services to an increasing percentage of the population, will place additional pressure on health systems and on the political and technical decision-makers responsible for them.
The report is structured to inform discussions in Recife and elsewhere, collating what we know can and should be done in support of the health workforce. It sets out a ten-point agenda for action and results. The ten points are framed as conditions for success in improving the availability, accessibility, acceptability and quality of the health workforce commensurate with the principles of universal health coverage. They will require inter- and intra-governmental actions with coordinated, sustained support from all stakeholders and partners – including those associated with public policy, economic development, labour, social protection and shared prosperity. The agenda is beyond the confines of the health sector and a critical first step is the recognition of the universal truth: no health without a workforce.