Despite these strides, projections indicate a potential shortfall of 6.1 million health workers by 2030, which is necessary to effectively tackle the Africa's disease burden through comprehensive health promotion, disease prevention, treatment, rehabilitation, and palliation[1]. The African region carries more than 52% of the global workforce crises, and 37 out of 55 countries identified globally as having vulnerabilities and needing Safeguards and Support are in the African continent.

Also, nearly 27% of the trained health workers remain unemployed, underscoring a mismatch between training outputs and actual job creation. This gap requires a 43% increase in current funding levels dedicated to health workforce employment. Moreover, Africa has faced challenges related to suboptimal working conditions, with at least 14 countries experiencing an average of four instances of health worker industrial unrest or strikes annually since 2018. At the same time, brain drain continues to be a significant issue, with one out of every ten doctors or nurses trained in Africa now working abroad.

The chronic under-investment in education and training of health workers in some countries and the mismatch between education and employment strategies in relation to health systems and population needs are contributing to a paradox of the co-existence of needs-based shortages and unemployment. These are compounded by difficulties in deploying and retaining health workers in rural, remote and underserved areas. Moreover, increasing international migration of health workers is exacerbating the health workforce shortfalls, particularly in low- and lower-middle income countries. Human resources for health information systems are often weak to track the stock of health workers in the public and private sector and provide evidence on demographics and geographic distribution of health workers which is vital for evidence-based planning and management of the health workforce.

Considering the vital roles of the health workforce in building the resilience of communities and health systems to provide essential health services and respond to disasters caused by natural or artificial hazards, as well as related environmental, technological and biological hazards and risks, concerted actions and investments are needed. 

Notably, women comprise almost 70% of the health workforce but are disproportionately occupying less paying and unpaid care work. Investing in the health workforce not only addresses health needs but also presents a valuable opportunity to create decent employment for women and youth. By prioritizing the development of the health workforce, countries can work towards both improved health outcomes and economic empowerment, fostering a healthier, fairer and more resilient society. In May 2024, the WHO, in collaboration with Member States and key partners launched the Africa Health Workforce Investment Charter[2], which was adopted through the Windhoek Statement on Investing in Africa’s Health Workforce at the inaugural Africa Health Workforce Investment Forum held in Namibia in May 2024. The Forum was attended by almost 200 participants, including Ministers, government representatives and high impact decision making partners across health, education, labour, finance and public service.

The Africa Health Workforce Investment Charter is an instrument to align Government stakeholders, partners, and the private sector in countries around a common national investment plan to expand the level of investments and reduce duplications and inefficiencies in the investment made by the different stakeholders in the health workforce. This will increase partner confidence in national priorities for common investment. It encourages the use of health labour market analysis to develop, negotiate, and formalize commitments by signing multi-sectoral national investment compacts in countries for mutual accountability and clarity in the flow of funding amongst partners. 
 

Guided by the Global Strategy on Human Resources for Health: Workforce 2030, and the African Regional Framework for the Implementation of the Global Strategy on Human Resources for Health: Workforce 2030, Africa Health Workforce Investment Charter and the Regional Framework for Nursing and Midwifery and based on current health workforce context in the African Region, WHO is supporting country level actions to transform the health workforce for a healthier future in the Africa Region by:

1. Accelerating efforts to reduce the 6.1 million health workforce gap by optimizing training for primary healthcare providers where the return on investment is highest.
2. Transforming the health profession education curriculum into a competency-based one that is responsive to the population’s evolving needs and the epidemiology of countries and the Region.
3. Expanding decent job opportunities and employment for health and care workers, especially for youth and women, ensuring their safety and well-being in both public and private sectors.
4. Implementing robust attraction and retention strategies to reduce migration and empower, motivate, and incentivize health workers to deliver essential services and ensure health security.
5. Leveraging digital technologies and innovations to enhance real-time planning, development, and management of the health workforce, driving efficiency and responsiveness.

Actions are centered in the following thematic areas:

HWF Policy and planning

This area of work is to support Member States to strengthen their capacity of developing, implementing, Health Workforce (HWF) policies and plans to align investment in HRH with the current and future needs of the population and their health systems, through:

• Develop and/or adapt planning tools, guidelines and evidence including determination of staffing norms and standards to facilitate development of evidence informed HWF policies and plans.
• Support countries to formulate and review HRH policies and plans including Investment plans.
• Support countries to conduct relevant health workforce assessments and studies including HRH situation analysis, HLMA, retention studies and HWF projections studies to inform the development of HRH policies and plans,
• Support the development and implementation of health workforce motivation and retention strategies including remuneration packages, monetary and non-monetary incentives.
• Strengthen the capacity of HWF governance systems (MOH units, technical and management capacities)

• Support regional networking of stakeholders for dialogue on effective strategies to address the HRH crisis in the region.

In the area of Advocacy, Resource Mobilization and Partnership, the focus is on promoting partnership and networking at country and regional levels, including strengthening the institutional infrastructure in countries and financing of HR development.

This is accomplished through:

• Advocating for improvement of workforce at regional and national level
• Supporting regional networking of stakeholders for dialogue on effective strategies to address the HRH crisis in the region.
• Mobilising financial resources for HRH development at regional, inter-country and national level.
• Establishing a network of a key pool of experts in HRH development
• Supporting the strengthening of regional training institutions and WHO Collaborating Centers.
• Supporting African HRH Platform and its Steering Committee activities
• Establishing intra- and inter-divisional collaboration on key health workforce issues.

In the area of Health Professions Education, the focus is on supporting countries strengthen national health professions education systems, support the adoption of competency-based education, and to support production of a health work force, with appropriate competencies through:

• Supporting the evaluation of educational programmes for relevance and capacity for scaling up production of health workers.
• Supporting the strengthening of accreditation mechanisms in countries specifically for health professions programmes
• Supporting the reforming of health professions education programmes through the adoption of competency-based education
• Supporting the introduction of innovative educational modalities
• Supporting the strengthening of health professions capacity for faculty development, educational equipment and materials, infrastructure investment and development.
• Supporting networking and twinning of education institutions, WHO Collaborating Centres and exchange of expertise
• Supporting national continuing professional development strategies

In this area, the focus is on contributing to the generation of current data and evidence, through HR information systems and research including the establishment of national and regional observatories for evidence-based policy implementation, monitoring and evaluation through:

• Establishing and maintaining the regional observatory
• Supporting countries for establishment of national observatories
• Supporting the research on HRH key issues in countries
• Maintaining the Regional Health Workforce Observatory
• Supporting countries to strengthen HRH information system in the context of Health Information Systems
• Capacity Building in Human Resource Intelligence in countries
• Collaborating and disseminating promising and best practices in HRH development.
• Collaborating with government, partners, and NGO for strengthening HR Intelligence Systems in countries
• Supporting monitoring and evaluation of HRH development and implementation in countries.

The focus is on supporting countries to promote effective and multi-sectoral governance and management of its health workforce, and create a conducive and safe workplace environment, including recruitment, distribution, motivation, and retention strategies through:

• Fostering multisectoral health workforce development dialogues based on evidence on health workforce.
• Supporting countries to implement effective HR management practices for attraction, recruitment, and utilization of health workers.
• Supporting the development and implementation of attraction and retention strategies including working conditions, remuneration, monetary and non-monetary incentives
• Designing evidence-based mechanisms for managing of internal and international migration
• Strengthening capacities for health workforce stewardship, leadership, and management systems
• Strengthening the functionality of professional regulatory bodies and regulation of health worker practice.
• Contributing to the implementation of the Code of Practice for International Recruitment of Health Personnel

Regional Frameworks and Instruments:

• Africa Health Workforce Investment Charter: Enabling sustainable health workforce investments for universal health coverage and health security for the Africa we want. https://iris.who.int/handle/10665/376689 

• Windhoek Statement: Investing in Africa’s health workforce. https://iris.who.int/handle/10665/376872 

• The African regional framework for the implementation of the global strategy on human resources for health: Workforce 2030. https://iris.who.int/handle/10665/332179 

• Africa Regional Framework for implementation of the Global Strategic Directions for Nursing and Midwifery 2021 – 2025. https://www.afro.who.int/sites/default/files/2023-08/AFR-RC73-4%20Framework%20for%20implementing%20the%20Global%20strategic%20directions%20for%20nursing%20and%20midwifery.pdf

Tools, Guidelines and Curricula

• Health labour market analysis support tool (beta version 3.0) user manual. https://iris.who.int/handle/10665/379059 

• Health workforce thresholds for supporting attainment of universal health coverage in the African Region. https://apps.who.int/iris/handle/10665/348854 

• Regional guide for determining health workforce staffing norms and standards for health facilities. https://apps.who.int/iris/handle/10665/348845 

• Four-year, integrated nursing and midwifery competency-based, prototype curriculum for the African Region 2016. https://apps.who.int/iris/handle/10665/331471 

• The regional professional regulatory framework for nursing and midwifery: Creating a common approach to regulation, educational preparation and practice: future direction for nursing & midwifery development in the African region. https://apps.who.int/iris/handle/10665/331472 

• Three-year regional prototype pre-service competency-based midwifery curriculum. https://apps.who.int/iris/handle/10665/331474 

• Three-year regional prototype pre-service competency-based nursing curriculum. https://apps.who.int/iris/handle/10665/331657 

Key Reports and analytics 

• A decade review of the health workforce in the WHO African Region, 2013-2022: Implications for aligning investments to accelerate progress towards universal health coverage. https://iris.who.int/handle/10665/376643

• Needs-based health workforce requirements to address Africa’s disease burden and demographic evolution: Implications for investing in the education and employment of health workers, 2022–2030. https://iris.who.int/handle/10665/376718 

• The state of the health workforce in the WHO African Region (2021). https://apps.who.int/iris/bitstream/handle/10665/348855/9789290234555-eng.pdf?sequence=1 

• Proceedings of the Africa Health Workforce Investment Forum 2024 https://iris.who.int/handle/10665/378689 

• Project on scaling up midwifery education in four African countries: Final project: evaluation report. https://apps.who.int/iris/handle/10665/346599 

The nursing and midwifery workforce in the African Region: Optimizing and accelerating investments for resilient health systems: a regional technical report. https://apps.who.int/iris/handle/10665/366121