Overview

It is now recognized that in order to scale up major health interventions, provide good-quality services, and achieve the health-related goals such as the Millennium Development Goals requires a health workforce that is well trained in sufficient in numbers, appropriate skill mix, adequately deployed and motivated. There is strong evidence that progress in health in countries will not be possible without strong health systems, for which the health workforce is the backbone. There is also a clear correlation between the density of health care providers and the attainment of high levels of coverage with essential health interventions, such as immunization and skilled attendance at birth. The World health report 2006 identified 57 countries, 36 of them in sub-Saharan Africa, where the density of health workers falls below the minimum threshold of 2.3/1000 population that is essential to achieve 80% skilled attendance at delivery. There is an estimated shortage of health services providers of around 2.3 million in these countries, and if management and support workers are included, the gap reaches to the order of 4 million.

The reasons for these acute shortages are manifold: there is a limited production capacity in many developing countries due to years of underinvestment in health education institutions, but there are also pull and push factors that make health workers leave their workplaces. The movement is from rural and underserved areas to the cities and from developing countries to more developed ones. The migration of health personnel has dire consequences for the health systems which already suffer from years of neglect coupled with weak capacity to manage the workforce. Furthermore inappropriate skill mix, imbalances; failure of domestic labour markets, a mismatch between educational output (quantitatively and qualitatively) and health needs of the population; rapid increases in disease burden coupled with evolving and expanding health worker roles and new forms of service provision; poor working conditions; lack of career plans, low salaries, a poor knowledge base; and lack of coordination between sectors including private sector are challenges faced by the workforce. Unless the region is able to overcome the current workforce crisis, neither priority disease initiatives nor health systems strengthening will succeed.

To meet the challenges faced by countries and achieve necessary changes, significant investments are needed to reverse the crisis. Concerted actions and strategies are required to address these issues. These include formulation of comprehensive HR policies and plans; strengthening institutions to train appropriate and relevant health workforce in terms of numbers and quality; development of regulatory frameworks into which the scope of work of new categories will fit, to ensure high standards of safe practice for public; strengthening capacity of ministries of health to manage their health-workforce; and generate evidence information and evidence for planning and implementation. A crucial issue at international level is to advocate for macroeconomic policies that have an impact on national health workforces in collaboration with HQ because the market for skilled health workers is global.

For more information please contact:

Dr. Djona Avocksouma
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Tel.: +47241 39174