“Action is Now” on Human Resources for Health

The first ever Global Forum on Human Resources for Health took place in Kampala in the beginning of last month. Although the debates at times were heated, eventually the 1,500 participants agreed on a Declaration and a Global Action Plan. The question now is whether this will make a difference and transform crisis into solutions.

The much-awaited Global Forum on Human Resources for Health was arranged in Kampala, Uganda the first week of March 2008. Organized by the Global Health Workforce Alliance (GHWA), the Forum attracted the hoped-for participation from a broad range of stakeholders, 1,500 participants totally.

According to the World Health Organization (WHO), over four million additional health workers are estimated to be required worldwide - with one million needed for Africa alone. Currently Sub-Saharan Africa faces the greatest challenges. While it has 25 percent of the global burden of disease, it has only 3 percent of the world's health workers.

"For too long we have watched this crisis unfold in front of our eyes. This is unacceptable. This first Global Forum is a historic occasion. The world is looking to us and encouraging us to be ambitious in our goals, open to innovation, and determined to implement the solutions which have been found. What we want is the political awareness and will of the highest level of the world's decision-makers to take forward promises made on this issue and translate these into concrete action," said Executive Director of GHWA, Dr Francis Omaswa.

One crisis - many concerns

Given the complexities surrounding the health workforce crisis, energy, innovation as well as tensions over existing conflicts of interest emerged in the discussions. For example:

  • the inequalities in access to health services between populations in low-income countries and populations in high-income settings (the rich-poor divide and its health implications)
  • the idea that any professional has the right to move or migrate pursue a career, vs. the need to secure the right of health services to underserved populations
  • the present underfinancing of health systems vs. the need to increase resources and provide incentive schemes to keep and retain health workers where they are most needed. IMF and World Bank were challenged in the session on financing, and presented suggestions on how to move forward
  • the globalized labour market forces and unethical recruitment practices vs. the need to protect the individual migrant from "social dumping" and misuse of competencies
  • the benefits to (rich) destination countries from getting ready trained professionals vs. the costs of training borne by source countries, that often are low-income countries remaining with heavy health burdens and chronic deficits of qualified health workers
  • the often perceived imbalance and funding bias in favour of aid for disease-specific initiatives and e.g. hiv/aids programmes, vs. the regular health system support. This issue emerged as critical and nearly jeopardized the final consensus in the final plenary on the Declaration.

An agreed Action Plan

From such critically challenging topics actually emerged sufficient agreement to endorse the Kampala Declaration and the Global Plan of Action. The Action Plan sets out six strategies:

  1. Building coherent national and global leadership for health workforce solutions
  2. Ensuring capacity for an informed response based on evidence and joint learning
  3. Scaling up health worker education and training
  4. Retaining an effective, responsive and equitably distributed health workforce
  5. Managing the pressures of the international health workforce market and its impact on migration
  6. Securing additional and more productive investments in the health workforce

In two years, the second Forum will review if governments and partners have delivered.

Tackling the issue in Norway

Meanwhile, in Norway, the Government has decided to take the health workforce issue forward by establishing two workgroups. One will prepare a proposal for the foreign and development policy on Human Resources for Health. Among other things, the Global Plan of Action will have to be considered including now Norway will follow it up and support it.. The other workgroup will prepare a proposal for Norway's domestic policy, which among other things will have to deal with recruitment and migration from other countries versus the degree of self-sufficiency.

Finally, at this stage, Norway is engaged in a global dialogue on health worker migration, moderated by Mary Robinson of Realizing Rights. Two state secretaries, Håkon Gulbrandsen of the Ministry of Foreign Affairs and Rigmor Aasrud of the Ministry of Health and Care Services held key note addresses at the opening of a global videoconference on 31 March, linking nine video sites from all over the world in a kick-off to the dialogue. The dialogue forms part of world-wide consultations in the development of a proposal for a Global Code of Practice for recruitment of health workers. The Code will be presented to the 2009 World Health Assembly.

Norad is involved and plays its advisory role in all these processes. Ways to engage with embassies on human resources issues at policy and macroeconomic as well as in higher education will be further pursued, as well as linking country level experiences and international processes.