The global shortage of health workers

As the first ever Global Forum on Human Resources for Health is underway in Kampala this week, the pressing question is what difference it will make on the global shortage of health workers. While the conference itself will not eliminate the shortfall of around four million health workers in Africa alone, it may become the most important milestone to date for concerted global action.

Africa carries 25 percent of the world's disease burden, yet has only three percent of the world's health workers and one percent of the world's economic resources to meet the challenge, according to The Lancet.

Among the 57 crisis countries defined by WHO, where the health worker density is below an absolute minimum, 36 are in Sub-Saharan Africa. Other hard-hit regions are in South and South-East Asia. While there are 14.3 nurses per 10,000 inhabitants in Norway, there are 0.14 in Bangladesh.

The crisis is not only about numbers, but also about poorly managed and underfinanced health systems, characterized by poor working conditions, migration leading to brain drain, maldistribution of personnel within and between countries, to name just a few challenges.

The most important milestone to date

The Global Health Workforce Alliance (GHWA) was created in 2006, following a series of knowledge gathering meetings, international consultations and championship by a number of institutions and leaders. Norway played one of the central roles in this process, and convened two of the meetings, in 2005 and 2006 respectively. Sigrun Møgedal of the Ministry of Foreign Affairs, with support from Norad, eventually also became one of the founding board members. Now the task is to convene the Forum in March 2008, in Kampala and then follow up actions.

The Forum will launch the Global Action Plan for Human Resources for Health, which will guide action over the coming decade and will serve as a tool to measure progress and monitor accountability. The Action Plan will be an opportunity to make real impact on the workforce crisis.

Key areas

The plan will rest on preparatory work by GHWA taskforces on some key areas, education and training of health workers being one of them, as a massive scale-up is needed. That entails improved quality and knowledge, skill mix and distribution to underserved areas of countries.

Migration and retention has to be addressed, involving such burning issues as a need for increased self-sufficiency in industrialized countries and the charge that rich countries "pouch" qualified health workers from the South. A global Code of Practice or ethical recruitment guidelines is one possible solution being tested.

Then there is the question of financing, financing of the workforce and of the health system in general. No disease-specific health initiative, however resourceful, can succeed without there being adequate and competent personnel to sustain actions.

Committed to respond

Norway has attracted international attention in its engagement in the human resource issue. Last year, four ministers met to discuss the problem and concluded with a need for joint action involving multiple domestic stake-holders. The government has engaged the ministries of health, foreign affairs, labour and inclusion, and education to develop a joint, coherent Norwegian policy. It has already stated it will avoid active recruitment of health workers from countries that themselves face shortages.

Several Norwegian ministries and directorates as well as academic institutions and NGOs will participate in Kampala. The attention to the issue will not diminish in Norway after this. But a lot remains to be done, not least in developing countries, and some painful discussions and decisions may have to follow. The issue is at the core of the health gap between North and South. We will report on the outcomes of the forum and the way forward.