The Norwegian response to the global health workforce crisis

Achieving a coherent health workforce policy at home and abroad is necessary to combat the appalling shortage of health personnel globally. Last year the Norwegian government commissioned two workgroups to work on the issue and their reports are now in.

In light of the global health workforce crisis, the Norwegian government initiated a process to develop a coherent and comprehensive health workforce policy last year. It commissioned two workgroups. One workgroup was to propose a plan of action for human resources for health (HRH) in Norway's foreign policy and development cooperation. The other was to propose measures for Norway's own workforce planning up to 2030. The reports from the workgroups have now been submitted to the relevant ministers.

According to the World Health Organization (WHO), four million more health workers are needed globally to secure a minimum level of health workers in the 57 countries now facing shortages below a critical threshold of workforce density. A critical threshold means that there are fewer than 2,5 health care professionals per 1000 population, counting only doctors, nurses and midwives. 36 of these countries are in sub-Saharan Africa. The shortages, maldistribution and skills needs represent a severe bottleneck in achieving the health related Millennium Development Goals (MDGs).

Norway's political leadership established a principle of no active recruitment of health workers from countries with severe shortages in this regard in 2006, acknowledging that HRH policies in OECD countries will impact on the situation in the South.

HRH and development assistance

Last month the report on HRH in Norway's foreign and development policy was submitted to the Minister of the Environment and Development Cooperation Erik Solheim in the Ministry of Foreign Affairs. The report establishes that many interventions have already been initiated and are being financed. In bilateral development assistance and in funds channeled through multilateral agencies and global funds like GAVI and GFATM for health systems strengthening, funding is allocated to HRH measures. These measures include research, support to the education of health workers, institutional twinning programmes, personnel incentives packages and infrastructure like staff housing and equipment to name but a few. These are some of the aid related activities that receive Norwegian funding.

Different aid channels and aid instruments are being used to target and assist developing countries in their own endeavors to help strengthening their HRH capacities. The health related MDGs provide direction and indicate priorities for achievements. Strategic HRH components are integrated in the Norwegian government's MDG 4&5 initiative, reducing maternal and child mortality.It is proposed to link the HRH components more clearly in other channels and interventions.

Education and institutional twinning

Education of health workers is given increased focus in the new proposal. Norad's program for master studies (NOMA) is proposed to be given an earmarked health education stream, and possibly be expanded to include the bachelor level as well. Health workers on this level are crucial to fight the crisis. NOK 150 million over four years is in total proposed for health worker education.

Involvement of Norwegian health and research institutions will take a more structured and focused approach. Already a network platform is being established to focus efforts from a variety of institutional and civil society health actors in Norway. Currently NOK 10 million per year is allocated to twinning arrangements through the ESTHER programme, administered by Fredskorpset.

Beyond aid - policy and international advocacy

Apart from aid, Norway will be ready to support leadership and advocacy in promoting HRH agendas, politically and strategically, in the many international fora and global arenas of importance to combat the crisis. The proposed global Code of Practice for international recruitment of health workers under negotiation in the WHO will be supported by Norway and with a strong concern for the right of people and populations to have access to health services - for which health workers are absolutely necessary.

Norway's Minister of Foreign Affairs is among seven foreign ministers who in 2006 launched the Foreign policy and global health initiative, where the health workforce crisis is one of the ten prioritized areas in the interface between foreign policy and global health. This, and other initiatives, will be followed closely by Norway with a particular HRH attention. The same attention will be given to our involvements at WTO/GATS and the EU, among other fora.

Next step is for the government to decide on the policy components from both work groups' recommendations and secure follow-up.