Addressing the Global Health Workforce Crisis

After an inspiring week spent talking about and drawing attention to the dire human resources for health crisis in Africa, I traveled to Mozambique to see how these formidable challenges are being faced on the ground.

The Kampala conference was historic, with Africans and especially high-ranking representatives from Ministries of Health and Finance taking center stage and focusing unprecedented world attention for the first time on the crisis. The results were impressive, with coverage from CNN on the brain drain in Malawi, the BBC and even my hometown paper, the Seattle PI.

The fact that the conference was dominated by African governments and civil society signals a new level of political engagement and commitment to creative, indigenous solutions. The final declaration will hopefully be only the start to an ongoing dialogue between donors, international institutions, governments of developed and developing countries, NGOS, and health workers themselves to implement these ideas. PHR’s workshops on advocacy and human rights will provide stakeholders with important tools to ensure that community voices are heard.

In Mozambique, I was able to see first hand how funds for vertical, disease-specific programs like PEPFAR can be used for health system strengthening. Sophia, a woman I met three years ago when working on a film for Health Alliance International, has gone from being desperately ill and hopeless, to accessing life-saving treatment, to working as an peer-counselor and now recently to serving as a treatment counselor in one of the HIV clinics in the city of Beira. With over 35% of adults living with HIV, Beira has one of the highest infection rates in the world. The huge disease burden threatens to overwhelm the already debilitated health care system. Sophia has gone from patient to provider, helping others with HIV overcome their fears of stigma and understand the importance of treatment adherence by drawing on her own experience. She helps take some of the burden off the nurses and doctors as they attend to an ever-growing patient population. As treatment has become more and more accessible, Sophia says she sees more hope and less fears about stigma in recent months. Even though she’s come very far, Sophia has still further ambitions. After working a full day in the clinic, she attends night school every evening and hopes to complete her high school degree in the next few years and eventually study to become a nurse.

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The Health Workforce Advocacy Initiative (HWAI) held our second strategy meeting during the opening two days of the Forum. PHR chairs and helped to found this international advocacy coalition affiliated with the Global Health Workforce Alliance. We’re a coalition of 14 institutions from Africa, the United States, Europe and Asia, with a loosely affiliated network. Building on plans from our first strategy discussion, we have decided to launch a Campaign on Sustained Health Workforce Financing.

The choice seemed fairly self-evident. So many of the things we’re talking about in the health workforce arena—retaining health workers, training new ones, improving their working conditions, ensuring that they receive health care, providing health workers to serve in rural areas—cost money. That money simply hasn’t been forthcoming. Since health workforce came onto the international agenda three, four years ago, we have all had one example of significant donor investments in health workforce—the United Kingdom (along with the Global Fund) in Malawi. The attention is now there, but not the money. Moreover, if there was one area where civil society had to be speaking out, it would be evident that governments—even those genuinely interested in strengthening the health workforce—and I think many are—weren’t going to be doing it on their own.

Well, this isn’t exactly our first launch. We decided upon this campaign back in July. But our work quickly moved elsewhere—rights-based national guidelines on developing health workforce plans, an advocacy toolkit for health workers, preparing for this Forum and more.

But that’s going to change. Over the past days, we strategized on how to re-energize the campaign, and I think we’re off to a good start. We still have to finalize our plans, but the opportunities are there, including bringing more international voices to PEPFAR reauthorization and doing what we can to encourage countries to apply for funds for health system strengthening from the Global Fund. And we will push on the International Health Partnership—a new effort by most donors other than the United States to focus their aid on national health strategies. This effort misses the important element of new money to fund these strategies. We’ve developed a platform, and are holding a press conference tomorrow about the launch of the campaign.

So be on the lookout for this exciting effort to start to turn the tide of funding! I hope through our growing coalition, and by taking advantage of our potential for reaching deep into the health workforce in Africa—our coalition members includes the International Council of Nurses, which has member organizations in 130 countries—we can make a difference, can help governments respond to the fact that there simply is no excuse for not making life-saving investments in the health workforce.

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