This week I’m in Recife, Brazil, at the Third Global Forum on Human Resources for Health (HRH). The forum focuses on the crucial role that health workers play in delivering health services to those in need and achieving universal health coverage. These workers are the engines of achievement in every health system, yet countries face acute and chronic health workforce challenges that are too often rate-limiting in achieving results.
1. Ambitious targets for better HRH performance are needed with a 15-year horizon. Fifteen years is more than enough time to galvanize a transformation in the health workforce. A few specific targets relevant to all countries could be articulated in relation to education and deployment of health workers. Targets for education institution performance might focus on the competencies required by graduates to pioneer equitable and efficient responses to priority health needs. Similarly, targets for workforce performance might give rise to innovative approaches to recruitment, deployment and career paths necessary to optimize the design and delivery of clinical, public health and broader intersectoral interventions.
2. Workers, employers and education institutions must take greater leadership in defining effective responses to outstanding health needs. For example, there is growing consensus on the need for more effective, high-quality, multidisciplinary professional teams of workers that can serve as a solid front-line for primary care. Yet, the health workforce in most countries remains largely concentrated in urban tertiary care centers. Three ideas for catalyzing this leadership include:
First, foster a culture of innovation and structure incentives amongst health workers to develop higher quality, more equitable and efficient, patient-centered systems of front-line care. There is a wealth of knowledge and know-how amongst those on the frontlines of service. Properly tapped and linked to next generation technologies, this can lead to disruptive and frugal innovations in performance.
Second, redefine and revitalize the education mission of academic health centers. We’re on the cusp of a revolution in education, mediated in part by information and communication technologies, as well as a focus on more discrete competencies that are challenging the hegemony of professional guilds . Forward-looking policies and strategies for educational institutional transformation should embrace both public and private sectors; value and evaluate faculty; and balance the demand for increasing transnational portability of qualifications, with the need for special skills to address problems of local relevance.
Third, recognize that “markets” for health workers exist within countries, across regions and globally. These markets are dynamic and driven by different forces that all too often are at odds with efforts of countries to achieve universal health coverage. We urgently need to develop better market analytics that track the stock and flows of health workers, relative wages within and across countries, and point to prospective shortfalls and/or surpluses. This sort of market intelligence is an invaluable ingredient to the leadership required to stem and resolve chronic market failures related to the health workforce.
3. Governments and international agencies need to develop more credible policy leadership capacity related to the health workforce. This leadership must be 21st century insofar as it engages diverse sectoral, stakeholder and local/global societal perspectives and adopts approaches to address complex health workforce challenges. This new leadership must also respond to the growing transnational policy agenda related to the education, accreditation and migration/working conditions of health workers. Key ingredients for successfully tackling this agenda include more, and more appropriately trained and supported, staff in both national and international institutions, as well as better arrangements for transparent inclusion of diverse stakeholders in policy negotiations.
In order to inform these deliberations, the role of better evidence is crucial. In this regard, the international community needs to wake up and realize that investment in evidence to address health workforce challenges -- endemic within and countries rich and poor alike -- is good value-for-money. There are important global public goods investments related to development of better indicators and instruments to measure the numbers, flows, trends and performance of health workers in countries. Together, these could be developed at a much higher level of quality, more rapidly and at a much lower cost, through concerted global evidence-gathering on the health workforce, than they would be if each country attempted these on their own.
While the declarations emanating from Recife will serve as testimony of a common commitment, the need to act quickly cannot be overstated given the reality of rapidly growing and fast-changing health systems. Our imperative is to mobilize now around time-bound targets and to strengthen the problem-solving potential of health workers to forge new pathways towards universal health coverage.
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Brief: Human Resources for Health