A new HRH agenda
Community Based Distributor Nyamuot examines Nyalieth, two, and consults with Nyalieth’s mother, Nyawech at Nyawech’s home in Pinyto village in Maiwut County South Sudan.
Credit: Colin Crowley/Save the Children
In consolidating the evidence on human resources for health (HRH) and Universal Health Coverage (UHC), the Global Health Workforce Alliance has identified seven priority themes to guide policy actions:
1. The achievement of UHC will depend on the availability, accessibility, acceptability and quality of health workers.
More equitable deployment in under-served areas with health workers that earn the respect and trust of the communities they serve is required. Governments must address not only the ‘hard-to-reach’ geographically but importantly the ‘failed-to-reach’. Governments must scale up pro-equity policies that remove financial barriers or extend financial protection to population groups who were previously excluded. The capacity of education and training institutions must be strengthened so that they can prepare health workers to assume new roles and acquire the type of skills to meet changing needs of populations.
2. The attainment of UHC will require integrated health services and multi-disciplinary health teams, and may imply new models that change the availability, accessibility, acceptability and quality of the health workforce.
Cost-effective health services that are responsive to demographics, multi-morbidity and population change is key. The performance and productivity of health workers and health workforce teams is central to this endeavour and has direct and indirect impact on health expenditure. Improvements in the quality of care will require new approaches to transformative education, effective use of information and technology, responsive methods of self-regulation, and supportive management and supervision.
3. Maximising the return on investment in health workforce education and training is essential. Supply and demand need to be aligned.
The cost-effectiveness of health services will be influenced by the costs of producing and retaining a workforce fit for purpose and fit to practice. This is a major recurrent cost, and investments in public sector education are required to maintain the capacity, faculty and quality of training institutions. Additionally, many health systems experience significant levels of attrition, or “wastage” as health workers leave for jobs in other sectors or countries. The costs implications of this wastage can be significant, and improved retention will contribute to cost containment, availability and accessibility.
4. HRH plans must be adaptable to change and to health labour markets dynamics, and be integrated within broader health and development strategies.
HRH plans only retain relevance as long as they are aligned with broader health strategies, and can adapt to changing circumstances and policy priorities. They must also be able to accommodate legitimate involvement and interests of a range of stakeholders – including health workers and civil society.
5. Effective governance and regulation are critical and central components of a comprehensive approach to HRH.
Sustained effectiveness is not achievable without regulatory and governance mechanisms in place which can ensure the quality and responsiveness of, and accessibility to, health services, including the health workforce. The role of formal, informal and private providers, in education and in service-delivery, must be part of the comprehensive approach. Where a trust relationship is built between government, health workers and users of services, self-regulation can be a form of governance more effective than bureaucratic control, and may achieve a better balance between health system/ patient safety requirements, and an enabling approach that harnesses intrinsic motivation of health workers.
6. Health workers must have rights of fair treatment at work, as much as they must treat others fairly.
If they wish to achieve UHC, countries and health systems must determine and deliver a ‘fair’ and formalised employment package to their workforce, which includes a living wage appropriate to their skills and contributions, and with timely and regular payment as a basic principle, as well as an enabling working environment, and good quality education and training. They must also address the issue of dual practice, which is often a coping mechanism by workers for the absence of a fair wage, and of employment and working conditions which motivate workers and facilitate their retention. The practice of formal and informal payments to health workers in some countries remains, and can create financial barriers for the population. Health workers themselves must also embrace the right to health and commit to and apply the basic principles of non-discrimination, dignity and respectful care.
7. Investment in HRH across all AAAQ dimensions requires a paradigm-shift on the economic and social benefits of health sector employment and productivity.
The disconnects between supply and demand in many countries will be exacerbated with greater demands on health coverage; in some cases this will contribute to a persisting “pull” of health workers towards high-income countries. Public sector intervention to correct for the under-provision of health workers, their inequitable deployment or their under-performance is needed. This will require increased public sector expenditure and new approaches to partnerships with the private sector and others. More funding for HRH is needed, but so is more HRH for the money. Development partners will continue to play an important role in funding health workforce strategies in low-income countries.