For Immediate Release
15 Principles for a G8 Plan to Overcome Africa's Health Worker Shortage and Build African Health Systems:
1. The plan must go beyond AIDS. It must offer total health workforce support, greatly expanding and retaining a motivated health workforce to enable universal access to comprehensive HIV prevention, care, and treatment by 2010, as well as to meet the Millennium Development Goals and provide universal access, no later than 2015, to a nationally-defined essential health package.
2. At the same time, short term results must be addressed, such as increasing the number of health workers trained and retained, increasing the number of health workers in rural areas, improving coverage and health outcomes. While some changes will take longer than others to achieve, a plan that is not achieving measurable results is a plan that must be re-examined. Investments should be carefully monitored, activities evaluated, and changes made in any strategies that don't seem to be working.
a.The plan must create tools and support efforts that make close monitoring and evaluation possible and that enable informed planning, such as computerized databases of health workforces (a tool which is already proving very useful in Kenya and elsewhere).
3. The support must be long-term, recognizing that the costs involved will require external support for some years to come.Given the time it takes to train health professionals, especially doctors, it will be some years before large numbers of higher-skilled health worker cadres can enter the health workforce. Long-term support is also needed to enable countries to have the confidence to make commitments that they must sustain over the long term, such as salary increases for health workers and hiring new health workers whose salaries must be sustained.
4. The plan must be country-driven.It should support country-identified leaders in human resources for health in developing a comprehensive, costed plan and catalyzing efforts to develop (if it doesn't yet exist) a consensus on how to move forward through consultations and meetings with a wide range of people, including the full spectrum of health workers, community representatives from rural and other underserved areas, people affected by diseases such as HIV/AIDS, government officials and others from relevant sectors outside health (e.g., finance, civil service, education), non-governmental health providers including faith-based organizations, unions, etc.
5. The United States should invest at least one-third of the funds required to develop an expanded, motivated health workforce in Africa that is capable of achieving universal access to AIDS treatment and other primary health services and the Millennium Development Goals. A preliminary estimate released by PHR and others from 2005 suggested that the cost of doubling Africa's health workforce (though more than a doubling is needed) would be $2.0 billion in the first year, rising to $7.7 billion in the fifth year, or a U.S. share that increases from $650 million to $2.6 billion (see www.healthactionaids.org). The actual cost of a U.S. initiative would depend on the cost of country plans. Finances should be new and additional to other AIDS, health, development and humanitarian funding.
6. The plan should prioritize efforts to increase access to health workers in rural and other deprived areas by boosting the number of health professionals in those areas using incentives and health training recruitment strategies focused on those areas.
7. The plan should vastly expand the number of community-level health workers, including community health workers and paraprofessionals, and shift lower-level duties to these workers where safe and appropriate, freeing physicians and nurses for more complex medical care.
8.The plan should prioritize building domestic capacity, both in creating an expanded, motivated health workforce and in building human resource management and planning capacity to help sustain and manage these changes. US health professionals may have a limited role, such as assisting in training and other capacity-building activities and meeting other country-identified needs for health workers from abroad.
9.Partnerships with private entities can be used to strengthening public, NGO, and existing faith-based organization health services, but should not be used to privatize public services. Funding should be directed to the public sector as well as NGOs, major foundations, experienced faith-based organizations and others.
10. The plan should include support for home and community-care givers, including adequate compensation, training, and materials. At present, these care givers, mostly women and mostly poor, are doing their best to provide care with little or no support.
11. The plan should incorporate human resource planning and investments into disease-specific health initiatives, such as PEPFAR, to ensure that these initiatives do not harm other health services and do not reduce the capacity of countries to proceed toward health goals outside of that disease.
In addition to bilateral investments in strengthening health workforces of developing countries:
12. G8 countries, particularly the US and UK, should reduce their reliance on health workers from abroad and seek to become self-sufficient in meeting their own health worker needs.For example, they should increase the domestic training of nurses, doctors, and other health workers. The United States should also develop a code of practice on international recruitment of health professionals, which includes not actively recruiting health workers from developing countries except in the context of an agreement with those countries that respects the right to health in those countries and is mutually beneficial.
13. The plan should support health worker issues in international forums. G8 countries should support health worker issues in international forums including the World Bank and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. G8 countries should support full funding for the Global Fund to Fight AIDS, Tuberculosis, and Malaria and a strong role for the Fund in health system strengthening.
14. G8 countries should ensure that policies of international financial institutions such as the International Monetary Fund do not limit the capacity of countries to invest in health and education.
15.G8 countries should collaborate with other wealthy nations to ensure that all developing countries suffering from health worker shortages, including the 57 countries identified by the World Health Organization as having the most severe shortages, have external financial support as required.
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.