Rising to the grand challenge of Human Resources for Health

Rising to the grand challenge of Human Resources for Health

The Global Health Workforce Alliance 2013 Annual Report

© World Health Organization 2014

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Photo credits

> Cover: © MERLIN> Chapter 1 : © Intrahealth International> Chapter 2: © M.H Bhuiyan/GHWA photo contest 2013> Chapter 3: © JHPIEGO> Chapter 4: © MERLIN

4 MessagefromtheChairandExecutiveDirector

6 Identifyingandpromotingevidence-basedsolutions6 Identifying best practices and Human Resources for Health

requirements for UHC

7 Health Labour Market Analytical framework

8 Strengthening and promoting evidence on community and

mid-level health workers

10 Strengtheningaccountability10 G8 Summit

10 Commission on Information and Accountability for Women’s

and Children’s Health

11 HRH agenda for change: A Universal Truth. No Health Without a Workforce

14 Catalysingglobalactionthroughadvocacy14 Third Global Forum on Human Resources for Health:

developing a new health workforce agenda

16 The Recife Political Declaration on Human Resources for Health:

A new health workforce agenda for achieving universal health coverage

17 Human Resources for Health commitments: Accelerating progress

towards universal health coverage

21 Saving lives and improving health:

21 The Human Resources for Health Awards 2013

22 Elevating HRH on the global agenda

23 Building health worker capacity in francophone Africa

24 Health Workers Count:

A day in the life of a health worker photo contest winners

26 Lookingforwardto2030

28 AnnualFinances

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the World Health Organization (WHO), allowing greater synergy in pursuit of their complementary mandate.

The future holds promise at GHWA: ground-break-ing new evidence in support of our advocacy, politi-cal commitments by countries, and a strengthened strategic partnership with key partners forged in the lead up to and after the Third Global Forum will play a fundamental role in bolstering momentum for the HRH agenda in the post-2015 period. The GHWA Secretariat is indebted to its members and partners for their unwavering dedication, support and engagement. Ensuring that every person, wherever they live, can see a health worker when they need one requires nothing less.

In 2013, GHWA succeeded in making a bridge between the health workforce agenda and the broader movement in support of the attainment of universal health coverage. The landmark Third Global Forum on Human Resources for Health has enabled WHO Member States, GHWA members and partners and the wider HRH community to identify the health workforce challenges and requirements for UHC, and contributed to the recognition that health workforce challenges affect countries at all levels of socio-economic development, and not just low- and middle-income countries with a severe shortage. The conference came at an opportune time, as the international community approaches the most critical phases of the debate on the post 2015 development framework.

The highlights of the Forum were the political statements presented in the Recife Political Decla-ration on Human Resources for Health, as well as more than 80 commitments made by WHO Member States and member organizations of GHWA which might be the best measure of the success of the conference.

The Forum was the culmination of an intense year of work at GHWA, which saw its members and partners contributing proactively to its vision and objectives. The Secretariat made critical contribu-tions towards positioning HRH centrally in the policy discourse at global level and facilitating the generation and synthesis of new knowledge prod-ucts to promote advocacy based on cutting-edge evidence, including on the role of mid-level and community-based health workers, health labour markets, and the identification of best practices and case studies on effective HRH coordination and governance.

During 2013, major steps were also made in defining the Secretariat scope of work in a more strategic manner vis-à-vis the responsibility of its members and partners; as part of that an opera-tional division of responsibilities was agreed with

DrMitsuhiroUshioBoard Chair, Global Health Workforce Alliance and Assistant Minister for Global Health, Ministry of Health, Labour and Welfare, Japan

DrMariePauleKienyDirector a.i. Global Health Workforce AllianceAssistant Director-General, Health Systems and Innovation, WHO

Message from the Chair and Executive Director

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2013 was a year of tangible progress with breakthrough achievements steering a direction for a renewed

human resources of health agenda instrumental to the achievement of universal health coverage. GHWA made

a major contribution to the HRH movement, including through:

> Convening a major international HRH agenda-setting event - the Third Global Forum on Human Resources

for Health- and putting at the forefront HRH messaging in key global events and processes;

> Facilitating Member States in developing commitments to improve HRH in a sustainable manner;

> Advocating for a long-term vision of HRH and the achievement of UHC to be incorporated in the post-2015

development agenda;

> Promoting accountability for HRH results in Member States.

Message from the Chair and Executive Director

Identifying and promoting evidence-based solutions

management of their health workforce. Other arti-cles contributed to strengthening the policy frame-works and evidence base for human resources for health by: 1 deepening understanding of the labour market

forces that affect health workers’ motivation, attraction, retention and performance;

2 identifying best practices and lessons learned in tackling the challenges of retaining workers in rural areas and international migration, and specifically in relation to implementing the WHO Global Code of Practice on the Interna-tional Recruitment of Health Personnel;

3 providing new evidence and recommendations on the effectiveness of and required system support for mid-level and community-based health workers;

4 identifying opportunities for innovation in the education and management support of human resources for health through emerging technologies;

A key factor in why health workforce problems persist is the tendency for simplistic solutions and quick fixes to address highly complex and evolving problems. GHWA has played a key role in devel-oping, collecting and disseminating knowledge, analysis and evidence on progress and challenges, lessons learned, recommendations, good prac-tices and effective policies for HRH.

Identifying best practices and Human Re-sources for Health requirements for UHC

The GHWA Secretariat coordinated the develop-ment of a theme issue of the WHO Bulletin on human resources for UHC, published to coincide with the Third Global Forum on Human Resources for Health. The articles provide concrete examples, success stories and lessons learned of how some countries have structured their efforts in this area and offers analytical tools and new evidence about successful or promising innovative approaches to improve the deployment, retention and

5 investigating levels of domestic spending on human resources for health and exploring how the impact of development assistance in that area can be maximized by targeting it more strategically; and

6 exploring how benchmarks and indica-tors related to human resources for health could influence and be part of the agenda for universal health coverage and post-2015 development.

GHWA members and partners were the main con-tributors to this collection of the state-of-the-art evidence and thinking on HRH for UHC, while other authors included Ministers of Health, parliamen-tarians, Directors of Human Resources (in MoH) and senior officials from development agencies and leading HRH experts.

Health Labour Market Analytical framework

Countries at all levels of socioeconomic develop-ment are facing the challenge of matching health workforce supply and demand under existing con-straints of affordability and sustainability; these challenges are particularly severe in the African continent. The Secretariat collaborated with the World Bank and African Development Bank in developing a health labour market analytical framework to support health policy makers and health programme managers in Africa. The frame-work is helping policy makers and programme managers to understand the status, trends and dynamics of factors affecting health workforce supply and demand, motivation, retention and performance. The key messages of the framework and from an expert consultation in Hammamet,

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Tunisia were captured in a policy and practice paper published in the WHO Bulletin, and served as background for discussions at the Third Global Forum.

Strengthening and promoting evidence on community and mid-level health workers

The GHWA Secretariat brokered a consensus among different constituen-cies and organizations on solutions of proven effectiveness in fully har-nessing the positive potential of community health workers (CHWs) and integrating them in health system support structures. Community health workers can represent an effective strategy of increasing access to essen-tial health care services in communities. However, it is critical that they are integrated with and supported by the health system in order to ensure they are adequate in number, have the required resources and equipment, can count on effective referral systems, have sufficient knowledge of health issues, and adequate information materials for dissemination.

GHWA convenes partners to ensure coordination of approaches and con-sistency of messaging on various issues. To this end GHWA established a global platform for consultation to promote synergy among partners to move forward the CHW discourse and ensure that different national and international actors working to promote the role of community health workers do so in a way that contributes to strengthening in an integrated way the primary health care system. GHWA members, with the facilita-tion of the Secretariat, developed thematic documents, to promote the enhanced performance of CHWs and to better integrate them in health care systems, and agreed on a framework for future actions; developed Working Papers to leverage agreement and action on the key principles for CHW programmes as a basis for optimizing synergies and results; and commissioned a global analysis on the cost-effectiveness of CHWs.

GHWA also coordinated the development of a global systematic review, examining the effectiveness of mid-level health workers (MLHW) in pro-viding essential health services. The review was complemented by eight country case studies in Asia, Africa, and Latin America. Evidence shows that MLHWs deliver services with quality standards comparable to tradi-tional care models where services are rendered by doctors. In some cases, particularly in relation to maternal health, evidence shows that have the potential to yield even better results and achieved higher patient satisfac-tion than standard care.

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1. Identifying and promoting evidence-based solutions

2. Strengthening accountability

3. Catalysing global action through advocacy

4. Looking forward to 2030

Partners’commitmenttocommunityhealthworkers

> Work together to adapt, apply and implement the CHW Framework for Partner Action, fostering harmoni-

zation and synergies, accountability and joint action on critical knowledge gaps, and reaching out to all

stakeholders engaged with CHW Programs.

> Advocate, endorse and apply the principles and processes delineated in the CHW Framework for Partner

Action.

> Promote jointly the culture of self and mutual monitoring and accountability (M&A) of commitments and

plans.

> Respond reciprocally to knowledge gaps and promote a coordinated response to needs-based research

on CHWs.

Strengthening accountability

Commission on Information and Account-ability for Women’s and Children’s Health

GHWA has been striving to link the HRH discourse to the reproductive, maternal, newborn and child health (RMNCH) agenda; as part of these efforts, undertaken in collaboration with the Partnership for Maternal, Newborn and Child Health, the Alli-ance in the past developed, inter alia, sections and a background paper of the UN Global Strategy for Women’s and Children’s Health, which have con-tributed to a greater prominence of HRH themes, issues and targets in the strategic document, as well as to an explicit focus on HRH of many com-mitments made by countries and other institutions in support of the UN Global Strategy.

Building on this work stream, GHWA members con-tributed with the facilitation of the Secretariat to the 2013 report of the Independent Expert Review

G8 Summit

GHWA, in collaboration with WHO, provided an overview of progress in health workforce develop-ment efforts towards the commitment made in Hokkaido 2008 - where the G8 members commit-ted to increasing health workforce availability in developing countries towards the WHO threshold of 2.3 heath workers per 1000 people. The analysis indicated significant progress in improving HRH availability in about a third of the countries, per-sisting challenges in others, and a considerable gap in updated information and/ or quality data from many countries; the briefing provided by the GHWA Secretariat was ultimately reflected in the G8 Accountability report for 2013, leading to the G8 assessing its own progress towards this goal as ‘below expectations’, and therefore indicating the need for greater efforts in this critical area of health system development.

Group set up by the Commission on Information and Accountability through the development of a case study on HRH development efforts in Malawi, which gave visibility to HRH as an essential – and successful - area for investment in the context of RMNCH.

HRH agenda for change: A Universal Truth. No Health Without a Workforce

The flagship report A Universal Truth: No Health Without a Workforce was launched at the Forum, providing state-of-the-art evidence on health workforce availability, accessibility, acceptability and quality. The report, which sets out a new agenda for all countries to build the health work-forces needed to achieve UHC, was crucial in the build-up and agenda-setting towards the Third Global Forum.

The report shows that all countries are facing the challenges of how to accelerate progress towards or to attain or sustain universal health coverage. Furthermore, demographic trends, the growing bur-den of noncommunicable diseases and long-term care, macroeconomic and fiscal restraints imposed in response to a difficult economic climate, and the need to adopt a systemic and long-term approach to understanding health labour markets will make the challenges of human resources for health in high-, middle- and low-income countries even more acute, rendering it a shared global priority. 100 countries currently fall below the threshold of 34.5 skilled health professionals per 10,000 popu-lation, and the global deficit is estimated to rise to about 12.9 million skilled health professionals (midwives, nurses and physicians) by 2035.

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Workforce to population ratios for 186 countries

Group 1: density of skilled workforce lower than 22.8/10 000 population and a coverage of births attended by SBA less than 80%

Group 2: density of skilled workforce lower than 22.8/10 000 population and a coverage of births attended by SBA greater than 80%

Group 3: density of skilled workforce lower than 22.8/10 000 population but no recent data on coverage of births attended by SBA

Group 4: density is equal or greater than 22.8/10 000 and smaller than 34.5/10 000

Group 5: density is equal or greater than 34.5/10 000 and smaller than 59.4/10 000

Group 6: density is equal or greater than 59.4/10 000

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At the same time, the report also highlights the fact that many advances have been made in the past decade. For instance, among the countries affected by severe shortages of skilled health professionals, the situation has improved in most of those for whom data are available. It will be criti-cal to ensure that gaps are closed between health worker supply and dis-tribution and the population’s health care needs. A skilled and available national health workforce can only be achieved through high-level political support in the formulation of HRH policy objectives and development of the evidence base and technical capacity to implement and monitor poli-cies. At the global level, international partners must focus their support on development assistance to build the capacity of health systems and aim to strengthen HRH governance and collaborative platforms. The report illustrates how progress can be made and highlights proven approaches and promising new ones.

Catalysing global action through advocacy

Third Global Forum on Human Resources for Health: developing a new health work-force agenda

A key focus for GHWA in 2013 was the organization of the Third Global Forum on Human Resources for Health which was jointly convened by the Government of Brazil, WHO, the Pan American Health Organization (PAHO) and the Global Health Workforce Alliance in Recife, Brazil, from 10 to 13 November 2013. The event, designed around the theme of “Human Resources for Health: Foun-dation for Universal Health Coverage and the Post-2015 Development Agenda”, provided an opportunity to bolster political commitment and to update the human resources for health agenda; to make it more relevant to the current global health policy discourse, including the push towards the health Millennium Development Goals, the univer-sal health coverage objective and the post-2015 agenda.

Health workers are at the heart of health systems, but there are critical gaps – in terms of numbers, distribution, competencies, quality, motivation and performance – that prevent progress in reduc-ing maternal and child mortality, controlling com-municable and non-communicable diseases and achieving UHC. There is also increasing awareness that health workforce challenges affect – although with varying levels of severity – countries at all levels of socio-economic development. GHWA supports, convenes and harnesses the capaci-ties of global, regional and national partners and members, working for human resources for health (HRH) and contributing towards UHC. It has a unique role in advocating to global lead-ers, national governments, regional platforms and international financiers to catalyse country and global action, increase investment, promote research and use of evidence, and strategically target resources towards achieving health work-force development priorities.

The organization of the Third Global Forum was a highly participatory process, benefitting from both the technical rigour and the normative functions of WHO as well as the capacity and contributions of the broader membership of the Alliance. This inclusive process directly shaped all aspects of the Forum: the overall strategic plan of the Forum and its conference programme were developed under the oversight of a Forum organizing committee together with a Forum working group convened by GHWA with representation from governments, civil society, academia, the private sector, intergov-ernmental agencies, development partners and professional associations.

With some 1800 participants from 93 Member States, including nearly 40 ministers or deputy ministers, the Third Global Forum on Human Resources for Health was the largest ever human resources for health event. The conference had a dual nature: a technical event to share new

evidence, best practices and lessons learned among experts and planners in human resources for health; and a political one, to galvanize the support of policy-makers. High-level plenaries, technical side sessions and satellite meetings with exhibition areas, poster presentations, photo exhibits, awards for excellence and other activities informed and inspired participants to advance the agenda for human resources for health and pro-vided opportunities for professional development and networking.

The messages from the Forum were clear: human resources for health are crucial in translating the vision of UHC into reality. Moving beyond an exclusive focus on the numbers of health workers, equal importance should be given to the accessi-bility, acceptability and quality of the services they provide. Just as important is adopting dynamic planning and forecasting models, based on high-quality data and including labour market analyses,

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to match workforce supply with demand. The way health professionals are trained needs to change radically, transcending the narrow transfer of clinical competencies and towards models of education that empower health workers as change agents in society. Health services should be organized and delivered to be comprehensive, integrated and people-centered to increase access to health care in rural and remote areas. A greater focus is required on putting incentives in place and ensuring good working conditions that can enhance health workforce productivity, qual-ity and responsiveness. Bringing about lasting change in human resources for health requires the collaboration of sectors and constituencies.

The Recife Political Declaration on Human Resources for Health: A new health workforce agenda for achieving universal health coverage

The Forum was an occasion of strategic and historical significance, with the adoption of the Recife Political Declaration on Human Resources for Health. Member States unanimously adopted the Declaration mak-ing a commitment to an ambitious agenda to develop national health workforces and achieve UHC. The Recife Political Declaration on Human Resources for Health, developed through extensive consultations with Alliance members and partners, and adopted by representatives of Mem-ber States attending the Third Global Forum, was the ultimate outcome of the event and enshrined these principles, heralding a new era in human resources for health. The Recife Declaration recognized the centrality of human resources for health in the drive towards achieving universal health coverage. It reaffirmed the vision that all people everywhere must have access to a skilled, motivated and facilitated health worker within a robust health system; it committed governments to creating the conditions for the inclusive development of a shared vision with other stakeholders; and it reaffirmed the role of the WHO Global Code of Practice on the Interna-tional Recruitment of Health Personnel as a guide for action to strengthen the health workforce and health systems. Further, it identified a range of actions, including improving planning, education, management, govern-ance, information systems and the adoption of innovative approaches, to be implemented in accordance with countries’ contexts and needs.

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Human Resources for Health commitments: Accelerating pro-gress towards universal health coverage

An overarching message emerging from the Third Global Forum was that only systemic action can address the deep-seated challenges in human resources for health by combining related and complementary actions to strengthen the health workforce towards universal health coverage. The reasons why health workforce problems persist are diverse, but a key factor is that often only fragmented or simplistic solutions and quick fixes have been tried, whereas the development of human resources for health continually changes and evolves under the pressure of a variety of factors and forces. Evidence and years of lessons learned, show that integrated and coordinated approaches are required that pay adequate attention to every critical step in the supply chain of health workers and that recognize the role that different sectors within government and differ-ent constituencies in society play. Thus, a systems approach needs to be applied to human resources for health. This entails addressing capacity, management and working conditions as well as a solid understanding of the health labour market dynamics that affect the production, deployment, absorption into the health system, retention, performance and motivation of human resources for health. The challenge is not lack of evidence on effective policies: it is to mobilize political will and catalyse action for a contemporary agenda on human resources for health instrumental to achieving universal health coverage.

In support of the objective of focusing political attention and generating political momentum, the Third Global Forum made another critical contri-bution: eliciting country- or institution-specific commitments in support of national agendas on human resources for health. In the lead-up to the event, GHWA, WHO, PAHO and the Government of Brazil invited countries and all other relevant stakeholders to identify areas requiring action and to make corresponding commitments on human resources for health at the conference. GHWA and WHO worked together on developing a frame-work to assess and organize those commitments in a structured manner, following pathways of interconnected and evidence-informed action on developing the health workforce.

The framework assisted countries and other stakeholders in identify-ing relevant commitments on human resources for health to be brought to the Forum by mapping out the most effective interventions and their interrelatedness to improve the situation of human resources for health. It drew inspiration from the WHO Global Code of Practice on the

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International Recruitment of Health Personnel, the policy documents on human resources for health which Member States have endorsed and state-of-the-art evidence. It identified systemic pathways of interventions and organized them along the universal health coverage framework of availability, accessibility, acceptability and quality, which proved to be a useful bridge between the agendas for human resources for health and universal health coverage. Countries and other entities were invited to identify pathways of interventions that maximized synergy and comple-mented one another through a systemic approach, recognizing that such interventions, if taken up as stand-alone, might not be equally effective and sustainable. Through a coordinated effort under the leadership of WHO - country offices, Civil Society Organizations and bilateral partners were able to support Governments to develop work plans based on path-ways of systemic interventions.

In response to this call, 57 Member States and 27 member organizations of GHWA or other entities submitted their commitments, which were announced at five dedicated sessions at the Third Global Forum and will strengthen the basis for future collaboration, follow-up and accountability efforts.

Examplesofcommitments

Benin will recruit every year until 2018 at least 775 health workers to address unmet needs in reproductive,

maternal, newborn and child health; this intervention will be accompanied by allowances to facilitate their

selective deployment in the most under-served rural areas, and by results-based financial incentives to further

reinforce their motivation and enhance their performance.

Ethiopia will by 2017 expand education of health workers to meet 100 % of the staffing standard considering

the skill mix in all primary health care facilities, while at the same time improving quality of new graduates

by implementing program level accreditation in both public and private training institutions and by instituting

competency-based pre-licensure system for all health workers.

Colombia will strengthen family health by educating 10,000 family physicians over the next 10 years, adapt-

ing their competency frameworks to health system and population needs, and improving their quality and

performance through continuous professional development activities.

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0

10

45

29 28

24

38

20

30

40

50

Labour marketsSkills mixRetentionIncentivesEducation

Countries making HRH commitments, categorized according to HRH action pathways.

Countries making HRH commitments, by income level.

Lowincome

22

Lower-middleincome

16

Upper-middleincome

15

High income

4

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MemberStatesandAlliancepartnersmakingHRHcommitments

AFRO: Benin, Burkina Faso, Burundi Côte d’Ivoire, Ethiopia, Ghana, Guinea, Kenya, Liberia, Malawi, Mali,

Mozambique, Nigeria, Senegal, South Sudan, Tanzania,Togo, Uganda

EMRO: Afghanistan,Djibouti, Egypt, Iran (Islamic Republic of ), Iraq, Kuwait, Lebanon, Libya, Oman, Pakistan,

Somalia, Sudan, Yemen

EURO: Ireland, Republic of Moldova

SEARO: Bangladesh, Bhutan, Democratic People’s Republic of Korea, Indonesia, Maldives, Myanmar, Nepal,

Sri Lanka

PAHO: Argentina, Belize, Brazil, Chile, Colombia, Dominican Republic, Ecuador, El Salvador, Guatemala,

Paraguay Peru, Suriname, Uruguay

WPRO: Cambodia

OtherConstituenciesandInstitutions:

• Palestinian Authorities• Institut Supérieur en Sciences Infirmières (ISSI), Democratic Republic of the Congo• Tanzanian Training Center For International Health• INTRAHEALTH• Peoples Health Movement• College of Physicians and Surgeons Pakistan• Health Services Academy (Hsa), Pakistan• COMISCA / Consejo de Ministros de Salud de Centroamerica y Republica Dominicana• Organismo Andino de Salud – Convenio Hipolito UNANUE• UNASUR / Grupo Técnico de Desarrollo de Recursos Humanos en Salud del Consejo de Salud

Suramericano• Save the Children, India• AEMRN network (Afro-European Medical and Research Network)• AMREF• ANSWERS (India)• CHESTRAD• Community health workers• International Pharmaceutical Federation (FIP)• Health workers count• Health workers for all• Institute for Collaborative Development• International Nurses and Midwives• Midwives French Speaking Network• Swasti• The voices of women health workers in India• THET• Wonca Working Party on Rural Practice• World Vision International

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Saving lives and improving health: The Human Resources for Health Awards 2013

Dr. Haruna Lule pioneered a ‘Hand Hygiene Project’ which has reduced illness among mothers and children drastically in a hospital where he works in Uganda. The enterprising project, which strengthens hospital infection control at Gombe Hospital, led to post-surgery sepsis in the maternity ward falling by over 60 percent, patients’ length of stay being reduced from 4.6 to 3.5 days in most wards, and cross-infection among children falling significantly. Health workers also received training in hand hygiene. Dr. Lule is one of the many remarkable actors recognized by the Alliance for his work in improving health .GHWA honoured four outstand-ing players during a special ceremony at the Third Global Forum on Human Resources for Health, in the following categories: health workers working in remote/hardship area, country-level decision makers, GHWA member organizations, and journalists. Having testimonies of awardees workers alongside the views of senior heads of state and health experts brought a personal dimension to the Forum discussions.

Dr.Maria IsabelRodríguez, the Minister of Health of the Republic of El Salvador, received an award for leading a process of national health care reform to provide UHC coverage through the strengthening of the nation’s health workforce. Her plan will add an additional 3,500 health profession-als to the workforce and will promote training of cadres of national health policy makers and the creation of a platform for the professional training of specialist physicians in the country.

The work of Alliance member AfricanMedicalandResearchFoundation(AMREF) has had a major impact upon the provision of health care in six African countries and saved many lives. The Kenyan-based international organization trains more than 10,000 community health workers every year in communities, health centres and hospitals. Trained health workers are then able to visit homes in some of Africa’s most marginalised com-munities. AMREF also trains doctors, nurses, midwives, clinical officers, laboratory technicians and pharmacists.

Ms.MarieYambo, a Kenyan journalist was honoured for her pioneering efforts in promoting health care development through a health segment on Kenyan television called ‘Health Matters’, exploring the role of health workers in the national health system. The programme has looked at the work of traditional birth attendants and community health workers to reduce the country’s infant and maternal mortality rates.

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Elevating HRH on the global agenda

GHWA supported and actively engaged in various policy and advocacy fora throughout the year. A number of policy dialogue processes and strategic events were successfully influenced through the inclusion and recogni-tion of HRH as a critical component in delivering health outcomes. Some events include:1. WorldHealthAssembly. GHWA collaborated with the Permanent

Mission of Brazil, the Permanent Mission of Belgium, and the World Health Organization to organize a side event building momentum ahead of the Third Global Forum and exploring innovative solutions to HRH challenges.

2. Consultationsonthepost-2015developmentagenda.GHWA pro-vided inputs through a collective effort facilitated by the Secretariat but harnessing the inputs and expertise of its members, into the discussions on the post-2015 development framework, including by supporting the inclusion of HRH elements in the discussions and pro-ceedings of two dedicated events. a. Ministerial Meeting on Universal Health Coverage, jointly

convened by WHO and the World Bank; b. The High-level Dialogue on Health in the Post-2015

Development in Gaborone, Botswana,

3. ConsultationonHRHinhigh-incomecountries. In its convening capacity, a consultation on HRH challenges and solutions in high-income countries (HIC) was jointly organized by GHWA with Norad and the Norwegian Director of Health in Oslo, Norway, on 4-5 Septem-ber 2013. The event enabled the sharing of experiences on common challenges and increased the involvement of HICs in finding global HRH solutions. Participating countries recognised the HRH crisis as a global one, requiring strengthened governance and management, suitable service delivery models, the availability of financial resources and appropriately trained, skilled health workers, and improved long-term planning to counter population demographic and disease challenges. The consultation further served to generate momentum leading to the Third Global Forum

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The civil society led Health Workforce Advocacy Initiative (HWAI), sup-ported by GHWA, contributed to keeping HRH high on the global health agenda through global meetings, reports and strategic partnerships. A powerful health worker advocacy social media movement – ‘#Healthwork-erscount’ – was launched in partnership with the Frontline Health Worker Coalition (FHWC), to promote health worker messages leading up to the Forum. HWAI members also organized a half-day advocacy session at the United Nations General Assembly in New York in September 2013, result-ing in the development of a civil society commitment announced at the Forum.

Building health worker capacity in francophone Africa

Building on the experience of country coordination and facilitation of an integrated HRH response developed during its first phase, GHWA is grate-ful to the French Government for their continued support of an initiative to accelerate the achievement of MDGs 4 and 5 (reducing maternal and child mortality), which is part of the French commitment to the G8 Muskoka initiative.

As part of the effort to increase coherence and alignment between GHWA and WHO, the health workforce component of this project is now (as of October 2013) implemented by the World Health Organization which has the mandate and is much better equipped than the GHWA Secretariat to conduct country work.

As part of this programme, WHO supports the development and imple-mentation of HRH strategies in several francophone countries in Africa, to improve the availability, accessibility and quality of the human resources needed for reproductive, maternal, newborn and child health (RMNCH).

In 2013 GHWA provided extensive technical support towards the finaliza-tion of HRH operational plans (including recruitment, deployment and retention approaches) for RMNCH health workers in Benin, Burkina Faso, Guinea and Togo. Several other capacity building initiatives were also carried out with Muskoka partners, including the development of a mid-wifery training plan for 11 countries - Benin, Burkina Faso, Cote d’Ivoire,

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Cameroon, Democratic Republic of Congo, Guinea, Mali, Mauritania, Niger, Senegal and Togo. The efforts also contributed towards building the advocacy capacity of the French midwifery and nursing professional associations in some of these countries. These activities were carried out in collaboration with the West African Health Organization [WAHO] and United Nations Population Fund (UNFPA). A tool for improvement in the quality of RMNCH care was developed with WHO. GHWA, partnering with UNFPA also carried out a quality assessment of midwifery schools in Benin, Senegal, D.R. Congo and Niger. Recognizing the potential of e-learning technology, GHWA supported WAHO and AMREFs efforts in the develop-ment of a regional roadmap for accelerating the training of midwives and nurses using e-learning technology.

Health Workers Count: A day in the life of a health worker photo contest winners

Firstplace:Md.MahfuzulHasanBhuiyan, for ‘A nurse in Bhairab, Bangladesh attending to a newborn and its mother’ (2013).

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Secondplace:AmitavaChandra, for ‘A community health worker administers a diphtheria and tetanus booster dose to a 5 year-old child in West Bengal, India’ (2013).

Thirdplace:HughRutherford, for ‘Dr Phetsamone patiently waits for the backup generator to turn on in order to commence surgery at an eye clinic in Oudomxay Province, Laos’ (2013).

Looking forward to 2030

At the same time, the international community should also be aware of and celebrate the many advances made in the past decade: among the countries affected by severe shortages of skilled health professionals, the situation has improved in most of those for which data are available. Evidence of the progress made and promising new approaches highlighted by emerging evidence provide the inspiration to initiate a decade of innovation on developing the health workforce, following the decade of action called for by The World Health Report 2006.

The needs for human resources for health that stem from the agenda for universal health cover-age require renewed attention, strategic intelli-gence and action. A systemic approach is required to devise and implement sound costed plans for

The research, policy work and advocacy conducted by the Alliance in 2013, as well as the discussions at the Third Global Forum on Human Resources for Health, highlighted that all countries face the challenge of how to attain, sustain or accelerate progress towards universal health coverage. Strengthening primary care is the way forward to provide comprehensive, integrated and people-centered services: this requires focusing on building partnerships between health care teams and communities and increasing access to health workers for people in under-served areas.

Human resources for health are central in translat-ing the vision of universal health coverage into reality. Nevertheless, gaps in human resources for health affect virtually all countries – albeit with dif-ferent connotations and varying level of severity.

human resources for health as part of broader national health strategies, built based on high-quality data and evidence. This requires long-term strategic planning, realistic forecasting and politi-cal commitment, combined with adequate policy dialogue and related funding to make a whole-of-government agenda on universal health coverage a reality. It is critical to foster an inclusive envi-ronment conducive to a shared vision with other stakeholders, including the private sector, civil society, academia, labour unions, professional associations and health worker representatives, and other sectors, including education, finance, labour and civil service.

In order to build a common sense of purpose and to translate the Recife Political Declara-tion on Human Resources for Health: renewed

commitments towards universal health coverage in practical actions both in countries and globally, an immediate follow-up action initiated by GHWA in the aftermath of the Third Global Forum in late 2013 was the decision to launch an inclusive and participatory consultation process . to develop a future strategy on HRH for countries at all stages of socio-economic development. The new HRH strat-egy will address key health workforce challenges and themes, including inter alia, health labour markets, measurement, accountability, leadership and governance, productivity and performance; and it will recognize the role of transformative education, the need to build human capability beyond the health sector, and the specific inter-ventions that are needed in fragile states. This effort will represent a key priority and an area of joint engagement by GHWA members and partners in 2014 and beyond.

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Table 1. Annual Financial Statement of the Alliance as of 31 December 2013

Financialoverview2013 US$

2013Income(inclCF)

Opening Balance* at 1 January 2013 1 943 032

New income during 2013 4 253 163

TotalAvailableFunds2013 6 196 195

Less

Expenditure

Expenditures & Encumbrances 3 880 736

Contingent Liabilities (WHO) 245 000

PSC charges 471 346

Total2013ExpendituresandLiabilities 4 597 082

ClosingBalance**at31December2013(gross) 1 599 113

* The Opening Balance at 1 Jan 2013, $1,943,032 (gross) corresponds to $1,719,497 (net of PSC).** The Closing Balande at 31 Dec 2013, of $1,599,113 (gross) corresponds to $1,415,144 (net of PSC)

NOTE – Further adjustments, as applicable, subject to WHO biennium financial closure (2012-13)

Annual Finances

28 29

* To be settled with WHO in 2014, deferred for purposes of managing GHWA’s cash flow constraints.

Note: The above figures are subject to adjustments, where applicable, through the WHO 20112-13 Biennium closure process.

2013GHWAworkplanExpenditureStatement(inclencumbrances) US$ (netPSC)

Objective1:EnablingSolutions

HRH,UHC, Post MDG Agenda

Share HRH Information

HRH Policy Dialogue

Global & Regional Consultations

Advocacy HRH for UHC

40 000

192 844

189 817

184 605

13 537

Sub-totalObjective1 620 803

Objective2:CatalysingActions

HRH Best Practices

Labour Market Meeting

Catalytic Support, Coalition Support & Muskoka

210 400

31 203

447 566


Objective3:EnsuringResults&Accountability

World HRH Report

138 561


Objective4:Governance,Oversight&Management

Mgmt Oversight, Operations

Governance & Board Meetings

Staff Costs

33 688

183 541

2 214 974

Sub-totalObjective4 2 432 203

ContingentLiabilitiestoWHO(2013ClusterCharges*) 245 000

* To be settled with WHO in 2014, for purposes of managing GHWA‘s Core

funding cash flow constraints.

2013TotalGHWAExpenditures&Encumbrances 4 125 736

PSC (WHO charges) 471 346

2013TOTALExpenditures(inclEncumbrancesandPSC) 4 597 082

Annual Finances

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Table 2. Funding contribution to the Alliance from 2006 to 2013 (Dec)

Donor FundingfromInception(US$)

Bill & Melinda Gates Foundation 5 000 000

Brazil 500 000

Canada (CIDA) 3 436 911

European Commision 1 771 121

France (AFD) 5 275 297

Germany (BMZ/GIZ) 2 166 391

Ireland (Irish Aid) 5 933 607

Japan 4 494 000

Norway (NORAD) 12 212 828

UK (DFID) 5 553 720

US (USAID) 1 692 175

Total 48 036 050

US (USAID)

4% UK

(DFID)12%

Norway(NORAD)

25%

Japan9%

Ireland(Irish Aid)

12%

Germany(BMZ/GIZ)

5%

France (AFD)11%

European Commision4%

Canada(CIDA)7%

Brazil1%

Bill & Melinda Gates Foundation

10%

30 31

Listofdonors2013–GHWAisgratefultothefollowingfundingpartners

> Agence France Development, France> Government of Brazil> Department for International Development, United Kingdom> Deutsche Gesellschaft für Internationale Zusammenarbeit, Germany> Irish Aid, Ireland> Japan> Norwegian Agency for Development Cooperation, Norway> United Nations Population Fund (UNFPA)> United States Agency for International Development.

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Launched in 2006, the GlobalHealthWorkforceAlliance is a partnership dedicated to iden-tifying and coordinating solutions to the health workforce crisis. It brings together a variety of actors, including national governments, civil society, finance institutions, health workers, international agencies, academic institutions and professional associations. The Alliance is hosted by the World Health Organization.

Forfurtherinformation,pleasecontact:

GlobalHealthWorkforceAllianceWorld Health OrganizationAvenue Appia 201211 Geneva 27SwitzerlandTel: +41 22 791 26 21 Fax: +41 22 791 48 41Email: [email protected]: www.who.int/workforcealliance

Rising to the grand challenge of Human Resources for Health

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