Health workforce 2030: a transformative agenda? (editorial)
Dear reader,
Next week, WHO’s Executive Board will discuss the draft Global Strategy on human resources for health: Workforce 2030. If all goes well, the final version will be endorsed at the 69th World Health Assembly in May. Workforce 2030 provides a new and progressive health workforce agenda.
A decade ago, The World Health Report 2006 already estimated a global shortage of 4.3 million health workers. Since then, the Global Health Workforce Alliance has tried to address the HRH governance challenges, albeit with a mixed impact. A major reason for this is that governments have not made, or were not in the position to make considerable additional investments in the health workforce. There were some notable exceptions, including in Low and Middle-Income Countries (LMICs), but in general the outcomes have been below expectations. Both within domestic and international health financing, recurrent expenditure (salaries and education) for health workers has lagged behind other health investments.
The new Sustainable Development Goals (SDGs) include as target 3c, ‘Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States’. Workforce 2030 uses a new benchmark indicator, the so called SDG composite method (see annex 1 of the Global Strategy). It estimates that 4.45 health workers per 1000 population are needed to reach the SDG health targets. This amounts to a total global deficit of 17.6 million health workers relative to current supply, with a projected deficit of 13.6 million health workers in LMICs alone.
Workforce 2030 is a strong building block for integrating health workforce development in broader health and socio-economic development. However there is an ambiguity underlying the strategy that merits attention, not unlike the one in the overall SDG agenda: social development still relies on the old model of (industrial) economic growth.
‘Workforce 2030 makes the case that investment in the workforce offers a triple return; social- and economic benefits, improved health outcomes and robust front-line defense for global health security’. (par.9)
Health equity will be at risk in this approach. The strategy relies on the assumption of (strong) economic growth in LMICs to finance workforce deficits. The global additional wage bill needed to scale up the workforce in LMICs is considerable. A major question is: who is going to finance that bill? Will domestic revenue suffice or will this be a shared responsibility, with also an international financial framework?
Workforce 2030 argues for public sector intervention to ‘recast insufficient provision of health workers and their inequitable deployment’ and public HRH investments should be supported by ‘appropriate macro-economic policies’ while ensuring ‘adequate fiscal space’ (par.38) The next paragraph mentions ‘expected growth in health labour markets …as a way to create qualified jobs’ (Par.39).
The crux is that the prevailing, resilient macro-economic model (the ‘Washington consensus’) has led to fiscal contraction, austerity measures across the globe, privatization of services, liberalisation of trade and capital, deregulation of labour markets etc. Although the Washington consensus has been criticized by some national governments and others, key tenets of it are still very dominant with impacts visible worldwide.
Emerging economies like Brazil face serious economic difficulties while the expected growth in many African countries seems overestimated. It is a fallacy and a myth to believe that such a monetarist economic model and the “labour market” will overcome the workforce deficits, and improve health outcomes. Privatization of education and health services will indeed create highly skilled, professional, medical staff, but these will be only accessible for those who can afford them (e.g. via health insurance schemes). This will stimulate further (global) mobility of the skilled medical workforce while limited public funding and philanthropy will need to cover other public health functions as well as the deployment of lesser skilled Community Health Workers (CHWs) to impoverished neighborhoods and rural areas. CHWs are essential for integrated, people-centred health services but the scenario above leads to parallel systems; access to a skilled medical professional for those who can afford it, poor services for the ones that rely on minimum health coverage.
The good thing is that there are alternative pathways if we dare to imagine and attempt them. A key advice for Workforce 2030 and the actors working on it would be to de-emphasize the instrumentalist, utilitarian role of the health workforce in economic growth and labor markets, and rather emphasize the intrinsic value of a competent workforce in improving health outcomes and reducing health inequalities. Inspiration can be sought from those that already aim to transform economic performance and policies, and consider them as a means towards social and health outcomes, rather than as the goal. In this scenario, Health workforce 2030 would not merely be a technical program or leading to yet another global health initiative. It could become part of a wider social and political project of which the time has come. Then, Workforce 2030 would be a truly progressive agenda that could help to transform the current global health paradigm.
Remco van de Pas, ITM Antwerp, Member of the MMI Board
Member of the MMI working group on HRH
Editorial also published in today’s IHP news
MMI at the 138th Session of the WHO EB: see events
MMI thematic guide: Human Resources for Health
MMI Network: Events, news, papers, projects, resources
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Network event: Medicus Mundi International
138th session of the WHO Executive Board
Geneva, 25-30 January 2016
The 138th session of the WHO Executive Board takes place from 25 to 30 January 2016. Items on the agenda include health systems / health workforce, health in the SDGs, the follow-up of the Ebola crisis (International Health Regulations, WHO and emergencies), the WHO reform (Framework on Engagement with non-State Actors) and many others. As in previous meetings of the WHO governing bodies, MMI will also host the “WHO Watch” project in its delegation. A series of civil society meetings co-hosted by the MMI Network will take place on the weekend before the WHO EB session.
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Network event: Medicus Mundi Switzerland
Polio: Ensuring the Global Public Health Dividend
Geneva, 27 January 2016
A public event in the week of the 138th session of the WHO Executive Board, organized by the Global Health Programme of the Graduate Institute, a member of Medicus Mundi Switzerland.
> http://graduateinstitute.ch/globalhealth-event27january
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Network article: HealthNet TPO
Dignity in Mental Health
“I attended a day of ‘celebrations’ for World Mental Health Day in Juba, South Sudan. I put this in inverted commas because it feels almost trite to require a globally recognized day to revel in the status of worldwide success of such a fundamental human right. Why are we celebrating the successes of service provision? Should this not just be a given that everyone have access to quality support if they are suffering? Should it not be internationally acknowledged that stigmatizing or discriminating against another human being because of something out of their control is entirely unacceptable?”
> http://www.healthnettpo.org/en/1735/dignity.html
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Network article: Health Poverty Action
Briefing papers on trade, tax and health
”In December 2015, Health Poverty Action has published two new briefing papers which form part of a wider series looking at how the structural causes of poverty impact on health. The first of the two briefings explores the relationship between tax and health. The second has been published jointly with the Trade Justice Movement and focuses on trade and health.”
> http://www.healthpovertyaction.org/news/briefings-tax-trade/
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Network video: i+solutions
What is pharmaceutical Supply Chain Management?
”Millions of people around the world lack continuous access to essential medicines. Improving the supply chain management of medicines is a crucial step in order to solve this problem. i+solutions is an independent, not for profit organisation specialized in pharmaceutical supply chain management. We work to solve the world’s unmet medical needs. In this video, you will learn more about our work.”
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Network conference report: DWA Cuamm
The role of Community Health Workers in two regions of Tanzania
Dar es Salaam, 17 December 2015
”A workshop organized by Doctors with Africa CUAMM took place to discuss the first results of a research, conducted with UNICEF, on the role of first line health care providers in many African contexts: Community Health Workers (CHWs). The CHWs are prominent representative of the community who work on a voluntary basis with communities to promote health seeking behavior and to provide information on availability of health care services also in remote and peripheral area.”
> http://www.mediciconlafrica.org/en/our-voice/news/a-workshop-about-community-health-workers/
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Network reporting: Health Poverty Action
Annual Review 2014-15
“Working to strengthen poor and marginalised people in their struggle for health” – The Annual Review 2014-15 of Health Poverty Action is available in English.
> http://www.healthpovertyaction.org/news/annual-review-201415/
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Network reporting: DWA Cuamm
Annual Report 2014
”Our work in the difficult, intense year of 2014 took us to Africa and across Italy both as health providers but also, and above all, as people. Each day we renew our promise to the world’s lowliest. This responsibility has kept us in Africa for over 60 years, alongside those fighting to survive on a daily basis, even when it would have been simpler to shun adversity and give up.” The annual report 2014 of Doctors with Africa Cuamm is available in Italian and English.
> http://www.mediciconlafrica.org/en/who-we-are/accountability/annual-report/annual-report-2014/
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Network project: Cordaid / South Sudan
Quick malaria response saves lives
“On top of the continuing conflict, the vulnerable South Sudanese state of Upper Nile now also has to deal with a serious outbreak of malaria. Fortunately, the medical staff of Cordaid comes well-prepared, and nearly all patients can return home quickly after treatment.”
> https://www.cordaid.org/en/news/malaria-outbreak-south-sudan-quick-response-saves-lives/
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Network resource: Medicus Mundi International
Thematic Guide: Universal Health Coverage
MMI thematic guides to internet resources lead you beyond the limits of the Medicus Mundi International Network. References to further thematic guides can be found in the “global health updates” below.