First-Ever Global Forum On Health Worker Crisis Opens In Kampala, Uganda
Delegates from the 57 countries identified by WHO as undergoing an acute crisis are attending the Forum, which is hosted by the Government of Uganda and organized by the Global Health Workforce Alliance (GHWA). Representatives and experts from the United Nations and international agencies, countries, health worker associations, civil society and academia are also participating in this event - over 1000 participants in total.
According to the World Health Organization (WHO), over 4 million additional health workers are estimated to be required worldwide - with 1 million needed for Africa alone.
"For too long we have watched this crisis unfold in front of our eyes. This is unacceptable. This first Global Forum is a historic occasion. The world is looking to us and encouraging us to be ambitious in our goals, open to innovation, and determined to implement the solutions which have been found. What we want is the political awareness and will of the highest level of the world's decision-makers to take forward promises made on this issue and translate these into concrete action," said Executive Director of GHWA, Dr Francis Omaswa.
The opening ceremony features welcoming speeches and remarks from General Yoweri Kaguta Museveni, President of the Republic of Uganda, Anarfi-Asamoa Baah, Deputy Director-General of WHO, Lincoln Chen, Chair of GHWA, and Mantombazana Tshabalala-Msimang, Chair, African Union Bureau of Health Ministers and Minister of Health of South Africa.
During the week-long Forum, participants will discuss and share experiences on the issues of leadership, education and training, migration and retention, financing, management and partnership for the global health workforce.
"Uganda welcomes the GHWA Forum to Kampala. We have strong links with the Global Alliance, with their Executive Director being Ugandan himself, and I have had the privilege to participate in the Task Force on Education and Training. Uganda has recently launched its own Human Resources for Health Plan because we recognize that this is a critical issue and that every country needs a plan. We are taking steps to make sure Uganda is taking action," said Honorable Stephen Malinga, Minister of Health, Uganda.
Key issues of the Global Forum
The importance of concrete and active Leadership will be central to the Forum. Leadership is about taking the facts and turning them into action. It is about identifying winning strategies and backing them to the full, with long term commitments. The Forum will underline how political leadership is needed at the country, regional and global level in order to give health issues in general, and the health worker crisis in particular, top priority.
To bridge the health worker gap, there is need for a massive and immediate effort by countries and international partners, to scale up education and training. Evidence from countries and governments who have scaled up and innovated in education and training will be shared. Emphasis will placed on the need to apply the knowledge, continue learning and use new technologies, as well as twinning developing and developed country training institutions. Task shifting can also provide a boost in delivery in the short term. Policy choices, including the types of health worker needed ('skill-mix'), need to be appropriate for country health priorities.
The challenges of migration and retention will be underlined as an issue for action from both the North and South, working together. Health worker migration must be managed - it cannot be halted. When significant numbers of doctors and nurses leave for wealthier countries, the countries that financed their education become de facto unwilling donors to those destination countries. On average one in four doctors and one nurse in 20 trained in Africa is working in OECD countries.
However, there is evidence that no matter how attractive major destination countries are, massive migration would not occur without strong push factors in the source countries. Forum discussions will focus on the issues of wages and working conditions which contribute to improving motivation for health workers to serve in their home countries or regions, or be willingly deployed to underserved areas. Adequate supervision, equipment, facilities and clear job descriptions are crucial to creating the proper working environment and will also be discussed.
The Forum will address the issue of human resource management (HRM), which should be a strategic and coherent approach to the management of an organization's most valued assets - its staff. Effective support systems and tools are essential for coherent management, and hence for delivering effective health services. Participants will focus on the importance of building HRM structures and capacity, as well as a good HR Information Systems as essential at the operational and policy levels. The importance of managers working in an enabling environment which makes it clear what they are expected to do and which encourages and rewards them appropriately will also be underlined.
Scaling up the health workforce will require long-term and sustainable funding. Participants will underline the importance of knowing how much funding is needed so that countries and development partners can plan accordingly. In 2006, the cost of training and hiring enough health workers to meet the MDGs by 2015 was estimated to be US $447 million per country per year on average. Now, experts warn that even more money may be needed once all latest associated costs for infrastructure, training and education are calculated. The Forum will discuss the need for macro-economic and national constraints on increased health workforce spending plans to be relaxed. The importance of ensuring funds are used efficiently, effectively, and equitably will also be stressed.
Partnership will be underlined as critical to success. GHWA stresses that the only way forward is to work together--North and South, East and West, rich and poor and that human dignity, human development and the quality of life of populations must be at the centre of national political and social agendas.
"Everyone has a part to play in resolving this crisis. This Forum gives a unique opportunity for us to come together as a real global community, to drive each other forward to find solutions. Health workers save lives. Preparedness to deal with health risks depends on health workers on the ground. We owe it to them and to all people that are deprived of access to take immediate action. The current situation makes us all vulnerable and undermines our commitments to global development," said GHWA Board Member and Chair of the Forum Organizing Committee, Dr Sigrun Møgedal.
Health Workers for All and All for Health Workers
The growing crisis in the global health workforce is now the biggest roadblock to improving health outcomes, which in turn impedes progress in the struggle against poverty. No matter how successful efforts may be in providing medicine, equipment and other materials needed for improving health, without an adequate health workforce in place these resources will be misused or wasted . Because access to decent health care is a fundamental human right, there is a clear global obligation to resolve this unacceptable state of affairs. People are suffering and dying in large numbers from preventable causes directly related to the health workforce crisis. .
While there has been a worldwide increase in awareness of the problem in recent years, concrete remedial actions have been lagging behind. Political momentum must be generated to begin implementing the required policies everywhere. If strong action is not taken to reduce significantly the growing deficit in the health workforce, global disparities in living conditions and quality of life will continue to grow, with all the attendant political, social and humanitarian consequences.
The Kampala Declaration and Agenda for Action of the Global Health Workforce Alliance (GHWA) builds on commitments already made around the world. It is both a call to action and a set of recommended steps designed to marshal the world's collective knowledge and resources to reverse this crisis. The Agenda also provides the means for assessing progress in meeting the challenge and, significantly, it anchors a platform for joint action. Its overarching principle is that it is not enough to commit to doing something: now is time to act on that commitment.
Recognition of the problem is still inadequate in several respects. For example, in low income countries, the rampant illness and premature death have become tolerated as God-given and unavoidable, yet these should be seen as social and health system failures. Richer countries, on the other hand, do not fully appreciate that the health workforce problem in their countries has global repercussions and that they have a stake in increasing the number of qualified health workers in their own countries as a step towards reversing actions that undermine health systems elsewhere, particularly ones that are already weak.
Building this recognition calls for strong political leadership in all aspects of responding to the problem. In every area, steps have to be taken even if some details may be lacking in our collective knowledge: we may not know where every single bump in the road ahead lies, but we know which road to take. Since all possibilities are not given at the outset, political courage and will is absolutely necessary in order to take the innovative, exploratory steps that will be needed. This Declaration and Agenda for Action is meant to guide those steps and to help strengthen the political resolve of actors across the world who must work together to face the crisis effectively.
The areas covered include migration, management and retention, finance, education, advocacy and accountability. Their interconnectedness is apparent: health worker migration is the counterpart of the need to bolster retention of trained personnel, while improving and enhancing the education and training of health workers provides a greater pool from which to hire and retain needed personnel. Better management of the existing workforce, including its conditions of work, not only favours retention but makes best use of the people retained. Finance touches on all of the above because the ability to make progress in any aspect of the problem depends significantly on finding financial resources and making them available. Advocacy and accountability in each of these areas maintain focus and momentum while ensuring that goals are met.
Because these areas are mutually reinforcing, coherent and coordinated political leadership is required to establish a proper framework for technical interventions in each. As a first priority, and as the cornerstone of an overall strategy, steps must be taken to ensure that the requisite political will exists and is made effective.
Expanding and improving the education and training of health workers is essential to increasing the supply of health personnel in response to the accelerating demand for services. Policy choices in this area need to be appropriate to each country's circumstances and should be made primarily by the countries themselves.
Effective management of the existing workforce is key to any improvement in the crisis, and an essential feature of this management involves retaining health workers close to their communities whenever possible, as well as deploying them more equitably in underserved areas.
Health workers will not be motivated to serve in their home countries or regions, or be willingly deployed to underserved areas, if working conditions are poor or if wage packages are insufficient to ensure decent living conditions. Adequate equipment and other facilities are important to creating the proper work environment, as are sufficient supervision, clear job descriptions and reasonable organization of the work.
Efforts at educating and retaining an adequate health workforce are undermined by market pressures encouraging the migration of trained personnel out of the country. Shortages of health workers in developed countries, due in part to demographic changes in the North, have increased demand for health personnel there. The imbalance of power and financial resources between rich and poor countries has caused a drain on health workers from regions such as sub-Saharan Africa, where health systems are already extremely fragile.
Progress in retention in the poorer countries will slow down this process, but rich countries need to appreciate that it is in their best interest to help bolster health systems across the globe. Trade and travel make everyone vulnerable to diseases from anywhere as was starkly demonstrated by the SARS outbreak. Investment is safer where both the local labour force and its supporting community are healthy. Moreover, there is a moral and political obligation: the scale-up of health systems worldwide is a critical part of meeting the international commitments already agreed to by developed nations. Meeting the Millennium Development Goals, for example, is everyone's responsibility. Effective political leadership is important here, and must be deployed to help both source and destination countries work together to establish equity in the recruitment of their health workforces.
Allocation of resources is a political decision, so strong political leadership at the national level is required if new ways are to be found for financing the scaling up of the health workforce. Governments and their partners need to demonstrate greater determination and longer-term vision by including health workforce matters more prominently in their poverty reduction strategies. Health issues in general, and the health worker crisis in particular, must be given top funding priority.
In parallel, international political leadership is needed in order to establish partnerships that will provide dependable financial flows towards under-financed health systems sufficient for achieving health objectives that have already been established. The ultimate hope is to enable countries to self-finance their own health needs adequately by creating the enabling national and global climate for fair trade and economic development. In the meantime dependable international financing is crucial. Equally important is the need in some countries to review and relax restrictive macroeconomic constraints on spending for health that are applied across the board and prevent the recruitment and retention of a sufficient number of health workers.
The momentum generated by undertaking the measures recommended in this Agenda will need to be maintained over the long term. If not, a strong start will quickly fade away, leaving various populations to continue suffering the disastrous effects of the crisis.
Ongoing advocacy, sustainable and sustained partnerships, and accountability based on transparent and extensive communication will help maintain the political will and energy required to see these efforts through to their successful conclusion.
No single entity can solve this crisis on its own. Everyone is part of the solution and partnership is critical to success. We cannot continue to let this human catastrophe unfold in front of our eyes. Most importantly, we cannot hope to address this issue unless political commitment for action and change is real, immediate and sustained.
The First Global Forum on Human Resources for Health takes place in Kampala, Uganda from 2 - 7 March. A full Agenda and list of speakers is available on the GHWA web site: http://www.who.int/workforcealliance/forum
World Health Organization
Primul forum global-vreodatã pe lucrãtor crizã de sãnãtate se deschide în Kampala, Uganda - First-Ever Global Forum On Health Worker Crisis Opens In Kampala, Uganda - articole medicale engleza - startsanatate