Health Professional School Leaders Are Critical in National Health Planning and Policies for Emerging Epidemics
Health professional school leaders must be seen as a vital health sector resource, and used accordingly. 
There have been over 4,000 known Ebola cases in Liberia, Sierra Leone, Guinea, and Senegal, resulting in 2,000 deaths. Of this number over 300 health workers have become sick and roughly half have died. There has been a significant immediate funding response from the international community including an initial $21 million investment in protective gear, chlorine bleach, and food aid, and deployment of CDC and USAID personnel, with additional USAID funding totaling $100 million. Further, there are commitments from the World Bank ($230 million) and the African Development Bank ($60 million).
These financial commitments are critical, but as Stephen Morrison of the Global Health Policy Center, Center for Strategic and International Studies, wrote recently, “On the ground, several thousand additional workers capable of implementing emergency disaster programs are needed, and will require protection and expedited training and deployment. These critical elements are needed urgently today, but where will they come from?”
The answer is that they will come predominantly from national—not international—health professional institutions.
Local health workers are central to any national response to a major health crisis, if they have the right training, are produced in the right numbers, and deployed where needed. They are essential for an effective national health system. The majority of health workers are produced by national medical, nursing, midwifery, pharmaceutical, and other health science schools. Even if over a thousand international health professionals were to volunteer in Liberia, which is highly unlikely, their numbers would be dwarfed by the more than 9,000 Liberian workers employed by the Liberian government and at least 3,000 more employed by faith-based and private health care providers. Local health workers also know the local languages and cultures, which help them deliver more effective care. National health professional school leaders are the people who determine the numbers of workers produced in each cadre, their skill sets, and practice behaviors. These are underlying determinants of health systems performance, whether in normal circumstances or in an unfolding epidemic situation.
The point is that while governments can announce laudatory health response goals, unless those who understand the complexities in pursuing human resources for health goals are directly engaged in the deliberations and decision-making process, the goals are destined to fall short.
In most low- and middle-income countries, health professional schools have been seen as responders to national health policies and programs, rather than as leaders, formal participants, or originators of health policy. In essence, those who are charged with producing health workers have been sidelined in the health policy debate and design.
As a result there is often a disconnect between what a policy calls for and what the health education, training, and research system can deliver.
Health professional school leaders must be seen as a vital health sector resource, and used accordingly. They can provide insight to ministries and other entities influencing the health sector; improve efficiency and coordination through partnerships with professional associations; and, interact with district, community, and health facilities by being responsive to their conditions and needs. They can ensure that health workers have training relevant to the sparse realties of frontline health clinics in rural areas and can work to recruit more qualified students from underserved communities.
In sum, strong and regular interaction between the institutions charged with producing a nation’s health workers and leaders responsible for policy is a sine qua non to dealing with health in general and emergencies in particular.
The role of health school leaders is likely to take on increasing importance as countries of all income levels consider how to put in place more robust compliance with the WHO 2005 International Health Regulations. This treaty requires state parties to have in place technical resources needed for a disease surveillance and response system to be able to address “all events which may constitute a public health emergency of international concern” (Article 6.1). Only about 20% of all countries have complied with this treaty obligation.
The Ebola epidemic is a wake-up call to countries to recognize that future health challenges will be fundamentally different—with different diseases and health demands—from those we have known. This will require greater inclusion of those with the knowledge of how to train health workers and carry out health service delivery research.
CapacityPlus’s new technical brief, Health Professional School Leadership and Health Sector Reform, Performance, and Practice, makes the case for inclusion of health school leaders in the formulation of national health policy and highlights examples of successful cases.
Richard Seifman is a senior consultant for education and training at CapacityPlus. He was previously a senior advisor in the World Bank AIDS Campaign Team for Africa (ACTAfrica) and is a serving member of the Technical Review Panel of the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
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Photo courtesy of Richard Seifman
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