Linking the Millennium Development Goals with Human Resources for Health

After being escorted past more security guards than I’ve encountered in my entire life, I arrived in a conference room in the United Nations building overlooking the East River in New York City eager to hear luminaries discuss the critical link between human resources for health (HRH) and the attainment of the Millennium Development Goals (MDGs).

I took the train from Washington, DC to NYC early this morning and watched the birth of a sunny, early fall day. I “immigrated” to NYC from Kansas after graduate school, and I still love its positive energy.

Progress in human resources for health
No Health Workforce. No Health MDGs. Is that acceptable? was a side event held at the MDG Summit this week, sponsored by the Global Health Workforce Alliance (GHWA) along with the governments of Norway, Brazil, and Cameroon, and the Health Workforce Advocacy Initiative. President of Malawi Dr. Bingu wa Mutharika delivered the keynote address, and Dr. Mubashar Sheikh from GHWA delivered the opening and closing remarks. The panelists included ministers of health from Cameroon, Malawi, Norway, and Brazil; a DFID representative; and a Japan International Cooperation Agency (JICA) vice president.

I was particularly struck by these promising comments made by the presenters:

• Six years ago Malawi faced the fact—as they put it—that their public health care system had collapsed. Engaging in an emergency HRH plan, Malawi has since increased the number of health workers by 66%, nearly stopped the out-migration flow, improved retention and reengaged many retired health workers, raised salaries for selected cadres, and invested in human resources management (HRM).

• Brazil also shared a success story—they are set to meet their MDGs early. Brazil is eight years into a social inclusion process; written into the constitution is the basic right for all citizens to quality, free health care. The HRH system is now the backbone of their reengineered public health system. They are the first country in the world to cover organ transplants in their public health care system. Among the key actions behind this success are a strong focus on HRM systems, the creation of a career ladder for all health workers, and effective health information systems to gather and store data made accessible for all through their Observatories.

• JICA’s new pledge to increase investments in global health will support health information systems implementation, encourage development of the community health worker cadre, and support construction of new facilities.

• DFID was upbeat about addressing HRH issues. The representative said, “We (all of us) can do this. We now know what works—what it takes to get health workers in place. We are on the cusp of significant breakthroughs.” DIFD wants to focus on getting health information systems up and running in all countries and working to strengthen basic HRM systems. The presenter used an example of a simple payroll audit that found an error rate of 15%, which when corrected freed up enough funds to pay for 1,000 additional health workers.

Common themes
Through the evidence presented, the moderator’s questions, and attendees’ comments, these four trends emerged:

• There is now more fiscal space in national budgets to support HRH than there was five years ago. Countries are more willing to invest in health, viewing it not as an expense but as an investment in the development of the country. They are realizing that investing in health care creates jobs, which in turn bolsters the economy.

• There is now a growing body of evidence about how to make progress. We have increasing knowledge about solutions for HRH—what works and what doesn’t. While there are still challenges and the path forward won’t be easy, we do know what critical actions we need to take.

• Countries throughout the world are realizing they have to consider their future HRH needs and plan accordingly. Many developed countries have aging populations and will have increasing demands for health workers. Hopefully the new World Health Organization Global Code of Practice on the International Recruitment of Health Personnel will inspire countries toward the development of their own workforce rather than recruiting from other countries.

• Human resources information systems and trustworthy HRM systems are crucial elements for improving the productivity of the current workforce.

The train trip home was peaceful, as I reflected on the panel discussion and how it intersects with my work on the CapacityPlus management team. I’m excited by the stories shared and by the work that is yet to come.

Photo: Courtesy of Wilma Gormley