Human Resources for Health Why we need to act now

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1 Human Resources for Health Why we need to act now Progress towards the MDGs, particularly in Africa is slow, or even stagnating. Poor people cannot access basic services for want of doctors, nurses and key health workers HIV/AIDS is undermining years of development gains, life expectancy is decreasing in many African countries There is a clear link between human resource capacity and health outcomes Poor countries cannot retain health workers, whilst their health remains poor, prospects for economic growth remain limited Resource rich nations have a responsibility to act. The inequity in health worker distribution globally is unacceptable. 1

2 Africa s progress towards health MDGs 2

3 Changes in life expectancy in selected African countries with high and low HIV prevalence: Life expectancy (years) with high HIV prevalence: Zimbabwe South Africa Botswana with low HIV prevalence: Madagascar Senegal Mali Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision. 3

4 Health Workforce-Output Relationship between health worker density and selected health outcomes in 97 countries 100 Trinidad Mozambique Measles Immunization 80 Eritrea Skilled Birth Attendance Percentage U ganda Keny a Venezuela C entrafrique Mali 20 Laos Nepal Density of health workers/10,000 population

5 Health Workforce - Outcome HR Density # Physician+Nurse+Midwife per 10,000 NOR IRL NLD BLR BEL DNK DEU ISL USA CUB RUS UZB SWE CZE LTU AZE JPN CHE FRA LUXISR AUS NZL ITA SVK UKR AUT SVN CAN ESTSYC GEO MDA KGZ TKM KAZ PO L BGR ESPPRT GBR MLT GRC CYP HRV MKD LVA FIN HUN YUG QAT PHL ROU MNG KOR BHR BRB ARM TJK SG P KWT BIH KNA ARE BRN OM DM NA URYLB YFSMSAUJOR EGY PR K BHS TUR ARG TTO TON VCT TUN SYR LBN IRNDZA LCA MUS MHL IRQ VEN GRDSUR NAM CHN VUT KIR BWA MYS FJIPAN MEX SLVDOM STP KEN SWZ COD CHL BLZ Rich CRI WSM THA ECUBRA MDV PER COL MAR JAM GTM ZAF LAO NGA Countries VNM GNB LKA TZA HND GUY PAK SL B NIC KHM AGO BOLIND ZMB GHA SDN SLE LSO MRT CPV PNG MMR DJIGIN PRY IDN YEM ZWE SEN GNQ COM BGD COG CIV HTI NPL BTN ERI MDG CMR BEN AFG TGO MOZ BFA NER GMB RWA BDI SOM TCDMLI CAF LB R UGA ETH Mortality rate, under-5 (per 1,000 live births) Source: WHR2002, WDI2003 U5M R Poor Countries 5

6 Global Distribution of Health Workers Unequal and Unacceptable. Basic healthcare requires 20 physicians and 100 Nurses per 100,000 people Western countries average of 222 doctors and more than 1000 nurses. 38 countries in sub-saharan Africa, have less than 20 doctors and 13 countries have 5 or fewer doctors 17 sub-saharan countries have less than half of the WHO minimum standard for nurses 6

7 Health Worker Migration the Brain Drain an international issue World Health Assembly resolutions (2004/2005) High Level Forum (Abuja 2004) Oslo Meeting (February 2005) Transitional Working Group Brazzaville (July), Bangkok (August) High Level Forum Paris (November) 7

8 Ratio of physician wages (PPP$US), destination country to source country 8

9 Percentage of health care professionals who intend to migrate the supply of migrants In Zambia, the public sector only retained 50 out of 600 doctors trained in the country s medical school from

10 A Growing Alliance for Action The issue of HRH is gaining political momentum WHA 2004 and 2005 Decade of Action 2006 Joint Learning Initiative has provided the global evidence HLF Abuja and Oslo, called for international action Africa Series of High Level Meetings (Abuja, Gabaronne) Brazzaville (July), Bangkok (August) strong regional commitment 10

11 The first steps forward Strong African Regional Commitment, - good country examples of action (Ghana, Malawi), a framework for HR planning, developed and ready for roll out. Increased coordination of information and technical resources the beginning of the regional observatory in Africa and Asia Debate on fiscal space, is critical for the long term recurrent cost of human resources Commitment of Global Health Partnerships to support system strengthening welcomed 11

12 So, what next? The response needs. Political commitment Global and Regional Platforms, informed by continued global and regional evidence gathering through Global and Regional Observatories. Coordinated and coherent action. an alliance building on strengths and mandates of existing organisations, behind a coherent global strategy for action. Financing this is primarily funding of country level HR plans, which needs long term sustainable financing but catalytic funding of the strategic plan, supported by a small secretariat (in WHO?), will be essential to maintain focus and momentum Collaboration - Support and engagement of global funding mechanisms, to strengthen system building 12

13 Vision 10 years from now. Comprehensive national HR plans part of national planning. Ministry of Finance recognition of financing needs (achievement of Abuja 15% target for health financing in Africa, and increased donor support provided predictably and over the long term International agreements to better manage HR, and migration, with sharing of regional training, inter-country agreements on recruitment, and incentives packages developed and funded for worker retention. HR management, included as an indicator of MDG commitment in PRSP planning and focus of MOF and donor attention in poverty monitoring 13

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