In the last decade, I’ve become well-versed in the revolving door of global health’s “it issues” – those that mobilize policy change and increase investment from donors, governments and multilateral institutions.
In the early 2000s, a focus on AIDS galvanized the creation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria – enabling millions of lives to be saved. In recent years, the United Nations Every Woman, Every Child Campaign and the Global Call to Action on Child Survival have refreshed enthusiasm around ending preventable maternal and child deaths.
Health workforce strengthening has yet to become global health’s “it issue,” though we’re seeing some signs that it’s on the verge. If those signs fizzle, much of the progress made in, and hoped for in strengthening the health workforce in the coming decades will be in jeopardy.
We don’t have nearly enough health workers in the places where most preventable deaths occur, and those we have need more support. As we work to end infectious disease pandemics, and ensure mothers and children survive and thrive, it will require getting services to harder-to-reach locales.
The World Health Organization (WHO) estimates at least 83 countries lack the number of doctors, nurses and midwives to provide essential services to their entire population, even if they were equitably distributed (which they are not). As a result, WHO estimates that about 1 billion people have little-to-no access to a health worker.
So where are the signs that health workforce is emerging as an “it issue?”
They have come from some of the countries facing the most acute health workforce crises.
About 10 years ago, the Ethiopian government decided train, support and pay tens of thousands of frontline health workers in rural and neglected areas. This resulted in astounding progress. Two years early, Ethiopia met the Millennium Development Goal (MDG) 4 target of slashing child mortality by two-thirds from 1990 to 2015. The country is expected to soon meet the MDG 5 target of decreasing maternal mortality by three-quarters, and since the introduction of PEPFAR in 2005, HIV incidence has dropped there by 90 percent.
In Nepal, the government approached the issue differently, recruiting 50,000 women to volunteer as community health workers and formally linking them to the health system. This focus on improving access to frontline health workers has also paid off. Nepal achieved its MDG 5 target early and is on track to achieve MDG 4 by 2015.
Fifty-seven countries made concrete health workforce commitments last year at the Third Global Forum on Human Resources for Health in Brazil. Ireland was the only country that made a donor investment commitment.
However, we’re beginning to see donor governments step it up for health workers. USAID helped lead the charge in pushing for the world’s health ministers to agree on a global strategy for the strengthening the health workforce by 2016. The health workforce was also included in the draft post-2015 Sustainable Development Goals. Strategies with concrete targets and financial commitments need to follow these actions.
At a recent Frontline Health Workers Coalition meeting, Martha Kwataine, executive director of the Malawi Health Equity Network, was asked if her alliance experienced any difficulty in mobilizing advocates who work on different health issues to push for health workforce improvements in Malawi. She said, “No, it was not difficult. It was a common secret – everyone knew we had to improve our health workforce.”
To make global health progress that could bring transformational changes in well-being and prosperity, our health workforce deficiencies and inequities must be transformed from a “common secret” to an “it issue.”
Photo credit: Chris James White/PSI.