Human Resources for Health Forum: The Evidence and the Way Forward!

8 and 9 November 2010

The Forum is being undertaken under the auspices of the Monash Africa Centre which is a joint initiative of Monash University, Australia and the Monash South Africa Campus.

The Monash Africa Centre has a core focus on addressing vital issues related to the development agenda in southern Africa in particular. It falls under the Research Portfolio at Monash South Africa under the leadership of Ass Prof Dina Burger, Deputy Pro Vice-Chancellor: Research. 
At the Forum, a number of key academic stakeholders, from the African continent and around the world, will discuss current and future challenges with respect to the health workforce in South Africa and other African countries.

Background – Human Resources for Health in Africa

After a century of the most spectacular health advances in human history, we have been confronted by unprecedented and interlocking health crises. Most African countries face rising death rates and plummeting life expectancy, even as global pandemics threaten us all. Human survival gains are being lost because of overburdened and overstressed health workers, too few in numbers, without the support they so badly need. Many are collapsing under the strain; many are dying, especially from AIDS; and many are seeking a better life and more rewarding work by departing for richer countries.

In the analysis of the global health workforce, the Joint Learning Initiative - a consortium of more than 100 health leaders - proposed that mobilisation and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world's poorest countries and for building sustainable health systems in all countries. Nearly all countries are challenged by worker shortage, skill mix imbalance, mal-distribution, negative work environment, and weak knowledge base. Especially in the poorest countries, the workforce is under assault by HIV/AIDS, out-migration, and inadequate investment.

It is estimated that the global health workforce is already more than 100 million people. Added to the 24 million doctors, nurses, and midwives who are recorded, there are at least three times more uncounted informal, traditional, community, and allied workers. The enumerated professionals are severely mal-distributed between regions and countries. Sub-Saharan Africa has a tenth the nurses and doctors for its population compared to Europe; Ethiopia has a fiftieth of the professionals for its population that Italy does. With such wide variation, every country must devise a workforce strategy suited to its health needs and human asset base.

Challenges with Human Resources for Health in Africa

• Regional shortage: There is a massive regional shortage of health workers. We estimate the global shortage at more than 4 million workers. Sub-Saharan countries must nearly triple their current numbers of workers by adding the equivalent of 1 million workers through retention, recruitment, and training if they are to come close to approaching the millennium Development Goals (MDGs) for health. A more evidence-based approach is necessary to validate data on regional shortage in Africa.
• Skill imbalances: Nearly all African countries have skill imbalances, creating huge inefficiencies. In some, the skill mix depends too much on doctors and specialists. What we know is that population-based public health is neglected and that most countries must revamp their health plans towards a workforce that more closely reflects the health needs of their populations especially through deploying auxiliary and community workers.
• Mal-distribution and migration: Nearly all African countries have mal-distribution, which is worsened by unplanned migration. Urban concentration of workers is a problem and improving within-country equity requires attracting health workers to rural and marginal communities—and retaining them. There is also mal-distribution between public and private sectors in many countries. And international equity is severely affected by international migration, because the loss of nurses and doctors is crippling health systems in many poor sending-countries.
• Poor work environments: Nearly all African countries must improve poor work environments by scaling up good practices to strengthen management of existing resources, assure adequate supplies and facilities, and create monetary and non-financial incentives to retain and motivate health workers. The voices of workers should be listened to.

The Monash Africa Centre HRH Forum

There is a need for immediate action to harness the power of workers for health equity and development. The imperative for action springs from the urgency of the health crisis, the timeliness of new opportunities, and the prospect that available knowledge, if applied vigorously, could save many lives. The cost of inaction is unmistakable - stark failures to achieve the MDGs, epidemics spiralling out of control, and unnecessary loss of many lives. At stake is nothing less than the course of global health and development in the 21st century.

Urgency in Africa demands an exceptional response from public health researchers and academics. At its core, the response must be evidence-based, regionally-based and led from the continent, because all regional developments must be implemented, planned, and owned in specific settings in Africa. The Forum will provide the space for providing evidence needed for a strategic response.

The Forum will also provide information, reliable analyses, and a firm knowledge base on HRH. The Forum will also provide research on workforce norms, standards, and best practices.

Invited Representatives