Investing in the health workforce? Enough with the cheap talk, come up with the money!

Authors: Amanda Banda & Dr. Fredrick Oluga

The video clip has been viewed more than 8000 times by now. We see Dr. Mashumba as she literally sheds tears as she speaks of her frustrations about the lack of basic facilities, medical equipment and staff at her hospital. Her words keep echoing in my head: “There is no sense of urgency, no priority. I’ve written a million lists, I’ve knocked on a thousand doors, but nobody is listening to us. My output are stillbirths and disabled babies.”

Such is the plight of many a health worker around the world. The theory is that the health workforce is the first and most important cornerstone of an effective health system. Without health workers our ambitions for Universal Health Coverage by the year 2030 remain a distant dream.  Yet as the world commemorates health workers this week, there is a growing shortage of health workers globally and little financial investment in health and the health workforce.

18 million health workers short

It’s not that nobody knows what to do. A 2016 report by the World Health Organization (WHO), the International Labour Organization (ILO) and the Organization for Economic Co-operation and Development (OECD) estimates that 40 million new jobs are needed in the health sector globally by 2030. At the same time, there is an estimated shortage of 18 million health workers, mostly in low- and lower-middle income countries. And while Africa alone has 24% of the global disease burden, the continent is home to only 3% of the global health workforce.

To achieve Universal Health Coverage (UHC), it has been calculated that a country should have at least 4.45 health workers per 1,000 people. In reality, most countries fall way below this. In Sub-Saharan Africa, for example, Malawi has 0.5 and Zambia 0.98. Even a middle income country like Kenya barely reaches 1.79 per 1000 people. For the sake of comparison: Norway can count on 19.6, Switzerland on 21.6 and Finland on 26.9 medical personnel per 1,000 people. Talking about global inequities.

Plans and more plans

Excellent global commitments have been made to address these gaps and challenges in human resources for health (HRH), but action is still missing, in particular when it concerns the financial investment in the health workforce and their working conditions. For example, a Global Strategy on Human Resources for Health (‘Workforce 2030’) was adopted in 2016 by the World Health Assembly (WHA) to help countries accelerate progress towards achieving UHC. In 2017, the WHA adopted a five-year ILO-OECD-WHO action plan ‘Working for health’ to catalyze and stimulate predictable and sustainable investments, among other things, in the health workforce.

In 2017, these developments gave rise to the African Regional Framework for the implementation of the Global Strategy on HRH Workforce 2030. It was adopted to guide member states in the African region to implement the Global Strategy on HRH. In May 2018, countries of the West African and Economic Monetary Union adopted the first sub-regional health workforce investment plan.

Where’s the money?

Unfortunately, all these commitments and plans give no clear guidance on how to finance the health workforce, especially for low- and middle-income countries with limited fiscal space. Therefore, many of these strategies, frameworks and implementation plans, although good first steps, are just sitting pretty on a shelf in bureaucrats’ offices.

And all along, health workers around the globe, like Dr. Mashumba, are met with the reality of an environment that prevents them from saving the lives they are trained to save. These people have entered the medical profession because they want to help patients get better and promote health in communities. But all too often, their facilities lack the necessary equipment, diagnostics or medication. So how are they supposed to deliver quality health services? Health professionals all over the globe are desperate for the increased investments in the health workforce that national, international, regional and global policy makers have been talking about in board rooms for years now.

Cough it up

Between now and 2030, there are just 10 years to build the economic foundations for a healthy and resilient health workforce globally: to mobilize domestic resources, to pool funds from health donors and multi-lateral agencies, to identify and tap new funding sources. So those of you with a wallet in your back pocket: take it out and cough it up.