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Public Health Workforce Crisis

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					                                                                                         In 2006, the Strengthening of Public
    Public Health                                                                        Health Associations (SOPHA) pro-
                                                                                         gram partners identified the human

     Association                                                                         resources for health (HRH) crisis/
                                                                                         shortage as an important overarch-
                                                                                         ing theme Public Health Associa-

    Perspectives                                                                         tion (PHA) partners should address
                                                                                         collectively.

                                                                   on the                This article summarizes the ques-
                                                                                         tionnaire responses highlighting

Public Health                                                                            the perspectives and experiences
                                                                                         expressed by SOPHA’s current six
                                                                                         PHA partners in Africa and the Ca-

  Workforce                                                                              ribbean (Cameroon, Congo, Haiti,
                                                                                         Malawi, Mozambique and Niger) on
                                                                                         the role PHAs can play to address
        Crisis                                                                           the public health workforce short-
                                                                                         age/crisis.




Situational Context and Main Findings

The human resources for health crisis is defined essential-                       From the responses to the questionnaire all the PHAs iden-
ly as a critical shortage of health workers. The 2006 WHO                        tified the human resources for health crisis and more spe-
world health report’s assessment of the crisis in the global                     cifically the public health workforce shortage to be an is-
health workforce estimated a shortage of 4.3 million doc-                        sue of importance. Questions on issues of supply of public
tors, nurses, midwives and support workers1. Highlighted                         health workers, gender, ethnic/socioeconomic and geo-
was the fact that this shortage is most severe in the poor-                      graphic representation, the role of government, matching
est countries and there is a particularly large demand for                       of skills to jobs and so on, were included to gauge the
health workers in sub-Saharan Africa. Two years later, the                       perceived degree (severe to none) of the human resource
2008 WHO health report argued for the need to renew                              shortage being encountered in each country and some of
the adoption and implementation of the primary health                            the underlying factors.
care approach emphasizing Health for All, as put forth
in 1978 at Alma-Ata2. However, shortages of trained and                          As expected, all the PHAs commented that there were
motivated health workers, who underpin health systems,                           critical shortages of nurses, doctors, midwives and labora-
may jeopardize the effectiveness of policies aimed at of-                        tory technicians, as reported in the current literature and
fering universal access to primary health care services to                       WHO reports. However, PHAs also highlighted and iden-
individuals and communities and to achieve the UN Mil-                           tified that the severe shortage in human resources also
lenium Development Goals.                                                        extends to public health educators, community health
                                                                                 workers and pharmacists.
With their multidisciplinary membership-base of public
health and non-health professionals PHAs are well posi-                          The PHA responses also confirmed what has been alluded
tioned as civil society associations to provide valuable                         to in the literature, that there are far higher concentra-
insights and to articulate and advocate possible solutions                       tions of health professionals in urban areas than in rural
relating to HRH policy and programs at both country and                          areas. In addition, health professionals placed in rural set-
community levels.                                                                tings often do not have the necessary skills and experi-

1       WHO, The World Health Report 2006: Working together for health. Geneva: World Health Organization, 2006.
                                                                                                                                                 1
2       WHO, The World Health Report 2008: Primary health care now more than ever. Geneva: World Health Organization, 2008.
                                                                   The 2006 WHO World
                                                                           Health Report’s
                                                                 assessment of the crisis
                                                                       in the global health
                                                                     workforce estimated
                                                                          a shortage of 4.3
                                                                  million doctors, nurses,
                                                                   midwives and support
                                                                                   workers

ence to meet local health needs. PHA comments reflect         •    Geographic and gender based disadvantages in terms
this gap by calling for the need to train health profes-          of access to education and public health services;
sionals in public health approaches and for government       •    The limited measures the government has put in
to consider improved incentive structures to motivate             place to address the human health resource short-
and retain health professionals in rural settings.                age; and
                                                             •    Poor intersectoral and intergovernmental coordina-
PHAs also identified the weak capacity and ineffective-            tion, needed in order to better allocate resources,
ness of national health systems to provide for equitable          collaborate for better policy on managing the hu-
and accessible health care to the entire population.              man resources for health crisis and provide better
They argue that health systems have remained weak in              employment conditions for health workers.
many countries despite the concentration of resources
for health being channeled to major disease types. Some
of the contributing factors discussed are:




The Roles Public Health Associations Can Play

The PHAs articulated possible roles they can play on       promotion, water and sanitation, disease prevention, in-
the human resources for health issue. These roles can      fant and maternal health, nutrition and so on.
be summarized within the three actionable spheres of
1) Training and information dissemination, 2) Advoca-      The issue of posting health professionals with insufficient
cy and collaboration and 3) Membership engagement:         skills and knowledge in health districts was highlighted.
                                                           These posts in the health districts tend to be filled by
1) Training and Information Dissemination:                 health professionals (doctors, nurses, hospital directors or
Community Health Workers/Educators                         health administrators) who lack the necessary expertise in
                                                           public health and/or community health. PHAs viewed this
The positive contribution that local community health      as an opportunity to fill a gap by facilitating the develop-
workers/educators (volunteer or paid) can make to          ment and delivery of training courses for health profes-
address the public health workforce shortage was ex-       sionals promoting the necessary skills and knowledge for
pressed by all. Three of the PHAs surveyed actively        public health and community health.
invest in activities aimed at strengthening the capac-
ity of community health workers and educators at the       A unanimous sentiment was expressed around the need to
local level. These efforts include training on health      engage and collaborate with government:
                                                                                                                          2
Public Health Workforce (PHW) Shortage PHA Survey Results by Selected Profession




                                                                                                          Mozambique

                                                                                                          Malawi


                                                                                                          Niger

                                                                                                          Cameroon


                                                                                                          Congo

                                                                                                          Haiti




•    To initiate short training programs to help augment           larly between rural and urban centers;
     the overall numbers of community-based health            4.   Poor employment conditions in terms of low salaries
     workers/educators; and                                        and incentives as well as a lack of recognition for
•    To educate health professionals on community                  public health work;
     health and public health.                                5.   Health systems and budgets that are too centralized
                                                                   and resources that do not reach rural and /or under-
2) Advocacy and Collaboration                                      serviced regions.

The lack of sufficient political will and action on the part   In light of the above, PHAs identified several possible
of national governments to address public health work-        advocacy roles and opportunities for collaboration.
force issues was identified by all. Undertaking advocacy
and collaborative action were seen as necessary steps to      Many PHAs expressed a clear advocacy role aimed at pe-
address the critical underlying institutional and systemic    titioning governments to invest resources to offer better
issues.                                                       financial and working conditions to public health work-
                                                              ers by providing sufficient incentives to fill vacant posts
The PHAs recognized and highlighted that strong leader-       in rural and/or disadvantaged zones.
ship, will and action is needed to address the following
contributing factors:                                         Another key advocacy role for PHAs is to promote gender
                                                              equality for both girls and boys to access and succeed at
1.   Weak inter-sectoral coordination between minis-          all educational levels, including specialized levels.
     tries and weak linkages between public health and
     other health and non-health sectors to plan for fu-      Finally PHAs suggest that they promote effective lines
     ture public health workforce needs;                      of communication between various governmental min-
2.   Poor access to education and access to health ser-       istries, provincial/municipal levels and other PH and/
     vices particularly amongst the poor, those who live      or health institutions in order to increase intersectoral
     in remote areas and women;                               dialogue and coordination.
3.   The unequal distribution of health workers, particu-
                                                                                                                          3
3) PHA Membership Engagement

PHA respondents recognized the Associational member-                                        that is contributing to the broader human resources
ship base as an important target group to engage with.                                      for health shortage in some countries;
A number of interventions were mentioned and they in-                                 •     The development of opportunities to bestow in-
clude:                                                                                      creased recognition to PHA members for their public
                                                                                            health work;
•     The delivery of targeted education to foster appro-                             •     The provision of training opportunities to members
      priate social and professional behavioral practices                                   to upgrade or gain new skills and knowledge in the
      by public health professionals to minimize risk of ex-                                areas of public health, community health and man-
      posure to prevailing diseases (eg. HIV/AIDS), an issue                                agement.


Conclusions


The Kampala Declaration’s vision that ‘all people, every-
where, shall have access to a skilled, motivated and fa-
                                                                                                The PHAs surveyed
cilitated health worker within a robust health system’3,
resonates with Public Health Associations. The PHAs sur-                                   were unanimous in their
veyed were unanimous in their agreement that without
attention being paid to augmenting the quantity and
quality of public health workers and human resources for
                                                                                            agreement that without
health more broadly, the Millennium Development Goals
pertaining to infant and maternal mortality, reducing the                                    attention being paid to
prevalence of HIV/AIDS and other diseases will not be
reached.
                                                                                           augmenting the quantity
This brief survey confirms that shortages in human re-
sources for health are a reality in each of the six coun-                                       and quality of public
tries covered. It is equally likely that this extends to
most sub-Saharan African countries. The responses gath-
ered here serve as a starting point for further investi-
                                                                                                 health workers and
gation into this topic and more in-depth country level
situational analysis would be necessary to quantify and                                        human resources for
fully document the human resources for health crisis in
each country.
                                                                                              health, the Millennium
Despite certain information gaps, this preliminary survey
demonstrates that PHAs possess valuable insights on this                                         Development goals
topic and can play a role in addressing the situation. No-
tably three important areas for PHA action are:
                                                                                            pertaining to infant and
1.    Training of community-based health workers and
      health professionals;                                                                child mortality, reducing
2.    Advocating nationally to promote government col-
      laboration, resource distribution and gender equal-
      ity; and
                                                                                             the prevalance of HIV/
3.    Engaging and mobilizing the national PHA members
      to act on this issue.                                                                AIDS and other diseases
                                                                                                 will not be reached


3 The Kampala Declaration and Agenda for Global Action: 1st Global Forums on Health Resources for Health. Geneva: Global Health Workforce Alliance, 2008.
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