Human resources for health

This opportunity could inform and promote official development assistance from sectors other than that which is earmarked for health in the infrastructure, education, and skills development of the future health workforce.

Abstract

In their Comment in The Lancet (July 16, p 220),1Mandeville K Lagarde M Hanson K Mills A Human resources for health: time to move out of crisis mode.Lancet. 2016; 388: 220-222Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar Kate Mandeville and colleagues support the shift in the policy discourse on human resources for health away from framing the issue as a crisis, and towards a new understanding of the health workforce as an opportunity to encourage economic growth through the creation of jobs in the health sector. The Global Health Workforce Alliance set out this argument in July, 2014, and the compelling evidence that health employment has a stimulating effect on the economy has informed both the WHO Global Strategy on Human Resources for Health and the UN Secretary General's High-Level Commission on Health Employment and Economic Growth. However, we urge caution on the authors' assertion that "calls for increased funding [to human resources for health] from limited budgets—whether government or donor—are unrealistic." First, in many low-income and middle-income countries government expenditure on health is substantially lower than the 4–5% of gross domestic product regarded as necessary to progress towards universal health coverage.2WHOHealth systems financing: the path to universal health coverage.http://www.who.int/whr/2010/en/Date: 2010Google Scholar In these settings, improved efforts to mobilise domestic resources are both necessary and possible, but will only happen when supported by appropriate macroeconomic policies and political will at the national level. Second, government expenditure on the health workforce is lower than typically assumed, and probably decreasing: in their study, Hernandez-Pena and colleagues3Hernandez-Pena P Poullier J Van Mosseveld C et al.Health worker remuneration in WHO Member States.Bull World Health Organ. 2013; 91: 808-815Crossref PubMed Scopus (19) Google Scholar noted how "in most low-income countries, funding for health is simply not enough…" and that "Considerably more will need to be spent on the health workforce…" Analyses also show that many low-income and lower middle-income countries might not have the domestic resources in the short-term and medium-term needed to meet health-sector needs.4Dieleman JL Templin T Sadat N et al.National spending on health by source for 184 countries between 2013 and 2040.Lancet. 2016; 387: 2521-2535Summary Full Text Full Text PDF PubMed Scopus (122) Google Scholar Together with more efficient service delivery models, continued international solidarity is needed to support health workforce investment, and to enhance health security, improve health outcomes, promote job creation (especially for women and young people), and foster inclusive economic growth.5The LancetNo health workforce, no global health security.Lancet. 2016; 387: 2063Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar This opportunity could inform and promote official development assistance from sectors other than that which is earmarked for health in the infrastructure, education, and skills development of the future health workforce. This would be part of a paradigm shift in which health workforce investments supported by global health initiatives and development partners are aligned with national health priorities and support—in settings where this is needed—pre-service education and health-worker remuneration. We declare no competing interests. Human resources for health: time to move out of crisis modeFor the past decade, attention on the global health workforce has been characterised by crisis. Advocacy efforts persistently frame this issue as a global emergency, with more than 50 countries identified to be facing "critical shortages" of health workers with "immediate action" required to "overcome the crisis".1,2 In light of the new global strategy on human resources for health presented at the 2016 World Health Assembly,3 we call for an end to this cataclysmic framing of the health workforce agenda. Full-Text PDF Human resources for healthAlthough we agree with Kate Mandeville and colleagues1 that human resources for health advocacy should move beyond its current crisis mode and adopt a long-term perspective, we believe that this view should be based on the idea that investment in employment in the public sector health will contribute to equitable economic growth and societal wellbeing.2 Data suggest that development of human resources for health in Guinea has stalled because of budgetary restrictions jointly imposed by the International Monetary Fund (IMF) and the Guinean Government on the health sector wage bill in the decade before the 2014–15 Ebola outbreak. Full-Text PDF Human resources for health – Authors' replyWe thank Giorgio Cometto and James Campbell, and Remco van de Pas and colleagues for their insightful responses to our Comment.1 Although we all broadly agree on the need to reframe policy discourse on this issue, we disagree on the following points. Full-Text PDF