Creative Approaches to the Global Health Workforce Crisis

Maurice I. MiddlebergFive years ago the World Health Organization told us that 57 countries had a critical shortage of health workers—fewer than 2.3 service providers for every thousand people. Today, all 57 countries are still below this threshold. What’s holding us back from faster progress?

First, the good news: many of these countries have national health workforce plans in place. Forty-four of the 57 crisis countries have a plan, according to the Global Health Workforce Alliance’s recent progress report.

Now, the bad news: not all of these countries are implementing their plans. Among the 57 crisis countries, only 24 have evidence-based and costed plans and are in the process of implementing them. Countries may be daunted by perceived barriers to implementation.

That’s why it makes me hopeful to see how many countries are trying creative approaches and moving from planning to action. Niger, for example, is improving maternal care by focusing on health worker performance. Beginning in 2009, 15 facilities and 11 district management teams in Tahoua Region took part in efforts to increase health workers’ productivity and engagement, and to improve quality and efficiency of maternal care services. 

Niger’s results to date are promising, and motivated health workers are performing their jobs better. For example:

  • Postpartum hemorrhage was cut in half at participating sites.
  • Adherence to essential newborn care standards rose to 98%.
  • In one health post, contraceptive prevalence increased from 11% to 42%, thanks to low-cost measures such as performance objectives and regular feedback on indicators.

Paying attention to productivity and performance makes sense. Since there aren’t nearly enough health workers, we need to make the most of the service delivery contribution provided by the workers we do have. To this end, CapacityPlus is developing a comprehensive catalog of interventions to improve retention and productivity. Uganda and Lao People’s Democratic Republic are already using the rapid assessment tool for retention in rural areas.

With so many lives at stake, countries can learn from each other and focus on implementing the best strategies for their specific contexts. Moving from planning to action will help get us where we need to be.

Related items:


Photo courtesy of IntraHealth International