Good News about Training More Health Workers—But Will They Be Absorbed?

Amid the continuing health workforce crisis, I think it’s important to acknowledge the positive steps that have occurred. In terms of donor support, one such area involves commitments to provide funding and support at the country level to train new health workers.

Training new health workers: two positive steps
For example, in 2008 the Japan International Cooperation Agency announced a major program to train some 100,000 local health workers to tackle one of Africa’s most serious problems, the unacceptably high mortality and sickness rate among pregnant women, new mothers, and their children.

And under the US Government’s PEPFAR reauthorization, there is a mandate to train and retain 140,000 new health workers by 2013. This is an excellent addition to PEPFAR, recognizing both the health workforce crisis and the important role that health workers play in providing increased access to care, including HIV/AIDS services.

HR management systems
While these examples constitute good news in terms of training, it is less clear that the funding and work to meet these goals takes into account the absorptive capacities of the human resources management systems needed to plan, recruit, deploy, manage, and retain new health workers. It is absolutely critical to analyze how these systems will influence the PEPFAR goal of training and retaining 140,000 new health workers.

The following are a sample of HR management systems issues that need to be considered:

  • Is the HR information system strong enough to supply sufficiently accurate data so country teams can be reasonably assured the new workers are filling critical needs? Have country-level human resources for health strategic plans (if available) been based on sound data, and have they been used to inform training investment decisions?
  • When these health workers graduate, will there be positions for them? Most countries can’t fill their current list of open positions. Some are extremely dependent on salary support from donors. 
  • Is the recruitment, hiring, and deployment system strong enough to absorb the new health workers? In many countries in east and southern Africa, it often takes 9-15 months to hire new workers. One consequence is that there is often a 40%-60% loss of new graduates between the time of graduation and the time that a job is offered. Imagine the problem that would occur if the new health worker training targets were achieved, but only half actually joined the workforce?
  • Will the new health workers have the facilities, supplies, and tools they need to be productive? Will they be able to rely on a reasonably supportive supervision system? Most countries face serious attraction and retention problems already, especially in rural and hard-to-reach places, caused by a variety of facility, tool, supply, and workplace environment issues.
  • Which HR systems need to be strengthened to be certain these new health workers are able to practice what they have been trained to do, and that they will be retained?

While investing in the right kind of training for the “right” health workers involves its own set of difficulties, we must pay attention to critical issues in other systems—or a good deal of the investment in training may be lost. While these larger systems issues are often ignored or avoided because they seem too complex or unattainable, I will suggest in my next blog post specific targets and actions to address some of these issues.

 

Photo: Trevor Snapp. (Health workers in Mali)