Local Solutions, Global Solidarity, and Accountability

This post was originally published on the IntraHealth International blog.

Meshack NdoloWhile the Second Global Forum on Human Resources for Health was full of opportunities, it was also quite deficient in addressing the one global issue that continues to hold back progress to achieving most of the health goals—the Millennium Development Goal 8: Global Partnership for Development. I do, however, remain optimistic.

In my country, Kenya, there is considerable awareness of the health workforce problem and there is momentum to act on many fronts. The Capacity Kenya project has worked closely with the Ministry of Health and others to develop a national Human Resources for Health Strategic Plan, which established national priorities for addressing Kenya’s workforce constraints. Planned targets range from increasing number of workers; improving retention, quantity, and quality of training and development programs; improving performance; and ensuring a sustained investment in the health workforce.

Progress indicators
I am happy that there was a vibrant discussion at the Global Forum on how to strengthen coordination and develop clear indicators for measuring progress. Kenya, one of the 57 health workforce crisis countries, requires significant resource allocations to achieve the plan’s targets. But with health expenditure comprising a paltry 6.5% of the national budget in 2010, the vast resource gap would need to be bridged through sustained investment that Kenya cannot afford in the short run.

Budget allocations
Clearly, there is a need for local action to generate genuine and sustained political will and support to, among others:

  • Allocate a significant proportion of Kenya’s national budget to health care progressively toward the Abuja target of 15%
  • Allocate a significant portion of the health sector budget to address priority workforce concerns (induction upon employment, training, equipment, housing, innovative forms of compensation, etc.)
  • Make policies and allocate resources to ensure workers are attracted and deployed to work in underserved areas
  • Develop public partnership innovations to provide benefits to health workers in remote underserved areas, with built-in opportunities for participating private sectors to recoup their investment indirectly
  • Renew commitment to fight waste and theft of health resources (corruption is rampant in the larger hospitals where funds and resources are perennially mismanaged or stolen)
  • Sustain this commitment—we need to move beyond positive rhetoric to action that will continue to mobilize actors across the board.

Kaimosi Hospital nurseLocal and global commitment
As it was dramatically captured in the UN Secretary General’s Report of 2005, accountability of those wielding political power is key to achieving the Millennium Development Goals, including Kenya’s health workforce development targets.

At the global level, there is, in my mind, an inexcusable obligation for rich countries to fulfill their part of the Millennium Development Goal commitment to poor countries in the South including addressing trade and aid imbalances and overall reform of the global financial system.

So, yes, it will take local action, but we must remember that it will also require global solidarity to address most of the problems that mankind has largely visited upon itself. In my opinion, accountability among the global leadership is needed as much as country-level action to address the health workforce crises facing our countries.

Related items:

Capacity Kenya, an IntraHealth International-led, USAID-funded project, works with Kenya’s health care leadership to strengthen human resources for health systems of the public, faith-based, and private health sectors to ensure improved delivery to primary health care and, ultimately, to improve health outcomes of the Kenyan people. It is an associate award of the Capacity Project, the predecessor to CapacityPlus.


Photo 1 courtesy of Meshack Ndolo. Photo 2 by Trevor Snapp. (Kaimosi Hospital nurse, Kaimosi, Kenya)