What’s Really Holding Us Back? Resolving the Health Workforce Crisis

Maurice MiddlebergLately I’ve been thinking about the big picture in the global health workforce crisis. What’s keeping us from getting where we need to be?

On the one hand, we’ve come a long way in just a few years. Since the release of the 2006 World Health Report and the First Global Forum on Human Resources for Health in 2008, we’ve made notable progress:

  • Awareness of the health workforce crisis is now pervasive; this is reflected in high-level declarations of both developing and developed nations.
  • We’ve amassed a large body of knowledge and practical experience.
  • There is emerging consensus on the actions needed on a range of issues, from retention to community health workers to task-shifting.
  • Many countries have developed health workforce strategies.
  • A few countries (Ethiopia’s a great example) have made remarkable progress in expanding access to qualified health workers.

On the other hand, let’s face it: progress has been slow.

Access to health workers with the right skills is still denied to millions of people. We’re not yet where we need to be. What are the root causes of this unsatisfactory progress?

At the core is a failure of implementation.

Our major challenge right now
To be sure, we still face significant gaps in knowledge and resources. But equally important is the fact that we’re often not using what we already know, nor are we making the best use of available resources. And too often, well-designed strategies are not implemented.

Removing the obstacles to implementation is key to resolving the health workforce crisis.

A variety of factors has contributed to the failure to implement. Areas bearing scrutiny include leadership, advocacy, coordination, realistic costing, adequate investment, and good data for management and decision-making.

But most of all, both the political will and the institutional capacity to implement must be present if we are to move beyond well-intentioned but unrealized plans.

Beyond awareness-raising
When we gather in Bangkok at the Second Global Forum on HRH, we’ll take stock of what has been accomplished and what remains to be done. CapacityPlus has been involved in the planning and is sending a delegation to this important event.

Despite slow progress, there’s a lot to celebrate, and many reasons to be hopeful. Shifting our focus to implementation will help us concentrate our energies on getting it done.

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