What Brought Us Here Won’t Get Us There: Implementing Country-Level Health Workforce Development Plans

CapacityPlus works with the Uganda Ministry of Health to enhance workforce performance support, including field testing the project’s global rapid discrete choice experiment (DCE) tool to address attraction and retention of health worker cadres in rural and remote areas and a retention costing tool, iHRIS Retain. This post was originally published on the IntraHealth International blog.

Three years ago, we met in Kampala, Uganda to discuss the critical needs of the global health workforce. Last week in Bangkok we gathered to take stock of what we’ve accomplished since.

Today, 86% of the 51 countries surveyed in the progress report on implementing the Kampala Declaration and Agenda for Global Action have a national human resources for health plan, but only 41% are actually implementing that plan.

Progress since Kampala
From the Second Global Forum on Human Resources for Health, there emerged two key concepts for me. First, it was clear that little progress has been made in implementing the 2008 Kampala Declaration and Agenda for Global Action. Second, it was also evident that participants know what the challenges are in the global health workforce and agree on the importance of fixing these problems; however, too little is being done, and the know-do gap—the discrepancy between what is known and what is done—is wide.

The progress report rated mechanisms to inform in-country policy-making at only 43%. Although policies exist to guide health workforce development, they’re not informed by compelling evidence. In part, this is because the available evidence is not presented to the policy-makers in language they understand. The policy developed is often not fully disseminated, and remains largely unimplemented.

Local funding and leadership

Furthermore, we’ve seen that while there’s been a significant increase in donor-financed support for the global health workforce in most countries, the governments have not increased local funding to match. Instead, they have discouraged the principle of additionality and maintained budget ceilings. In my opinion, this reflects inadequate local leadership, lack of ownership, and a half-hearted commitment to supporting the health workforce. It is disappointing to see.

Uthong HospitalCommitted health workers
In Ethiopia, Malawi, and Rwanda—countries recognized for their successes in the health workforce—we have seen committed leadership and demonstrations of increased financing and the willingness and ability to take bold actions. We know there are outstanding health workers who are committed to serving their communities. Some of them were recognized at the conference for their dedication and superior performance in health care. They spoke on personal experiences, which exemplified their selfless commitment to their work and intrinsic motivation that cannot be adequately compensated by pay.

In light of the overall limited progress on the global health workforce, at the end of the conference a recommendation was made not to hold the next Global Forum until there is substantial progress to report on.

Uganda's progress
The situation in Uganda is not different; the know-do gap is a reality here, too. What needs to be done to close the gap? As I traveled back to Uganda from the conference I became more convinced that the modest progress we have made is not enough to take us to the next level. To strengthen the health workforce and create action plans to guarantee we have adequate human resources for health, we will need to:

  • Create and maintain a sense of urgency for action nationally and locally
  • Strengthen country-level leadership, ownership, and true commitment to addressing the health workforce, including increasing local resource allocations
  • Review and develop education and training programs that focus on community orientation and cultivating intrinsic motivation. We need health workers who are committed to providing care to people most in need.

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Photo 1 courtesy of IntraHealth International. Photo 2 by David Nelson. (Second Global Forum participants visit the Uthong Hospital, Amphur-Uthong, Thailand)