Wrap Up: The 3rd Global Forum on Human Resources for Health

The Third Global Forum on Human Resources for Health started Saturday (Nov 10) in Recife, Brazil. After the first editions in Kampala in 2008 and Bangkok in 2011, the Global Health Workforce Alliance (GHWA) is now in the situation to assess the progress made, but also the challenges laying ahead, which are not few. A lot remains to be done, globally, to remove the obstacles on the road to Universal Health Coverage (UHC).  The key words here are availability, accessibility, acceptability and, last but not least, quality.

An initial round of interesting and challenging discussions occurred on Saturday and Sunday (Nov 10 and 11) with a series of side sessions on hot topics. MSH’s presence and active participation in the Forum was initiated the morning of the first day with a side session on “Developing Leadership for Managing and Governing UHC”. In this well-attended and lively session, the panelists exposed the experience of their respective organizations in developing Leadership, Management and Governance (L+M+G) with the public health workforce and presented evidence that L+M+G can lead to strengthened health systems and improved health services. Mary O’Neill moderated the session and introduced the panel, emphasizing the depth and width of the experience accumulated in this area by an array of global players from the public, non-profit and private sectors.

A common theme emphasized in the presentations by Lisa Meadowcroft (AMREF USA), Karen Caldwell (MSH/LMS Kenya), Michael Bzdak (Johnson and Johnson) and I (MSH/LMG Arlington and Global Health Consortium) was the need to increase and expand the effort with the development and integration of L+M+G curricula across public and private institutions, for all levels of the health workforce. The presentations and the numerous questions from the audience highlighted the advances made and the demand from health workers and their organizations but also the need to continue advocating for the key role L+M+G can play on the road to UHC. Interestingly enough, discussions by global actors around management currently seem to revolve mainly around the quantity of the health workforce, less on their quality (the 4th pillar of UHC), and even less on specific L+M+G competencies. The main challenge in this area still is that leaders, managers and governors in the health sector still receive insufficient formal preparation to succeed and to make sure that the huge investments made in the sector are utilized to their potential. The value of their role, as opposed to (or, better said: complementary with) that of surgeons or nurses still has to be fully recognized in many countries. AMREF, Johnson and Johnson, MSH, USAID, JICA and many others are working on it…

The discussions in the other side sessions of the Forum highlighted a number of key global issues (migration of the health workforce, political commitment, the respective roles and responsibilities of international donors and local governments…), and showed that the discussions in the coming days promise to be very lively. Stay tuned…

Leaving Recife

We concluded the conference with a round table discussing the agenda for the way forward. There are always good ideas in this discussions.  We hope that they are integrated and make up an actionable roadmap for HRH.

The dilemma of many of the panels has been on where to focus. There is much to support a focus way into the future, which would take into account the rising economic status of many developing countries. This could change the formula considerably. On the other hand, there is an immediate need to train new health workers and the consensus is that the capacity of those institutions responsible for this are inadequate to the task. So, as with any large, global forum, we come away with a broad agenda. We are heartened by the number of calls for strengthening leadership and management in order to manage the health system of the future, which is envisioned as not standing on its own, but operating in partnership with the private sector, which currently provides up to 50% of the health services in many countries.

A summary from the panel, expressed by Tim Evans, of the World Bank can be viewed in 4 components:

  1. anticipate:   we must anticipate what is seen as a rapid expansion and growth of the health sector, along with the use of technology
  2. articulate:   we must articulate ambitious targets.  An example of this is the government commitment in Ethiopia to train 30,000 CHWs.
  3. participate:  not only with the private sector but with all relevant constituencies
  4. innovate:  work smarter and engage the health workers in the process of problem solving and policy settings.

I can see a lot of synergy here with MSH technical strengths.

Mary O’Neil is the MSH Global Technical Lead for Human Resources for Health.

Gender Equity at Global Forum in Recife

This post also appears on the LMGforHealth Blog

Women at 3GFHRH Recife

Lola Dare, Gaylor Hoskins, Gwen Ramokgopa, Ghida Fakhry, and Tim Evans, at the close of 3GFHRH

The 3rd Global Forum on Human Resources for Health ended today with the presentation of its outcome document, the Recife Political Declaration on HRH and with questions on how better represent women in senior management roles. Within it, Article Two states that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion, political belief or economic or social condition”. Gender is not mentioned here but Article Six mentions that gender imbalances remain a major matter of concern.

For example in Uganda, top leadership and management positions for eight districts and four national facilities remain quite unequal. The table below indicates the discrepancy:

Position and salary scale Number of employees Male Female
Senior management level 133 77% 23%
Middle management level 326 63% 37%
Graduate and diploma entry level 2,406 39% 61%
Lower level 3,585 43% 57%
Total 6,450 43% 57%

(source: Capacity+/IntraHealth)

Article 14(v) of the declaration recognizes the need to “promote equal opportunities in education, development, management and career advancement for all health workers, with no form of discrimination based on gender, race, ethnicity or any other basis”.

As the numbers in Uganda show, much remains to be done, but many women leaders have shown their strong leadership and have made their voices heard during the forum. As the forum closes we have witnessed the need for more fundamental shifts in how women are represented. They are and will continue being at the forefront of the advocacy and action for the reduction of inequalities.

Exploring Public-Private Partnership at Global Forum on Human Resources for Health

This post also appears on the LMGforHealth Blog

A fascinating panel session on public-private partnerships to advance Human Resources for Health, occurred with a line-up of high-level experts at the 3rd Global Forum on Human Resources for Health.  What could have been only one more discussion on the pros and cons of partnering with the private sector and the civil society ended up bringing a very lively discussion on the professionalization of the health workforce and on the importance of leadership, management and governance.

Tim Evans, Director of Health Nutrition and Population and Human Development Network at the World Bank Group, moderated the session. Mr. Evans provided insightful inputs and summarized the session by stressing key concepts and rising essential questions on how to face multi-stakeholder engagement, accountability and transparency challenges. Several of the questions following the discussion were based on principles of good leadership, management and governance for health:

-Who do we need to train to make sure that capacity in leadership and management  is being built across the health sector?

-How do we make sure that the LMG principles can be integrated into all curriculums, and at which levels?

What is the best way to deliver these trainings? Through the schools of public health or in-service through leadership development programs

-How to establish governance mechanisms which are sufficiently solid and diverse to efficiently help manage governance in multiple settings?

Mr. Evans ended the session by insisting on the need for a governance framework based on leadership by values, formal mechanisms of participation, and monitoring of performance and accountability.

Participant at 3GFHRH

Participant at 3GFHRH

LMG Partner AMREF Receives Award at Global Forum on Health Workforce

This post also appears on the LMGforHealth Blog

AMREF staff after winning ceremony at 3GFHRH

The African Medical and Research Foundation (AMREF) promotes long lasting changes in health in Africa, and believes that the power of transformation lies within its communities. Every year, AMREF, headquartered in Nairobi, Kenya, trains thousands of community health workers who bring health to some of Africa’s most marginalized populations. AMREF also trains doctors, nurses, midwives, lab technicians and pharmacists.

As the Third Global Forum on Human Resources for Health continues, Peter Ngatia, Director for Capacity-Building at AMREF, will also be part of a panel, together with Mary O’Neil, Global Lead for Human Resources for Health (HRH) at MSH, to discuss public-private partnerships to advance HRH.

During the forum AMREF was recognized for its learning program that helped upgrade the skills of 20,000 nurses for program management including coordination, stakeholder management, content development, capacity building of the implementers, and monitoring and evaluation. For their part, AMREF was presented with an award on behalf of a cheerful Global Health Workforce Alliance award ceremony, becoming distinguished members. This program will be adapted for midwives and has the potential to be replicated to African countries facing health worker shortages.

AMREF is one of the key partners of the LMG Project consortium and it has been very much in the limelight in the Forum. Besides presenting its work with LMG in the side session organized by MSH on Leadership and Management for UHC on the first day of the Forum, it also presented yesterday its coordinating role of the African Health Leaders and Managers Network (AHLMN) in a session on Transforming and Scaling up Health Professional Education and Training. LMG is supporting the AHLMN Secretariat and the organization of meetings of the network for its strategic planning and the development of its activities. One of these key activities will be a Virtual Leadership Development Program (VLDP) to adapt and promote AMREF’s curriculum for Leadership, Management and Governance and disseminate it through AHLMN members. The LMG Project also supports AMREF to implement courses for nurses in five African countries with proper leadership, management and governance training.

Congratulations to AMREF for the recognition of their important work by the international HRH community!

AMREF receiving award.

Shaking hands at 3GFHRH

Working to Bring UHC to Life – Opening Ceremony from Global Forum on Human Resources for Health

This post also appears on the LMGforHealth Blog

GFHRH Recife 2013 Opening

Two thousand participants gathered at the Recife Convention Center in Recife, Brazil for the opening ceremony of the Third Global Forum on Human Resources for Health. And as expected, it was lively!

Not only thanks to the lovely cultural presentation by local performers (a lot of singing and dancing) or the succulent food served at the reception by the Brazilian Government, but also due to the opening speeches by organizers and the first high-level roundtable on “Are we on the right track to UHC (Universal Health Coverage)?” The moderator Ghida Fakhry, former news anchor at Al Jazeera, asked challenging and sometimes unexpected questions to the speakers on the lessons learned from the last decade of action on Human Resources for Health and the efforts by different players.

Mozart Sales (Secretary of Labor and Education Management in Health, Brazilian Ministry of Health) highlighted the progress made on the gender, race and ethnicity fronts with regard to the inclusion of key populations in the various medical professions but also presented the Brazilian response to the gap in the number of new physicians graduating. The Brazilian government formed a partnership with the Cuban government and invited thousands of Cuban physicians to come and work in Brazil. The Cuban Minister of Public Health, Roberto Morales, explained that Cuba has been “exporting” physicians to 60+ countries in the last decades. The Assistant Administrator for Global Health at USAID, Ariel Pablos-Mendez, detailed the progress made towards UHC with “Obamacare” now in full affect. He also reminded the attendees that adopting UHC has help save 100,000 million lives worldwide since the 1990s thanks to massive investments in public health workforce.

Pape Gaye, President and CEO of IntraHealth, emphasized the importance of a people-centered approach to health workforce development and the essential role played by front line health workers. One strong challenge is to retain health workers in the rural areas, in the absence of good incentives. Demographics do not help either, with a growing and aging population, which is more and more affected by non-communicable diseases. In the words of Pape Gaye, the generation born today deserves that we achieve UHC during its lifetime. This is the time horizon we should count on and this is why 80+ countries are gathered in Recife to help re-energize their commitment.

Follow us at: @LMGforHealth for updates from Recife and find more information on our key LMG events here.

Tuesday’s updates from the HRH Forum

Unfortunately, MSH President and CEO Jonathan Quick wasn’t able to attend the Forum and join this morning’s plenary roundtable. Still, the session highlighted the need to deploy and support the right personnel to make care affordable in low-income settings. The panel featured PAHO Director Carissa Etienne, describing a vision for health workforce management in which every health system would strengthen first at the community provider level—selecting health workers from the community, trained to deliver the basic services needed there, with support and accountability coordinated by the government.

HRH Forum 2013-2

This frontlines-focused approach has been a theme of the conference from MSH and partners like the Frontline Health Workers Coalition and One Million Community Health Workers. In the context of massive health workforce shortages (7.2 million worldwide, as estimated by a WHO report launched yesterday) and poor distribution to rural areas, we’ve argued that health systems should build around community health workers (CHWs). While these workers already operate in many settings, their role is often seen as ancillary to that of doctors, nurses and health facilities. The disadvantages of this ad hoc approach include fragmentation and duplication of programs, discussed in a side session Saturday, and inadequate management and support, as MSH’s Mary O’Neil noted on another panel today.

To enable progress towards universal health coverage–a theme of the Forum–CHWs can no longer be seen as a stopgap measure for healthcare access. They should be formally integrated into health systems as providers of potentially life-saving primary care.

See you in Recife!

Join us at the Third Global Forum on Human Resources for Health (the Forum), November 9-13, 2013, in Recife, Brazil.   

The Forum brings together over 1,500 policy makers, experts, and advocates in the health workforce field, and frontline health workers. This year’s theme addresses the foundation of universal health coverage and the post-2015 development agenda: “Rising to the grand challenge of human resources for health.”

We hope to see you at these side sessions, high-level roundtable with our President and CEO Jonathan D. Quick, and our booth in the marketplace!