Posted by: davidjolson | 11/05/2010

The challenge of scaling up human resources for health

This is guest blog by Aarthi Rao, a program associate at Results for Development, the co-host of a briefing at the Global Health Council yesterday.

Will the renewed attention on Human Resources for Health (HRH) gaps spur the global health policy community to meet this need?

It’s a tough question that a panel of policy experts and global health practitioners sought to address yesterday during the Results for Development Institute (R4D) and Global Health Council’s joint policy dialogue in Washington, D.C., “Pharmacists, Doctors, Nurses, Oh My! Solving the HR Problem in Developing Countries.” The session was the fourth installment in the on-going series, “New Visions for Improving Health Care in the Developing World.” Lead co-panelists and facilitators of the session were Marty Makinen, managing director, R4D; Jim McCaffery, deputy director for HRH/Health Systems Strengthening, USAID CapacityPlus Project; Marko Vujicic, senior economist for Human Development Network, World Bank; and Estelle Quain, team lead for Health Systems Strengthening at the Office of HIV/AIDS, USAID Bureau of Global Health.

Health workers are the lynchpin of a health system. They directly affect the quality of healthcare provision within a country and represent the confluence of medical education systems, financing efforts and public health management. Without cohesive HR policies, care is fragmented at best and sometimes, in rural areas, even unavailable.

Consider a recent example from Haiti, the results of a preliminary study found that infants who receive a Prevention of Mother-to-Child Transmission package to thwart vertical transmission of HIV/AIDS are still dying from common diseases like syphilis. This reinforces the urgency of the HRH debate and points to the stark reality that a health worker who is able to provide state of the art care for one disease, may lack the basic know-how to address another. The critical need to integrate vertical HRH programs and increase overall competencies of general health workers is one of the many HRH challenges that policy experts and practitioners are tracking closely with renewed attention.

To tackle these issues, the policy dialogue opened by highlighting key recommendations from the Global Health Workforce Alliance (GHWA) publication, “Will We Achieve Universal Access to HIV/AIDS Services with the Health Workforce We Have? A Snapshot from Five Countries.” The report will be formally launched at the Second Global Forum on Human Resources for Health in Bangkok, Thailand in January 2011.

The recommendations outline eight policy areas that are critical for scaling up HRH for HIV/AIDS, and also provide insights for HRH beyond HIV/AIDS. The session participants broke into discussion groups to review three of these eight areas — human resources management systems, costs and financing and incentives for rural retention of workers.

Some cross-cutting themes quickly emerged across all three areas including the need to integrate HRH initiatives into the overall health system, the potential to scale up tested and true pilot interventions, streamline and focus training programs and the important role of partnerships. It also became clear that issues surrounding country ownership and political will — buzzwords in many areas of global health — can make or break efforts to improve HRH from a health system perspective.

Lessons and approaches may be broadly relevant across countries, but to act successfully on these recommendations policies must be nuanced to needs and obstacles of individual country systems. Differences in disease prevalence alone can wholly change the feasibility of task-shifting and the necessary training regimens for health workers. This is another reason why collaboration between sectors is so important; if a ministry of finance, ministry of health and private sector groups work together, they will produce a much more accurate landscape of a country’s HRH needs and resources than if a ministry of health acts alone.

In the coming months it will be very interesting to see how these issues of country ownership and political will are addressed by the upcoming Global Forum on HRH and, most importantly, how policy makers within low-income countries choose to leverage the many policy options available to them in light of the GHWA’s newest recommendations.


  1. Thank you so much for sharing a summary of your discussions. Some of your readers might have an interest in a new Global Scale Up Community of Practice to share this type of learning with a wider community. More information here: &

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