Consultation on the WHO Global Strategy on Human Resources for Health: Workforce 2030

Thursday, 29 Oct 2015

We know that health systems in Africa do not meet their full potential due to a lack of health care workers and other health-related staff. The health worker deficit has become the focus of international campaigns. More needs to be done to train and retain staff on the continent. Alongside this we need a strategy to support the health workforce that tends to the health of communities – often in sub-optimal conditions with limited support. We have been exploring whether there are cost-effective and sustainable ways that researchers can support changes in performance management within the health system, particularly at sub-national level, in Ghana, Tanzania and Uganda. We welcome the opportunity to share some of our learning as part of the Consultation on the WHO Global Strategy on Human Resources for Health: Workforce 2030. Our comments are as follows: 

  1. We note the range of health staff that the strategy aims to support. We would strongly recommend that the cadre of "health service managers" is included in this list. Since without these health professionals other staff cannot operate effectively. There is a need for capable, professional health managers and that their capacity needs to be built at all levels, including the district level. 
  2. The strategy has a focus on building national capacity. However we would argue that decisions about health system planning and the health workforce should increasingly be devolved to lower levels of authority – particularly districts. Our study focused on people and processes at this level. We used approaches that addressed real problems that managers were experiencing and used locally available planning and management tools that managers were familiar with. We believe that there is a case for improving management systems and competencies of mid-level managers at the interface with health workers, especially management at the district level where there is sufficient “decision space” or room for manoeuvre.
  3. We agree with the strategy that there is a need for cost-effective approaches. The action research, which was adopted in PERFORM, could pay dividends in this respect. Through this approach we supported health managers to carry out a situation analysis on the health system, with a particular focus on workforce performance, in nine study districts (three per country). They then identified the areas of health workforce performance to be improved, developed and to, implemented integrated human resource and health systems strategies feasible within the existing context to improve health workforce performance, and monitor the implementation of the strategies, evaluate the processes and impact on health workforce performance and the wider health system. Because we wanted to support sustainable change we did not provide extra financing for the intervention but supported key actors in the health system to devise and implement innovative change on improved human resource management for themselves and monitored the results.
  4. We appreciate the focus on effective collaboration with the private sector (for-profit and not-for-profit). We believe that it is possible to harness the capacity and resources of these actors in support of the health workforce agenda. For example in Uganda PERFORM collaborated with private sector –using bank financing to support the induction of new staff.  

Further resources:

Strengthening health management and workforce performance: How action research can help

How did action research strengthen district health management and improve health workforce performance in Ghana, Uganda and Tanzania?