Developing a Productive and Effective Health Work Force

GLOBAL HEALTH WRITES

Citizen Journalist: Siobhán Tracey

“Expenditure on an effective health work force is not a cost but an investment.”

The overarching message from the opening speakers at RCSI’s Global Health Conference held in Dublin on 21^st and 22^nd April, 2016 is that expenditure now, on building a skilled health work force, will pay dividends in the immediate term, as well as for future generations.

Nicola Brennan of Irish Aid, standing in for then Minister for State for Overseas Development Assistance, Trade Promotion, and North-South Cooperation, Sean Sherlock, stated that 20% of Irish Aid’s global budget goes to health, and stressed the need for increased collaboration between ministries and organisations to strengthen and combat global health crises, and to ensure pandemic preparedness for outbreaks such as Ebola. She emphasized the multiple links between global health and education and highlighted the lack of surgical personnel in the East, Central and Southern African region (ECSA) as being a significant problem. Instead of the 20 surgical personnel per 100,000 recommended to meet the population’s surgical needs, countries in the ECSA region will typically have as few as 0.5 per 100,000 population.

James Campbell, Director of Health Workforce at the WHO, and Executive Director of the Global Health Workforce Alliance (GHWA) also emphasised the need to ‘make connections between global and domestic strategies’ stating that ‘the majority of solutions will be inter-sectoral’, coming not just from the Department of Foreign Affairs and Trade but also from other departments such as Health, Education and Labour. He referred to the Global Strategy on Human Resources for Health: Workforce 2030 (GSHRH) which aims to support the WHO, Member States, and partners such as the World Bank, to address health workforce challenges to move towards Universal Health Coverage (UHC) – one of the UN Sustainable Development Goals (SDGs). The ultimate aim is that by 2030 all communities will have universal access to health workers.

The key elements to achieving these aims will be: optimising the workforce in pursuit of the SDGs (education, employment, retention); anticipating future workforce requirements and planning for these; strengthening individual and institutional capacity to manage HR policy and planning; and strengthening data evidence and knowledge for cost-effective policy decisions.

In asking what we can do globally to drive investment in health workforces, Campbell cited the example of Germany as leading the way.  Even during the global economic recession, Germany continued to invest in health, with over 700,000 new jobs in health being created between 2005 and 2012 – resulting in one in seven Germans currently being employed in the overall health economy.  A new policy towards ageing and care in the community for the elderly will create a further 200,000 jobs over the next few years.  Expenditure on health is viewed as an investment to grow the economy rather than being a demand on it.

Yet despite such evidence that investing in health workers contributes to economic growth, health workforce investment has been cut in many counties, and health expenditure continues to be viewed as a sunk cost rather than something that will provide a return.  According to Campbell, referring to World Bank figures, there is a projected need to create 40 million new health sector jobs by 2030.  The majority of these will be in middle and high income countries, as the population ages and lives longer, but as many as 18 million health care workers will be required to achieve the health workforce SDG target of 4.45 health workers per 1,000 population by 2030 in low and middle income countries.

A clear risk to achieving SDG targets in low income countries is the migration of health workers to the higher income countries in search of higher salaries and better conditions.  However, research into the retention of surgical graduates in East, Central, and Southern African region presented by Avril Hutch, Assistant Programme Director of the RCSI-COSECSA Collaboration Programme, suggested that the brain drain which is estimated to cost Africa $2 billion per year doesn’t appear to apply to surgical graduates. The research produced some encouraging figures – throughout Africa, 93% of graduates are retained within the region and in the ECSA countries, 87% of graduates remain.

While it is not known whether there is a brain drain that occurs before the surgical training, Hutch’s conclusion would appear to be that investment in indigenous services is worthwhile.

-Siobhán Tracey, Dublin, May 2016

Siobhán is a lawyer and communications consultant with a strong interest in development issues. A graduate of English and French from Trinity College Dublin, she subsequently trained as a solicitor and practiced in Dublin for 4 years. Siobhán has spent 10 out of the last 15 years living outside of Ireland, in 4 different countries, where she worked in magazine publishing in New York and provided media advice to an MEP in Brussels, before returning to Ireland in 2015.

To contact Siobhán, please email [email protected]