Elsevier

The Lancet

Volume 364, Issue 9449, 27 November–3 December 2004, Pages 1984-1990
The Lancet

Public Health
Human resources for health: overcoming the crisis

https://doi.org/10.1016/S0140-6736(04)17482-5Get rights and content

Summary

Background

In this analysis of the global workforce, the Joint Learning Initiative—a consortium of more than 100 health leaders—proposes that mobilisation and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world's poorest countries and for building sustainable health systems in all countries. Nearly all countries are challenged by worker shortage, skill mix imbalance, maldistribution, negative work environment, and weak knowledge base. Especially in the poorest countries, the workforce is under assault by HIV/AIDS, out-migration, and inadequate investment. Effective country strategies should be backed by international reinforcement. Ultimately, the crisis in human resources is a shared problem requiring shared responsibility for cooperative action. Alliances for action are recommended to strengthen the performance of all existing actors while expanding space and energy for fresh actors.

Section snippets

The power of the health worker

After a century of the most spectacular health advances in human history, we confront unprecedented and interlocking health crises. Some of the world's poorest countries face rising death rates and plummeting life expectancy, even as global pandemics threaten us all.1 Human survival gains are being lost because of feeble national health systems. On the front line of human survival, we see overburdened and overstressed health workers, too few in number, without the support they so badly

Workforce strategies

Evidence confirms that effective workforce strategies enhance the performance of health systems, even under difficult circumstances.9, 10, 11 Indeed, the only route to reaching the health MDGs is through the worker; there are no shortcuts. Workers alone are not panaceas. Building a high-performance workforce demands hard, consistent, and sustained effort. For workers to be effective they must have drugs and supplies, and for them to use these inputs efficiently they must be motivated, skilled,

Putting workers first

We call for immediate action to harness the power of workers for global health equity and development. The imperative for action springs from the urgency of the health crisis, the timeliness of new opportunities, and the prospect that available knowledge, if applied vigorously, could save many lives. The cost of inaction is unmistakable—stark failures to achieve the MDGs, epidemics spiraling out of control, and unnecessary loss of many lives. At stake is nothing less than the course of global

Strengthening sustainable health systems

Every country, poor or rich, should have a national workforce plan shaped to its situation and crafted to address its health needs. These plans should aim to ensure access of every family to a motivated, skilled, and supported health worker. Where feasible, that worker should be recruited from, accountable to, and supported to work in the community. Our specific recommendations are described below.

First, all countries should develop national workforce strategic plans to guide enhanced

Mobilising to combat health emergencies

In crisis countries severely affected by HIV/AIDS, especially in much of sub-Saharan Africa, popular mobilisation to harness workers is urgently needed to overcome the crisis of human survival. Crisis countries must assess the suitability of their current workforce and mobilise support for appropriate delegation of core health functions to well-trained community-based auxiliary workers. The support of donors, regional bodies, and global organisations is vital for effective implementation. Our

Building the knowledge base

Effective action, both urgent and sustained, needs solid information, reliable analyses, and a firm knowledge base. But data and research for human resources are underdeveloped, especially in low-density-high-mortality countries. National and global learning processes must be launched to rapidly build the knowledge base—essential for guiding, accelerating, and improving action. A culture of science-based knowledge building must be infused into the human resources community. Our specific

Action and learning

Implementation of this work agenda demands immediate action backed by simultaneous learning. We must spark a virtuous circle of acting, learning, adjusting, and growing, because we do not have all the answers and yet we must urgently launch concerted action.

Because the key actions rest with national governments, we call on national leadership to implement these recommendations. We also call on international agencies—especially WHO and the World Bank, but also UNDP, UNESCO, the Global Fund, the

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