In sub-Saharan Africa, a woman is likely to deliver her baby without a skilled birth attendant. That makes her chance of dying unacceptably high. Skilled attendants are present at only 47% of deliveries, and there is one maternal death for every 100live births.

Contrast this with Southeast Asia, where 73% of deliveries take place with a skilled birth attendant and there is one maternal death for every 300 live births. The maternal mortality ratio is one third of that in sub-Saharan Africa.

Skilled health workers save lives

We know we need more skilled health workers. Fortunately, the Obama Administration’s Global Health Initiative focuses attention on the need for more health workers with the skills and training to help their communities, as I commended in my previous post. One of the GHI’s targets is “Increased numbers of trained health workers and community workers appropriately deployed in the country.”

This is laudable. However, the GHI needs a strategy for the health workforce component.

This absence stands in marked contrast to the so-called vertical programs, such as family planning, HIV/AIDS, malaria, and maternal and child health, which already have well-developed strategies.

Defining a strategy for the health workforce component of the GHI

The GHI rightly emphasizes the importance of developing the health workforce (and other health systems) but currently falls short of defining a meaningful approach to the issue. We need to move forward with a strategy that includes clear objectives, resource allocation, technical approach, and appropriate indicators of progress.

In doing so, the US Government could make optimal use of the funds available for human resources for health, create a model for addressing the other health systems issues included in the GHI, and help ensure that this pillar of health systems is available to support the government’s contribution to achieving the Millennium Development Goals.

In my forthcoming paper I propose a strategic approach to the health workforce challenge that would support implementation of the GHI. The key elements are:

1. Setting a global goal for increasing the health workforce
2. Defining clear, measurable, and comprehensive objectives
3. Identifying a set of priority countries
4. Articulating a comprehensive, evidence-based technical approach
5. Allocating and tracking resources commensurate with objectives
6. Assessing progress on a regular basis using a set of key indicators
7. Testing promising practices and encouraging adoption of best practices
8. Proposing an organizational structure that provides the necessary leadership, expertise, and coordination.

In my next post I’ll talk about why this is important for the enduring legacy of the US Government’s Global Health Initiative.