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In Transforming the Health Workforce—a new open-access publication released by New York University College of Nursing—a chapter by IntraHealth International experts Laura Hoemeke, Barbara Stilwell, Kate Tulenko, former IntraHealth vice president Maurice Middleberg, and others highlights some health workforce policy options countries can adopt to improve the health of their populations.
“Transforming the health workforce is an ongoing and iterative process,” write editors Marilyn A. Deluca and Agnes Soucat in their introduction. “It requires long-term vision, commitment, and resources; it demands national leadership, political will, and the participation of engaged stakeholders.”
And according to the IntraHealth authors’ analysis, leadership and models of deployment may affect the achievement of national health targets more than the absolute numbers of health workers in a country.
Beyond Numbers
The World Health Organization estimates that there is a shortage of 2.4 million doctors, nurses, and midwives worldwide.
In the chapter “Promising choices: How health workforce policy choices dictate health outcomes,” the authors explain that problems such as misdistribution, out-migration, and low productivity of health workers cannot be solved by increasing numbers alone. And many countries lack the capacity and resources to train great numbers of new doctors, nurses, and midwives.
“Countries of modest means and limited access to health professionals can still achieve major gains in health by the policy choices they make to overcome health worker deficits,” the authors say.
They point out that countries with similar levels of doctors, nurses, and midwives experience an astonishingly wide range of health outcomes. For example, child mortality rates in the 57 health workforce crisis countries—those defined by the World Health Organization (WHO) as having fewer than 2.3 doctors, nurses, and midwives per 1,000 people—range from as low as 16 deaths per 1,000 births in El Salvador to 180 per 1,000 in Somalia. The authors argue that the way countries are deploying health workers not counted in the WHO’s ratio, i.e. health workers other than doctors, nurses, and midwives, explains a large part of this variance.
The authors compared how those 57 countries ranked on the Health Workers Reach Index—developed by Save the Children-UK to take into account access to an array of frontline health workers—to common health indicators. The analysis revealed a strong relationship between countries’ index ratings and their rates of child and maternal mortality and contraceptive use.
Smart Policies
The authors urge countries with severe health workforce shortages to prioritize policy options that will ensure more health workers are present, ready, connected, and safe. They suggest a variety of policy options countries can consider to both increase the number of their health workers and maximize the potential of their current health workforces. These include policies and programs aimed at strengthening retention and health workforce management, training, technology, and on-the-job protection for health workers.
Governments, donors, and development partners are increasingly recognizing that a strong health workforce is vital to making sustainable gains in global health. This week, representatives gathered at the Third Global Forum on Human Resources for Health in Recife, Brazil, to announce specific country and donor commitments, share experiences, and advocate for the central role of the health workforce in establishing new international development goals.