This blog entry is the first in a series of three. The second and third entries are now online.

Entering a one-room health clinic in Cambodia’s Pursat Province, I saw a heavily pregnant woman suffering on the dirt floor. A midwife was the lone health worker staffing this rural post. This midwife—who probably had minimal training and little or no supervision or support—didn’t recognize the symptoms of eclampsia. She had no colleagues to ask for help, and she didn’t know what to do.

We placed the pregnant woman in a vehicle with instructions to the driver to take her to the nearest town so she could seek treatment. I never found out what happened to that woman. I think about her often.

We know we need more skilled health workers

Properly trained and supported health workers save lives. Yet access to them remains difficult or impossible for millions of people. The health worker shortage is a major barrier to achieving the Millennium Development Goals. And the World Health Organization has identified 57 countries with a health worker crisis.

Addressing the health workforce challenge

President Obama’s Global Health Initiative recognizes this problem and commits to filling the void. Among the GHI’s targets is “Increased numbers of trained health workers and community workers appropriately deployed in the country.”

Within the US Government’s global health portfolio, there are pockets of excellence in human resources for health, from effective projects and technical working groups to knowledgeable staff. Extensive financing supports health worker training and related activities, generally embedded within disease-specific programs. Projects and programs are tackling thorny challenges ranging from task-shifting to strengthening human resources information systems.

However, this doesn’t constitute a coherent approach to support implementation of the GHI.

An undefined approach

So far none of the following has been defined for the health workforce component within the GHI:

• Objectives
• Focus countries
• Resource allocation
• Technical approach
• Organizational structure
• Leadership
• Staffing
• Metrics
• Approach to monitoring and evaluation.

For the GHI to be effective and make a sustainable impact, we need to define a strategy to achieve the GHI’s health workforce aims. In my next post I’ll propose elements of such a strategy.