Academic journal article Bulletin of the World Health Organization

Tackling Health Workforce Challenges to Universal Health Coverage: Setting Targets and Measuring progress/Relever Les Defis Des Effectifs De Sante Pour Realiser la Couverture Sanitaire Universelle: Etablir Les Objectifs et Mesurer Les progress/Abordar Los Desafios del Personal Sanitario Para Alcanzar la Cobertura Universal De la Salud: Fijacion De Objetivos Y Evaluacion del Progreso

Academic journal article Bulletin of the World Health Organization

Tackling Health Workforce Challenges to Universal Health Coverage: Setting Targets and Measuring progress/Relever Les Defis Des Effectifs De Sante Pour Realiser la Couverture Sanitaire Universelle: Etablir Les Objectifs et Mesurer Les progress/Abordar Los Desafios del Personal Sanitario Para Alcanzar la Cobertura Universal De la Salud: Fijacion De Objetivos Y Evaluacion del Progreso

Article excerpt

Introduction

The eight Millennium Development Goals (MDGs) (1) have been credited with catalysing a greater focus on the development priorities they targeted--poverty reduction, gender equality, primary education, maternal and child health, control of major diseases, environmental issues, and partnerships for development--and with mobilizing the relevant resources. With three of the MDGs being health-related, health is awarded a high priority in the current framework. The progress being made towards achieving these three goals is inequitable within and across countries, but despite this, many countries are recording improvements in health outcomes. (2)

However, limitations in the MDG framework--and particularly in the health-related MDGs--are being recognized: a lack of attention to equity, (3) the neglect of health issues that were not explicitly included in any of the MDGs, and the fragmentation of efforts targeted at the different health priorities (the latter might have contributed to a narrowly selective focus on development assistance for health). (4) The targets and indicators currently used for the health-related MDGs focus on increasing the coverage of some priority health services--such as skilled birth attendance --and on improving health outcomes in relation to maternal health, child health and infectious diseases. However, none of the MDG targets refers explicitly to the health system actions required to attain such objectives. Yet it has been evident for over a decade that only by overcoming the structural deficiencies of health systems--including those related to governance, the health workforce, information systems, health financing and supply chains--will it be possible to improve specific outcomes for individual diseases or population subgroups. (5)

Although econometric analyses have confirmed that an adequate health workforce is necessary for the delivery of essential health services and improvement in health outcomes, (6,7) there have been systemic failures in the planning, forecasting, development and management of human resources for health (HRH). (8,9) This has led to unacceptable variations in the availability, distribution, capacity and performance of health workers, and these have resulted, in turn, in uneven quality and coverage of health services. In many low-income countries, acute shortages in the health workforce have been compounded by the emigration of health workers to high-income countries that offer better working conditions. The situation has heightened a sense of injustice that culminated in the adoption, in 2010, of the WHO Global Code of Practice on the International Recruitment of Health Personnel. (10)

Health workforce benchmarks

The world health report 2006 included an estimate of the minimum density threshold of physicians, nurses and midwives deemed generally necessary to attain a high coverage of skilled birth attendance: 2.28 per 1000 population. (9) According to the statistics available when the report was published, 57 countries fell below this benchmark and an additional 4.3 million health workers would be required to achieve the minimum density globally.

Thanks to its grounding in evidence, its relative simplicity and the fact that it could be easily standardized, the minimum density of physicians, nurses or midwives suggested in The world health report 2006--2.28 per 1000 population--has become the most widely used health workforce "target". It was adopted in the commitments of the Group of Eight (G8) in 2008H and has served as a basis for several monitoring and accountability processes that were either focused on the health workforce (12) or had a different and broader focus. (13) However, this benchmark focuses exclusively on physicians, nurses and midwives and was developed with the objective of attaining relatively high coverage of selected essential health services of relevance to the health MDGs. In today's world, it is no longer adequate in the health workforce discourse for at least four reasons:

i) The evidence underpinning the threshold value was based on data on immunization coverage and skilled birth attendance. …

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