The Global Health Workforce Alliance 2013 Annual Report

Rising to the grand challenge

of Human Resources for Health
Photo credits

> Cover: © MERLIN

> Chapter 1 : © Intrahealth International
> Chapter 2: © M.H Bhuiyan/GHWA photo contest 2013
> Chapter 3: © JHPIEGO
> Chapter 4: © MERLIN

© World Health Organization 2014

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 4 Message from the Chair and Executive Director

6 Identifying and promoting evidence-based solutions

6 Identifying best practices and Human Resources for Health
requirements for UHC
7 Health Labour Market Analytical framework
8 Strengthening and promoting evidence on community and
mid-level health workers

10 Strengthening accountability
10 G8 Summit
10 Commission on Information and Accountability for Women’s
and Children’s Health
11 HRH agenda for change: A Universal Truth. No Health Without a Workforce

14 Catalysing global action through advocacy

14 Third Global Forum on Human Resources for Health:
developing a new health workforce agenda
16 The Recife Political Declaration on Human Resources for Health:
A new health workforce agenda for achieving universal health coverage
17 Human Resources for Health commitments: Accelerating progress
towards universal health coverage
21 Saving lives and improving health:
21 The Human Resources for Health Awards 2013
22 Elevating HRH on the global agenda
23 Building health worker capacity in francophone Africa
24 Health Workers Count:
A day in the life of a health worker photo contest winners

26 Looking forward to 2030

28 Annual Finances
Message from the Chair
and Executive Director

In 2013, GHWA succeeded in making a bridge the World Health Organization (WHO), allowing
between the health workforce agenda and the greater synergy in pursuit of their complementary
broader movement in support of the attainment mandate.
of universal health coverage. The landmark Third
Global Forum on Human Resources for Health has The future holds promise at GHWA: ground-break-
enabled WHO Member States, GHWA members and ing new evidence in support of our advocacy, politi-
partners and the wider HRH community to identify cal commitments by countries, and a strengthened
the health workforce challenges and requirements strategic partnership with key partners forged in
for UHC, and contributed to the recognition that the lead up to and after the Third Global Forum will
health workforce challenges affect countries at play a fundamental role in bolstering momentum
all levels of socio-economic development, and for the HRH agenda in the post-2015 period. The
not just low- and middle-income countries with GHWA Secretariat is indebted to its members and
a severe shortage. The conference came at an partners for their unwavering dedication, support
opportune time, as the international community and engagement. Ensuring that every person,
approaches the most critical phases of the debate wherever they live, can see a health worker when
on the post 2015 development framework. they need one requires nothing less.

The highlights of the Forum were the political

statements presented in the Recife Political Decla-
ration on Human Resources for Health, as well as
more than 80 commitments made by WHO Member
States and member organizations of GHWA which
might be the best measure of the success of the
conference.

The Forum was the culmination of an intense year

of work at GHWA, which saw its members and Dr Mitsuhiro Ushio
partners contributing proactively to its vision and Board Chair, Global Health Workforce Alliance
and Assistant Minister for Global Health,
objectives. The Secretariat made critical contribu- Ministry of Health, Labour and Welfare, Japan
tions towards positioning HRH centrally in the
policy discourse at global level and facilitating the
generation and synthesis of new knowledge prod-
ucts to promote advocacy based on cutting-edge
evidence, including on the role of mid-level and
community-based health workers, health labour
markets, and the identification of best practices
and case studies on effective HRH coordination
and governance.

During 2013, major steps were also made in

defining the Secretariat scope of work in a more Dr Marie Paule Kieny
strategic manner vis-à-vis the responsibility of its Director a.i. Global Health Workforce Alliance
Assistant Director-General, Health Systems
members and partners; as part of that an opera- and Innovation, WHO
tional division of responsibilities was agreed with
4 5

2013 was a year of tangible progress with breakthrough achievements steering a direction for a renewed
human resources of health agenda instrumental to the achievement of universal health coverage. GHWA made
a major contribution to the HRH movement, including through:

> Convening a major international HRH agenda-setting event - the Third Global Forum on Human Resources
for Health- and putting at the forefront HRH messaging in key global events and processes;

> Facilitating Member States in developing commitments to improve HRH in a sustainable manner;

> Advocating for a long-term vision of HRH and the achievement of UHC to be incorporated in the post-2015
development agenda;

> Promoting accountability for HRH results in Member States.

Identifying and promoting
evidence-based solutions

A key factor in why health workforce problems management of their health workforce. Other arti-
persist is the tendency for simplistic solutions and cles contributed to strengthening the policy frame-
quick fixes to address highly complex and evolving works and evidence base for human resources for
problems. GHWA has played a key role in devel- health by:
oping, collecting and disseminating knowledge, 1 deepening understanding of the labour market
analysis and evidence on progress and challenges, forces that affect health workers’ motivation,
lessons learned, recommendations, good prac- attraction, retention and performance;
tices and effective policies for HRH. 2 identifying best practices and lessons learned
in tackling the challenges of retaining workers
Identifying best practices and Human Re- in rural areas and international migration, and
sources for Health requirements for UHC specifically in relation to implementing the
WHO Global Code of Practice on the Interna-
The GHWA Secretariat coordinated the develop- tional Recruitment of Health Personnel;
ment of a theme issue of the WHO Bulletin on 3 providing new evidence and recommendations
human resources for UHC, published to coincide on the effectiveness of and required system
with the Third Global Forum on Human Resources support for mid-level and community-based
for Health. The articles provide concrete examples, health workers;
success stories and lessons learned of how some 4 identifying opportunities for innovation in
countries have structured their efforts in this area the education and management support of
and offers analytical tools and new evidence about human resources for health through emerging
successful or promising innovative approaches technologies;
to improve the deployment, retention and
5 investigating levels of domestic spending on Health Labour Market Analytical framework
human resources for health and exploring how
the impact of development assistance in that Countries at all levels of socioeconomic develop-
area can be maximized by targeting it more ment are facing the challenge of matching health
strategically; and workforce supply and demand under existing con-
6 exploring how benchmarks and indica- straints of affordability and sustainability; these
tors related to human resources for health challenges are particularly severe in the African
could influence and be part of the agenda continent. The Secretariat collaborated with the
for universal health coverage and post-2015 World Bank and African Development Bank in
development. developing a health labour market analytical
framework to support health policy makers and
GHWA members and partners were the main con- health programme managers in Africa. The frame-
tributors to this collection of the state-of-the-art work is helping policy makers and programme
evidence and thinking on HRH for UHC, while other managers to understand the status, trends and
authors included Ministers of Health, parliamen- dynamics of factors affecting health workforce
tarians, Directors of Human Resources (in MoH) supply and demand, motivation, retention and
and senior officials from development agencies performance. The key messages of the framework
and leading HRH experts. and from an expert consultation in Hammamet,
Tunisia were captured in a policy and practice paper published in the WHO
Bulletin, and served as background for discussions at the Third Global
Forum.

Strengthening and promoting evidence on community and mid-

level health workers

The GHWA Secretariat brokered a consensus among different constituen-

cies and organizations on solutions of proven effectiveness in fully har-
nessing the positive potential of community health workers (CHWs) and
integrating them in health system support structures. Community health
workers can represent an effective strategy of increasing access to essen-
tial health care services in communities. However, it is critical that they are
integrated with and supported by the health system in order to ensure they
are adequate in number, have the required resources and equipment, can
count on effective referral systems, have sufficient knowledge of health
issues, and adequate information materials for dissemination.

GHWA convenes partners to ensure coordination of approaches and con-

sistency of messaging on various issues. To this end GHWA established
a global platform for consultation to promote synergy among partners to
move forward the CHW discourse and ensure that different national and
international actors working to promote the role of community health
workers do so in a way that contributes to strengthening in an integrated
way the primary health care system. GHWA members, with the facilita-
tion of the Secretariat, developed thematic documents, to promote the
enhanced performance of CHWs and to better integrate them in health
care systems, and agreed on a framework for future actions; developed
Working Papers to leverage agreement and action on the key principles
for CHW programmes as a basis for optimizing synergies and results; and
commissioned a global analysis on the cost-effectiveness of CHWs.

GHWA also coordinated the development of a global systematic review,

examining the effectiveness of mid-level health workers (MLHW) in pro-
viding essential health services. The review was complemented by eight
country case studies in Asia, Africa, and Latin America. Evidence shows
that MLHWs deliver services with quality standards comparable to tradi-
tional care models where services are rendered by doctors. In some cases,
particularly in relation to maternal health, evidence shows that have the
potential to yield even better results and achieved higher patient satisfac-
tion than standard care.
 1. Identifying and promoting evidence-based solutions
2. Strengthening accountability
3. Catalysing global action through advocacy
8 9 4. Looking forward to 2030

Partners’ commitment to community health workers

> Work together to adapt, apply and implement the CHW Framework for Partner Action, fostering harmoni-
zation and synergies, accountability and joint action on critical knowledge gaps, and reaching out to all
stakeholders engaged with CHW Programs.

> Advocate, endorse and apply the principles and processes delineated in the CHW Framework for Partner
Action.

> Promote jointly the culture of self and mutual monitoring and accountability (M&A) of commitments and
plans.

> Respond reciprocally to knowledge gaps and promote a coordinated response to needs-based research
on CHWs.
Strengthening accountability

G8 Summit Commission on Information and Account-

ability for Women’s and Children’s Health
GHWA, in collaboration with WHO, provided an
overview of progress in health workforce develop- GHWA has been striving to link the HRH discourse
ment efforts towards the commitment made in to the reproductive, maternal, newborn and child
Hokkaido 2008 - where the G8 members commit- health (RMNCH) agenda; as part of these efforts,
ted to increasing health workforce availability in undertaken in collaboration with the Partnership
developing countries towards the WHO threshold for Maternal, Newborn and Child Health, the Alli-
of 2.3 heath workers per 1000 people. The analysis ance in the past developed, inter alia, sections and
indicated significant progress in improving HRH a background paper of the UN Global Strategy for
availability in about a third of the countries, per- Women’s and Children’s Health, which have con-
sisting challenges in others, and a considerable tributed to a greater prominence of HRH themes,
gap in updated information and/ or quality data issues and targets in the strategic document, as
from many countries; the briefing provided by the well as to an explicit focus on HRH of many com-
GHWA Secretariat was ultimately reflected in the mitments made by countries and other institutions
G8 Accountability report for 2013, leading to the in support of the UN Global Strategy.
G8 assessing its own progress towards this goal
as ‘below expectations’, and therefore indicating Building on this work stream, GHWA members con-
the need for greater efforts in this critical area of tributed with the facilitation of the Secretariat to
health system development. the 2013 report of the Independent Expert Review
Group set up by the Commission on Information The report shows that all countries are facing the
and Accountability through the development of a challenges of how to accelerate progress towards
case study on HRH development efforts in Malawi, or to attain or sustain universal health coverage.
which gave visibility to HRH as an essential – and Furthermore, demographic trends, the growing bur-
successful - area for investment in the context of den of noncommunicable diseases and long-term
RMNCH. care, macroeconomic and fiscal restraints imposed
in response to a difficult economic climate, and the
HRH agenda for change: A Universal Truth. need to adopt a systemic and long-term approach
No Health Without a Workforce to understanding health labour markets will make
the challenges of human resources for health in
The flagship report A Universal Truth: No Health high-, middle- and low-income countries even
Without a Workforce was launched at the Forum, more acute, rendering it a shared global priority.
providing state-of-the-art evidence on health 100 countries currently fall below the threshold of
workforce availability, accessibility, acceptability 34.5 skilled health professionals per 10,000 popu-
and quality. The report, which sets out a new lation, and the global deficit is estimated to rise
agenda for all countries to build the health work- to about 12.9 million skilled health professionals
forces needed to achieve UHC, was crucial in the (midwives, nurses and physicians) by 2035.
build-up and agenda-setting towards the Third
Global Forum.
Workforce to population ratios for 186 countries

Group 1: density of skilled workforce lower than Group 4: density is equal or greater than
22.8/10 000 population and a coverage of births 22.8/10 000 and smaller than 34.5/10 000
attended by SBA less than 80%
Group 5: density is equal or greater than
Group 2: density of skilled workforce lower than 34.5/10 000 and smaller than 59.4/10 000
22.8/10 000 population and a coverage of births
attended by SBA greater than 80%  Group 6: density is equal or greater than
59.4/10 000
Group 3: density of skilled workforce lower than
22.8/10 000 population but no recent data on
coverage of births attended by SBA
 1. Identifying and promoting evidence-based solutions
2. Strengthening accountability
3. Catalysing global action through advocacy
12 13 4. Looking forward to 2030

At the same time, the report also highlights the fact that many advances
have been made in the past decade. For instance, among the countries
affected by severe shortages of skilled health professionals, the situation
has improved in most of those for whom data are available. It will be criti-
cal to ensure that gaps are closed between health worker supply and dis-
tribution and the population’s health care needs. A skilled and available
national health workforce can only be achieved through high-level political
support in the formulation of HRH policy objectives and development of
the evidence base and technical capacity to implement and monitor poli-
cies. At the global level, international partners must focus their support
on development assistance to build the capacity of health systems and
aim to strengthen HRH governance and collaborative platforms. The report
illustrates how progress can be made and highlights proven approaches
and promising new ones.
Catalysing global action
through advocacy

Health workers are at the heart of health systems, Third Global Forum on Human Resources
but there are critical gaps – in terms of numbers, for Health: developing a new health work-
distribution, competencies, quality, motivation force agenda
and performance – that prevent progress in reduc-
ing maternal and child mortality, controlling com- A key focus for GHWA in 2013 was the organization
municable and non-communicable diseases and of the Third Global Forum on Human Resources
achieving UHC. There is also increasing awareness for Health which was jointly convened by the
that health workforce challenges affect – although Government of Brazil, WHO, the Pan American
with varying levels of severity – countries at all Health Organization (PAHO) and the Global Health
levels of socio-economic development. GHWA Workforce Alliance in Recife, Brazil, from 10 to 13
supports, convenes and harnesses the capaci- November 2013. The event, designed around the
ties of global, regional and national partners theme of “Human Resources for Health: Foun-
and members, working for human resources for dation for Universal Health Coverage and the
health (HRH) and contributing towards UHC. It Post-2015 Development Agenda”, provided an
has a unique role in advocating to global lead- opportunity to bolster political commitment and to
ers, national governments, regional platforms update the human resources for health agenda; to
and international financiers to catalyse country make it more relevant to the current global health
and global action, increase investment, promote policy discourse, including the push towards the
research and use of evidence, and strategically health Millennium Development Goals, the univer-
target resources towards achieving health work- sal health coverage objective and the post-2015
force development priorities. agenda.
The organization of the Third Global Forum was a evidence, best practices and lessons learned
highly participatory process, benefitting from both among experts and planners in human resources
the technical rigour and the normative functions for health; and a political one, to galvanize the
of WHO as well as the capacity and contributions support of policy-makers. High-level plenaries,
of the broader membership of the Alliance. This technical side sessions and satellite meetings
inclusive process directly shaped all aspects of the with exhibition areas, poster presentations, photo
Forum: the overall strategic plan of the Forum and exhibits, awards for excellence and other activities
its conference programme were developed under informed and inspired participants to advance the
the oversight of a Forum organizing committee agenda for human resources for health and pro-
together with a Forum working group convened by vided opportunities for professional development
GHWA with representation from governments, civil and networking.
society, academia, the private sector, intergov-
ernmental agencies, development partners and The messages from the Forum were clear: human
professional associations. resources for health are crucial in translating
the vision of UHC into reality. Moving beyond an
With some 1800 participants from 93 Member exclusive focus on the numbers of health workers,
States, including nearly 40 ministers or deputy equal importance should be given to the accessi-
ministers, the Third Global Forum on Human bility, acceptability and quality of the services they
Resources for Health was the largest ever human provide. Just as important is adopting dynamic
resources for health event. The conference had planning and forecasting models, based on high-
a dual nature: a technical event to share new quality data and including labour market analyses,
to match workforce supply with demand. The way health professionals
are trained needs to change radically, transcending the narrow transfer
of clinical competencies and towards models of education that empower
health workers as change agents in society. Health services should be
organized and delivered to be comprehensive, integrated and people-
centered to increase access to health care in rural and remote areas. A
greater focus is required on putting incentives in place and ensuring good
working conditions that can enhance health workforce productivity, qual-
ity and responsiveness. Bringing about lasting change in human resources
for health requires the collaboration of sectors and constituencies.

The Recife Political Declaration on Human Resources for Health:

A new health workforce agenda for achieving universal health
coverage

The Forum was an occasion of strategic and historical significance, with

the adoption of the Recife Political Declaration on Human Resources
for Health. Member States unanimously adopted the Declaration mak-
ing a commitment to an ambitious agenda to develop national health
workforces and achieve UHC. The Recife Political Declaration on Human
Resources for Health, developed through extensive consultations with
Alliance members and partners, and adopted by representatives of Mem-
ber States attending the Third Global Forum, was the ultimate outcome of
the event and enshrined these principles, heralding a new era in human
resources for health. The Recife Declaration recognized the centrality of
human resources for health in the drive towards achieving universal health
coverage. It reaffirmed the vision that all people everywhere must have
access to a skilled, motivated and facilitated health worker within a robust
health system; it committed governments to creating the conditions for
the inclusive development of a shared vision with other stakeholders; and
it reaffirmed the role of the WHO Global Code of Practice on the Interna-
tional Recruitment of Health Personnel as a guide for action to strengthen
the health workforce and health systems. Further, it identified a range of
actions, including improving planning, education, management, govern-
ance, information systems and the adoption of innovative approaches, to
be implemented in accordance with countries’ contexts and needs.
 1. Identifying and promoting evidence-based solutions
2. Strengthening accountability
3. Catalysing global action through advocacy
16 17 4. Looking forward to 2030

Human Resources for Health commitments: Accelerating pro-

gress towards universal health coverage

An overarching message emerging from the Third Global Forum was that
only systemic action can address the deep-seated challenges in human
resources for health by combining related and complementary actions
to strengthen the health workforce towards universal health coverage.
The reasons why health workforce problems persist are diverse, but a
key factor is that often only fragmented or simplistic solutions and quick
fixes have been tried, whereas the development of human resources for
health continually changes and evolves under the pressure of a variety
of factors and forces. Evidence and years of lessons learned, show that
integrated and coordinated approaches are required that pay adequate
attention to every critical step in the supply chain of health workers and
that recognize the role that different sectors within government and differ-
ent constituencies in society play. Thus, a systems approach needs to be
applied to human resources for health. This entails addressing capacity,
management and working conditions as well as a solid understanding of
the health labour market dynamics that affect the production, deployment,
absorption into the health system, retention, performance and motivation
of human resources for health. The challenge is not lack of evidence on
effective policies: it is to mobilize political will and catalyse action for
a contemporary agenda on human resources for health instrumental to
achieving universal health coverage.

In support of the objective of focusing political attention and generating

political momentum, the Third Global Forum made another critical contri-
bution: eliciting country- or institution-specific commitments in support
of national agendas on human resources for health. In the lead-up to the
event, GHWA, WHO, PAHO and the Government of Brazil invited countries
and all other relevant stakeholders to identify areas requiring action and
to make corresponding commitments on human resources for health at
the conference. GHWA and WHO worked together on developing a frame-
work to assess and organize those commitments in a structured manner,
following pathways of interconnected and evidence-informed action on
developing the health workforce.

The framework assisted countries and other stakeholders in identify-

ing relevant commitments on human resources for health to be brought
to the Forum by mapping out the most effective interventions and
their interrelatedness to improve the situation of human resources for
health. It drew inspiration from the WHO Global Code of Practice on the
 International Recruitment of Health Personnel, the policy documents on
human resources for health which Member States have endorsed and
state-of-the-art evidence. It identified systemic pathways of interventions
and organized them along the universal health coverage framework of
availability, accessibility, acceptability and quality, which proved to be a
useful bridge between the agendas for human resources for health and
universal health coverage. Countries and other entities were invited to
identify pathways of interventions that maximized synergy and comple-
mented one another through a systemic approach, recognizing that such
interventions, if taken up as stand-alone, might not be equally effective
and sustainable. Through a coordinated effort under the leadership of
WHO - country offices, Civil Society Organizations and bilateral partners
were able to support Governments to develop work plans based on path-
ways of systemic interventions.

In response to this call, 57 Member States and 27 member organizations

of GHWA or other entities submitted their commitments, which were
announced at five dedicated sessions at the Third Global Forum and will
strengthen the basis for future collaboration, follow-up and accountability
efforts.

Examples of commitments

Benin will recruit every year until 2018 at least 775 health workers to address unmet needs in reproductive,
maternal, newborn and child health; this intervention will be accompanied by allowances to facilitate their
selective deployment in the most under-served rural areas, and by results-based financial incentives to further
reinforce their motivation and enhance their performance.

Ethiopia will by 2017 expand education of health workers to meet 100 % of the staffing standard considering
the skill mix in all primary health care facilities, while at the same time improving quality of new graduates
by implementing program level accreditation in both public and private training institutions and by instituting
competency-based pre-licensure system for all health workers.

Colombia will strengthen family health by educating 10,000 family physicians over the next 10 years, adapt-
ing their competency frameworks to health system and population needs, and improving their quality and
performance through continuous professional development activities.
 1. Identifying and promoting evidence-based solutions
2. Strengthening accountability
3. Catalysing global action through advocacy
18 19 4. Looking forward to 2030

Countries making HRH commitments, by income level.

High
income
4

Low
income Upper-middle
22 income
15

Lower-middle
income
16

Countries making HRH commitments, categorized according to HRH action pathways.

50
45

38
40

29 28
30
24

20

10

0
Education Incentives Retention Skills mix Labour markets
Member States and Alliance partners making HRH commitments

AFRO: Benin, Burkina Faso, Burundi Côte d’Ivoire, Ethiopia, Ghana, Guinea, Kenya, Liberia, Malawi, Mali,
Mozambique, Nigeria, Senegal, South Sudan, Tanzania,Togo, Uganda
EMRO: Afghanistan,Djibouti, Egypt, Iran (Islamic Republic of ), Iraq, Kuwait, Lebanon, Libya, Oman, Pakistan,
Somalia, Sudan, Yemen
EURO: Ireland, Republic of Moldova
SEARO: Bangladesh, Bhutan, Democratic People’s Republic of Korea, Indonesia, Maldives, Myanmar, Nepal,
Sri Lanka
PAHO: Argentina, Belize, Brazil, Chile, Colombia, Dominican Republic, Ecuador, El Salvador, Guatemala,
Paraguay Peru, Suriname, Uruguay
WPRO: Cambodia

Other Constituencies and Institutions:

• Palestinian Authorities
• Institut Supérieur en Sciences Infirmières (ISSI), Democratic Republic of the Congo
• Tanzanian Training Center For International Health
• INTRAHEALTH
• Peoples Health Movement
• College of Physicians and Surgeons Pakistan
• Health Services Academy (Hsa), Pakistan
• COMISCA / Consejo de Ministros de Salud de Centroamerica y Republica Dominicana
• Organismo Andino de Salud – Convenio Hipolito UNANUE
• UNASUR / Grupo Técnico de Desarrollo de Recursos Humanos en Salud del Consejo de Salud
Suramericano
• Save the Children, India
• AEMRN network (Afro-European Medical and Research Network)
• AMREF
• ANSWERS (India)
• CHESTRAD
• Community health workers
• International Pharmaceutical Federation (FIP)
• Health workers count
• Health workers for all
• Institute for Collaborative Development
• International Nurses and Midwives
• Midwives French Speaking Network
• Swasti
• The voices of women health workers in India
• THET
• Wonca Working Party on Rural Practice
• World Vision International
 1. Identifying and promoting evidence-based solutions
2. Strengthening accountability
3. Catalysing global action through advocacy
20 21 4. Looking forward to 2030

Saving lives and improving health:

The Human Resources for Health Awards 2013

Dr. Haruna Lule pioneered a ‘Hand Hygiene Project’ which has reduced
illness among mothers and children drastically in a hospital where he
works in Uganda. The enterprising project, which strengthens hospital
infection control at Gombe Hospital, led to post-surgery sepsis in the
maternity ward falling by over 60 percent, patients’ length of stay being
reduced from 4.6 to 3.5 days in most wards, and cross-infection among
children falling significantly. Health workers also received training in hand
hygiene. Dr. Lule is one of the many remarkable actors recognized by the
Alliance for his work in improving health .GHWA honoured four outstand-
ing players during a special ceremony at the Third Global Forum on Human
Resources for Health, in the following categories: health workers working
in remote/hardship area, country-level decision makers, GHWA member
organizations, and journalists. Having testimonies of awardees workers
alongside the views of senior heads of state and health experts brought a
personal dimension to the Forum discussions.

Dr. Maria Isabel Rodríguez, the Minister of Health of the Republic of El

Salvador, received an award for leading a process of national health care
reform to provide UHC coverage through the strengthening of the nation’s
health workforce. Her plan will add an additional 3,500 health profession-
als to the workforce and will promote training of cadres of national health
policy makers and the creation of a platform for the professional training
of specialist physicians in the country.

The work of Alliance member African Medical and Research Foundation

(AMREF) has had a major impact upon the provision of health care in six
African countries and saved many lives. The Kenyan-based international
organization trains more than 10,000 community health workers every
year in communities, health centres and hospitals. Trained health workers
are then able to visit homes in some of Africa’s most marginalised com-
munities. AMREF also trains doctors, nurses, midwives, clinical officers,
laboratory technicians and pharmacists.

Ms. Marie Yambo, a Kenyan journalist was honoured for her pioneering
efforts in promoting health care development through a health segment
on Kenyan television called ‘Health Matters’, exploring the role of health
workers in the national health system. The programme has looked at the
work of traditional birth attendants and community health workers to
reduce the country’s infant and maternal mortality rates.
Elevating HRH on the global agenda

GHWA supported and actively engaged in various policy and advocacy fora
throughout the year. A number of policy dialogue processes and strategic
events were successfully influenced through the inclusion and recogni-
tion of HRH as a critical component in delivering health outcomes. Some
events include:
1. World Health Assembly. GHWA collaborated with the Permanent
Mission of Brazil, the Permanent Mission of Belgium, and the World
Health Organization to organize a side event building momentum
ahead of the Third Global Forum and exploring innovative solutions to
HRH challenges.

2. Consultations on the post-2015 development agenda. GHWA pro-

vided inputs through a collective effort facilitated by the Secretariat
but harnessing the inputs and expertise of its members, into the
discussions on the post-2015 development framework, including by
supporting the inclusion of HRH elements in the discussions and pro-
ceedings of two dedicated events.
a. Ministerial Meeting on Universal Health Coverage, jointly
convened by WHO and the World Bank;
b. The High-level Dialogue on Health in the Post-2015
Development in Gaborone, Botswana,

3. Consultation on HRH in high-income countries. In its convening

capacity, a consultation on HRH challenges and solutions in high-
income countries (HIC) was jointly organized by GHWA with Norad
and the Norwegian Director of Health in Oslo, Norway, on 4-5 Septem-
ber 2013. The event enabled the sharing of experiences on common
challenges and increased the involvement of HICs in finding global
HRH solutions. Participating countries recognised the HRH crisis as
a global one, requiring strengthened governance and management,
suitable service delivery models, the availability of financial resources
and appropriately trained, skilled health workers, and improved
long-term planning to counter population demographic and disease
challenges. The consultation further served to generate momentum
leading to the Third Global Forum
 1. Identifying and promoting evidence-based solutions
2. Strengthening accountability
3. Catalysing global action through advocacy
22 23 4. Looking forward to 2030

The civil society led Health Workforce Advocacy Initiative (HWAI), sup-
ported by GHWA, contributed to keeping HRH high on the global health
agenda through global meetings, reports and strategic partnerships. A
powerful health worker advocacy social media movement – ‘#Healthwork-
erscount’ – was launched in partnership with the Frontline Health Worker
Coalition (FHWC), to promote health worker messages leading up to the
Forum. HWAI members also organized a half-day advocacy session at the
United Nations General Assembly in New York in September 2013, result-
ing in the development of a civil society commitment announced at the
Forum.

Building health worker capacity in francophone Africa

Building on the experience of country coordination and facilitation of an

integrated HRH response developed during its first phase, GHWA is grate-
ful to the French Government for their continued support of an initiative to
accelerate the achievement of MDGs 4 and 5 (reducing maternal and child
mortality), which is part of the French commitment to the G8 Muskoka
initiative.

As part of the effort to increase coherence and alignment between GHWA

and WHO, the health workforce component of this project is now (as of
October 2013) implemented by the World Health Organization which has
the mandate and is much better equipped than the GHWA Secretariat to
conduct country work.

As part of this programme, WHO supports the development and imple-

mentation of HRH strategies in several francophone countries in Africa, to
improve the availability, accessibility and quality of the human resources
needed for reproductive, maternal, newborn and child health (RMNCH).

In 2013 GHWA provided extensive technical support towards the finaliza-

tion of HRH operational plans (including recruitment, deployment and
retention approaches) for RMNCH health workers in Benin, Burkina Faso,
Guinea and Togo. Several other capacity building initiatives were also
carried out with Muskoka partners, including the development of a mid-
wifery training plan for 11 countries - Benin, Burkina Faso, Cote d’Ivoire,
Cameroon, Democratic Republic of Congo, Guinea, Mali, Mauritania,
Niger, Senegal and Togo. The efforts also contributed towards building
the advocacy capacity of the French midwifery and nursing professional
associations in some of these countries. These activities were carried out
in collaboration with the West African Health Organization [WAHO] and
United Nations Population Fund (UNFPA). A tool for improvement in the
quality of RMNCH care was developed with WHO. GHWA, partnering with
UNFPA also carried out a quality assessment of midwifery schools in Benin,
Senegal, D.R. Congo and Niger. Recognizing the potential of e-learning
technology, GHWA supported WAHO and AMREFs efforts in the develop-
ment of a regional roadmap for accelerating the training of midwives and
nurses using e-learning technology.

Health Workers Count:

A day in the life of a health worker photo contest winners

First place: Md. Mahfuzul Hasan Bhuiyan, for ‘A nurse in Bhairab,

Bangladesh attending to a newborn and its mother’ (2013).
 1. Identifying and promoting evidence-based solutions
2. Strengthening accountability
3. Catalysing global action through advocacy
24 25 4. Looking forward to 2030

Second place: Amitava Chandra, for ‘A community health worker

administers a diphtheria and tetanus booster dose to a 5 year-old
child in West Bengal, India’ (2013).

Third place: Hugh Rutherford, for ‘Dr Phetsamone patiently waits

for the backup generator to turn on in order to commence surgery
at an eye clinic in Oudomxay Province, Laos’ (2013).
Looking forward to 2030

The research, policy work and advocacy conducted At the same time, the international community
by the Alliance in 2013, as well as the discussions should also be aware of and celebrate the many
at the Third Global Forum on Human Resources advances made in the past decade: among the
for Health, highlighted that all countries face the countries affected by severe shortages of skilled
challenge of how to attain, sustain or accelerate health professionals, the situation has improved
progress towards universal health coverage. in most of those for which data are available.
Strengthening primary care is the way forward to Evidence of the progress made and promising new
provide comprehensive, integrated and people- approaches highlighted by emerging evidence
centered services: this requires focusing on provide the inspiration to initiate a decade of
building partnerships between health care teams innovation on developing the health workforce,
and communities and increasing access to health following the decade of action called for by The
workers for people in under-served areas. World Health Report 2006.

Human resources for health are central in translat- The needs for human resources for health that
ing the vision of universal health coverage into stem from the agenda for universal health cover-
reality. Nevertheless, gaps in human resources for age require renewed attention, strategic intelli-
health affect virtually all countries – albeit with dif- gence and action. A systemic approach is required
ferent connotations and varying level of severity. to devise and implement sound costed plans for
human resources for health as part of broader commitments towards universal health coverage
national health strategies, built based on high- in practical actions both in countries and globally,
quality data and evidence. This requires long-term an immediate follow-up action initiated by GHWA
strategic planning, realistic forecasting and politi- in the aftermath of the Third Global Forum in late
cal commitment, combined with adequate policy 2013 was the decision to launch an inclusive and
dialogue and related funding to make a whole-of- participatory consultation process . to develop a
government agenda on universal health coverage future strategy on HRH for countries at all stages of
a reality. It is critical to foster an inclusive envi- socio-economic development. The new HRH strat-
ronment conducive to a shared vision with other egy will address key health workforce challenges
stakeholders, including the private sector, civil and themes, including inter alia, health labour
society, academia, labour unions, professional markets, measurement, accountability, leadership
associations and health worker representatives, and governance, productivity and performance;
and other sectors, including education, finance, and it will recognize the role of transformative
labour and civil service. education, the need to build human capability
beyond the health sector, and the specific inter-
In order to build a common sense of purpose ventions that are needed in fragile states. This
and to translate the Recife Political Declara- effort will represent a key priority and an area of
tion on Human Resources for Health: renewed joint engagement by GHWA members and partners
in 2014 and beyond.
Annual Finances

Table 1. Annual Financial Statement of the Alliance as of 31 December 2013

Financial overview 2013 US $

2013 Income (incl CF)

Opening Balance* at 1 January 2013 1 943 032

New income during 2013 4 253 163

Total Available Funds 2013 6 196 195

Less
Expenditure

Expenditures & Encumbrances 3 880 736

Contingent Liabilities (WHO) 245 000

PSC charges 471 346

Total 2013 Expenditures and Liabilities 4 597 082

Closing Balance** at 31 December 2013 (gross) 1 599 113

* The Opening Balance at 1 Jan 2013, $1,943,032 (gross) corresponds to $1,719,497 (net of PSC).
** The Closing Balande at 31 Dec 2013, of $1,599,113 (gross) corresponds to $1,415,144 (net of PSC)

NOTE – Further adjustments, as applicable, subject to WHO biennium financial closure (2012-13)
28 29

2013 GHWA workplan Expenditure Statement

US $ (net PSC)
(incl encumbrances)

Objective 1: Enabling Solutions

HRH,UHC, Post MDG Agenda 40 000
Share HRH Information 192 844
HRH Policy Dialogue 189 817
Global & Regional Consultations 184 605
Advocacy HRH for UHC 13 537

Sub-total Objective 1 620 803

Objective 2: Catalysing Actions

HRH Best Practices 210 400
Labour Market Meeting 31 203
Catalytic Support, Coalition Support & Muskoka 447 566

Sub-total Objective 2 689 169

Objective 3: Ensuring Results & Accountability

World HRH Report 138 561

Sub-total Objective 3 138 561

Objective 4: Governance, Oversight & Management

Mgmt Oversight, Operations 33 688
Governance & Board Meetings 183 541
Staff Costs 2 214 974

Sub-total Objective 4 2 432 203

Contingent Liabilities to WHO ( 2013 Cluster Charges*) 245 000

* To be settled with WHO in 2014, for purposes of managing GHWA‘s Core

funding cash flow constraints.

2013 Total GHWA Expenditures & Encumbrances 4 125 736

PSC (WHO charges) 471 346

2013 TOTAL Expenditures (incl Encumbrances and PSC) 4 597 082

* To be settled with WHO in 2014, deferred for purposes of managing GHWA’s cash flow constraints.

Note: The above figures are subject to adjustments, where applicable, through the WHO 20112-13 Biennium closure process.

Table 2. Funding contribution to the Alliance
from 2006 to 2013 (Dec)

Donor Funding from Inception (US$)

Bill & Melinda Gates Foundation 5 000 000

Brazil 500 000

Canada (CIDA) 3 436 911

European Commision 1 771 121

France (AFD) 5 275 297

Germany (BMZ/GIZ) 2 166 391

Ireland (Irish Aid) 5 933 607

Japan 4 494 000

Norway (NORAD) 12 212 828

UK (DFID) 5 553 720

US (USAID) 1 692 175

Total 48 036 050

US Bill & Melinda

(USAID) Gates Foundation
UK
4% 10%
(DFID) Brazil
12% 1%
Canada(CIDA)
7%
European Commision
4%

Norway France (AFD)

(NORAD) 11%
25%

Germany
(BMZ/GIZ)
5%
Japan Ireland
9% (Irish Aid)
12%
30 31

List of donors 2013 – GHWA is grateful to the following funding partners

> Agence France Development, France

> Government of Brazil
> Department for International Development, United Kingdom
> Deutsche Gesellschaft für Internationale Zusammenarbeit, Germany
> Irish Aid, Ireland
> Japan
> Norwegian Agency for Development Cooperation, Norway
> United Nations Population Fund (UNFPA)
> United States Agency for International Development.
Launched in 2006, the Global Health Workforce Alliance is a partnership dedicated to iden-
tifying and coordinating solutions to the health workforce crisis. It brings together a variety
of actors, including national governments, civil society, finance institutions, health workers,
international agencies, academic institutions and professional associations. The Alliance is
hosted by the World Health Organization.

For further information, please contact:

Global Health Workforce Alliance

World Health Organization
Avenue Appia 20
1211 Geneva 27
Switzerland
Tel: +41 22 791 26 21
Fax: +41 22 791 48 41
Email: [email protected]
Web: www.who.int/workforcealliance