PEPFAR Funds a Step Forward
A Step Forward: Promoting Evidence-Based Policy Dialogue
About Human Resources for Health
The issue of human resources for health is receiving increasing national and international attention. According to the World Health Organization (WHO), many limited-resource countries cannot scale up health interventions without a sufficiently large workforce that is adequately educated and appropriately deployed, managed, and motivated. Studies in sub-Saharan Africa indicate that human-resource shortages threaten the achievement of HIV/AIDS targets set by governments and their partners, including the Global Fund, the Multi-Country AIDS Program (MAP), WHO’s 3X5 Initiative, and the President’s Emergency Plan for AIDS Relief (PEPFAR).
Cote d’Ivoire is faced with three major challenges.
First, the country’s civil conflict and worsening socioeconomic conditions have increased the demand for public health services. Second, human-resource levels have decreased across all health-worker categories. Since 2002, human-resource levels in the public health sector have reached crisis proportions: In northern regions under Forces Nouvelles control, 70% of health facilities are not functioning, and a majority of health workers have left or are unable to return to work for security reasons. Finally, the health system faces difficult challenges in mobilizing adequate financial resources to deliver basic health services to its population. Inadequate public health funding has hindered the recruitment of new health workers.
PEPFAR Funds a Step Forward.
PEPFAR funded Partners for Health Reformplus (PHRplus) to evaluate human-capacity needs and to promote evidence-based policy dialogue among key stakeholders in Cote d’Ivoire. According to key findings of its evaluation, the composition, size, and distribution of human resources are major constraints to scaling up HIV/AIDS services and attaining major international targets, including the Millennium Development Goals. Attrition rates among all health workers were high. The nursing shortage was found to be the single largest human-resource impediment.
Promoting Evidence-Based Policy Dialogue.
In October 2005, the Ministry of Health and U.S. government partners organized a one-day high-level policy workshop to address the issue of human resources for health based on key findings of the PHRplus evaluation. Stakeholders included national policy- and decision-makers from the ministries of Finance, Education, Social Welfare as well as bilateral and institutional representatives, managers, and donors. Minister of Health Albert Mabri Toikeusse and workshop participants agreed that training, recruitment, and adequate incentives for health workers require particular attention. They also agreed to create a follow-up committee to plan short-term actions. The workshop was a major steppingstone toward the development of a coherent and coordinated strategy grounded in evidence.
The Way Forward.
Policy-makers and practitioners in Cote d’Ivoire agree that a robust response to this crisis is urgently needed and that it should focus on the development of practical interventions to ameliorate the critical human-resource shortfalls in the health sector. Implementation of even the most well-conceived and cost-effective health interventions will depend primarily on the capacity of workers to be in the right place at the right time with the right skills.