Committing donors to building health workforces

A major report from the Joint Learning Initiative suggests that donors can support the growth and better performance of health workforces in developing countries by providing technical support and mobilising adequate financial resources.

Donors committed to the health Millennium Development Goals (MDGs) are responsible for helping to build the health workforces needed to meet the needs of developing countries. This means not only adding to and better distributing available staff, but also:

• improving the quality of initial education and lifelong training
• creating a motivating work environment
• putting in place a policy framework that sustains a stable and performing workforce.

Donors must first recognise the problems, as most have done recently, and commit to helping countries to address the multiple and interconnected workforce problems facing the health sector.

There is a danger that donors’ actions will harm health workforces further, for example, through the promotion of programmes that:

• drain staff from health services or add to already heavy workloads
• recruit, or poach, scarce national staff from general services
• resist contributing to recurring funding needs, such as salary increases.

Also, donor countries should not try to solve their own recruitment problems by importing developing countries’ best staff.

Instead donors should coordinate their interventions, such as training and production of technical guidelines, as well as reporting and accounting procedures, as they have committed to in adopting the Rome Declaration on Harmonisation of Aid in February 2003. A recent OECD report suggests that progress is slow but that coordination improves as donors move from a project to programme approach, like sector-wide approaches (SWAP) increasingly preferred in the health sector. Further to this they should:

• Help create capacity, at individual, organisational, and institutional levels, and enhance a country’s autonomy in meeting its health workforce needs.
• Give access to technical support to assist the production of national strategies to strengthen the health workforce and health system. This includes making sure that good data and analytical work is available to inform these strategies on costs of scaling-up, fiscal impact, labour market dynamics, and effective practices in planning, training, and performance management.
• Support, politically and technically, the insertion of health workforce policies in Poverty Reduction Strategies and other national policy documents.
• Guarantee the continuity, flexibility, and transparency of their financial support. Health workforce expansion will take time, and developing countries are more likely to succeed if they can rely on long term support.
• Substantially boost their financial contribution to meet the costs of providing populations with equitable access to well trained, motivated, and performing health workers.

Neglecting health workforce problems has prevented people in developing countries from accessing health services. Donors can change that, and now is the time to start.

Gilles Dussault
World Bank Institute
1818 H Street NW
Washington
D.C. 20433
USA
T +1 202 473 8709
F +1 202 614 1137
gdussault@worldbank.org

See also

Human resources in health: overcoming the crisis, report of the Joint Learning Initiative, 2004
www.globalhealthtrust.org

Incentives for harmonisation in aid agencies, report by ODI for OECD, 2005
www.oecd.org/dataoecd/61/32/34609836.pdf

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