Message of the Regional Director , Dr Luis G. Sambo, on occasion of World Health Day, 7 April 2006

For the first time ever, WHO is organizing a World Health Day entirely devoted to human resources for health, the people who significantly contribute to establish, restore and maintain our health. We should seize this opportunity to create a momentum that compels governments and communities to develop and implement a healthworkforce policy that enhances equity in health - universal access to essential health care. The World Health Day calls upon the governments, civil society, individuals and entire international community, to better understand and take action to plan for production of skilled health workers and improve the working environment and well-being of health workers.

In our daily struggle against various global health crises, less attention has been paid to the people who actually deliver health care. For too long, the health workforce has been ignored, left to toil and trudge on in silence. This cannot continue. The rate of progress towards achievement of internationally agreed development goals, including those contained in the Millennium Development Goals (MDGs), depends mainly on our health workers. That is the price of equitable health for all.

An unprecedented crisis in human resources for health plagues Africa, leading to a health crisis whereby the survival gains achieved after a century of the most spectacular health advances in human history are fast eroding. Indeed, Africa possesses 14% of the world population, harbors 25% of global disease burden and has only 1.3% of global health workers. It is known that 2.5 health workers per 10,000 inhabitants are needed to achieve the Millenium Development Goals. The health workers/population ratio in Africa is currently 0.8 health workers per 10,000 inhabitants. Obviously, very little progress can be achieved if the situation remains unchanged and Africa needs immediately at least 1 million more health workers to enable noticeable improvement.

A number of factors underlie the human resources for health crisis. They include financing arrangements, weak planning of health workforce in countries and migration. Inadequate fiscal space and financial arrangements and ceilings on recruitment make it difficult to scale up production of health workers, recruit them and implement appropriate motivation and retention schemes. Weak planning of the health workforce leads to a paradoxical situation whereby some countries are producing more medical doctors than midwives. One of the most negative combined effect of these two factors resides in unemployment of many health workers in Africa while there are still not enough health workers to deliver health care in countries in general and in rural or remote areas in particular. Migration of health workers from African countries to developed world has reached the extent that there are more health workers from African countries working in identified large cities of developed countries than in their countries of origin. Rates of health workers who have migrated range from 8% to as high as 60% in countries in Africa.

Old causes are now compounded by new dimensions. The HIV/AIDS epidemic has further compounded the situation. It has led to distortions in global and national health worker markets and chronic under-investment and overall weak health system. The consequences are complex, raising issues of worker shortages and mal-distribution, public sector reform, health sector reform, donor behaviour as well as issues of policy and governance.

Several initiatives have been launched to meet the challenges posed by the major health workforce crisis in Africa. We recall the joint World Bank/WHO conference in January 2002 which gave impetus to a new partnership of health professionals and main stakeholders in human resources development and enabled documentation of the magnitude of the crisis through the work of the Joint Learning Initiative. This conference was followed by many other regional and international fora including High Level Forum on the MDGs, African Union Heads of States and Government Meetings, World Health Assembly, and G8 Summit in 2005. All these fora underscored the need to strengthen health system and human resources for health which constitute its main asset.

The regional stakeholders consultation on human resources for health in Brazzaville in 2005 was a milestone in this endeavour. The consultation urged countries to involve governments, the private sector, civil society and partners in human resources for health development and identified regional mechanisms for follow up action. Awareness on human resources for health issues has raised remarkably and they have been put high on political agenda of African and world leaders.

These efforts at regional and international level complement action taken at country level. Indeed, individual African countries developed and are implementing sound HRH policies and plans. Some countries came up with incentives packages able to retain health workers in rural areas. A few countries were able to establish new modalities of recruitment and employment including contracting based on performance and flexible working arrangements. Evaluation of health sciences training institutions and implementation of training curricula reforms are being progressively undertaken. Finally, a set of countries are using the framework of global health initiatives such as Global Alliance on Vaccines and Immunization (GAVI) and Global Funds for HIV/AIDS, Tuberculosis and Malaria, Highly Indebted Poor Countries (HIPC) as well as Poverty Reduction Strategy Papers (PRSPs) to scale up training and recruitment of health workers.

Despite these efforts, human resources for health situation remain of concern mainly due to the piecemeal approaches and fragmented action taken by different stakeholders in the same countries. We need to cast solutions to HRH issues in the context of strengthening of health system and the overall socio-economic development. Time has come for Africa to turn today's dramatic health reversals by investing massively in the health workers. This will call for a dynamic, concerted, integrated and comprehensive action from countries and their partners. Countries should revitalize their national health system using primary health care approach as they undertake their health sector reforms. They should strive to prioritize their spending and better use the available resources including the health workforce. For sake of sustainability, they should augment their national level of investment in health system and human resources as more external resources are accrued from macroeconomic initiatives. The central issue of migration should be addressed both through bilateral agreements and reaching global consensus on key aspects such as ethical recruitment of health workers from developing countries and aid from developed countries to mitigate its adverse effects. Particular attention should be paid to implementation of salary schemes able to motivate and retain health workers. Partners who expressed their solidarity and willingness to reinforce African health system are committed to continue their support to and supplement the action of African countries.

The human resources crisis is complex, multifaceted and further weakens an already feeble health system. Overcoming the crisis requires sustainable solutions adapted to country specific contexts. All stakeholders should be brokered to this end.

The Year 2006 provides each of us an opportunity to remind the world that we need sufficient skilled, ethical, motivated and well-supported health workforce that forms the bedrock of healthy nations. I would like on the occasion of the World Health Day 2006, to pay special tribute to existing health workers in the African Region who have contributed greatly to the health of hundreds of millions of Africans each year, often at great personal cost. 

WHO will continue working closely with all governments, professional organizations, civil societies, non governmental organizations and other development partners to improve availability of the skilled and motivated health workers.

Let us therefore “Work together for Health” of Africa’s peoples.

I thank you so much for your attention.