The United Nations Population Fund (UNFPA) hosted an Expert Group Meeting on International Migration and the Millennium Development Goals in Marrakech, Morocco on 11-12 May 2005. Invited experts were requested to speak on a number of topics relating to migration and development, including: poverty reduction, health, gender, environment, and global partnerships for development with a view towards exploring migration as both a facilitating and constraining factor in the achievement of the Millennium Development Goals (MDGs). This report is a compilation of selected papers presented at the meeting together with a synopsis of the discussion highlighting some of the more salient points raised by the experts.
Human Resources
International migration and the MDGs
Maintaining health worker performance in resource-poor settings
The Lancet 2005
"In low and middle income countries, health workers are essential for the delivery of health interventions. However, inadequate health-worker performance is a very widespread problem. We present an overview of issues and evidence about the determinants of performance and strategies for improving it. Health-worker practices are complex behaviours that have many potential influences. Reviews of intervention studies in low and middle income countries suggest that the simple dissemination of written guidelines is often ineffective, that supervision and audit with feedback is generally effective, and that multifaceted interventions might be more effective than single interventions." (Requires registration)
Wastage in the health workforce: the experience of African countries
"Sub-Saharan Africa faces a human resources crisis in the health sector. Over the past two decades its population has increased substantially, with a significant rise in the disease burden due to HIV/AIDS and recurrent communicable diseases and an increased incidence of noncommunicable diseases. This increased demand for health services is met with a rather low supply of health workers, but this notwithstanding, sub-Saharan African countries also experience significant wastage of their human resources stock."
An approach to estimating human resource requirements to achieve the MDGs
Health Policy and Planning 2005 20(5):267-276
“In the context of the Millennium Development Goals, human resources represent the most critical constraint in achieving the targets. Therefore, it is important for health planners and decision-makers to identify what are the human resources required to meet those targets. Planning the human resources for health is a complex process. It needs to consider both the technical aspects related to estimating the number, skills and distribution of health personnel for meeting population health needs, and the political implications, values and choices that health policy- and decision-makers need to make within given resources limitations.”
Introducing substitute health workers in Africa
id21 Insights
Massive shortages in trained health care professionals in sub-Saharan Africa have led to an examination of substitute health workers as an immediate response to the workforce crisis. For many countries these substitute health workers (SHWs) are not new. They already play various minor roles in health services, especially in rural and deprived areas. In Tanzania, Malawi and Mozambique, assistant medical officers are used as substitutes for doctors. They perform surgery and a variety of other tasks.
Responding to the health workforce crisis
id21 Insights
The shortage of health workers with the right expertise and experience has reached crisis levels in many developing countries. The human resources (HR) crisis in the health sectors of many developing countries is now firmly on the international policy agenda. The work of the Joint Learning Initiative (JLI) and the High Level Forum on Health has described the magnitude of the HR challenge, identified the key contributory factors, and defined some of the potential solutions.
* Relating Link
The Joint Learning Initiative Report: overcoming the crisis
http://www.id21.org/health/InsightsHealth7art6.html
Human resources for emergency obstetric care in northern Tanzania
Human Resources for Health 2005
"Health care agencies report that the major limiting factor for implementing effective health policies and reforms worldwide is a lack of qualified human resources. Although many agencies have adopted policy development and clinical practice guidelines, the human resources necessary to carry out these policies towards actual reform are not yet in place. The goal of this article is to evaluate the current status of human resources quality, availability and distribution in Northern Tanzania in order to provide emergency obstetric care services to specific districts in this area. The article also discusses the usefulness of distribution indicators for describing equity in the decision-making process."
World Health Report 2005 policy brief two: rehabilitating the workforce
World Health Organization (WHO), 2005
This policy brief from the World Health Report argues that it will not be possible to effectively scale up Maternal, Newborn and Child Health (MNCH) care without confronting the global health workforce crisis. It argues that the low number of health professionals is one of the main factors in the exclusion from care and high mortality rates for mothers and newborns. It highlights how lack of managerial autonomy, gender discrimination and violence in the workplace, dwindling salaries, poor working conditions and some donor interventions have all contributed to a lack of productivity, as well as the rural to urban, public to private and poor to rich country brain drain and migration.
Human resources for health exist in communities
This paper responds to some central assertions in the paper Country Action Alliances to drive the HRH agenda (circulated as background reading for the Oslo consultation on Human Resources for Health, 24-25 February 2005), which describes the diverse nature of partnerships required to enhance global and country level commitments to expanding human resources for health. In response, this paper describes three examples of human resource development in community-driven HIV/AIDS programmes. The basic proposition is that acknowledgement, inclusion of and support for community based health initiatives is necessary to understand fully where health action is occurring and where potential for expansion lies.
The role of the UK in the loss of health professionals
The already inadequate health systems of sub-Saharan Africa have been badly damaged by the emigration of their health professionals, a process in which the UK has played a prominent part. In 2005, there are special opportunities for the UK to take the lead in addressing that damage, and in focusing the attention of the G8 on the wider problems of health-professional migration from poor to rich countries. This article from The Lancet suggests some practical measures to these ends. (requires registration)