For G8 summit in Gleneagles, Scotland, United Kingdom (July 2005) Statement for Group of 8 meeting in July 2005 on actions needed to support human resources for health to achieve the Millennium Development Goals We are nurses and doctors, pharmacists and laboratory technicians, medical assistants and community health workers. We are non-governmental organizations. We are [members of] government[s]. We are people with HIV/AIDS. Some of us sit in government ministries, some of us work in rural health facilities, and some of us work wherever it is we find people in need. We share in common a deep concern for the health and well-being of the members of our communities and citizens of our own and other countries. Yet despite our best efforts, health systems in many developing countries are in crisis, and millions of people whose lives we could save and whose health we could preserve are dying and becoming seriously ill. Health workers are at the core of these health systems. Health systems collapse where there are too few health workers, or health workers without proper training, supervision, and management and support structures, or health workers who are separated from their community structures and needs, or health workers who are themselves ill and dying and working in unsafe conditions. Yet this is the situation many of our countries face. Annual health budgets that are often $10 or less per capita, the exodus of health professionals, failure to prioritize human resources, and the HIV/AIDS pandemic, both through the disease burden it creates and its impact on health workers themselves, have combined to create a crisis. Until we surmount this crisis in human resources for health and health systems, preventable death and suffering on a massive scale will continue. Overcoming this crisis will require the joint efforts of your countries and ours. We will take the lead, but require cooperation and support in what must be a global response to a problem of global proportions. Together, we must develop and implement sustainable and greatly expanded responses that address underlying causes to the health worker crisis, that improve health systems, and that dramatically improve access to quality health services for people in underserved areas. Everyone has the right to the highest attainable standard of health. Fulfilling this right requires addressing the crisis in human resources for health and in health systems. The efforts of our countries alone will not be enough to resolve this crisis and secure for every person the dignity she deserves. We therefore urge your governments to meet your obligations under the UN Charter and other human rights law to join us in taking the actions required to resolve this crisis. To enable our countries to have the health workforces we require to meet our people’s health needs and achieve the Millennium Development Goals, we urge the members of the G8 to make the following commitments: 1. Strengthening national health systems 1.1 We urge you to support African and other developing countries that are experiencing crises in human resources for health by providing the necessary financial and technical support to enable our countries to develop and fully implement national strategies on human resources for health as a central part of any overall plan to improve service delivery and strengthen national health systems so as to achieve the Millennium Development Goals. 1.2 We urge you to ensure that through your efforts and those of others, the resources required to fully fund these strategies are available. 1.3 We urge you to coordinate your investments and those of other donors and organizations with those of regional communities and developing country governments, and to use local technical resources where possible. 1.4 Strategy development should be led by national authorities with broad stakeholder participation that engages civil society and responds to local needs. 1.5 Assistance in the development of strategies should not delay the provision of urgently needed financial assistance and other technical assistance. 2. Supporting and enlarging health worker capacity 2.1 We urge you to support, with financial and technical assistance, national efforts to create conditions that facilitate health worker retention and deployment to underserved areas, including adequate compensation; improved health worker management, planning, and information systems; incentives; continuous learning opportunities; and; safe working environments for health workers through universal precautions and other forms of infection prevention and control, universal access to post-exposure prophylaxis, and workplace HIV treatment and prevention programs. 2.2 We urge you to support models of education and care that respond to national circumstances and priorities, providing quality health care to the maximum number of people and expanding health services in underserved areas. The models of care will often include the development of high quality mid-level and community health worker cadres, effective competency-based training strategies, and policies, training, supervision, and adequate compensation to enable nurses to engage in advanced nursing practices. We urge you to further support the development of career pathways for mid-level and community health worker cadres, permitting competence- and skills-based movement up the hierarchy of the health system. 2.3 Community members, including people living with HIV/AIDS, have a vital role in supplementing the care provided by health professionals. We urge you to support local, regional, and national efforts to empower community health workers and caregivers, including by enabling them to have the compensation, training, accreditation, supervision, and support structure required to maximize their effectiveness. We urge you to support local efforts to increase community awareness and capacity to participate in a comprehensive scale-up of prevention, care, and treatment programming through activities such as treatment preparedness, treatment literacy, and treatment adherence support. 2.4 We urge you to support expanded capacity of health professional training institutions including through incentives and other support for faculty, expanded physical space, and creation of new training institutions as needed, and to support these institutions in reviewing curricula to assure that the skills are relevant to required public health needs and competencies. 2.5 We consider it a tragic irony that many of the same countries facing enormous human resources deficits have in our midst large numbers of unemployed health care workers. We urge you to take all necessary steps, working with our governments and other parties, including international financial institutions, to enable their rapid re-engagement. 3. Overcoming macroeconomic challenges 3.1 We urge you to seek agreement with the International Monetary Fund and other international financial institutions, finance, health, and other ministers, and central banks to increase fiscal space for expanded funding from external and domestic sources, including debt cancellation, for health and other forms of human development. Civil society must have a voice in this process. Macroeconomic challenges should not and need not impede the flow of the required resources. 3.2 We urge you to ensure that new and existing developing country agreements with the IMF and other international financial institutions do not require or lead to freezes in health worker recruitment, prevent payment of wage levels required to retain health workers, or prevent the hiring of unemployed health workers. Programs critical to public health should be exempt from budget and wage ceilings contained in such agreements. 3.3 Long-term, sustainable economic growth requires investments to reduce poverty and hunger, improve health and expand education at all levels, empower women, and ensure environmental sustainability, including through improving living conditions in rural and slum areas and universal access to clean water and sanitation. 3.4 We urge you to commit to providing your assistance in a long-term and predictable manner, including for both bilateral and multilateral mechanisms, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. 4. Addressing health worker needs in high-income countries 4.1 We urge you to meet your country’s own health care needs without reducing the capacity of developing countries to meet our health needs. 4.2 We urge you to meet your obligations under World Health Assembly Resolution 57/19, “International migration of health personnel: a challenge for health systems in developing countries.” 4.3 We urge you to evaluate the recruitment practices of public and private health providers in your country, and implement strategies that will protect the health human resource base of our countries. The strategies may include ending active recruitment from certain countries and working with developing country governments and regional and international organizations to develop satisfactory policies on recruitment, such as through managed migration with mutual benefits to both source and destination countries. 4.4 We urge you to take the necessary measures to increase your country’s supply of domestically-trained health care workers. 5. Supporting international organizations 5.1 The technical capacity and normative role of the World Health Organization gives it a special role in addressing the human resources for health crisis. We urge you to provide WHO the additional funding it requires to support expanded and accelerated large-scale technical assistance in this area; to build its own capacity at headquarters, regional, and country levels, including through interdepartmental collaboration and nationally led teams, and; to enhance national capacities to develop and implement strategies to meet Millennium Development Goals, including effective development and management of the health workforce. We further urge you to ensure that WHO has the funds to develop and sustain a human resources for health observatory in Africa. All funding to expand WHO capacity should be in addition to the funding WHO requires to support anti-retroviral therapy scale-up. 5.2 The Global Fund to Fight AIDS, Tuberculosis and Malaria supports health system strengthening, including human resources. We urge you to ensure that the Global Fund is fully funded, including so that it can renew all deserving proposals from previous rounds, fully fund Round 5, and launch Round 6 in a timely manner. We further urge you to make available technical support to help applicants develop ambitious proposals in the area of AIDS, including treatment, tuberculosis, malaria, and health system strengthening. 5.3 We urge you to support regional health and development organizations in their effort to address the human resources for health crisis through regional and sub-regional interventions. 6. Ensuring soundness of donor programs 6.1 We urge you to ensure that your own funding mechanisms and programs strengthen, and do not weaken through resource diversion or other means, public health systems and their human resource capacities. Bilateral programs should help build local capacity and utilize and catalyze local capacity wherever possible. To sign: Please email Eric Friedman of Physicians for Human Rights (efriedman@phrusa.org) by Monday, June 20, 2005 to sign this statement. If you are a health worker, please include your name, institutional affiliation, and country. Please indicate your exact profession/job (nurse, doctor, community health worker, etc.). If you are a government official, include your name, position, and country. Please also indicate whether you are signing in your individual capacity (in which case your affiliation will be for identification purposes only) or whether you a signing as a representative of the Ministry of Health or of the full Government of your country. If you are representing an NGO, please include the NGO’s name and country.