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No global health security without a decent work force

By Milou Lustermans
on June 8, 2016

“It falls to the health sector to show some principled ethical backbone in a world that, for all practical appearances, has lost its moral compass,” these powerful words spoken by Dr Margaret Chan, Director-General of the WHO, during  her opening speech at the 69th World Health Assembly (WHA) continue to echo through my mind long after we returned  home. Post-WHA, as we try to reorganize our thoughts, we struggle to find peace in our heads. It’s safe to say though that attending the WHA in Geneva was one of the most inspiring, yet simultaneously daunting experiences so far in our brief experience as Global Health professionals (to-be).

It was right after the WHO declared Ebola a “Public Health Emergency of International Concern”, two years ago, that we started our master’s program in Global Health at Maastricht University, in The Netherlands. Ambitious and slightly naïve as we were, we overloaded our final exam paper with critique on the failing approach of the world’s leaders to tackle it. The Ebola outbreak wreaked havoc; and yet it, in some way, also defined the global health challenges of our time.

Two years on, the Ebola outbreak and the subsequent need for resilient, responsive health systems, as well as robust global health security measures seem to have risen on the priority list for global health (and that’s probably an understatement). One of the key gaps identified towards developing resilient health systems, equipped to prevent, prepare for and tackle any future Ebola-like health crises is that of human resources for health (HRH). Official discussions on HRH in Geneva took place in Committee B (as has been the case for a few years already now), among others, but HRH as a theme also surfaced again and again across discussions, sessions, and side meetings at the recent World Health Assembly. Indeed, the lack of adequate health workforce structures is not merely a problem within the context of the Ebola outbreak in Sierra Leone, Liberia and Guinea, but one that affects us all and is related to virtually all SDG health targets, one way or another. As is well known, though, many low-resource settings bear an inequitable brunt of health workforce shortages. The African continent for example, faces the highest burden of disease worldwide, but has only 3 per cent of the global health workforce. In total, it is estimated that there will be a global shortfall of 18 million health workers (with most of them in low- and lower-middle income countries) by 2030 (if we at least intend to achieve the SDGs by then). At the same time, a global demand of 40 million new health workers (mostly in middle- and high-income countries) is also projected by 2030 due to ageing populations and changing disease trends. Staggering figures, no less. And so, if we really want to learn from the Ebola crisis to (re)build more robust and resilient health systems, which will protect all of humanity from the next outbreak, building a global health workforce would be a good place to start.

2016 was also the year that the Global Strategy on Human Resources for Health: Workforce 2030 was adopted. The Strategy aims to address the health workforce challenges that hamper progress towards universal health coverage (UHC) and the achievement of the SDGs. Had Ebola been a “cosmopolitan moment” after all, leading us to the very relevant and much needed changes? Now that would be something, now that ‘cosmopolitanism’ is almost everywhere increasingly on the defensive! The jury is still out.

Discussions on health workforce also included those on the WHO Code of Practice on the International Recruitment of Health Personnel first adopted during the 63rd WHA; this year, results from round- II of the national reporting on the Code were presented. The Code which was introduced in 2010 within the context of the migration of health workers from low-resource settings continues to be relevant. The Global Strategy also reaffirms the need for the Code within the context of ethical recruitment practices towards ensuring that all communities have universal access to health workers – an ambitious goal even today! Criticisms on the Code highlight the need to encourage host countries, many of which are high-income countries to invest more in increasing their workforce capacity.  Although health workforce development is now part of the SDGs (target 3.c) and HRH receives more and more attention, it still remains an issue which struggles to compete with other health and development priorities that are high on the global health agenda such as antimicrobial resistance and emerging infectious diseases. And yet, it’s public health issues such as these (which are in vogue now) that time and again emphasise the need for societies to strengthen their health systems, and invest in their health workforce.

A few months before the 69th WHA, in March 2016, Ban Ki-moon announced the appointment of the UN High Level Commission on Health Employment and Economic Growth.  This power packed political initiative aims to address the above mentioned health workforce deficits through the creation of health and social sector jobs, especially in the context of LMICs. In September, the Commission is expected to deliver its final report in the margin of the 71st regular session of the UN General Assembly.   Much work remains to be done, and the current (extremely volatile) economic and geopolitical environment is not exactly helping either.

In sum, as relatively new entrants to the field of global health and health policy, following the trajectory of the health workforce issue on the policy agenda was very interesting. For us, it seems obvious that strengthening and investing more in the health workforce and systems is fundamental towards achieving UHC. It also seems critical in addressing the (currently) pressing issues of health security and emergency management, prevention and treatment of communicable and non-communicable diseases – across countries of varying economic status.  The migration of health workers and the push towards ethical recruitment or mobility of health workers should make us question why people chose to move, and what must be done to produce, attract and retain health workers of all cadres.

And yet, while all this seems so obvious to us, attending the WHA also allowed us to witness first-hand the complexities of policy making. After being exposed to the wheeling and dealing in Geneva, one’s question remains pertinent, though: even though the new Resolutions adopted are titled ‘global strategies’, when it comes to health security we still face a very common dilemma: do we only care about protecting ‘us’, or do we actually care about ‘all of us’?

Only time will tell whether the world has learnt an important lesson in the past two years. As you might recall, the Ebola crisis should have taught us that our own protection increasingly requires caring about “all of us”…  And yes, a decent health work force all over the world comes in handy then.

About Milou Lustermans

Milou Lustermans is a Masters student Global Health with an interest in (global) health emergency preparedness and response. She is currently working on her final research thesis on the role of the health workforce in times of crisis.

About Anika Veenstra

Anika Veenstra is a Junior Global Health Consultant. She has a graduate degree in Global Health.