Road Map for Scaling up for Human Health for Improved Health Service Delivery in the African Region 2012-2025

Ensuring the availability of sufficient numbers of qualified health workers in the right place is essential for delivering quality health services to the population. Existing weaknesses in health systems including shortage of skilled human resources for health (HRH) 1 in most African countries is recognized as a major impediment to delivery of essential interventions and progress towards achieving health objectives. Of the 46 countries in the Region; 36 have critical shortage of HRH with only about 0.8 physicians; nurses and midwives per 1000 of the population while the minimum acceptable density threshold is 2.3 per 1 000 population. The estimated shortage of doctors; nurses and midwives in the Region was 820 000 in 2006. When all categories of health workers are included; the shortfall is estimated at 1.4 million. Migration of qualified health workers; inadequate remuneration and incentives; poor distribution of the available health workers; under investment in the production of sufficient health workers; inadequate capacity of HRH departments to carry out the main HRH functions and; low implementation of most of the existing plans are identified as the main causes of the present situation that constitutes a key impediment to meeting the needs for health care delivery for all. There are significant disparities between rural areas and urban areas; with shortages in the rural areas. Over 90 of pharmacists and dentists practise in urban areas. The situation is the same for other cadres; as medical specialists (86 ); general physicians (63 ) and nurses and midwives (51) serve mainly urban areas. The challenges facing the countries are uneven and pose a strategic threat to national and regional health systems development and the overall well- being of populations in the Region. A number of major and pressing HRH challenges are identified The road map recognizes that sustained political; institutional and financial commitment with the involvement of different critical stakeholders and partners that influence HRH production; availability and performance is critical to improving HRH development at country level. The road map builds on a number of national; subregional; regional and global efforts and has six strategic areas for achieving the objectives: strengthening health workforce leadership and governance capacity; strengthening HRH regulatory capacity; scaling up education and training of health workers; optimizing the utilization; retention and performance of the active health workforce; improving health workforce information and generation of evidence for decision-making; and strengthening health workforce dialogue and partnership. Each of these strategic areas has a set of identified priority interventions for achieving the objectives. It is recognized that implementation of the road map will require the commitment and collaboration of all stakeholders and partners under the leadership of national governments

The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving better Health for Africa in the New Millennium

The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa focuses on nine major priority areas: 1) leadership and governance for health; 2) health services delivery; 3) human resources for health; 4) health financing; 5) health information systems; 6) health technologies; 7) community ownership and participation; 8) partnerships for health development; and 9) research for health. This paper describes a framework constructed for implementing the necessary activities in each of these priority areas; and proposes recommendations for consideration by Member States in the development of their own country frameworks. The frameworkfor implementing activities related to health information and research for health which have been taken into account in the Algiers Framework are discussed separately elsewhere in this issue

The cost of health-related brain drain to the WHO African Region

The African Region continues to experience loss of a sizeable number of highly skilled health professionals (physicians, nurses, dentists and pharmacists) to Australia, North America and European Union. Past attempts to estimate cost of migration were limited to education cost only and did not include the lost returns from investment. The objective of this study was to estimate the social cost of emigration of doctors and nurses from the African Region to the developed countries. The cost information used in this study was obtained from one nonprofit primary and secondary school and one public university in Kenya. The cost estimates represent unsubsidized cost. The loss incurred by African countries through emigration is obtained by compounding the cost of educating a medical doctor and a nurse over the period between the age of emigration and the retirement age in recipient countries. The main findings were as follows: total cost of educating a single medical doctor from primary school to university is US$65,997; for every doctor that emigrates, a country loses about US$1,854,677 returns from investment; total cost of educating one nurse from primary school to college of health sciences is US$43,180; for every nurse that emigrates, a country loses about US$1,213,463 returns from investment. Developed countries continue to deprive African countries of billions of dollars worth of invaluable investments embodied in their human resources. If the current trend of poaching of scarce human resources for health (and other professionals) from African countries is not curtailed, the chances of achieving the Millennium Development Goals would remain dismal. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Africa and to keeping majority of her people in the vicious circle of poverty. Therefore, both developed and developing countries need to urgently develop and implement strategies for addressing this issue.

Development of Human Resources for Health in The WHO African Region: Current Situation and Way Forward

Human resources for health (HRH) are widely recognised as the most important assets and pillar of any health system. However the African Region is faced with severe shortages of this important human capacity. This has resulted in weak health systems with a limited capacity to achieve their national health goals. The problem is more severe in rural and remote areas where most people typically live in the countries in the African Region. This paper provides information about the efforts and commitments by Member States and the various opportunities created by Regional and global partners; including the progress made. The paper also explores issues and challenges related to the underlying factors of the HRH crisis; such as chronic underinvestment in health systems development in general; and specifically in human resources for health development; migration of skilled health personnel as a result of poor working conditions and remuneration; lack of evidence-based strategic planning; insufficient production of health workers and poor management systems