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Introduction to Human Resources for Health

In this video, Assefa Seme Deresse gives an overview of Human resources for health. (Step 4.3)
ASSEFA SEME DERESSE: I’m going to talk about some introductory remarks of human resource for health. Globally, more than 59 million persons are employed as health workers according to the WHO, the World Health Organization. On average, countries devote just under 50% of total health expenditure to paying its health workforce. Health workers personify system’s core value. They do provide health care for people. They ease pain and suffering that the people face. And also, they are there to prevent disease and to mitigate risk. It’s known that health workforce are so critical to the functioning of the health systems. Countries require motivated, competent, well-distributed, and supported human resource for health to achieve health care targets in any nation.
Health workforce is one of the elements of the core building block of the health system. At the heart of each and every health system, the workforce is central to advancing health. This is a critical resource for health system as without competent health worker, health system becomes dysfunctional or non-functional. Health system without competent health workforce is equated as a car without an engine. Let’s look at a fit for purpose model with regard to human resource for health. What does that mean? A fit for purpose health workforce should have the competencies and quality standards required to meet the current population needs and achieve the intended policy outcomes.
The fit for purpose model is a new concept that translate to whether the availability, accessibility, acceptability, and the quality of health workforce are collectively able to deliver effective coverage of the service required. What do we mean by availability of human resource for health? That is to mean the supply appropriate stock of health workers with the relevant competencies and skill mix that corresponds to the health needs of the population.
On the other hand, accessibility to human resource for health mean the equitable distribution of health workers in terms of travel time and transport, opening hours, and cross-bonding workforce attendance, the infrastructure’s attributes– that is to mean the physical accessibility for people, like disabled friendly buildings– referral mechanisms, and the direct and indirect cost service, both formal and informal, which is to mean financial accessibility. Acceptability of human resource for health, on the other hand, characterizes the ability of the workforce to treat the patient with dignity, create trust, and enable or promote demand for services.
This may take different forms, such as same sex provider or a provider who understand and thus speaks one’s language and whose behavior is respectful according to the age, religion, social, and cultural values of the communities they serve. The last important aspect of the fit for model is quality of human resource for health. By equality for human resource for health, for we mean competencies skills knowledge and the behavior of the health worker as assessed according to the professional norms based on some guiding standards of each country and as perceived by the user themselves. Why indeed? Without sufficient availability, accessibility to health workers cannot be guaranteed.
And even if availability and accessibility are adequate, without acceptability, the population may not use the health service. Finally, when the quality of health workers is inadequate, whatever availability, accessibility, and acceptability there, the effect on the service in terms of improving health outcomes will be suboptimal. Next, I’m going to show you the map of the world that shows the workforce to population ratio density. From the map, you can understand that developing countries, like sub-Saharan African and Southeast Asia have the least density of workforce for the population it serves while the high income countries, including USA, Europe, and Russia have the highest density of the population workforce to serve their population.
As we said earlier, at the heart of each and every health system, the workforce is central to advancing health. There is ample evidence that worker numbers and quality positively associated with immunization coverage, outreach of primary care, infant, child, and maternal survival. The quality of doctors and the density of their distribution have been shown to correlate with positive outcomes in cardiovascular disease. Conversely, child malnutrition has worsened with the staff cutbacks during health sector reform. This graph shows here that as the density of health workers increase, which is on the x-axis, the probability of infant, child, and maternal survival increases, as you can see on the y-axis.
As I mentioned earlier, some countries have critical shortage of health service providers– like doctors, nurses, midwives. Expanding labor markets have intensified professional concentration in urban areas and accelerated international migration from the poorest of the wealthiest countries. The consequent workforce crisis in many of the poorest countries is characterized by a severe shortage, inappropriate skill mix, and gaps in service coverage. The World Health Organization has identified a threshold in workforce density below which high coverage of essential interventions, including those necessary to meet goals, is very unlikely. Based on these estimates, there are currently 57 countries with critical shortage equivalent to a global deficit of 2.4 million doctors, nurses, and midwives.
The proportional shortfall for are greatest in sub-Saharan Africa and Southesast Asia, as you would see on these maps. Paradoxically, this insufficiency is often co-existing in a country with large number of unemployed health professionals. Poverty, imperfect private labor market, lack of public funds, bureaucratic red tape, and political interference produce this paradox of shortage in the midst of underutilized talent. On this graph, we see the relationship between the number of vaccinators and the outcomes. This figure summarizes by years the relationship between the estimated number of polio cases reported active flaccid paralysis cases, individuals participating in national immunization days, and health workers conducting active flaccid paralysis surveillance during the period 1988 to 2003.
It demonstrates in particular the market increase that was required in the voluntary immunization workforce as the eradication strategies began to be implemented throughout Asia and sub-Saharan Africa. The trend in polio cases reflects the impact of national immunization days in those areas.

Assefa Seme Deresse, MD, MPH School of Public Health, Addis Ababa University, Ethiopia

As you listen to the lecture, consider your own experience – has your program, organization, or region experienced a critical shortage of health care workers? What have been some of the reasons for this?

Please take a moment to review Chapter 1 and Chapter 2 of ‘Working Together for Health: The World Health Report 2006’, listed below. These provide a detailed overview on the size and distribution of the healthcare workforce, key characteristics, and proposed strategies for meeting performance challenges.

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