A Commitment Is a Promise, a Promise Is a Debt

By Judith Winkler, IntraHealth International

Note: This blog was originally published in IntraHealth’s blog Vital.

From A to Z, countries lined up to announce their commitments to health workers at the Third Global Forum on Human Resources for Health in Recife, Brazil, last week. Delegate after delegate announced the interventions they believe will have the greatest impact on their countries’ health workforce barriers.

Are their commitments ambitious? Yes. Achievable? I think so. Vital to our global well-being? Absolutely.

These commitments have the potential to help countries meet their Millennium Development Goals. The most robust statements reflected the overarching themes of the forum itself:

• Universal health coverage: The goal is that all people obtain the health services they need without suffering financial hardship when paying for them.
• System complexity: Integrated, coordinated approaches are more effective than simplistic efforts or quick fixes. This means addressing capacity, management, and working conditions; the labor market dynamics that affect production, deployment, absorption, retention, performance, and motivation of health workers; and, as required, policy and fiscal action, so that the health workforce meets population needs.
• Multisectoral engagement: Different sectors of the government, the private sector, and civil society must work together to solve complex challenges in the field of human resources for health.

Commitments from countries and civil society organizations are still rolling in to the Global Health Workforce Alliance, but we expect to see at least 90 from around the world. I know how much advance planning and political will is required to make a public commitment and I salute the commitment makers. Over the past six months, IntraHealth has worked closely with our government counterparts and their civil-society partners to finalize their commitments. For example:

• Dominican Republic will develop a performance management system that includes tools and supportive supervision for service providers to improve the quality of services.
• Ethiopia will expand health worker education to meet 100% of the staffing standard, considering the skill mix, in all primary health care facilities by 2017.
• Kenya will recruit at least 12,000 health workers per year by 2017 to support facility- and community-level health services.
• Mali will ensure that 60% of health districts are fully staffed by qualified health providers (including doctors, midwives, and nurses) by 2018.
• Nigeria will develop plans to ensure there is a clear career pathway for all cadres within the health workforce, including pre- and in-service training and skills assessments.
• Palestine* will develop and adopt a system of incentives for health workers.
• Tanzania will reduce the vacancy rate of skilled health workers at all levels of health service delivery from 52% to 40% by 2017.
• Uganda will strengthen performance management by institutionalizing individual performance planning, monitoring, and appraisal for all staff at health center levels III and IV and general hospitals by 2015.

IntraHealth’s Renewed Commitment to Health Workers

“As global champions for health workers, we at IntraHealth believe we need to support health workers as individuals,” said Pape Gaye, president and CEO of IntraHealth International, during the opening ceremony in Recife. “Health workers—especially those on the frontlines of care—are the human face of the health system. They are the best link from the people to the health system. We must be open to partnering broadly, including with the private sector. And gender must be part of our approach, because many of the workers on the front lines are women, and they deserve decent working conditions and fair compensation in line with the service they provide.”

At the forum, Rebecca Kohler, IntraHealth’s senior vice president, announced IntraHealth's own three-pronged commitment:

1. We will help create a global network of national senior leaders in human resources for health in countries around the world. Our target: Engage with 1,000 of them by 2020.
2. Through research and partnerships, we’ll uncover and promote evidence of the health systems interventions that work. Our target: Publish 100 studies by 2020.
3. We’ll make sure more health workers have the training, supervision, pay, and working conditions they need to do their very best work. Our target: Reach 475,000 health workers annually by 2020.

Read IntraHealth’s full commitment.

As Francis Omaswa of the African Centre for Global Health and Social Transformation said during the forum, “A commitment is a promise—and a promise is a debt.” If we as a global community—all government sectors, civil society, businesses, health worker groups, education, and more—come together to keep our promises and pay this debt, we will be repaid in the currency of improved health.

*Referred to as West Bank and Gaza by USAID.