Addressing the health workforce crisis: towards a common approach

The challenges in the health workforce are well known and clearly documented. What is not so clearly understood is how to address these issues in a comprehensive and integrated manner that will lead to solutions. This editorial presents – and invites comments on – a technical framework intended to raise awareness among donors and multisector organizations outside ministries of health and to guide planning and strategy development at the country level.


Background
The existence of a widespread health workforce crisis with the potential to reverse the health gains of the past decade and contribute to the collapse of the health system in some countries is generally acknowledged. The challenge is what to do about it. The World health report 2006: Working together for health asks: "How can a country begin to solve the myriad and complex problems of human resources for health that confront it? Is there a tool or a technical framework that will assist governments and national health workforce planners to develop and implement a comprehensive strategy in a systematic way?"

Towards a common approach
The World health report 2006 presents an evolving technical framework to help countries resolve the problems underlying the crisis. The framework was developed by representatives of multilateral and bilateral agencies, donors, partner countries, nongovernmental organiza-tions and the academic community who came together at an informal consultation sponsored by the World Health Organization and the United States Agency for International Development in Washington, DC, in December 2005. Their goal was to agree on the characteristics of a simple but comprehensive technical framework that would enable countries to develop a concrete national health workforce strategy that could be supported and implemented in a planned and systematic manner.
The resulting health workforce framework ( Figure 1) presents six components of planning and managing the health workforce so that appropriately trained staff are available in the right places at the right time: health workforce management, policy, finance, education, partnerships and leadership. Health workforce management systems are at the center of the framework because of their importance in integrating all the other components.
Subsequent to the December 2005, a steering committee of participants in the consultative meeting and other health workforce experts have defined the six components and their subcomponents ( Table 1).

Benefits of the technical framework
The benefits of a comprehensive technical framework to the development and implementation of a sustainable health workforce include: • identification of the key dimensions of technical competence needed to develop and implement a strategy for human resources; • informing the growing number of groups interested in this area about the complexities of the health workforce and preventing the spread of simplistic and limited views on what is involved; • providing a common reference point for all health workforce stakeholders and preventing policy-makers, implementers, donors, academics and others from "reinventing the wheel".
Many actions can be taken to address each of the six components of the health workforce framework. Tools and guidelines will facilitate implementation of the interventions related to each of the six components. However, a fragmented approach to health workforce issues may be counter-productive and fail to result in sustainable change. While one intervention may concentrate on one or two of the components initially, it is crucial that a comprehensive plan be developed to integrate challenges in all six components. For example, it is essential to address the policy and financial implications of the crisis, but success in these components will not improve health services if the health workforce managers in the health facilities cannot turn these policy changes into practices that create positive workplace conditions. Likewise, even a well-managed health facility will not be able to cope with the overwhelming demands related to HIV/AIDS if partnerships are not formed with the community. Finally, leadership at all levels is critical for each component, to develop human capacity that can be sustained. Table 2 presents a set of guiding principles developed to assist health workforce planners and implementers in applying the framework so as to serve the needs of a particular country best.