One of the worst ironies of the global health workforce crisis is the lack of people with the skills to address the crisis. This applies both to developing countries as well as to the aid and development institutions that work with them. Forget about finding dyed-in-the-wool experts with graduate degrees in health workforce planning---you can’t even find people with minimal practical experience. That’s how long ignored the subject has been.
Each development partner is addressing this challenge in its own way. This year, USAID (the US Agency for International Development, the US’s lead agency addressing the health workforce crisis) will be training all its health country officers in the basics of health workforce reform. That may seem like an insurmountable challenge but it isn’t. USAID doesn’t have to make health workforce experts out of them. Instead, the country officers need to be able to do three things:
1) Familiarize themselves with basic concepts: Some of the most basic concepts include the importance of considering financing and sustainability in heath workforce solutions, the need for health managers, the need for greater political commitment and donor coordination, involving the private sector, training workers whose skills match those of the health needs of the poorest, and the fact that for each dollar spent, non-salary incentives can increase retention greater than salary incentives.
2) Avoid common misconceptions: Common misconceptions include the fantasies that we just need to do more of the same thing that hasn’t been working (training mainly doctors and nurses in public universities), that raising health worker salaries alone will increase retention and productivity, and that the International Monetary Fund is the main reason that governments don’t expand their health workforce.
3) Know where to go for help: No one can be an expert in all areas of health, but they can know where to go for help. That means knowing who to call for technical assistance or knowing what websites to visit for the latest research and data. (e.g. www.africahrh.org, www.hrhresourcecenter.org, www.human-resources-health.com)
This approach is particularly important in an organization like USAID which is highly decentralized. With a few exceptions for centralized programs such as the AIDS/PEPFAR, the health country officers basically decide what USAID will focus on in each country. If a given health officer is not passionate about health workforce or does not feel confident is his or her ability to guide the work, chances are that USAID won’t invest in health workforce in that country. USAID is now taking the first steps toward creating health workforce champions out of their country officers. Watch this space for updates. We wish them luck!