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Human resources are crucial for a functioning health system. This short article in the Lancet shows how the global shortage of health workers is evident in many developing countries, especially in fragile states; countries whose governments, for various reasons, cannot or will not deliver core functions to most of the population. For many health professionals, there are growing opportunities that encourage movement from fragile states to search for better professional and economic environments. Many health teams also need urgent support in fragile states.

The authors discuss how efforts are needed to establish performance-management systems, to support promotion based on merit, and to provide wider opportunities for professional development. However, these efforts must be accompanied by measures to restructure the workforce thus matching staffing levels with agreed norms and redressing imbalances between rural and urban areas, and between different levels within the system. The authors warn that without a more strategic approach, human resources gaps will continue in fragile states, which will undermine not only other investments in the health sector but also the achievement of the Millennium Development Goals at the global level.

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