Global health trust

The aim of the Global Health Trust was to advance global health equity through strengthening the production, deployment, and empowerment of human resources for health in low-income countries. The work was launched through a Joint Learning Initiative (JLI), a multi-stakeholder participatory learning process, to better understand the role of workers in health systems and to identify new strategies to strengthen their performance.

The aim of the JLI was to undertake analysis and propose strategies for enhancing the production, deployment and performance strengthening of HR for health, with the overall goal of improving equity in health outcomes. Addressing inequities in HR production and distribution is part of this agenda.

Incorporating a new framework, the JLI's work reflects the critical importance of:

• macro level financing and development policies and the tools to support them (HIPC, PRSPs, MTEFs)
• public sector, and health and education reform processes
  private/public sector interface
• international and national labour market economics
  health needs (linked with poverty and
• demographic/epidemiological transition) in developing countries.

This framework allowed for an analysis of push and pull factors in national, regional and international mobility, and the exploration of innovative policies at all levels to build and support 'the global trust of human resources' in the context of globalisation. This approach will help to deal with the pressure to target international migration as the main factor contributing to the HR crisis, especially in Africa.

The main target audiences of this work are national ministries and government cabinets, and OECD countries as both donors and part of the labour market, and international financing and policy making institutions (WB, ILO, WHO, WTO).

The work took place through seven working groups, using three parallel processes:

• consultation and participatory inputs from major constituencies
•  evidence and data analysis
• collaboration with agencies involved in wider governance and reform, institutional development, investment in health/social sectors and labour market policy

Historical perspectives (Elizabeth Fee, NIH, USA) - persisting focus on contributions from public health field, but keen to explore lessons from recent history in post colonial, post Cold War developing countries (disease eradication etc).

Production/supply (Nelson Sewankambo, Dean of Medicine, Makerere Uni, Uganda) - moving from a rather narrow focus on mapping training capacity, to exploration of health needs and changing 'production function' requirements, and policy, financial and strategic responses to migration pressures, critical review of role of donor agencies.

Demand/employment/deployment (Suwit Wibulpolpraset, Deputy PS, Thailand, also GFATM board member) - very strong focus on macro-level issues, and assessing and addressing multiple factors that lead to weak performance and poor health outcomes.

Africa (Demissie Habte, WB Africa region) - impact of HIV/AIDS, HR capacity mapping and needs, regional and international mobility case studies (WHO AFRO), analysis of bottlenecks and strategies in institutional reform in public/health sector (eg Ghana, Zambia).

Selected diseases (Gijs Elzinga, Nat Institute of PH, Netherlands, also chair Global TB/HIV Working Group) - to use TB/HIV and a few diseases/conditions to provide insights on innovative HR models and interfaces with other sector workforces.

New thinking (Marion Jacobs, Child Health Unit, UCT, SA) - systems theory, research-into-policy, social entrepreneurship, role of civil society.

Macro level and cross cutting issues (Lincoln Chen, plus overall co-ordination) - international labour market issues, overview of macro policy and public sector reform impact, opportunities in PRSPs, financial planning etc, institutional strategies and financing mechanisms.

Constituencies include national ministries of health, education, finance, public service administration, training institutions, provider and professional associations, civil society organisations.

The JLI initative culminated in its Strategy Report Human Resources for Health: Overcoming the Crisis. The report provides a snapshot of the global health situation and the major threats such as HIV and AIDS. It then gives an overview of the problems faced by the health workforce in tackling the crisis, the importance of health workers as central actors in the fight against HIV and AIDS and other threats. The report suggests that action based in the community, with leadership at country level and globally supported is the best approach. In order to tackle the health workforce crisis, the report calls for strengthening health systems, mobilising to combat health emergencies in crisis countries and building a knowledge base. The report closes by making an appeal to all national governments to follow the recommendations included in the report, the international community to assume its supportive role and particularly to WHO and the World Bank to take leadership role in the process.