Why are human resources important

The essential role in advancing global health

Global resources are available to tackle existing health threats. Yet many health systems are unable to deliver adequate health care to ensure a healthy population. Health care is a labour-intensive service industry and human resources are essential in realising global health goals. The World Health Organization (WHO) argues that health workers represent the human face of health systems: they represent its values and are essential for the use of its available resources. New evidence about strategies to fight against diseases and to promote health can only be put in practice through the skilled intervention of health workers. The number and skills of health workers are positively related to improvements in health such as infant, child and maternal survival.

The role of HRH in consolidating and scaling up health systems

The WHO recognised in 2005 that shortage of human resources for health is a major constraint in scaling up the response to HIV and AIDS and the achievement of the other health MDGs (See Health and the Millennium Development Goals) Countries most affected by shortages in HRH, particularly in sub-Saharan Africa, are those where advancement towards the MDGs has been most limited.

 

Health workers as gatekeepers of health systems

The quality and quantity of health care workers has been shown to significantly impact on the health of a population. The quality of doctors and the density of their distribution have been linked with positive outcomes in cardiovascular diseases. Child malnutrition has worsened with staff cutbacks during health sector reform.

The WHR 2006 argues that cutting-edge quality improvements in health care are best initiated by workers themselves because they are in the best position to identify opportunities for innovation. Health workers can function as gatekeepers and navigators for the effective, or wasteful, application of all other resources such as drugs, vaccines and supplies.

 

Health workers are at the frontline during health crises

The Joint Learning Initiative on Human Resources for Health has shown that HRH mobilisation and strengthening is central to combating health crises and to building sustainable health systems. Nearly all countries are challenged by worker shortage, skill mix imbalance, maldistribution, poor work environments, and weak knowledge base. In poorer countries, the workforce is also under assault by HIV and AIDS, out-migration of skilled health workers, and inadequate investment.

Effective country strategies need to be backed by international support. The JLI task force argues that the crisis in human resources is a shared problem that requires a shared responsibility for cooperative action. Alliances for action are needed to strengthen the performance of all existing actors while expanding space and energy for fresh actors.

 

Human resources contribute to keep a healthy and productive population

Poverty Reduction Strategy Papers (PRSPs) are the major aid instrument in tackling poverty. They provide a mechanism for countries to have a clear focus on this central objective. The link to debt relief for heavily indebted poor countries (HIPC countries) provides real incentives for those very poor countries to make progress. In a World Bank publication, Review of the Poverty Reduction Strategy Paper (PRSP) approach: main findings, the authors recognise that there has been widespread acceptance of the PRSP approach and that PRSPs are leading to better informed decision-making. But they also recognise that strategies alone are not sufficient—they must be followed up by actions. The implementation of PRSPs cannot realistically be achieved without clear human resource plans.

An analysis of PRSP and HIPC documentation illustrates the problem. Most of the country based documentation, interim PRSPs, PRSPs and progress reports refer to human resource problems but few indicate how these problems are to be addressed. HIPC documentation is even weaker in this respect. Of course it can be argued that PRSP documents and HIPC documents are not designed to address these issues. But the fact remains that without complementary human resources strategies and plans; few PRSPs will achieve the improvements they envisage.

A Bank review of the HIPC/PRSP process in 18 African countries, Enhancing human development in the HIPC/PRSP context: progress in the Africa region during 2000, observes that it is important to take advantage of the specific opportunities presented by the HIPC initiative to strengthen the link between debt relief and improvements in social services and eventually, progress in poverty reduction. As well as the human resource issues of increasing coverage of services to poor people, there is an emphasis on improving efficiency of human resource utilisation. Often civil service reform has focused on reducing staffing numbers but the sustained improvements have been elusive. Civil Service Reform: a review of World Bank assistance provides recommendations on how the implementation of World Bank supported civil service reforms can be improved.