My blog from the UN Summit on the Millenium Development Goals
Day three: Tuesday 21st September
Event 1: No Health Workforce. No Health MDGs
Yesterday, a packed room full of high-level delegates, policymakers and civil society organizations met at the United Nations Headquarters in New York to address the critical question: “No health workforce. No health MDGs. Is that acceptable?”
The critical message stressed by all panellists, was the clear and critical link between the health workforce and health MDGs 4, 5 and 6. Japan’s Vice President of JICA – Mr. Kiyoshi Kodera, spoke of the strong correlation between the availability of health workers, coverage of health services and health outcomes. Given this relationship, Dr. Bjorn-Inge Larsen – Director General of the Norwegian Directorate of Health argued that it is essential for global leaders to drastically scale up access to motivated and well trained health workers; without them, the international community will fail to reach new commitments to maternal and child health.
So what can be done? The audience learned the positive news from the Malawian Minister of Health – Dr. Francisco Eduardo de Campos. Since the initiation of Malawi’s six-year Emergency Human Resource Programme in 2004, the country has succeeded in increasing the number of health professionals by 66%. Consequently, Malawi is now on track to achieve MDG 4 on child health, prevention of mother to child transmission services now reach 68% of women, and over 13,000 lives have been saved.
The speakers were clear on what needs to happen. There must be strong, sustained and significant financial and political commitment to the health workforce. This includes the effective scale-up and support of an additional 3.5 million health workers. And leaders are willing to take action. As Mr. Kodera of JICA Japan fervently declared, “we must take this opportunity to take the issue of human resources for health forward… and Japan is ready to ramp up its efforts”.
Event two: Accelerating Progress in Achieving MDG 5: Trends and Lessons from Countries
‘Accelerating Progress in Achieving MDG5’ was one of the best events I have been to in a while. The event was held in UNICEF house, with some highly prestigious and interesting speakers, including the Director General of the WHO – Dr. Margaret Chan and the Executive Director of UNICEF. What excited me most about this event was the clear message on the health workforce - reiterated time and time again: we will not have a hope of meeting MDG 5, unless we rapidly scale up numbers of health workers.
Perhaps the most interesting speakers for me were Dr. Kessetebrean Admasu from the Ethiopian Ministry of Health, the Minister of Health from Benin, and the Vice President of the World Bank – Ms. Tamar Manuelyan Atinc. Dr. Admasu (see video) spoke about Ethiopia’s 2006 Health Extension Programme, which to date has trained over 34,000 Health Extension Workers (HEW). HEW’s are given training for up to one year, and are then deployed to rural health posts across the country. Dr. Admasu highlighted the dramatic impact this programme has had on maternal, newborn and child health outcomes in the country [N.B. look up recent evaluation]. And for him, the reason this programme has had such dramatic success, is because the programme makes ‘an important move away from volunteerism’, which means engaging health extension workers as full-time, salaried civil servants, rather than as volunteer community health workers.
And what were Ethiopia’s plans moving forward? Dr. Admasu described passionately his government’s plans to empower HEW to provide clean and safe deliveries, including interestingly, the provision of misoprostol as prophylaxis against post-partum haemorrhage (it is well appreciated in Ethiopia that some women will continue to deliver in their homes). He also outlined plans to accelerate the training of health officers, increase numbers of nurses (to ensure there is one nurse for every 4,500 people), expand midwifery and medical schools and improve the enrolment capacity of older ones, and roll-out in-service training to improve access and quality of emergency obstetric care. These plans sounded both exciting and significant. The only challenge with enacting these plans, he said, was that “there is no fresh money”, in which to do so.
The Minister of Health from Benin clearly emphasized the strong and critical link between the health workforce and MDG 5 – maternal health. In Benin, the government is tackling maternal death and morbidity head-on, through a drastic increase in skilled birth attendance, now provided to 67% of the population. He said, “if you wish to tackle maternal mortality, you must hire and train quality personnel at every level”. Scaling up health personnel will require all partners to work together. Benin is now planning to recruit and train an additional 3,000 health workers. He reiterated GHWA’s increasingly well known slogan, “health workers for all, all for health workers” and then made his plea to the audience: “please help us train our specialists”.
The World Bank then raised the interesting and controversial issue of the results-based financing model. Results-based Financing (RBF) for Health is a tool used for increasing the quantity and quality of health services. It combines the use of incentives for health-related behaviours, with a strong focus on results. Ms. Tamar Manuelyan Atinc said that the World Bank has seen significant results both on the supply side (rewarding facilities based on good performance, or bonuses paid to good health workers) and the demand side (e.g. incentives for mothers to deliver in facilities, transport vouchers, or supplies for newborns). As she said, “results-based approaches hold considerable promise for improving maternal and child health services”.
It was in this spirit, that the World Bank committed to an additional $600 million over the next five years, to invest in results-based financing for health in 35 countries – particularly in Africa and Asia.