CNS: Global Health Workforce - Pathways to Health

The Irish Forum for Global Health's (IFGH) two days conference, which opened in Dublin on 2nd February, 2012, focuses on the theme of the Global Health Workforce Crisis, recognising that one of the greatest challenges facing global health today is the critical shortage of skilled health personnel, especially in remote areas of the world. Its aim is to synthesise, build upon and propose further actions on how to train, retain and get maximum benefits from a motivated workforce.

There are one billion people in the world who have no access to any healthcare service. The health workforce has been the cornerstone in channelling efforts to achieve the health-related millennium development goals (MDGs), where much of the focus has been on women, children and those most vulnerable to, and infected and affected by, HIV and other health conditions. Millions of lives are lost each year due to inadequate access to skilled, motivated and supported health workers, with one billion people in 57 countries facing a daily struggle to access basic healthcare due to health workforce shortages and uneven distribution of health workers within countries. The inequality of distribution between countries is substantial: Sub-Saharan Africa bears 25% of the global burden of disease – but has only 3% of the world‘s health workers.

While inaugurating the IFGH conference, the Minister of State for Trade and Development, Joe Costello TD, announced that Ireland is joining the European ESTHER Alliance. The ESTHER Alliance is a network of Governments working in synergy to tackle HIV/AIDS and major diseases and improve women, newborn and children‘s health. It involves twinning between European hospitals and institutions in developing countries to build capacity to improve health care services. ESTHER Ireland will strengthen health institutions and human resources so as to improve provision of essential health care for women, children and those suffering from HIV and other major diseases; with a focus on sub-Saharan Africa. It is worth mentioning here that Ireland has always been a firm supporter of the Global Fund to Fight AIDS, Tuberculosis and Malaria since its inception in 2001, providing a total of €133,390,000 to the Fund in total, making us one of its biggest funders per capita.

The health workforce crisis has been identified as one of the main bottlenecks to achieving the health MDGs. Resolving this crisis is a collective and shared responsibility which requires increased political will, greater allocation of adequate resources, and scaling up of appropriate technical expertise to support better management of fragile health systems. The Global Health Workforce Alliance was established to catalyse and advocate a global coordinated response to this crisis.

Community health workers and community-based responses make a vital contribution to addressing the global health workforce problems and there is potential for expansion of their roles. They need to be integrated into national human resource plans so that they are properly trained, supervised, supported, motivated and remunerated. Strategies will have to be adopted to attract and retain health workers with appropriate skills mix in rural and other under-served areas. The availability of a strong human resources information system in low as well as high income countries is essential. Many governments have good human resources strategies but the implementation of such strategies at the district and health facility level is slow and uneven. The urgency of improving working environments and employment conditions for healthcare workers cannot be understated. Building human resource management capacity and skills is an essential building block to attaining a motivated and productive workforce.

There is a need to further explore the potential role of technology as a cost-effective intervention that can help improve working conditions for health workers; increase access to training materials; facilitate continuing education; and enhance both motivation and supervision. There are now five billion mobile phones in the world of which four billion are in the developing world. There are 600 million mobile phones in Africa alone for a population of one billion. The disruptive effect of mobile technology offers the game changing opportunity to reach the rural poor with health services and advice in ways that were previously unimaginable. Across the developing world mobile phones are being used by community health workers and other health care professionals to collect real time data of disease outbreaks, vaccination uptake rates and to connect rural health care workers to both their community members and supports higher up within the healthcare services. They are being used to text health messaging reminders to those in pregnancy and childbirth to uptake services and drive compliance amongst those on HIV and TB medication. Point of care testing in the field for Malaria, TB etc using microscopy attachments are now gaining widespread usage and even eye refraction testing, using a cheap add on device to a mobile phone, is now available for those needing glasses. These are just a few examples of the multitude of add on devices and Apps for mobile phones that are changing healthcare delivery month by month for the most vulnerable people on the planet.

Another great opportunity which mobile technology offers is to help train the one million community health workers needed urgently across the developing world to reduce maternal and child mortality. New distance training content designed to teach specific skills available on mobile devices will help to train community health workers faster, cheaper and keep them in the field up skilled, mentored, supervised and accredited.

Ireland as a leading European headquarters for many major global technology and mobile industry leaders is uniquely placed and has a strong responsibility to drive collaboration across sectors to build sustainable solutions for human resource management through this technology. iheed Institute is a new Irish organisation working with Irish and world class partners in Health, Education, Distance Training and Mobile Technology to build such distance training content making it available to NGOs and Ministries across Africa and beyond.