1 This report is extracted from the Summary report on the Meeting on the strategic framework for health workforce development in the Eastern Mediterranean Region, 1–2 June 2016, Cairo, Egypt (http://www.emro.who.int/health-workforce/meetings-events/meeting-on-the-strategic-framework-for-health-workforce-development-in-the-eastern-mediterranean-region.html, accessed 9 May 2017).
Universal health coverage – defined as all people being able to use needed health services with sufficient quality to be effective without financial hardship (1) – is a shared vision of health system development for Member States in the Eastern Mediterranean Region (EMR), and a major element of the United Nations Sustainable Development Agenda, which came into force on 1 January 2016 (2). The Sustainable Development Goals (SDGs), in particular SDG 3 (3), highlights the need for a substantial increase in the recruitment, development, training and retention of the health workforce in developing countries. Well planned and concerted efforts are required to ensure availability, accessibility, acceptability and quality of health workforce. In response to this, the Sixty-seventh World Health Assembly also asked the World Health Organization (WHO) to develop the “Global strategy on human resources for health: workforce 2030”, which was adopted by the Health Assembly in May 2016 (4).
Member States are facing an overall shortage of health workers in a Region that is diverse and with a multitude of challenges (5). Member countries of the Gulf Cooperation Council (GCC) are heavily reliant on expatriate health workers, while middle-income countries with relatively well-established health delivery infrastructure face geographical and skill imbalances with increasing quality concerns (5). The remaining Member States face critical shortages of health workforce. Overall production and availability of health workers is suboptimal, further compounded by their imbalanced inter-state distribution (low-income countries versus middle-income countries in EMR), inappropriate skill mix, quality concerns and high health workforce mobility (5).
In order to address the needs for health workforce development, the WHO Regional Office for the Eastern Mediterranean organized a regional meeting on the strategic framework for health workforce development in the Region from 1 to 2 June 2016, Cairo, Egypt (6).
The objectives of the meeting were:
to share evidence and discuss countries’ experiences in addressing health workforce challenges and actions taken to progress towards universal health coverage;
to review and build consensus towards finalizing the draft regional health workforce strategic framework; and
to discuss the way forward for implementation of the strategic framework.
Summary of discussions
Discussions took place on the challenges that could be faced by the countries in implementing the strategic framework and the monitoring and evaluation system to ensure effective implementation. The Meeting also introduced the “Global strategy on human resources for health: workforce 2030”, along with the working document on the regional strategic framework for health workforce development. An overview of the challenges faced by Member States in developing their health workforce in the Region, and achieving universal health coverage and the SDGs, was presented.
Participants expressed appreciation of the draft strategic framework in terms of its comprehensiveness in addressing the major issues, as well as in addressing the different aspects of the health workforce. They also provided constructive suggestions on how to enhance the working document in addressing the needs of countries aligned with other regional and global frameworks, as well as contributing towards reaching the targets of the SDGs. However, while policy directions, strategies and interventions were thought to be appropriate, they were felt to require refinement.
Monitoring and evaluation system for effective implementation of the Framework
The monitoring and evaluation framework was clearly defined although it was recognized that the availability of data and access to information in countries remains a major challenge. A well-defined and well-selected set of indicators were felt to be needed to monitor the regional strategic framework. In addition, a set of indicators should be considered that can monitor and evaluate the overall performance of the framework. In ensuring effective monitoring and evaluation of health workforce strategies, mechanisms needed to be put in place, along with a strengthening of research on health workforce needs.
Implementation of the framework at country level
Potential challenges in implementation of the framework included commitment, capacities for implementation, coordination and cooperation of stakeholders, the socioeconomic and political situation of countries and availability of resources, among other issues. In taking forward the regional strategic framework, there was a need to develop context-specific national health workforce strategic plans aligned with global and regional strategies. Development of such strategic plans requires the involvement and coordination of a number of stakeholders.
However, the Region consists of diverse countries with varying health systems and health workforce needs. Out of a total of 50 million refugees and internally displaced persons, more than 29 million (58%) came from the Region, where health workforce strategic planning can be a real challenge (7). In such situations, identifying enablers and prioritizing actions is important.
Building capacities for health workforce governance and planning may also be required in taking forward the health workforce agenda in countries. Moreover, policy dialogues among stakeholders are critical and should be enhanced. Thus, it is essential to learn from the experiences of other countries, and WHO is positioned to ensure information and experience sharing among countries is facilitated.
References
- World Health Organization. Health systems – universal health coverage. Geneva: World Health Organization; 2016 (http://www.who.int/healthsystems/universal_health_coverage/en/, accessed 9 May 2017).
- United Nations. The Sustainable Development Agenda. New York: United Nations; 2016 (http://www.un.org/sustainabledevelopment/development-agenda/, accessed 9 May).
- World Health Organization. SDG 3: ensure healthy lives and promote wellbeing for all at all ages. Geneva: World Health Organization; 2016 (http://www.who.int/sdg/targets/en/, accessed 10 May 2017).
- World Health Organization. Global strategy on human resources for health: workforce 2030. Geneva: World Health Organization; 2016 (http://www.who.int/hrh/resources/pub_globstrathrh-2030/en/, accessed 9 May 2017).
- El-Jardali F, Jamal D, Abdallah A, Kassak K. Human resources for health planning and management in the Eastern Mediterranean Region: facts, gaps and forward thinking for research and policy. Hum Resour Health. 2007;5(9) (https://human-resources-health.biomedcentral.com/articles/10.1186/1478-4491-5-9, accessed 9 May 2017).
- World Health Organization. Summary report on the meeting on the strategic framework for health workforce development in the Eastern Mediterranean Region. Cairo: WHO Regional Office for the Eastern Mediterranean; 2016 (http://www.emro.who.int/health-workforce/meetings-events/meeting-on-the-strategic-framework-for-health-workforce-development-in-the-eastern-mediterranean-region.html, accessed 9 May 2017).
- World Health Organization. Refugees and internally displaced persons in the Eastern Mediterranean Region: a health perspective. Cairo: WHO Regional Office for the Eastern Mediterranean; 2015 (http://www.emro.who.int/images/stories/eha/documents/migrants_refugees_position_paper.pdf?ua=1, accessed 9 May 2017).