WHO EMRO
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An introduction from the Regional Director on the occasion of World Health Day
In the Name of God, the Compassionate, the Merciful
On the 7th of April every year, World Health Day is celebrated across the globe. The event has always been an advantageous opportunity to address important health related issue. It creates an atmosphere at global, regional and country levels, to raise awareness, promote debate and discussion that hopefully leads to a targeted change in decision-making and interventions. This year’s World Health Day is of a peculiar nature as it addresses the health workforce. All members of the workforce have been for ages and will keep on “Working together for health”.
Health workers have been saving lives and contributing remarkably to the achievement of the level of health that human kind has reached by the turn of the 21st century. All those who worked in every corner across the globe during the rising and falling civilizations, have a stake in this achievement. Despite this, the increasing demand for health and the augmenting magnitude of challenges to health still necessitates closer look into the problems facing health workers planning, training and management. But, whom do we mean by health workforce? During last few decades the terminology has been changing according to changes in health concepts, health practice and health systems. Indeed, health is the target of all mankind: at individual, family and community levels. Human Resources for Health (HRH) incorporate three groups: first, those trained health professionals like doctors, nurses, midwives, pharmacists, laboratory and other technical assistants. Second, those non-health professionals working in health systems like managers, economists, accountants, information technologists and all other administrative supporting workers. Last but never the least, are those who have gained some knowledge and skills and volunteer to support health in communities and families.
There can be no doubt that there is a growing health workforce crisis in many parts of the world. The global population is rising, but the number of health workers is stagnating or even falling. This is especially true in places with the most serious health problems. Across the developing world, health workers are facing economic hardship, deteriorating health infrastructures and social unrest. In many countries, a rise in chronic health problems among ageing populations has led to an ever-growing demand for health workers. This demand is increasingly being met by the active recruitment of trained workers from developing countries. This makes shortages of skilled human resources even worse in the poorest countries. Health systems around the world are now facing a triple crisis of workforce shortages, low morale and fading trust. WHO estimates the current global health workforce to be around 59 million women and men. There are 39.5 million health service providers and over 19.5 million management and support workers. It is estimated that there is a global shortage of more than 4 million doctors, midwives, nurses, pharmacists, dentists, technicians and support workers. Decades of cost cutting and under-investment in health have also resulted in deterrent working conditions for health workforce. The morale and performance of overburdened, underpaid and unsupported health workers have sharply declined. As a result, many health workers feel they can no longer continue under these conditions. This has led to loss of health workers, deterioration of health services and erosion of public trust in the health system. Human Resources Development (HRD) Interventions involve three stages namely: evidence-based policy formulation and planning, responsive production and optimal utilization.
It was not by coincidence that the development of human resources for health has consistently been a vital area for the World Health Organization, Regional Office for the Eastern Mediterranean collaborative work with member states since its inception more than half a century ago. Human resource was and remains the most critical factor in the delivery of health care activities and for the attainment of national health goals in any country. While the World Health Organization, Regional Office for the Eastern Mediterranean commitment to HRH development remained steady fast yet the focus of its collaborative developmental work in this field shifted over the years in parallel with the different phases of development of health systems and human resource in member states. At the earliest phases in almost all countries of the region, there was the immense scarcity of trained health personnel in all categories. This fact was well illustrated by the fact that fifty five years ago, there were only 18 medical schools in the entire region, while there was not even a single bachelor degree program for nursing. This is in startling contrast to the current situation where there are more than 250 medical schools in the region and hundreds of higher science institutions where academic and post graduate nursing, pharmacy, dentistry and other allied health professions programmes are in place within most countries of the region.
Thus at its earliest phases (up to late 1960s) the Regional Office for the Eastern Mediterranean technical collaboration in HRH development was directed towards expanding and bolstering national capacities for the production of the main categories of health professionals. This goal was pursued through the provision of assistance to countries in the form of long term fellowships for training professionals, the fielding of expatriate trainers and the procurement of equipment, appropriate technology and essential supplies for these training programs. At the same time the World Health Organization, Regional Office for the Eastern Mediterranean started providing technical assistance to ministries of health to establish HRH and training management departments. .
At the second phase of HRH development in the region (up to late nineteen seventies), the World Health Organization, Regional Office for the Eastern Mediterranean assistance continued to be focused on building the capacity for production of human resource but prioritizing its assistance to selected areas. Public health, nursing and allied health personnel training programmes were selectively supported. This was in line with health care delivery strategies advocated by WHO at the time and adopted by the countries which emphasized MCH services delivery. Later on the integrated health center delivery model evolved out of these strategies. Thus at this phase the World Health Organization, Regional Office for the Eastern Mediterranean assistance was directed towards support of national training institutions in the selected fields through curriculum design, provision of equipment and training learning material and fellowships. Still during this phase and later on the Health For All and the PHC strategy were born in the international health scene. Then WHO in coordination with other partners started to embark on support to massive programmes of on the job national training activities. These short national training activities were instrumental in the wide implementation of PHC activities such as EPI, diarheal disease control, nutrition and maternal health services. The Regional Office for the Eastern Mediterranean still supports these activities as an important tool for maintaining and introducing new skills among the health human resources. During this same period, the World Health Organization, Regional Office for the Eastern Mediterranean assisted countries to develop national HRH policies and to build up HRH databases from regular health information systems and occasional HRH surveys.
The third phase for the Regional Office for the Eastern Mediterranean support of human resource development in the region (started at late seventies) has its focus on strategies, which are directed towards improving the quality, performance and impact of the human resources. Thus at the production level the World Health Organization, Regional Office for the Eastern Mediterranean was a pioneer in the leadership of the international movement towards the reform of training curricula to become community oriented and relevant to the needs of its population. To this extent some of the institutions in the region which were supported by the Regional Office for the Eastern Mediterranean in this direction are among the founding members of the international movement of Community Oriented Medical Education (COME). At present time, almost all member states in he region have institutes adopting innovative programmes in different health professions education (HPE). Special programmes were also established by the World Health Organization, Regional Office for the Eastern Mediterranean to support national languages use in health, production of training learning material in these languages and finally a rather unique leadership development and several health management training courses in several member states. The Regional Office for the Eastern Mediterranean is collaborating with member states to accomplish major development strategies for the human resources, This includes closer coordination and integration of human resources development with services, education and research. Adoption of regional strategies for nursing and midwifery, initiating national HRH information systems, establishing national systems of accreditation and strengthening of HRD national mechanisms at central and peripheral levels to improve planning and balanced management.
No doubt, the changing roles and functions of health professionals in response to the changing health systems and population health needs, demands a continuous review and reform of the process of human resources development. The celebration of the World Health Day by itself marks the beginning of a decade that is devoted to address human resources development as a priority in WHO and member states strategies and actions. It is anticipated that during the decade 2006-2015, major achievements to improve the health workforce status are attained. Hence, active alliances of stakeholders within countries backed by global and regional reinforcement are needed to properly address the technical and political challenges of health workforce development. The decade represents a real opportunity for countries to invest more in this field and make effective use of global, regional and inter-country cooperation and support towards achieving important results that improve drastically the health workforce balance and efficiency. Without achieving this, national health systems will still suffer from weakness and inefficiency despite all attempts for reform and modernization.