'Action to resolve the accelerating crisis in the global health workforce': the GHWA Forum: Nester T Moyo, ICM Senior Midwifery Adviser, attended the First Global Forum on Human Resources for Health, in Kampala, Uganda, 2-7 March 2008.

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The first ever Global Forum on Human Resources for Health was organised by the Global Health Workforce Alliance (GHWA) in Kampala, Uganda. The GHWA is a partnership dedicated to identifying and implementing solutions to the health workforce crisis. It brings together national governments, civil society, finance institutions, workers, international agencies, academic institutions and professional associations. The Alliance is hosted and administered by the World Health Organization.

ICM was able to participate and contribute through the support of UNFPA.

Participants and programme

The forum was attended by nearly 1500 participants, including more than 30 ministers of health, education and finance and some former heads of state. The midwives of Uganda were well represented. There were also midwives from other countries such as India, Papua New Guinea, Mozambique and Zimbabwe.

The programme offered a diversity of topics, plenary sessions, concurrent workshops, a skill-building workshop and constituency meetings. ICM took part in the constituency meeting organised and moderated by UNFPA with participants from the WHO Making Pregnancy Safer Department, AMDD, FIGO, and UNFPA Zimbabwe

Key contributions

The contribution from ICM emphasised:

* The value of midwives as the lynchpin of care provision in maternal newborn and child health and the need for effective competency-based education for all cadres who work in this field, the importance of supportive super-vision, appropriate rewards systems and incentives for retention of staff. The provision of quality care involves not only the placing of people in the community but ensuring those people have the relevant skills to save life.

* The value of partnerships with others of similar interests such as UNFPA and others.

* Auxiliary workers are particularly effective if they are well supported and supervised and are in an enabling environment and regulatory framework. Midwives can offer the support that auxiliary workers need. It may be helpful for governments to educate one midwife for every 10 auxiliary workers they produce: a short-term solution that also builds to the long-term solution.

* Effective provision of maternal newborn and child health care is a development issue, as health workers of any category are more likely to stay in the communities if those communities have the facilities required for a reasonable living standard.

* ICM places strong emphasis on strengthening midwives associations in order to bring the voices of midwives to the decision-making table and provide ministries of health with a real partner who can contribute to strategy development and provide some solutions to the crisis. Strong organisations are more able to meet their objectives and unify their members for effective care provision, standards setting, quality control, advocacy for providers and women, and contribute to regulation and legislation of practice and education of midwives.

Major outcomes of the Forum

The forum produced a global action agenda and declaration--the Kampala Global Action Agenda and the Kampala Declaration.

The Kampala Global Action Agenda

The agenda called for immediate and sustained action to resolve the critical shortage of health workers around the world, setting out the essential steps that need to be taken over the next decade to turn the crisis around. The Forum mandated the Alliance to monitor progress made on the Agenda and report its findings in 2010.

The Agenda calls on all countries to give top priority to training and recruiting sufficient health personnel from within their own country and to providing adequate incentives and better working conditions to ensure the retention of health workers. It calls on international and regional financial institutions to relax constraints such as public health recruitment ceilings, and calls on WHO to accelerate negotiations for a code of practice on the international recruitment of health workers.

"This is about much more than a health issue. It is about political choice. It is about quality of life and the dignity of individuals. Therefore, providing health workers for all is the responsibility of all societies and their governments," said Dr Francis Omaswa, Executive Director of GHWA. The full text of the document is available at: www.who.int/workforcealliance/forum We, the participants at the first Global Forum on Human Resources for Health in Kampala, ...;

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Acknowledging that the enjoyment of the highest attainable standard of health is one of the fundamental human rights; Recognizing the need for immediate action to resolve the accelerating crisis in the global health workforce, including the global shortage of over 4 million health workers needed to deliver essential health care; Recognizing the devastating impact that HIV/AIDS has on health systems and the health workforce, which has compounded the effects of the already heavy global burden of communicable and non-communicable diseases, accidents and injuries and other health problems, and delayed progress in achieving the health-related Millennium Development Goals; Recognizing that in addition to the effective health system, there are other determinants to health; Aware that we are building on existing commitments made by global and national leaders to address this crisis, and desirous and committed to see immediate and urgent actions taken;

Now call upon:

1. Government leaders to provide the stewardship to resolve the health worker crisis, involving all relevant stakeholders and providing political momentum to the process.

2. Leaders of bilateral and multilateral development partners to provide coordinated and coherent support to formulate and implement comprehensive country health workforce strategies and plans.

3. Governments to determine the appropriate health workforce skill mix and to institute coordinated policies, including through public private partnerships, for an immediate, massive scale-up of community and mid-level health workers, while also addressing the need for more highly trained and specialized staff.

4. Governments to devise rigorous accreditation systems for health worker education and training, complemented by stringent regulatory frameworks developed in close cooperation with health workers and their professional organizations.

5. Governments, civil society, private sector, and professional organizations to strengthen leadership and management capacity at all levels.

6. Governments to assure adequate incentives and an enabling and safe working environment for effective retention and equitable distribution of the health workforce.

7. While acknowledging that migration of health workers is a reality and has both positive and negative impact, countries to put appropriate mechanisms in place to shape the health workforce market in favour of retention. The World Health Organization will accelerate negotiations for a code of practice on the international recruitment of health personnel.

8. All countries will work collectively to address current and anticipated global health workforce shortages. Richer countries will give high priority and adequate funding to train and recruit sufficient health personnel from within their own country.

9. Governments to increase their own financing of the health workforce, with international institutions relaxing the macro-economic constraints on their doing so.

10. Multilateral and bilateral development partners to provide dependable, sustained and adequate financial support and immediately to fulfill existing pledges concerning health and development.

11. Countries to create health workforce information systems, to improve research and to develop capacity for data management in order to institutionalize evidence-based decision-making and enhance shared learning.

12. The Global Health Workforce Alliance to monitor the implementation of this Kampala Declaration and Agenda for Global Action and to re-convene this Forum in two years' time to report and evaluate progress.

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