World Health Day 2006: working together for health.

THE WORLD HEALTH REPORT 2006: Working together for health was launched on 7 April to coincide with World Health Day. It contains an assessment of the current crisis in the global health workforce and an action plan over the next ten years that focuses on all stages of these workers' career lifespan, from entry to training and from job recruitment through retirement. The plan includes proposals in which countries can build their health workforce with the support of global partners.

At least 1.3 billion people worldwide lack access to the most basic health care, often because there is no health worker. The global profile shows that there are more than 59 million of them in the world, distributed unequally between and within countries. Health workers are found predominantly in richer areas, where health needs are less severe, but their number remains insufficient to meet the health needs, with a total shortage of 4.3 million doctors, midwives, nurses and support workers worldwide. The shortage is most severe in the poorest countries, especially in sub-Saharan Africa, where health workers are most needed. A serious shortage in 57 countries is impairing provision of essential life-saving interventions, including childhood immunization, safe pregnancy and delivery services for mothers, as well as access to treatment for HIV/AIDS, malaria and tuberculosis. Combined with a lack of training and knowledge, according to The World Health Report, this shortage is also a major obstacle for the health systems, as they attempt to respond effectively to chronic diseases, avian influenza and other health challenges. More than 4 million additional doctors, nurses, midwives, managers and public health workers are urgently needed to fill the gap in these countrics--36 of them are in sub-Saharan Africa, which has 11 per cent of the world's population and 24 per cent of the global burden of disease, but only 3 per cent of the total health workforce.

Every country needs to improve the way it plans for, educates and employs doctors, nurses and support staff, who make up the health workforce, and provide them with better working conditions. The Report calls for national leadership to urgently formulate and implement country strategies, which needs to be backed by international donor assistance. More direct investment in training and support of health workers is needed, and health budgets will have to increase by at least $10 per person per year in the 57 countries with severe shortages, to educate and pay the salaries of the 4 million health workers needed to fill the gap. Financing this will require significant funding from national sources and international development partners. The Report recommends that of all new donor funds for health, 50 per cent should be dedicated to strengthening the health system, of which 50 per cent should specifically be for training, retaining and sustaining the health workforce.

The World Health Report recommends that in order to achieve the goal of getting "the right workers with the right skills in the right place doing the right things", countries should develop plans that include better working conditions for health workers, a well-developed plan to train them, and accreditation and licensing for quality improvement. Beyond the national strategies, the Report urges joint investment in research and information systems, agreements on ethical recruitment of, and working conditions for, migrant health workers, as well as international planning on the health workforce for humanitarian emergencies or global health threats like an influenza pandemic, and commitment from donor countries to assist crisis countries with their efforts to improve and support the health workforce.

World Health Day is celebrated annually on 7 April. In 2006, it was devoted to the health workforce crisis. Hundreds of organizations around the world hosted events to mark the day and celebrate the dignity and value of working for health.

The Director-General of the World Health Organization, Dr. Lee Jong-wook, in his World Health Day-message said: "Without a strong health workforce, advances in health care cannot reach and benefit the people who need them. Effective ways of preventing and treating disease require assessment, delivery and monitoring by health workers. The capacity to respond to the threat of pandemic human influenza, global efforts to reach the Millennium Development Goals, and all our efforts to address priority diseases are threatened by health workforce shortages. Poor distribution of resources and unused skills, and migration of health workers are making a bad situation worse."