Editorial

Over the last years many of us have become aware of the dire shortage of professional health care workers to deliver essential health services in sub-Saharan Africa and elsewhere. In many instances we are confronted with insufficient numbers of staff working in hospitals and especially in primary care services in rural areas. We observe that health workers may be poorly motivated, not sufficiently qualified for executing their clinical or managerial task or simply absent from work either for reasons of following-up training courses or for conducting parallel activities in view of earning the means for supporting their daily life. Such or similar experiences in our daily practice are underlined by various recent reports such as the World Health Report 2006 which points out the necessity to tackle the human resource for health crisis.

Until recently, most of us saw the solution in capacity building measures for health staff, in form of short training courses. These measures are typically being delivered in a fragmented way and without a broader vision and harmonization across programs. Yet short training courses can only in few instances be accredited as a master or other programs. Whereas donor and recipient countries willingly committed funds for continuous education measures, more comprehensive investments in human resources were either of low priority or remained a taboo. The readiness to invest in medical training schools or concise human resource policies was small and funding recurrent costs of staff through increasing salaries and creating new posts was absent.

Today, human resource related problems do receive considerable attention so that we can outline and test previously unthinkable approaches. In most countries salary levels of health staff are extremely low and awareness to see it as an essential condition for carrying forward health systems development is substantially increasing. Various donors are starting to accept the funding of salaries, be it either through budgetary support or through providing top ups. Funding is also made available for creating and sustaining new positions and again those who opposed during many years to such measures have changed their opinion.

Even though there is some light at the end of the tunnel, many challenges remain: How to improve the working environment so that the performance of health workers increases? How can we offer decent working conditions for health staff? Yet many solutions are not known, but through the increased commitment to tackle human resource for health development, we increasingly can hope that evidence on effective, efficient and sustainable solutions will emerge.

One of the largest bottle-necks will remain institutional capacity building or in other words the strengthening of the institutional context in which health workers operate. Inevitably, this requires a long-term commitment over many years from those who do accompany and assist the institutional development and also includes the promotion and application of principles of good corporate governance.

*Kaspar Wyss is a public health expert and head of unit at the Swiss Center for International Health of the Swiss Tropical Institute. He is in charge of the “Tajik-Swiss Health Reform and Family Medicine Support Project” and other projects in West Africa and Eastern Europe. He also oversees the performance of Global Fund supported programs in ten countries. His research interest relates among others to the role and importance of human resources for health in the context of scaling-up priority interventions.