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GHF2006 – PL05 – Global Gaps in Research, Capacity Building and Human Resources

Session Outline

Plenary session, Friday, September 1 2006, 9:00-10:30
Chair(s): Jean-Louis Carpentier, Switzerland, Tikki Pang, Switzerland
Putting Research Evidence into Practice
Nirmal Kumar Ganguly, Director General, Indian Council of Medical Research, New Delhi, India  
Manuel Dayrit, Human Resources for Health, World Health Organization, Geneva, Switzerland   
Towards Improving Transparency in Clinical Trials
Odette Morin, Director, Regulatory and scientific Affairs, International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), Geneva, Switzerland
Can Research Make a Difference in Global Access to Health?
Stephen A. Matlin, Executive Director, Global Forum for Health Research, Geneva, Switzerland 

Session Documents

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Session Report

Submitted by: Anne May (ICVolunteers)

Image: Dominic Monnier

Plenary V addressed the current challenges and conditions for effective capacity building in the health workforce as well as medical research to improve health and give access to health care in developing countries.

Dr. Manuel Dayrit, of Human Resources for Health at World Health Organization (WHO), discussed the current challenges and conditions for effective capacity building in the health workforce. Although Mr. Dayrit's focus was on human resources for health, he insisted throughout his presentation on the fact that capacity building was constantly taking place in a much broader context of socioeconomic and political circumstances, institutions, and involved many actors from different horizons. Hence, it is essential, in order to be effective, that capacity building be systemic. However, failure to address the capacity constraints (political, institutional) limiting the achievement of overall capacity building project objectives has repeatedly been shown.

Mr. Dayrit defined "capacity building" as "a process by which individuals, groups, institutions, organizations and societies enhance their abilities to identify and meet development challenges in a sustainable manner." As set forth by WHO's late Director General, Dr. Lee Jong-wook, the ultimate goal of capacity building is "to ensure access to a motivated, skilled, and supported health worker by every person in every village everywhere."

The health workforce, Mr. Dayrit noted, must be understood as "all people engaged in actions whose primary intent is to enhance health," not only doctors and nurses, but also such diverse professionals as economists, drivers, cooks, etc.

Mr. Dayrit, provided various illustrations of the strong positive correlation observed worldwide between the proportion of health workers in the population and population's health measured by various indicators. The latest WHO World Health Report (2006) provides ample evidence supporting the view that shortages of health workers in certain areas in the world must be addressed as one key step to improve overall health. The causes of such shortages are many and diverse and may be grouped into three tiers: the entry level, including planning, education and retirement; the workforce level, including supervision, adequate compensation, continuing education; and the exit level, limiting emigration, changes in career and ensuring the health of the workforce. Only a strategy tackling these three aspects (a "lifespan strategy") may lead to effective sustainable results. To illustrate this point, Mr. Dayrit described the case of Thailand where multiple strategies have helped to improve the retention of trained health workers in rural areas. With concerted regulatory, economic, educational, managerial and social strategies, the country has indeed managed to shift the ratio of health workers in Bangkok v. those in the northeast of the country from a 22:1 ratio in the eighties to a 10:1 ratio in 1999.

In conclusion, Mr. Dayrit reiterated the view that capacity building efforts will succeed only where they take adequate account of the prevailing local politics, economics and institutions and are country-owned rather than donor-driven. To that effect, he noted that countries have to take the lead in developing capacity building efforts and that donors should harmonize their support around the countries' priorities.

Ms. Odette Morin, Director of Regulatory and Scientific Affairs of the International Federation of Pharmaceutical Manufacturers and Association (IFPMA), presented the newly created IFPMA Clinical Trials Portal, launched in 2005, that is the first portal to provide public, online information about on-going and completed clinical trials sponsored by pharmaceutical companies worldwide.

The portal was developed as a response to various pressures for improved trial transparency. Through their associations, the pharmaceutical companies have taken a joint position on the disclosure of clinical trial information that has led to the creation of the portal. Pursuant to ongoing public pressures, the number of clinical trial postings on the portal has almost doubled during the first months of its launch.

The portal is not a database but is structured as a platform giving access to various sources which centralize information, such as national industry associations, governments or international organizations. It allows multiple-criteria searches in English, French, German, Japanese and Spanish.

The portal is not only useful to doctors and patients, it is also an essential tool, as was discussed after Ms. Morin presentation, to inform health systems management. Of course, the portal may be only as good as the information made available by companies and governments. It was hence emphasized that national registries should be improved in many regions to improve coverage.


Mr. Stephen A. Matlin, Executive Director, Global Forum for Health Research, discussed the crucial role of health research in ensuring that people everywhere have access to health. Mr. Matlin first provided an overview of the changing face of health problems worldwide. Although infectious, communicable diseases (CDs) remain the major health burden in Africa, there is an overall increase in non-communicable diseases (NCDs) among low and medium income countries (LMICs). Health research agenda should adapt to these evolving needs.

Health research, Mr. Matlin highlighted, is not limited to biomedical research and the development of new products. The health research agenda should also focus on systemic aspects such as strengthening health policy and systems, the promotion of health equity, the study of social and other determinants of health including the availability of public transport networks for access to health resources.

It is widely recognized that there is a major lack of spending on health research for the needs of developing countries, both by HICs and by LMICs themselves. Although global health research expenditure is growing at a rapid pace, only a small proportion of it (less than 5% in the 1990s) is devoted to diseases and health problems that are endemic in LMICs. As a result, during the last few decades, very few new products for diseases that are mainly endemic in poor countries were registered for clinical use. In parallel, health systems and health research capacities in LMICs have not been sufficiently developed.

In order to tackle the disease burden in LMICs, concerted approaches should be implemented by both LMICs and HICs. HICs should focus on research that generates leads for LMICs and support country-based research and capacity building in LMICs. LMICs should similarly support their own research capacity and utilization. They should focus on the development of national health research systems, foster innovation and ensure that local research capacity addresses local priority health needs.

There is an emergence of innovating developing countries, such as Brazil, China, India and South Africa. These countries have demonstrated a growing capacity to undertake health innovation and assume an increasing role in the development of new drugs, vaccines and diagnostic tools, as well as of new techniques and new policies in health systems and services. One characteristic of these countries is that they manage to span the spectrum from innovative research to product delivery.

One major source of funding for, in, and by, LMICs is philanthropy. Over the 1993-2003 period, the 50 most generous philanthropists collectively donated over 50 billion USD. Public-Private Partnerships (PPPs) are playing a growing role in the financing of health research for LMICs. PPPs' Research & Development (R&D) expenditure has increased dramatically since 2000 and 75% of all neglected disease R&D projects are currently conducted by PPPs. The public sector should devote an increased share of available R&D resources to the health needs of developing countries, as they have fallen short of meeting the the targets set at the 1990 Commission on Health Research for Development (2% of government health budget on essential health research).

Mr. Matlin concluded by highlighting areas to which government financing of health research for development should focus. In HICs, greater priority should be given to national research programs and more health research should be included in bilateral and multilateral channels. In LMICs, in additional to giving greater priority to national health programs, capacity building for national health research systems and innovation should be emphasized.

Capacity Building: Self-Defeating or Beneficial?

Presenter: Manuel Dayrit
Author(s): Manuel Dayrit1, B. Stilwell1, C. Dolea1
Affiliation(s): 1Human Resources for Health, World Health Organization, Geneva, Switzerland
Key issues: This presentation has four parts: first, it reviews the various definitions and approaches to capacity building elicited during the last 20 years; secondly, by taking an analogy with a battery, the presentation will discuss capacity building as a means to achieve performance; thirdly, it will illustrate the concepts by narrating actual experiences in the area of capacity building for specific cadres of health workers, with Reflection on lessons learnt, and in the fourth and last section, issues will be raised related to access, investments, absorptive capacity and environmental influences. Definitions: There are many definitions of capacity development, some of which are operational, and others conceptual. The reason for these differences is that capacity development has, in the past, often been considered as the international assistance provided to developing countries, and most frequently implemented as training activities. As a result some definitions describe capacity development as an approach or process, whereas others see it as a developmental objective. While a common definition may prove elusive, there is the risk that without definition, the concept remains fuzzy, losing meaning, and is applied to describe activities rather than emphasize a way of approaching development work. This presentation will highlight the range of definitions, suggesting the most appropriate for workforce development. Achieving performance: The capacity that health workers have to perform well, so that they achieve desirable health targets and outcomes is highly relevant to the theme of health equity. When health outcomes are unmet and goals appear unreachable, health planners and governments seek to build capacity so that people and systems can accomplish their expected tasks. It has been suggested that creating performance without building capacity is not sustainable, but simply building capacity without motivating performance wastes that capacity. This clearly makes a distinction between capacity and performance and points out their dynamic relationship. Learning from experience: In this section concrete experiences of capacity building will be described in communities and countries, and factors that may predict success and failure identified. What lessons can be learned? These concrete experiences will serve to properly inform the debate on this topic. Not just training: Taking into account what we know about capacity development, what perspectives should be explored in development work? This presentation will ultimately show that capacity building for the workforce is not simply about training programmes. There are a host of complex issues related to capacity building which involve governance, leadership, self-reliance, the development of individuals and institutions, even the nurturing of a supportive environment.

GHF2008 – PL08 – Research and Training for Health: Seeds for the Future

Session Outline

Plenary session PL08, Wednesday, May 28 2008, 9:00-10:30, Room 2
Chair(s): Marcel Tanner, Director, Swiss Tropical Institute, Switzerland & Peter Suter, President, Swiss Academy of Medical Sciences, Switzerland
Shaping Innovative Research and Training in a Global World 
Charles Kleiber, Former Secretary of State for Research and Education, Lausanne, Switzerland
Research, Training and Service Development to Address Global Health Challenges: What Should Be the Priorities of Universities?
David Sanders, Director, School of Public Health, University of the Western Cape, South Africa  
Shaping the Research Agenda for Low-Income Countries
Charles Mgone, Executive Director, European and Developing Countries Clinical Trials Partnership Programme (EDCTP), The Netherlands 
Pharmaceutical Innovation and Meeting the Needs of Global Access
Harvey Bale, Director General, IFPMA, Geneva, Switzerland 

Session Video

Session Report

Submitted by: Emma Greenaway (ICVolunteers); Contributors: Janina M. Mank (ICVolunteers)


How can we bridge the gap of inequality between donor and recipient, the developing and the developed, the researchers and the researched, to serve the health systems of tomorrow? The four speakers, despite coming from a diversity of backgrounds, made an important contribution to this forum by emphasizing the need for a mutual, supportive partnership between those at either extreme of the inequality gap. Ways of achieving this partnership are closely linked to research on health-related issues and training of a global health workforce, but there is no doubt that further research is crucial to arrive at effective outcomes on both the national and the international level.

Building the capacity of health care systems to respond to ever greater challenges and increasing demand, requires the development of effective and targeted research and training strategies. The four speakers addressed different aspects of this issue from their own varied perspectives.

Dr. Charles Kleiber, Former Secretary of State for Research and Education, Lausanne, Switzerland, emphasized the importance of linking academic development and capacity building on a global level by taking into consideration the challenges the health sector will have to face in the near future. Dr. Kleiber identified the factors that shape innovation as globalization and the interdependence this creates, a knowledge society characterized by its drive for competition and its constantly changing environment; as well as upcoming challenges in health (including income-dependent diseases as well as the current monopoly of the doctor) and in education research (global universities with international campuses). He thus recommended a rethink of current strategies on the factors mentioned, in order to build capacity, in particular at institutions in low-income countries, using globalization to enhance our educational experience, thereby encouraging 'brain circulation' rather than 'brain drain'.

Professor David Sanders, School of Public Health, University of the Western Cape, South Africa, focused his presentation on Sub-Saharan African countries which are facing a crisis in health care, greater health inequality, declining life expectancy and increasing mortality rates. Health care systems are under increasing pressure due to higher levels of extreme poverty and disease epidemics, such as the HIV/AIDS. Governments are failing to achieve even the minimum spending targets on health care recommended by the World Health Organization (WHO). In addition, health systems are suffering from increased fragmentation, competition, effects of 'brain drain' and stagnating global immunisation rates. This situation presents particular challenges for the future direction of public health research, education and training.

Public health training, research and funding must now focus on implementation: how to put existing knowledge into practice to make a difference. Research at the local level into the effectiveness of health care systems or institutions can identify implementation problems, enable local action to be taken, to bring about improvement and inform national and global advocacy campaigns.

Successful implementation and capacity building depends on increasing training in leadership and managerial skills, as well as extending in-service training to all public health workers by introducing distance learning programmes. Enhancing the capacity of southern institutions to implement research and training activities depends on increased financial support and developing South-South collaboration and more equitable North-South partnerships.

Dr. Charles Mgone, Executive Director, European and Developing Countries Clinical Trials Partnership, The Hague, spoke of the importance of an effective response from the health care research and training community to the many challenges faced by health care systems in low income countries. Long-term partnerships must be built with active partners working in synergy and coordinating their activities. These partnerships must recognise that ownership lies in the southern country and defining and planning of the research agenda must lie with them and not with their northern partners.

Building capacity within institutions in the South to carry out research programmes effectively depends on developing personnel and creating an enabling environment. Training should focus on developing leadership skills, good governance and financial and project administration. Greater networking and South-South mentorship will enable southern countries to learn from each other. Support for infrastructure, improved career pathways and sharing best practice all help to develop an environment in which research capacity can grow.

Dr. Guy Willis, Director of Communication, International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), successfully deputized the Federation's Director General by catching his audience's attention with the private sector's point of view on the establishment of a partnership between the recipient countries of vaccines and the producing industry. The considerable costs and amount of time spent on creating new vaccinations have to be met by guaranteeing property protection and profit if the private sector is to continue to act responsibly and is to be able to keep contributing towards improving health in the developing world.

Dr. Willis put forward the idea that research on new therapies and vaccines to address a diverse range of diseases, in particular for children, can be enhanced through voluntary licensing or a preferential price system for low-income countries thus planting the seeds for the future in research and training where health problems are often most acute.

GHF2008 – PS20 – Task Shifting: The Solution for Healthcare Worker Shortages

Session Outline

Parallel session PS20, Tuesday, May 27 2008, 16:00-17:30, Room 4
Chair(s): Alexandre Bischoff, Division of International and Humanitarian Medicine, Department of Community Medicine and Primary Care, University Hospitals of Geneva, Switzerland, Deborah Ward, Associate Professor, School of Nursing, University of Washington, USA
Effects of Health Labour Migration on Low and Mid-Level Health Personnel for Infectious Disease Control at the Periphery in the Volta Region of Ghana 
Frank Nyonator, Director, Policy, Planning, Monitoring, and Evaluation Division, Ghana Health Service, Ghana  
Lessons Learned and General Principles
David Benton, Nurse Consultant, International Council of Nurses, Switzerland 
Non-Physician Clinicians in 47 Sub-Saharan African Countries
Seble Frehywot, Assistant Research Professor of  Health Policy and Global Health, George  Washington University, USA 

Session Documents

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Session Report

Submitted by: Bahia Egeh (ICVolunteers)

Like much in the world, task shifting has its successes and failures. In health care it encompasses doctors to non-physician clinicians (NPCs), NPCs to registered nurses, registered nurses to community health workers (CHWs) and CHWs to expert patients. In order to tackle the question whether task shifting is the solution for health care worker shortages, lessons must be learned from the successes and failures uncovered in studies conducted on task shifting.

"There are negative and positive lessons to be learned from task shifting," emphasized David Benton, nursing and health policy consultant at the International Council of Nurses.

Regarding the positive lessons, literature review on task shifting show an increase in coverage and equity of access to care in underserved communities, and growing evidence that community health workers can undertake interventions that lead to improved health outcomes. Audience members contributed country specific success examples, such as Ethiopia, where maternal mortality was curbed due to CHWs being trained in performing cesarean sections. Seble Frehywot, member of the George Washington University Department of Health Policy and Global Health, identified NPCs in 25 of 47 Sub-Saharan African countries studied. These were trained in specialist activities such as cesarean section, ophthalmology and anesthesia.

Regarding negative lessons, the problem with task shifting is volunteerism cannot be sustained for a long period of time, and poor health care workers expect and require income. In addition volunteerism does not provide a sustainable solution because CHWs cannot engage in other work, like tending to the field.

The 12 principles endorsed by the World Health Professionals Alliance (WHPA) - which can be found detailed at - also address the problem of volunteerism. The 12 principles also outline other problems of task shifting in three ways. Firstly, it increases demand on health professionals by increasing their responsibilities as trainers and supervisors, taking scarce time away from their other tasks. Secondly, successful task shifting requires higher numbers of assistive personnel to take care of the new patients. Lastly, health professionals will be faced with patients who have more complex health needs and require more sophisticated analytical, diagnostic and treatment skills, since the simpler cases will be covered by task shifting.

Frank Nyonator, from the Policy Planning Monitoring and Evaluation Division of the Ghana Health Service, starkly portrayed the negative effects of task shifting experienced in Ghana, where migration of health care workers has increased the workload for mid-level cadres, leading to a reduction in time available per patient, and has decreased the quality time patients receive from health workers. Patients, aware of long waiting times, are seeking alternative care.

The audience illuminated other problems encountered with task shifting like resistance - for instance in India there is a shortage of anesthetics and task shifting to NPCs is resisted by the Association of Anesthetics - and the problem of definitions and scope of practice.

"If you talk to five people in a room, you'd get different definitions of 'community worker'," said Mr. Benton. The problem with task shifting as a solution is that health care workers do not know where their scope of practice starts and finishes. However, it has been stressed that where outcomes have been less positive they are due to the failure of the health system and professionals within that system, to provide necessary support for CHWs.

"This can be solved by having a regulatory framework," said Frehywot. Task shifting can be a solution if scope of practice is defined, competence based models of education and practice are applied, recruitment is put into operation, regular performance appraisal is practiced, supervision and delegation is executed, and services and education accreditation are arranged.

Audience members also suggested a need for change in curricula. The change of curricula would go as far as reviewing the current carbon copy curriculum taken from the North and applied in the South; instead it would be based on needs assessment. Audience members also reiterated that task shifting was not really a solution because it takes one profession away, leaving "a gaping hole that needs to be filled." Other audience members differed and suggested that task shifting be viewed as not 'the' solution, but one among many: "part of the slate of solutions."

"It's one thing to say 'let's shift tasks'; it's another thing to say 'let's shift quality', quipped Frehywot. Therefore, a need for other quality solutions, designed for short-term, mid-term and long-term must be probed. Mr. Nyonator recommended development of a policy to increase intake and reduce barriers to professional practice, as an alternative quality solution instead of task shifting. "This can be achieved by redefining functions, reforms in staffing and refocusing on in-service training," he added.

With other solutions in mind, Mr. Benton framed the conclusion drawn by the audience and panellists: "Task shifting is not a total solution and must not replace the development of sustainable, fully functioning health care systems".

GHF2008 – PS18 – Human Ressources: Policies and Retention Strategies

Session Outline

Parallel session PS18, Tuesday, May 27 2008, 11:00-12:30, Room 15
Chair(s): Alexandre Bischoff, Division of International and Humanitarian Medicine, Department of Community Medicine and Primary Care, University Hospitals of Geneva, Switzerland, Naasson Munyandamutsa, Psychiatrist and Psychotherapist, Professor of Psychiatry in the National University of Rwanda, Rwanda
Job Satisfaction among Staff in a Rural Hospital in Burundi
Mit Philips, Analysis and Advocacy Unit, Médecins Sans Frontières, Operational Centre Brussels, Belgium
Alignment and Harmonization in Support of Health Research: Human Resources Development in Low and Middle Income Countries - the ‘AHA Study’
Sandrine Lo Jacono, Council on Health Research for Development, Switzerland 
Building a Framework for Strengthening Nursing Leadership in Tanzania
Petronella Joy Mwasandube Obe, Health and Diversity Performance Consultant, UK  

Session Documents

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Session Report

Submitted by: Emma Greenaway (ICVolunteers)

This session consisted of three key presentations that presented a range of challenges facing Human Resources in health care in different African countries, including low staff morale, recruitment and retention problems, illustrating the issues with specific case studies.

Job Satisfaction among Staff in a Rural Hospital in Burundi

Médecins Sans Frontières (MSF) is working in a very poor rural area of Burundi with the aim of improving access and quality of care and supporting the existing health infrastructure. Problems of low morale and thus performance and quality of care among both Ministry of Health (MoH) employees and staff employed through local health structure management (HSM) prompted the MSF to carry out a survey to identify both reasons for staff dissatisfaction and key solutions.

Motivation is affected by a range of factors which can vary depending on the terms of employment (MoH or HSM), levels of training or education, job status and geographical origin. Non-local members of staff with higher levels of training were found to be more likely to be dissatisfied or to leave their jobs. The survey highlighted the following as key issues affecting staff morale:

  • The absence of clearly defined job descriptions leading to lack of job satisfaction;
  • Poor living conditions and long distances to travel to work;
  • Low levels of remuneration and insufficient financial incentives to cover basic needs;
  • Working conditions, for example low staffing levels, poor treatment of staff and HR management, lack of safety or protection at work and poor working environment.

Some issues, such as housing, must be dealt with at national level. MSF have implemented the following actions:

  • Precise job descriptions for all staff;
  • Provision of protective equipment;
  • Staff (refresher) training;
  • Free health care for staff and direct family.

Due to a particular shortage, incentives to recruit and retain medical doctors include 'specialist' status for all and a significant increase in salary. Nursing staff benefit from increased performance-linked incentives.

Donor Alignment and Harmonisation in Relation to Health Research - Implications for Human Resources for Health Research (HR - HR) Retention

The objectives of this study being carried out by the Council on Health Research for Development (COHRED) are to assess the implementation of the Paris Declaration in the area of Human Resources for Health Research (HR - HR) as well as to gain a better understanding of national health research systems (NHRS) and donor funding strategies in specific donor and African countries.

This Donor Alignment and Harmonisation (AHA) study highlights that NHRS in the five African countries in question are not fully operational. HR - HR at country level is currently characterised by fragmentation, the absence of a defined agenda or operational research policies, limited government funding and a high dependence on external funding. Needs assessments have not been carried out and there is inequity in career development. Donor alignment and harmonisation in support for health research capacity has not yet been achieved. Implications of this include the fragmentation of HR-HR into donor areas of interest, lack of programme continuity, possible brain drain and increased costs. This will lead to problems for governments and institutions in building long-term HR-HR and retention strategies.

To move forward, countries now need to focus on developing the following: a needs assessment of research capacity, dialogue with donors for long-term partnerships, greater links between education and research and also between HR - HR and broader human resources for health initiatives.

Building a Framework for Strengthening Nursing Leadership and Nursing at Muhimbili Hospital

A partnership model between the UK health service and Tanzania is being developed to address the human resources crisis in health care and promote leadership in the nursing profession.

Nurses at Muhimbili Hospital face a range of challenges including staff and equipment shortages, high demand for hospital beds, lack of admission and care protocols and poor employment benefits. More generally, a chronic crisis in recruitment of health care professionals is leading to a serious shortage of nurses. A low professional profile and low levels of motivation, particularly in the public sector, are attracting nurses away to the private sector or abroad and few graduates are joining the profession.

In essence, moving forward depends on "bringing back the vibrancy and motivation" in nursing. Partnership working is essential for the implementation of an effective framework for recruiting and retaining health care staff. A training and professional development programme for nurses is a key priority and must focus on providing high quality pre-service and in-service training for all nursing staff and enabling nurses to share best practice. Skills gaps must be addressed and the right staff matched to the right jobs.

GHF2008 – PL04 – The Global Health Workforce: Challenges for the Future

Session Outline

Plenary session PL04, Tuesday, May 27 2008, 9:00-10:30, Room 2
Chair(s): Mireille Kingma, Consultant, International Council of Nurses, Switzerland, Jean-Dominique Vassalli, Rector, University of Geneva, Switzerland
Health Workers for All and All for Health Workers: From Commitment to Action
Mubashar R. Sheikh, Executive Director, Global Health Workforce Alliance, WHO, Switzerland 
The Medical Professionals of Tomorrow 
Richard Smith, Director, Ovations/National Heart, Lung and Blood Institute Chronic Diseases Initiative, UK 
Development of Hospitals in the 21st Century 
Per-Gunnar Svensson, Director General, International Hospital Federation, France 
Erasing the Boundaries: New Patterns in Nursing Care 
Deborah Ward, Associate Professor, School of Nursing, University of Washington, USA  

Session Documents

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Session Video

Session Report

Submitted by: Alessandra Sauven (ICVolunteers); Contributors: Janina M. Mank (ICVolunteers)

Photo © World Health Organization

Looking to the challenges of the future, participants reflected on the changing needs and demands of a global health workforce confronted with globalisation, climate change and an evolving perception of what healthcare entails. Integrating new technologies and the means through which to obtain and use funding and resources were just some of the challenges addressed by participants. All, however, focused on the need for a new approach, a new way of thinking, and a new way of acting to ensure that healthcare needs are met.

Dr. Mubashar R. Sheikh, Executive Director of the Global Health Workforce Alliance, stressed the need to tackle the severe shortage of health workers who act as "the cornerstones and drivers of health systems."  A shortfall of over 4 million health workers, along with huge disparities in health expenditure across the globe, has led to a growing crisis within the health sector. The Global Health Workforce Alliance (GHWA) was created in May 2006 as a common platform for joint action on the crisis. Dedicated to identifying and implementing solutions to the health workforce crisis the Alliance has a vision of access for all to a skilled, motivated and supported health worker as part of a functioning health system. In achieving this goal Dr Sheikh highlighted the importance of working as a team. The healthcare sector cannot tackle the problem alone but must instead work to build up partnerships with a wide range of stakeholders, including national governments, civil society, financial institutions and international agencies.

The Kampala declaration and agenda for global action signed by participants at the first Global Forum on Human Resources for Health in Kampala, 2-7 March 2008, represented a breakaway from traditional approaches and a move towards a new way of thinking and working, as well as a new way of using resources and funds. In particular, the declaration focused on the need to create a more enabling environment for health workers to ensure an effective, responsible and equitably distributed health workforce. There is increasing recognition of what must be done at both the global and country level. It is vital to join hands and work together to share issues and challenges, and to find common strategies and approaches. As Dr Sheikh points out, "we should all work for health workers because health workers are working for us".

Dr. Richard Smith, Co-Director of Ovation/NHLBI Chronic Disease Initiative, challenged the audience with his view of what the future of health, including its workforce and its skills as well as its institutions and their management, has in store for us. He introduced to this future- and solution-oriented session the idea of the self-educated patients' health and wellbeing rather than their diseases being at the core of prospective health care systems.

Having identified the shortages in today's heath care, Dr. Smith emphasized the need to meet upcoming challenges by addressing a 'new professionalism' amongst health workers: Thus, some of the health worker's skills will have to be managerial and technical, focusing on evidence, efficiency and the entire health system. This system should be one of prevention and should essentially embrace a broader approach on who to classify as health workers. Hence the need should be acknowledged for a 'real contract' which breaks down professional boundaries by recognizing the limits of doctors and by empowering nurses, as well as the patients' closer community, as potential drivers of health care. This is a future trend.

Professor Per-Gunnar Svensson, Director General of the International Hospital Federation, picked up on Dr. Mubashar's elaboration on the critical shortage of the global health workforce and related to this the prospective managerial challenges of complex institutions like hospitals. As future health care management will become more system-centred, experienced managers will have to be capable of dealing with the problems of the future such as globalization, climate change, an ageing society, tailor-made pharmaceuticals and integrative community care.  They will also have to cope with the international tendency towards privately funded solutions instead of public funding through, for example, taxation.

Professor Svensson's vision of hospitals of the 21st century is one of health promotion and integration, being IT engineered as well as partly privately funded. He recommended training specifically for hospital managers to meet future demands in health care and put forward the request for government regulation for cases in which private sources of funding, be they non-profit or for-profit, fail to cover disadvantaged components of the population.

Dr. Deborah Ward, of the University of Washington, Seattle, reinforced the need to reconsider roles and functions within the health workforce. She focused in particular on the need to recognise and expand the role of nurses who play a fundamental part in the health workforce and operate in a wide variety of healthcare settings. It is necessary, not only to ensure a change in the way we view the role of nurses, but also to adapt professional boundaries in order to activate and benefit fully from this change.

The session highlighted the need to consider anew the image and role of health workers, and to adapt skills and training accordingly. The increasing promotion of health, well being and prevention, in contrast to a more traditional 'diagnose and treat' perspective brings with it new challenges, and new opportunities to health care. In particular, participants focused on the need for integration, both within the health sector itself, and at a global level to work together to ensure a global health workforce capable of addressing the challenges and needs of a constantly changing world.

GHF2010 – PS40 – Health Workforce Distribution and Retention Strategies

Session Outline

Parallel session PS40, Monday, April 19 2010, 11:00-12:30, Room 14
Chair(s): Mireille Kingma, Consultant, Nursing and Health Policy, International Council of Nurses, Switzerland, Alexandre Bischoff, PhD in Epidemiology, Division of International and Humanitarian Medicine, Geneva University Hospitals, Switzerland
Understanding Health Care Worker Migration
Noreen Sugrue, Women and Gender in Global Perspectives, University of Illinois at Urbana-Champaign, USA
More Healthcare Providers: A Crisis in Armenia's Health System
Gohar Jerbashian, Department of Healthcare Practice, Cardno Emerging Markets, Armenia
Diaspora Health Professionals: Contributing to Health Systems Strengthening in Countries of Origin
Anna Basten, Migration Health Assistant in the Migration Health Department of the International Organization of Migration, Switzerland
Health Workers Retention: Spatial Analysis of Basic Services Using GIS Technologies
Benjamin Mayala, Health Statistics and IT, National Institute for Medical Research, United Republic of Tanzania

Session Document

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The Connecting Nurses Initiative



Author(s): Sylvie Coumel1
Affiliation(s): 1Stakeholder & Advocacy Strategy, Sanofi corporate, France
1st country of focus: NA
Additional countries of focus: US, Canada, France, UK, Morocco
Relevant to the conference theme: New roles and responsibilities of health personnel
Summary: The Connecting Nurses program is an initiative for nurses supported by Sanofi and developed in collaboration with Nurses Federations.  Its mission is to bring nurses together on-line and in the real world through the Care Challenge ( platform launched in May 2011.

This worldwide on line nursing recognition program’s ambition is to help turn caring ideas into reality: nurses from all countries are invited to showcase on line their creativity and their care solutions/practice innovations.
What challenges does your project address and why is it of importance?: Nurses are at the fore front of patient care in a wide range of areas but their role is key in chronic disease management and patient education while their role will expand and become even more important in the future.
How have you addressed these challenges? Do you see a solution?: Connecting Nurses will provide a web 2.0 collaborative platform for nurses from all around the world to share their ideas, advice and innovations. This network of shared knowledge and resources will equip nurses with the tools to advance their practices and inspire patients to become partners in their healthcare.

Care Challenge ( has been created to celebrate the immensely important role the nursing community plays in healthcare provision around the world, while addressing the challenges which arise within modern healthcare systems.
Care Challenge is part of the Connecting Nurses international initiative. It comes in the form of a contest, accessible from a dedicated website where nurses can submit their ideas, vote for or engage conversation about other nurses’ ideas.
Winners and awards
There are two categories in the recognition program, “Helping Hand” and “Nurse in the Limelight.” Taking into account various criteria, including but not limited to, a web-based vote, a jury will choose ten winners from each category. Ten winners in the “Helping Hand” category will receive 3,000 Euros to support their innovative projects’ continued success, and ten winners in the “Nurse in the Limelight” category will be prominently featured on the Care Challenge website with a professionally produced video of their innovations. The program is focused on identifying nursing innovations related to:
  • Education: Resources promoting patient self-management or raising community awareness of a disease
  • Practice: Nursing services, procedures, techniques or tools promoting patient self-management of disease or new ways to support families and caregivers.
  • Research: Studies of outcomes of innovative approaches to nursing, patient care, and patient education.
The program will bring a range of other benefits to nurses such as improving recognition of the nursing community by giving them a stronger voice. Indeed, it will support dialogue within the nursing community by creating networking opportunities at a national and international level. Helping to share knowledge on nursing techniques will enhance education, research and practice as well as the care of patients.
The Care Challenge unique nursing community enables members to share information and education with others in the field and nominate colleagues for an award in nursing excellence. This recognition program is open to licensed nurses anywhere in the world. There will be a total of 20 awards for the best ideas, which will support an incredible opportunity to develop the initiatives further and give them international recognition.
How do you know whether you have made a difference?: Among the internet nurses landscape worldwide we have found no equivalent of Care Challenge as a unique repository of nursing innovation, allowing on line cross-continent share knowledge.
Have you or the project mobilized others and if so, who, why and how?: The Connecting Nurses Initiative has been developed in partnership with Nurses Organizations:  Care Challenge is part of the Connecting Nurses program, which was developed by Sanofi in partnership with the Nurse Practitioner Healthcare Foundation (NPHF), International Council of Nurses (ICN), the Secrétariat International Des Infirmières et Infirmiers de l'Espace Francophone (SIDIIEF), and the Association Française pour le Développement de l'Education Thérapeutique (AFDET).
When your donor funding runs out how will your ideas continue to live? NA

Health Professionals for a New Century: A Proposal for Implementation

First: Lenias
Last: Hwenda
Name your project or intiative: Health professionals for a new century: A Proposal for Implementation
1st country of focus: International
Relevant to the conference theme: Health governance
Summary: Factors contributing to the on-going global health workforce crisis include the globalisation of the labour markets. 'Pull' factors, including targeted recruitment efforts from wealthy destination states, combine with 'push factors' in source countries, such as low wages and unsafe working environments to exacerbate acute health workforce shortages. Ageing populations and a growing demand for chronic care are driving up demand for health workers globally whilst global under investment in health professional education is limiting the supply of health professionals. Furthermore, health professional education has not evolved to meet the health challenges of the 21st century. This has generated disparities between population health needs and health professional education.  Despite health professionals being the backbone of well-functioning health systems, total global expenditure on their education represents a meagre ~US$1billion, 1.8% of total global expenditure on health. A global analysis of health professional education by Julio Frenk et al commissioned by the Lancet concluded that health professional education in the 21st century is out-dated, produces health professional who are poorly-equipped to meet the heath population needs of the communities they serve and therefore needs reform. This presentation considers some of the inadequacies of health professional education today, based on the study by Frenk et al. and discusses whether the WHO Global Code of Practice on the International recruitment of Health Personnel could provide an international legal framework for implementing health professional education reforms needed to generate a 21st century health workforce.
What challenges does your project address and why is it of importance?: The inadequacies of health professional education in meeting the population health needs of the 21st century. It considers how the proposed reforms in health professional education can be implemented global using existing international legal frameworks. It is important to understanding how global health professional education could be reformed through international cooperation.
How have you addressed these challenges? Do you see a solution?: I have made a proposal of a possible framework for implementation and delineated how this framework might work and why it would be useful in implementing the necessary reforms.
How do you know whether you have made a difference?: So far, there has been a proposal for health professional education reform but no existing framework of how these reforms can be implemented. Therefore, my proposal fills a gap that exists towards putting solutions into practice.
Have you or the project mobilized others and if so, who, why and how?: This idea has been discussed by other health professionals at the 125h anniversary of the Norwegian Medical Association as well as amongst other health diplomats in Geneva. The ideal was proposed because putting the reforms into practice requires a international legal framework and highlights how this can be done within existing frameworks.
When your donor funding runs out how will your idea continue to live?: This idea is not donor funded since it is being explored within the context of multilateral health discussions which are ongoing.