Advancing the healthworkforce agenda within universal health coverage

The Global Health Workforce AllianceStrategy 2013 - 2016

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The Global Health Workforce Alliance (The Alliance) has played a catalytic role to address the challenges related to the shortage, maldistribution, migration and the inadequate working environment of health workers, since its inception in 2006. At the close of its first phase (2006 – 2011) the Alliance stands as an established name among those engaged with the human resources for health (HRH) crisis. It has lived up to its mandate as a global convenor for mobilizing worldwide attention to the crisis and generating political will and action for positive change.

Created as a common platform for action to address the health workforce crisis, The Alliance is a partnership of national governments, civil society, international agencies, finance institutions, researchers, educators and professional associations with a vision that “all people everywhere will have access to a skilled, motivated and supported health worker, within a robust health system.” Its mission, while preserving the original core functions, has been adapted to the new environment in which it operates: “to advocate and catalyse country and global actions to address human resources for health challenges, contributing towards and beyond the health-related Millennium Development Goals and for universal health coverage.”

A recent independent external evaluation1 found that the Alliance Secretariat’s work in 2006–2011 represented “good value for money” provided an opportunity for the Alliance Board to review the current situation and revise its strategies to overcome the health workforce challenges that lie ahead. In light of an evolving global health and development landscape and with continued gaps in the production, deployment and support to health workers, the Alliance is realigning its focus for its second phase (2013 – 2016), ensuring its relevance to influence a constantly adapting HRH agenda.

1 http://www.who.int/workforcealliance/media/news/2012/eeBoardChairLetter/en/index.html1

The unfinished HRH agenda

• There is uneven progress across and within countries in addressing shortage;

• Training capacities for health workers are inadequate and the potential for innovative skills mix approaches under-exploited;

• Countries have not yet developed or fully implemented their health workforce strategies;

• Information on health workers’ availability, distribution and performance,is incomplete;

• political attention has only partly been translated into revised policies and additional resources for HRH;

• The role of the private sector and its potential positive contribution remains untapped;

• Addressing the specific needs of fragile states and vulnerable population groups remains a challenge.

AcHievemenTS foR THe AlliAnce And iTS membeRS 2006 – 2011

Significant achievements of the Alliance, at the level of its members and partners as well as the Secretariat, include global breakthroughs as well as progress in specific countries. Select examples are highlighted below.

• HRH mainstreamed into the health policy and development discourse. For example, NCDs, HIV/AIDS;

• HRH-specific language and targets included in the UN Global Strategy for Women’s and Children’s health countries;

• Two global forums on human resources for health, organized in collaboration with Alliance members and partners;

• Regional Alliance-supported conferences (Asia Pacific Action Alliance for Human Resources for Health; African platform on Human Resources for Health), provided a platform for policy dialogue among countries;

• Thematic task forces convened by the Alliance led to ground-breaking knowledge products on health workforce development;

• Collaborative platforms at the national level strengthened through the Country Coordination and Facilitation (CCF) approach;

• Norway and Thailand spearheaded efforts for the development and adoption of the WHO Global Code of practice on International Recruitment of Health personnel in 2010;

• Adoption of a resolution on the Global Code of practice on the International Recruitment of Health personnel;

• Members of the World Health professions Alliance (WHpA), improved working conditions for health professionals through the positive practice Environment campaign;

• The Governments of Japan, Italy and France led the G8 commitments in 2008, 2009 and 2011 respectively to support HRH development.

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advancing and refining the human resources for health agenda in the dynamic health development landscape”

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THe new pHASe of THe AlliAnce (2013–2016)

The Alliance, building on the widespread commitment to HRH that it helped generate, will remain an influential and credible coalition of players, anticipating, responding to and monitoring key developments and challenges in the evolving HRH environment. The Alliance is firmly committed to achieving greater results, fulfilling its mandate and strengthening its operations. The second phase of the Alliance (2013–2016) will be characterized by:

• transformed strategic objectives with prioritization of high value-added areas of work where the Alliance has comparative strength;

• greater emphasis on results, with improved clarity on the specific roles of members, partners, regional and global networks, and countries, along with its own governing structures (Board and Secretariat); and

• an enhanced partnership model, with a progressive shift of responsibility for activities to members and partners, and the facilitating role of the Secretariat.

Ultimately, the desired results of the Alliance relate to greater access to, and improved performance of, the health workforce in countries as a critical and integral element of health systems strengthening and universal health coverage goals.

objecTiveS

The Alliance will achieve this through three core objectives:

1. Enabling solutions: promote the adoption of coherent policies and investment decisions through advocacy to strategic constituencies and by stewarding a global HRH agenda. The Alliance will be an inclusive HRH hub, open to contributions from each of its members and other constituencies, and where policy dialogue and advocacy initiatives of a strategic nature can converge or originate.

2. Catalysing actions: Foster interaction for more effective HRH coordination, policy dialogue and actions across different sectors and constituencies in society, including government and private sector, civil society and professional associations.

3. Ensuring results and accountability: Monitor and report on HRH developments and commitments through a process of accountability underpinned by cutting-edge intelligence and analysis. The accountability process will establish linkages, as relevant, with other monitoring and accountability frameworks, including those of the UN Global Strategy for Women’s and Children’s Health and the WHO Global Code of practice on International Recruitment of Health.

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deliveRAbleS

The Strategy differentiates between Alliance-wide achievements, to which members, partners and countries contribute according to their respective roles and mandates, and the specific results expected from the Secretariat.

EnablIng solutIons

alliance wide Secretariat specific

• Global consensus adopted on HRH strategies and priorities in the post-MDG agenda and for universal health coverage.

• HRH-specific actions and commitments included in political declarations and investment decisions.

• Increased volumes and improved quality of HRH investments achieved, by both domestic and international sources.

• Regular HRH consultations by regional, sub-regional networks and inter-governmental organizations.

• The HRH crisis recognized as a global issue, with limited to 57 crisis countries.

• HRH mainstreamed in proceedings, political declarations and commitments of key global and regional health and development events.

• Thematic issue papers on key HRH topics published and yearly campaigns undertaken.

• Intelligence and information on HRH policy dialogue opportunitie gathered and disseminated.

• Two global forums on HRH successfully organized.

• Advocacy support and materials made available to members and partners.

empowering members and partners with increased leadership, responsibility and ownership”

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influencing political and policy choices

through sharing and uptake of evidence

and best practices on HRH coordination,

policy, planning and innovation”

CatalysIng aCtIons

alliance wide Secretariat specific

• Increased uptake and implementation of HRH policy options of proven effectiveness in countries.

• HRH coordination strengthened, policy dialogue facilitated, costed HRH strategies and plans developed and implemented as an integral component of national health strategies, enabled as appropriate by applying country coordination and facilitation principles.

• Financial and technical support provided to improve HRH training, deployment, retention, distribution and performance, contributing to saving millions of lives through improved coverage with essential health services.

• Catalytic support extended to HRH coordination and facilitation as an integral part of national health policy dialogue and planning processes.

• HRH coalitions supported in priority countries to strengthen capacity at national level.

• HRH framed as an intersectoral priority, including through labour market analyses in selected countries.

• Best practices of HRH coordination, policy, planning and innovative approaches, including on the WHO Code implementation, documented and disseminated.

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translating commitments into synergistic inter-sectoral actions in countries through high-level advocacy, and strengthened accountability mechanisms”

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PromotIng rEsults and aCCountabIlIty

alliance wide Secretariat specific

• Credible evidence and strategic intelligence available on HRH availability, distribution and flow in HRH priority countries.

• Information available on international HRH investment flows, and results of priority global HRH initiatives and programmes promoted by development partners and agencies.

• Consensus achieved on a set of benchmarks for HRH development and monitoring.

• Advocacy successfully conducted based on analyses demonstrating impact of HRH investment on lives saved, improved population health and socioeconomic development.

• Two “State of the World’s HRH” reports developed and disseminated at the HRH Global Forums.

• Commitment to results and acceptance of a global process of accountability advocated.

• Results on HRH actions and ongoing commitments under review to address gaps.

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An enHAnced pARTneRSHip model

A key principle of 2013–2016 activities will be to galvanize and harness the power and capacity of Alliance members, partners and relevant stakeholders, including those with presence in countries, to work in alignment in achieving the three common objectives. Salient features of this model include:

• A progressive shift of responsibility for activities to members, with increased ownership, participation and contribution.

• Awards, as well as official recognition of Alliance “implementers” and “advocates” will be used to encourage, reinforce and acknowledge outstanding successes at both the institutional and individual levels.

• A new membership e-platform has been introduced to improve communication with members. Online technologies will be used to enable Alliance members and partners to share and map information on global and country activities to achieve the agreed results.

• Strengthened collaboration with WHO will continue to promote opportunities for greater synergy in the respective mandates and actions.

• Alliance governance structures, including the Secretariat will focus on their catalytic and enabling role.

actioning a partnership model that promotes and enables greater engagement, coordination and alignment of members, partners and other stakeholders”

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complementarity with wHo

This Strategy fully recognizes that WHO provides the organizational location for the Alliance, that WHO’s functions include supporting ministries of health, and that there is scope for improving the partnership between the Alliance and WHO. Accordingly, collaboration with WHO will continue to be improved, strengthened and consolidated to exploit and promote opportunities for greater synergy in the respective mandates and actions. Intensified dialogue on thematic priorities of joint interest will continue, resulting in mutual benefits, including on implementa tion of the WHO Global Code of practice on the International Recruitment of Health personnel, HRH training and retention, and HRH aspects of the MDG agenda and the NCD response. WHO, as a permanent member of the Alliance Board, will use the opportunity to flag areas that require coordi nation, through review and endorsement of Alliance strategic documents.

Key cHAngeS fRom THe fiRST To THe Second pHASe of THe AlliAnce

Phase 1 (2006–2012) Phase 2 (2013–2016)Overall framework: KD-AGA as part of MDG agenda

Overall framework: responsive to new challenges, environment and players

Develop new agenda as part of universal health coverage and post-MDG framework

Advocacy primarily aimed at health sector audience

Advocacy increasingly focused on intersectoral action and higher political level

Emphasis on development of new knowledge products through task forces

Greater emphasis on uptake and use of existing and emerging knowledge through advocacy and sharing

No explicit strategy available to facilitate country actions

CCF principles applied, based on country demand, and adapted for stronger linkages with the health systems strengthening agenda

Focus on 57 HRH crisis countries Framing the HRH crisis as a global issue for all countries and focusing on the 75 countries of the UN Global Strategy for Women’s and Children’s Health

First (basic) attempt to monitor KD-AGA progress in 2011

Evidence-based and results-oriented monitoring of wider HRH development for increased accountability

Diffuse responsibilities within the Alliance and process-oriented approach

Clarity in roles of Alliance governance structures, members and partners for greater results

5 objectives, 46 indicators 3 objectives, 24 expected results

Members and partners involved in some initiatives

Systematic empowerment and engagement of members to drive forward HRH agenda

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A vision of success in 2016

In 2016 the Alliance will collectively consider its mission accomplished if the following results are achieved:

• Commitments to train, deploy and retain at least an additional 2.6 million health workers, in support of the United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health and universal health coverage, are delivered and being implemented;

• Evidence-based quality HRH plans, developed through inclusive mechanisms of coordination among HRH stakeholders, are integrated within national health strategies and implemented in at least 75% of the Alliance’s priority countries;

• A new, equitable, long-term vision for HRH, that seeks to eliminate avoidable morbidity and mortality and promote well-being, is firmly embedded in the post-2015 development agenda;

• Accountability for HRH results is ensured as an integral part of existing health governance and monitoring platforms; and

• HRH stakeholders mobilized to take proactive roles in support of national HRH development priorities within a health systems strengthening.

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launch ceremony of the Alliance strategy. Tunis, july 2012

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For further information, please contact: Global Health Workforce Alliance World Health OrganizationAvenue Appia 20CH-1211 Geneva 27SwitzerlandTel: +41 -22- 791 26 21 Fax: +41 - 22 791 48 41Email: ghwa@who.intwww.who.int/workforcealliance

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