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Strategy 2013 – 2016 ADVANCING THE HEALTH WORKFORCE AGENDA

WITHIN UNIVERSAL HEALTH COVERAGE

The Global Health Workforce Alliance

Abbreviations and acronyms

Alliance GlobalHealthWorkforceAllianceAMREF AfricanMedicalandResearchFoundationCCF CountryCoordinationandFacilitationDFID UnitedKingdomDepartmentforInternationalDevelopmentHBCI HighBurdenCountriesInitiativeHHA HarmonizingHealthinAfricaHRH humanresourcesforhealthICPD InternationalConferenceonPopulationandDevelopmentIHP+ InternationalHealthPartnershipandrelatedinitiativesKD-AGA KampalaDeclarationandtheAgendaforGlobalActionMDG MillenniumDevelopmentGoalNCD noncommunicablediseasePEPFAR UnitedStatesPresident’sEmergencyPlanforAIDSReliefSWAps sector-wideapproachesUNAIDS JointUnitedNationsProgrammeonHIV/AIDSUZIMA Kiswahiliwordfortheabundantlife–isayouthempowermentNGOUSAID UnitedStatesAgencyforInternationalDevelopmentWHO WorldHealthOrganizationWHPA WorldHealthProfessionsAllianceWHR WorldHealthReport

WHO/HSS/HWA/Strategy2013-2016/ENG

© World Health Organization

(acting as the host organization for, and secretariat of, the Global Health Workforce Alliance), 2012

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Contents

Preface 4

1. Introduction 6

2. Thenewphaseofthealliance(2013-2016) 7

3. Objectivesanddeliverables 9

4. Enhancingthepartnershipmodel 16

5. Anewapproach 19

ListofAnnexes

1 ThefirstphaseoftheAlliance 21

2 Keyachievementsofcountries,members, 22 partnersandAllianceSecretariat(2006-2012)

3 TheunfinishedHRHagendainanevolving 24 globalhealthanddevelopmentlandscape

4 AlearningAlliance 26

5 Coordinatingandfacilitatingcountry 27 HRHpolicydialogue

6 Definitionofroles 29

7 Strengthenedgovernanceof 31 Alliancestructures

The Global Health Workforce Alliance (the‘Alliance’)waslaunchedin2006asaresponseto the global human resources for health(HRH)crisis.Itsaddedvalueisitsmandatetosupport, convene and harness the capacitiesof its global partners and members, workingacrossthemultipledimensionsofHRHinthehealth,education,financeandlaboursectors.This has enabled a stronger, multi-sectoralfocusonHRHwithintheglobalhealthagenda.At theheartof theAlliance is thevision that“all people everywhere will have access to a skilled, motivated and supported health worker, within a robust health system”.

TheAllianceplaysacatalyticrole,addressingthespecificandsharedchallenges inHRHatnational,regionalandgloballevels,including:shortages, inequitable distribution, labourmobility and migration, and the working andliving environments of health workers. Anindependent external evaluation of the Alli-ance operations in 2006-11 was published in2012. It documented the collective achieve-ments, highlighted some areas in need ofimprovement, and found that the results initsfirstfiveyearsrepresentedgoodvalueformoney. The Alliance Board has attentivelyexamined the independent report, tookaccountofitsfindings,andnotedtheprogressregistered as evidence of the multi-sectoralHRHmomentumthatnowexists.

HRH challenges yet persist. Greater col-laboration, outputs and results are requiredto achieve the vision of the Alliance and indoingsoaddressthemostcriticalbottleneckin the attainment of the health Millennium

Development Goals (MDGs) and universalhealth coverage. Moreover, a rapidly evolv-ing global health and development contextdemands revitalised attention, strategicintelligenceandrenewedactiononHRH.Thechallenge is toaddress thepastandpresentgaps while simultaneously anticipating anddeliveringthetransformativeactionsrequiredforthefuture.

Themembers,partners,BoardandSecretariatoftheAlliancehavetakenaccountofthiscon-textindevelopingits2013-2016strategy.Thisrecognisesthatitsimplementationwillunfoldinaperiodofcompetingattentionforpoliticalcapital and resources, extraordinary changesinthesupplyanddemandforhealthcare,andan evolving discourse for global health anddevelopment in the post-2015 agenda. Keypillarsinthenewstrategyincludeafocusonaccountability for results and an enhancedpartnershipmodelthatmutlipliesthecapaci-ties of its individual members as a collectiveenterprise.Bothwilllendsupporttocountries’effortsatstrengtheningtheirhealthworkforceandachievingimprovedhealthoutcomes.

TheAlliancewillconsideritsstrategyfor2013-2016anditscurrentmandateto2016accom-plishedifthefollowingresultsareachieved:> commitmentstotrain,deployandretain

atleastanadditional2.6millionhealthworkers,insupportoftheUnitedNationsSecretary-General’sGlobal Strategy for Women’s and Children’s Healthanduni-versalhealthcoverage,aredeliveredandbeingimplemented;

Preface

4

> evidence-basedqualityHRHplans,devel-opedthroughinclusivemechanismsofcoordinationamongHRHstakeholders,areintegratedwithinnationalhealthstrate-giesandimplementedinatleast75%oftheAlliance’sprioritycountries;

> anew,equitable,long-termvisionforHRH,thatseekstoeliminateavoidablemorbid-ityandmortalityandpromotewell-being,isfirmlyembeddedinthepost-2015devel-opmentagenda;

> accountabilityforHRHresultsisensuredasanintegralpartofexistinghealthgov-ernanceandmonitoringplatforms;and

> HRHstakeholdersmobilizedtotakeproac-tiverolesinsupportofnationalHRHdevel-opmentprioritieswithinahealthsystemsstrengtheningframework.

The Board invites members, partners andother HRH stakeholders to commit to thisvisionandsupport thesuccessful implemen-tationoftheAlliancestrategyinthenextfouryears. Achieving these results and ensuringthatall peoplehaveaccesstoahealthworkerisourcollectiveresponsibility.

Dr Masato Mugitani, Chair of the Board

Alliance Board• ProfErnestAryeetey,UniversityofGhana• DrCristianBaezaWorldBank• DrKazemBehbehani,Kuwait• MsCatherineBonnaud,France• ProfEricBuch,UniversityofPretoria• DrFranciscodeCampos,Brazil• MsSusanChandler,DFID• MsFrancesDay-Stirk,InternationalCon-

federationofMidwives• DrCarissaEtienne,WHO,Geneva• DrBjarneGarden,Norway• AmbEricGoosby,PEPFAR• ProfSamuelKingue,Cameroon

Dr Mubashar Sheikh, Executive Director

• DrOtmarKloiber,WorldHealthProfessionsAlliance

• DrJinfengLiu,China• DrCarolynMiller,Merlin,UK• DrSrinathReddy,PublicHealthFoundation

India• DrGeorgeShakarishvili,GlobalFundto

FightAIDS,TuberculosisandMalaria• DrAgnesSoucat,AfricanDevelopment

Bank• DrDavidWeakliam,IrishAid• ProfMiriamWere,UZIMAFoundation,

Kenya

Strategy 2013 – 2016 ADVANCING THE HEALTH WORKFORCE AGENDA WITHIN UNIVERSAL HEALTH COVERAGE

5

Introduction

6

The Global Health Workforce Alliance (theAlliance)was launched in2006toserveasacommon platform for human resources forhealth (HRH) practitioners, stakeholders andadvocates to collaborate in addressing theglobalandmulti-facetedHRHcrisis(Annex 1).

In its first phase (2006–2012) the Allianceactively contributed to an HRH movement inlinewithitspurposeofspurringa“DecadeofAction” in this neglected key component ofhealthsystems.Duringthisperiod,collectiveactivities and inputs resulted in significantprogress for health workforce development(Annex 2).

In March 2008 the Alliance Secretariatconvened the First Global Forum on HumanResources for Health, which resulted in theadoption of the Kampala Declaration andAgenda for Global Action (KD-AGA); this hasbecome an overarching framework of refer-ence for HRH development at all levels. TheSecondGlobalForumonHumanResourcesforHealth, held in Bangkok,Thailand in January2011, provided an opportunity to reconvenetheglobalHRHcommunitytoreviewprogresssince the First Global Forum, and renew themomentum and commitment to health work-force development and the principles andstrategiesoftheKD-AGA.

Asaresultoftheseefforts,national,regionalandgloballeadershipnowrecognizethecriti-calimportanceofinvestinginanddevelopinga

supportedhealthworkforcetoimprovehealthoutcomes. These gains are, however, vulner-able: without sustained effort, the increasedrecognition of HRH risks being diluted tojust another element of the health systemsstrengtheningagenda.

Indeed,theHRHcrisisisstillanacutelylimit-ing factor in countries’ attempts to reducematernalandchildmortality,tocontrolpriorityinfectious and non-communicable diseases,and to attain the broader target of universalhealth coverage. This is due to a persistinggapsinfinancingandsupportforthetrainingand deployment of health workers. Address-ing these challenges and ensuring that theAlliance remains relevant to and influencesthe evolving global health and developmentlandscape(Annex 3)areprioritiesof itsgov-erningBoard,membersandpartners.

Anindependentexternalevaluationfoundthatthe Alliance Secretariat’s work in 2006–2011represented“goodvalueformoney”,comple-menting the findings of earlier assessmentsand analyses. The evaluation enabled theAllianceBoardtoreviewthecurrentsituation,assess progress and revise its strategies toovercome the health workforce challengesthatlieahead(Annex 4).

The Alliance is firmly committed to achiev-inggreater results, fulfilling itsmandateandstrengtheningitsoperations.

1

Thenewphaseofthealliance(2013-2016)

7

InthecontextofthecomplexandunfinishedHRHagenda,anuncertainglobaldevelopmentscenario, a crowded health landscape andstagnatingresourcesforhealth,itisimperativethat the Alliance retains its leadership posi-tion,remainsresponsiveandconcentratesitseffortsonthepriorityhealthworkforceactionswhereithasacomparativeadvantage.

TheAlliance’svisionremainsthat“all people everywhere will have access to a skilled, moti-vated and supported health worker, within a robust health system”. While preservingthe original core functions1, the Alliance hasadapteditsmissiontothenewenvironmentinwhich itoperates:“to advocate and catalyse country and global actions to address human resources for health challenges, contributing towards and beyond the health-related Mil-lennium Development Goals and for universal health coverage.”

TheAlliancewillremainaninfluentialandcred-iblecoalitionofplayers,anticipating,respond-ingtoandmonitoringkeydevelopmentsandchallenges in theevolvingHRHenvironment.Recognizingtheimportanceofbuildingonitsachievements so far, and realigning its focustorespondtothechanginggloballandscape,thesecondphaseoftheAlliance(2013–2016)willbecharacterizedby:

> transformedstrategicobjectiveswithprioritizationofhighvalue-addedareasofworkwheretheAlliancehascomparativestrength;

> greateremphasisonresults,withimprovedclarityonthespecificrolesof

members,partners,regionalandglobalnetworks,andcountries,alongwithitsowngoverningstructures(BoardandSecretariat);and

> anenhancedpartnershipmodel,withaprogressiveshiftofresponsibilityforactivitiestomembersandpartners,andthefacilitatingroleoftheSecretariat.

While many have contributed to addressingtheHRHcrisis,theextentofprogressrealizedthusfarwouldnothavebeenachieved if theAlliance had not existed. Similarly, achievingthe ambitious vision of change in HRH by2016(Box 1)willrequiregreatersynergyandactionbyallstakeholders. Indeed,deliveringthis vision will only be possible through col-lectiveeffortsinsupportofcountryactionstostrengthentheirhealthworkforceandtherebyto enhance integrated health systems devel-opment. The role of the Alliance governancestructures will be to catalyse and foster anenabling environment for these actions. TheAlliance Secretariat will support the achieve-ment of this vision through the functions ofadvocacy, brokering knowledge, and conven-ingpartnerstopromotesynergies.

TheAlliancewasestablishedwithanoriginal10-yeartimeframe.ThisStrategycoversactivi-tiestoachieveitsmandateduring2013–2016,andservesasafoundationforanexitstrategy,envisaging a progressive transition of func-tions that should continue beyond this timeframe to its members and partners, unlessotherwisedecidedbytheBoard.

1 Advocacy,brokeringknowledge,convening.

2


8

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 framework.

Box 1

Objectivesanddeliverables

3

9

Ultimately,thedesiredresultsoftheAlliancerelatetogreateraccessto,andimprovedper-formanceof,thehealthworkforceincountriesas a critical and integral element of healthsystems strengthening and universal healthcoveragegoals.TheAlliancewillachievethisbyprovidinganenablingenvironmenttomobi-lizeglobal,regionalandnationalleadershiptoadoptandinvestinthemostappropriateandeffective policy options for health workforcedevelopment, in collaboration with relevantdomestic stakeholders and the internationalcommunity,throughthreecoreobjectives:

1. Enabling solutions: Promotetheadop-tionofcoherentpoliciesandinvestmentdecisionsthroughadvocacytostrategicconstituenciesandbystewardingaglobalHRHagenda.

2. Catalysing actions: FosterinteractionformoreeffectiveHRHcoordination,policydialogueandactionsacrossdifferentsec-torsandconstituenciesinsociety,includ-inggovernmentandprivatesector,civilsocietyandprofessionalassociations.

3. Ensuring results and accountability: MonitorandreportonHRHdevelopmentsandcommitmentsthroughaprocessofaccountabilityunderpinnedbycutting-edgeintelligenceandanalysis.

3.1 Enabling solutions

Advocacy, communication and sensitizationactivities will be undertaken to promote theadoptionofpoliciesandinvestmentdecisionsthat are coherent with the universal healthcoveragegoalanditsHRHneeds.Theseactivi-tieswilltargetstrategicconstituencies,acrossandwithinsectors,andincreasinglyaimatthehigher political levels. A key priority in thiscontext will be to broker global consensuson appropriate HRH strategies and prioritiesin the evolving development discourse andensurethattheyareembeddedwithintheuni-versalhealthcoverageandpost-MDGagenda.

The Alliance will be an inclusive HRH hub,open to contributions from each of its mem-bers and other constituencies, and wherepolicy dialogue and advocacy initiatives of astrategicnaturecanconvergeororiginate. InadditiontothedirectinvolvementoftheBoardandtheSecretariat,thelatterwillgatheranddisseminate strategic information on globalHRH developments, and flag opportunitiesforpolicydialoguetomembersandpartners,enablingthemtobeinfluentialadvocates.

Inordertobeeffective,theAllianceadvocacywilltargettherightaudiences,usingappropri-ateforumsandrelevantchannelsanddeliverymechanisms(Table 1).

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. The Secretariat’s annual workplans will detail its expected results, and its human and financial resource requirements will be determined accordingly.


10

National level Regional level Global level

Key partners

to engage

HeadsofstateHeadsofgovernmentMinistriesofhealth,finance,education,labourNationalparliamentsPrivatesector

AfricanUnionASEANUNASUREuropeanCommission

OECDdonorsWB,IMFGlobalFundGAVIAllianceUNSecretary-GeneralPrivatesectornetworks

Forums CabinetmeetingsAnnualhealthsectorreviewsHRHcoordinationcommitteemeetings(CCFapproach)NationalHRHconferenceadvocacyeventsNationalHRHobservatories

Regionalandsub-regionalconferencesRegionalHRHobservatories

WorldHealthAssemblyUNGeneralAssemblyG20,G8,HRHglobalforumsWB-IMFjointmeetingsCHOGM

Actors

delivering

advocacy

messaging

CoalitionsofAlliancemembersHealthWorkforceAdvocacyInitiative,othercivilsocietyandprivatesectororganiza-tionswithcountrypresence

AlliancememberswithregionalfocussuchasAfricanPlatformonHRH,AAAH

AllianceSecretariatandBoardmembersAlliancemembersandpartnersHealthWorkforceAdvo-cacyInitiative

AAAH,Asia-PacificActionAllianceonHumanResourcesforHealth;ASEAN,AssociationofSoutheastAsianNations;CCF,CountryCoordinationandFacilitation;G8,aforumforthegovernmentsofeightoftheworld‘slargestecono-mies;G20,GroupofTwentyFinanceMinistersandCentralBankGovernors;GlobalFund,GlobalFundtoFightAIDS,TuberculosisandMalaria;HRH,humanresourcesforhealth;IMF,InternationalMonetaryFund;OECD,OrganizationforEconomicCo-operationandDevelopment;UN,UnitedNations;UNASUR,UnionofSouthAmericanNations;WB,WorldBank;CHOGM:CommonwealthHeadsofGovernmentMeeting.

Table1

High-level advocacy approach for greater investment in HRH

However,theidentificationofopportunitiesforpolicydialogueandadvocacydoesnot implythat engagement is limited to these events

only;rather it illustratesthetypeofpartnerswithwhomtheAllianceneedstoengage.


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Expected results

Alliance-wide: > Globalconsensusadoptedonappropri-

ateHRHstrategiesandprioritiesinthepost-MDGagendaandforuniversalhealthcoverage.

> HRH-specificactionsandcommitmentsincludedinpoliticaldeclarationsandinvestmentdecisions.

> Increasedvolumesandimprovedqual-ityofHRHinvestmentsachieved,bybothdomesticandinternationalsources.

> RegularHRHconsultationsconvenedbyregional,sub-regionalnetworksandinter-governmentalorganizations.

Secretariat-specific:> TheHRHcrisisrecognizedasaglobal

issue,andnotlimitedto57crisiscountries.

> HRHmainstreamedinproceedings,politi-caldeclarationsandcommitmentsofkeyglobalandregionalhealthanddevelop-mentevents.

> ThematicissuepapersonkeyHRHtop-icspublishedandyearlycampaignsundertaken.

> IntelligenceandinformationonHRHpolicydialogueopportunitiesgatheredanddisseminated.

> TwoglobalforumsonHRHsuccessfullyorganized.

> Advocacysupportandmaterialsmadeavailabletomembersandpartners.

3.2 Catalysing actions

TheAllianceSecretariatwillfosterinteractionfor more effective HRH coordination, policydialogue and actions across different sec-tors, constituencies and stakeholder groupsin countries, embedded within an integratedhealthsystemsstrengtheningapproach.

In the last three years the Secretariat hasexpandeditsfocusoncountriesbydevelopinganapproachandasetofprinciplestoprovidecatalyticsupporttonationalhealthworkforcecoordination and development processes,called Country Coordination and Facilitation(CCF).This includesadvocacy formore inclu-sive coordination and planning processes,provision of backstopping and facilitationof support by partners with the requisitecapacity, and demand-driven seed fundingbasedoncountryrequests.Thisapproachwasconsideredeffectivebymultipleindependentevaluationsinfosteringcollaboration,catalys-ing policy dialogue, and planning and actionbynationalstakeholders.

Moving forward, this experience will befurther improved and refined, so that HRHcoordinationandplanningprocessesbecomeanintegralpartofthewidernational(health)policy dialogue, are embedded in existingmechanismsandaredriventhroughmembersandpartnerswithalocalpresence,includingWHOcountryoffices.

Attheheartofcountrycoordinationandfacili-tationiscountryownershipofabroadframe-workofprinciplesandactionstobeadaptedtocountrycircumstancesandnationalhealthpolicies, and not a blueprint of prescribedactivities.

In essence, the principle of creating a spacefor interaction and for more effective HRHcoordination and policy dialogue will beretained,buttheapproachwillbestreamlined(Annex 5), with Alliance partners providingdirectcountrysupportwhereverpossible,andtheSecretariatfacilitatingtheirwork.

ComplementarityandstrategicalignmentwithWHOwillalsobehighlightedandmoreclearlycommunicated.Inparticularthefacilitationof


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Principles underpinning country coordination and facilitation processes for HRH development

> Promote the centrality of an HRH committee to bring together all stakeholders, harness more effectively their contributions, and build coherence, coordination and national relevance of their actions, without duplicating existing structures.

> Identify the comparative advantages of the various HRH stakeholders and facilitate collaboration for health systems strengthening around a single national health plan.

> Facilitate the environment for the engagement and development of linkages among programmes with HRH implications.

> Integrate HRH coordination in health systems strengthening mechanisms, such as sector-wide approaches (SWAps), Harmonizing Health in Africa (HHA) and the agreements established under the International Health Partnership (IHP+2) umbrella, implementing the Paris principles on aid effectiveness.

Box 2

HRHpolicydialoguewillbepursuedasacom-ponentofwiderhealthsectorstrategies,andlinked to health coordination processes andmechanismssuchastheIHP+andSWAPs,toensurethecompleteintegrationofHRHdevel-opment within the national health systemsstrengtheningagenda.

TheAlliancerecognizesthegreatpotentialofdeeper collaboration with and strengtheningof regional networks and platforms such asAAAHandtheAfricanPlatformonHRH,whichwill be critical in advancing the HRH agenda

2 TheInternationalHealthPartnershipandRelatedInitiativesisacollaboration,hostedbyWHOandtheWorldBank,thatseekstoachievebetterhealthresultsbymobilizingdonorcountriesanddevelopmentpartnersaroundasinglecountry-lednationalhealthstrategy.TheAlliancecontributestothisframeworkbyworkingwithcountriestoensurethattheHRHcomponentofnationalhealthstrategiesisdevelopedandimplementedaccordingtoaninclusiveprocessthatharnessesthecontributionofallrelevantstakeholders.AlliancemembersadheretotheParisprinciplesonaideffectivenessthatformthebasisofIHP+work.

andpromotingpolicydialogueinregions.TheAlliancewillactasahubtopaircountryneedswithpartnersupportthrough,forexample,thepromotionofhigh-qualityHRHplans.TheSec-retariat will commission the documentationofbestpracticesofHRHcoordination,policy,planning and innovative practice, and facili-tate the sharing of experience and learningacrosscountries,inpartnershipwithregionalnetworksandforums.

ThefirstphaseoftheAlliancefocusedonthe57countriesdeemedtofaceacriticalshortage


13

3 The“Health4+”(H4+)agencies(UnitedNationsPopulationFund,UnitedNationsChildren’sFund,WorldHealthOrganization,WorldBankandtheJointUnitedNationsProgrammeonHIV/AIDS)areworkingtogethertosupporttheUnitedNationsSecretary-General’sEveryWomanEveryChildcampaign.ThisincludestheH4+HighBurdenCountriesInitiative(HBCI)thatissupportingin-depthnationalassessmentsofmidwiferyineightcountries(Afghanistan,Bangladesh,DemocraticRepublicoftheCongo,Ethiopia,India,Mozambique,NigeriaandtheUnitedRepublicofTanzania).

of HRH as assessed through the 2006WorldHealth Report. Moving forward, the AlliancewillpromoteHRHactionbyeverycountry,con-sideringshortfallsinwealthiercountrieshavea profound effect globally. Country coordina-tionandfacilitationwillthereforebepromotedalsoinhigh-incomecountriestocontributetoaddressing their HRH challenges, includingunder-investmentintrainingandover-relianceonmigranthealthworkers.

Atthesametime,specificfocuswillbegivento the75countries that togetheraccount for97% of maternal and child deaths globally.

ParticularemphasiswillbeplacedoncountriesoftheH4+HighBurdenCountryInitiative.3TheWHOGlobalCodeofPracticeonInternationalRecruitment of Health Personnel (the WHOCode)willbepromotedforintersectoralpolicydialogue among both high- and low-incomecountries. The Secretariat will provide thefoundation and advocate for members andpartnerstoplayamoreproactiveroleaccord-ingtotheirmandateandcomparativestrengthincountries,topromotethepracticeofinclu-sive and evidence-based HRH planning anddevelopment, embedded in national healthstrategies.

Phase 1 Phase 2

MembersandpartnersinformedaboutCCFapproach,selectiveinvolvementinsomecountries

Secretariatwillencouragemembersandpartnerstobecomeresponsibleforprovidingassistance,followingsimilarprinciplesand/ormodel

FocusonHRHcoordinationandplanning(i.e.inputsandprocessesinHRHdevelopmentcycle)

Emphasisonconcretestepsleadingtoquantitativescale-up,moreequitabledistributionandqualitativeimprovementofhealthworkforceperformanceandcapacity

Cross-sectoralparticipationencouragedthroughinvolvementinnationalHRHcoordi-nationprocesses

AnalysesandpolicydialoguesonHRHlabourmarketswillbespecificallyusedasanentrypointforcross-sectoralpolicydialogueandcollaboration

Goodpracticemodelsdevelopedandpartnersandcountriessensitizedtothem

DocumentbestpracticesinnationalHRHcoordinationandplanningprocesses

Table 2

Refining the CCF approach


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Expected results

Alliance-wide:> Increaseduptakeandimplementationof

HRHpolicyoptionsofproveneffectivenessincountries.

> HRHcoordinationstrengthened,policydialoguefacilitated,costedHRHstrategiesandplansdevelopedandimplementedasanintegralcomponentofnationalhealthstrategies,enabledasappropriatebyapplyingcountrycoordinationandfacilita-tionprinciples.

> FinancialandtechnicalsupportprovidedtoimproveHRHtraining,deployment,retention,distributionandperformance,contributingtosavingmillionsoflivesthroughimprovedcoveragewithessentialhealthservices.

Secretariat-specific: > CatalyticsupportextendedtoHRHcoordi-

nationandfacilitationasanintegralpartofnationalhealthpolicydialogueandplanningprocesses.

> HRHcoalitionssupportedinprioritycoun-triestostrengthencapacityatnationallevel.

> HRHframedasanintersectoralpriority,includingthroughlabourmarketanalysesinselectedcountries.

> BestpracticesofHRHcoordination,policy,planningandinnovativeapproaches,includingontheWHOCodeimplementa-tion,documentedanddisseminated.

4 BossertTJ,OnoT.FindingAffordableHealthWorkforceTargetsInLow-IncomeNations.Health Affairs,2010,29(7):1376–1382.

3.3 Promoting results and accountability

Countries and development partners havemade significant commitments and adoptedresolutions, political declarations and state-ments on strengthening HRH. Examples oftheserelatetonationalhealthorHRHstrate-gies,developmentpartnersupportforglobalhealth, including the UN Global Strategy forWomen’sandChildren’sHealth,WorldHealthAssemblyandAfricanUnionresolutions,com-mitments made in the G8 and the G20, andmultilateralinitiatives.

TheAlliance,asaplatformthatworksdirectlywithitsmembers,partnersandwithcountries,andgovernedbyanindependentBoard,iswellplacedtoensureaccountabilitybymonitoringprogress against these commitments andimplementationofinitiatives.

Goingforward,therefore,asapartofitscorefunctions, the Secretariat will monitor theactions of countries and Alliance membersand partners on HRH development, leadingto greater accountability by HRH stakehold-ers on their commitments. An initial step forevidence-based monitoring of progress willbe to adopt targets that reflect the diversecompositionofthehealthworkforce,andthatrepresent attainable and realistic objectives,consideringthefinancialconstraintsfacedbymanylow-incomecountries.4


15

Toaddressthisneed,theAlliancewillproposethatagenciesandpartnersthathavetheleadin normative mandates (like WHO and theInternational Labour Organization) developandbrokerconsensusonfit-for-purposeHRHbenchmarksincollaborationwithprofessionalassociationsandotherrelevantstakeholders.

At the national level, Alliance members andpartnerswillsupportcountriestoensurethatHRHbenchmarksinnationalhealthstrategiesaremetand linkedto relevantaccountabilityprocesses, such as IHP+ country compactsandannualhealthsectorreviews.

Theinitialreviewofprogressinimplementingthe KD-AGA at the Second Global Forum onHRHrevealedademandforimprovedinforma-tionandregularaccountabilityandreportingbothatcountrylevelandonthecontributionsof leading global agencies and developmentpartners.

Forsubsequentprogressreviews,theAllianceBoard proposes to focus on convening andcoordinatinganoverallaccountabilityprocessand framework (including but not limited toimplementationoftheKD-AGA,resultingina“State of the World’s HRH” report every twoyears). These reports will not entail the col-lectionofnewquantitativeprimarydata,butrathersupportanduseexistingmechanisms,suchasnationalandregionalhealthworkforceobservatories and databases managed byWHO,theWorldBankandtheOECD.Thiswillalsominimizetransactioncostsandreportingrequirements forcountries.Beyondquantita-tivedata,thereportswillalsoincludequalita-tiveassessmentsofbestpractices,reasonsforsuccessandfailure,andpoliciesandpractices

5 Thiswillrequirecountriesand/ornationalHRHobservatoriestosubmitrelevantinformationtotheWHOGlobalAtlasoftheHealthWorkforce,andrequireWHOtoregularlyupdatethisdatabase.

adopted by development partners and otherHRHstakeholders.

Theaccountabilityprocesswillestablishlink-ages, as relevant, with other monitoring andaccountability frameworks, including thoseof the UN Global Strategy for Women’s andChildren’s Health and the WHO Global Codeof Practice on International Recruitment ofHealthPersonnel.

Expected results

Alliance-wide: > Credibleevidenceandstrategicintelli-

genceavailableonHRHavailability,distri-butionandflowinHRHprioritycountries.5

> InformationavailableoninternationalHRHinvestmentflows,andresultsofpriorityglobalHRHinitiativesandprogrammespromotedbydevelopmentpartnersandagencies.

> Consensusachievedonasetofbench-marksforHRHdevelopmentandmonitoring.

> AdvocacysuccessfullyconductedbasedonanalysesdemonstratingimpactofHRHinvestmentonlivessaved,improvedpopulationhealthandsocioeconomicdevelopment.

Secretariat-specific:> Two”StateoftheWorld’sHRH”reports

developedanddisseminatedattheHRHGlobalForums.

> Commitmenttoresultsandacceptanceofaglobalprocessofaccountabilityadvocated.

> ResultsonHRHactionsandongoingcom-mitmentsunderreviewtoaddressgaps.

Enhancingthepartnershipmodel

4

16

Countries are the primary drivers of HRHaction,supportedbyavarietyofstakeholderswho have been actively involved in imple-mentingthestrategiesoftheKD-AGAsinceitsadoptioninMarch2008.Inthissecondphasethe Alliance will adopt an enhanced partner-ship model which, while spurring the impor-tantroleofcivilsociety,theprivatesectorandother stakeholders, recognizes the centralityof national governments and ministries ofhealthinparticular.

TheidentityandthestrengthoftheAlliancelieinitsmembersandpartners:thenewStrategywillrelyonthemtobethekeyimplementersand to commit to undertake and deliver onspecific activities to assure the achievementofitsmandate.

ExamplesofsuccessfulpartnershipsbetweencountriesandAlliancemembersandpartnerssinceitslaunchin2006aregiveninAnnex 2.These examples only represent a fraction ofthe numerous HRH initiatives undertaken tostrengthen the health workforce; however,theyillustratetheextensiverangeandwealthofcontributionsthattheAlliancecanbring.

Acomprehensiveresults-orientedagendathatcan transform the HRH landscape at globalandcountrylevelscannotrestsolelywiththeSecretariatguidedbytheBoard.Since“busi-ness as usual” will not achieve the desiredresults,Allianceoperationswillbeadjustedtosecurebroaderownershipandengagement.

To begin with, the Strategy fully recognizesthatWHOprovidestheorganizationallocationfortheAlliance,thatWHO’sfunctionsincludesupporting ministries of health, and thatthere is scope for improving the partnershipbetween the Alliance and WHO. Accordingly,

collaboration with WHO will continue to beimproved, strengthened and consolidated toexploitandpromoteopportunitiesforgreatersynergy in the respective mandates andactions. Intensifieddialogueonthematicpri-oritiesofjointinterestwillcontinueresultinginmutualbenefits, includingonimplementa-tionoftheWHOGlobalCodeofPracticeontheInternationalRecruitmentofHealthPersonnel,HRHtrainingandretention,andHRHaspectsoftheMDGagendaandtheNCDresponse.Itis also envisaged thatWHO, as a permanentmember of the Alliance Board, will use theopportunitytoflagareasthatrequirecoordi-nation, through review and endorsement ofAlliancestrategicdocuments, reflectsuitableroleclarityanddifferentiation.

AttheoutsettheAlliancedidnotsetatargetfor itsmembership.Thecurrent formalmem-bership (over 400) shows the wide interestin HRH, even though geographic distribu-tion and composition can still be improved.Most importantly, thefullpotentialofsuchalarge membership remains under-exploited,and this is a key focus of the Strategy goingforward.

The Alliance’s identity and affiliations are,however, multi-faceted and not limited toformal membership, as it needs to interfacewithcriticalHRHstakeholdersthat,althoughnot formal members, are essential, by virtueof their role, in advancing the HRH agenda.ThesestakeholdersincludegovernmentsandtheHRHfocalpointswithinnationalministriesofhealth.

Moreover, while countries have the primaryresponsibility for the development anddeploymentof theirhealthworkforce,avari-etyofotherstakeholdershavea role toplay


17

inprovidingtechnicalassistanceandfinancialsupport, continuous professional develop-ment initiatives, training and research, anda number of other enabling and ancillaryactivities.

Indefiningitsfutureroleandprovidingleader-shipforcollectiveactions,theAlliancewillbeambitiousbutrealisticinsettingprioritiesandtargets and clearly delineate a hierarchy ofresults that distinguishes between the deliv-erables expected from the Secretariat andfrom Alliance-wide actions, working togetheraccording to respective roles and mandates(Annex 6).

Akeyprincipleof2013–2016activitieswillbetogalvanize,harnessandenablethepotentialcapacity of Alliance members, partners andotherrelevantstakeholders.Astrategywillbedeveloped under the guidance of the Boardand in consultation with members and part-ners to operationalize this principle, includ-ingwaysandmeansof facilitatingmembers’engagement in and contribution to the threeobjectives.

There will be different levels of engagementby members and recognition of their uniquecontributions. This takes into account thatsome members are primarily motivated byinformation sharing while others have thecapacityandinteresttoplayanactiveroleinthevarious initiativesof theAlliance,asout-linedinthisStrategy.Voluntaryself-reportingonHRHactivitiesconductedbymemberswillbeencouraged,tofacilitateinformationshar-ingandtoacknowledgeachievements.

Members will be given greater access toinformationconcerningthegovernanceoftheAlliancestructures,includingreportsofBoard

meetings,annualworkplansoftheSecretariatand the list of staff members and their func-tionspostedonthewebsite.Toimprovecom-munication,themembershipplatformwillbeenhanced. Online technologies will be usedto enable Alliance members and partners toshareinformationonglobalandcountryactivi-tiesandmapwhoisworkingwheretoachievetheagreedresults.Awards,aswellasofficialrecognition of Alliance “implementers” and“advocates” will be used to encourage, rein-force and acknowledge outstanding successatboththeinstitutionalandindividuallevels.

In particular, the Alliance will increasinglyfocus on mobilizing members and partnerswith presence in countries who can serve asadvocatesforHRHanddriveforwardthecoun-try health workforce development agenda,withtheSecretariatprovidingcatalyticsupportandfacilitation.Thismaytakedifferentformsindifferentcountries,buttheSecretariatwillassistandsupportcurrentandemergingcoa-litionsofconstituenciesandgroupsofactorsthat can foster HRH dialogue, processes andactionsatthenationallevelonspecificissues(e.g. on theWHO Code, HRH migration, HRHadvocacy,KD-AGAmonitoring,roleofthepri-vatesectorandprofessionalassociations).

TheAllianceplanstocontinueitsbiennialHRHglobal forums, while exploring cost-effectiveoptionsforadditionalregularmemberforumstoenablemoreeffectiveplanning,sharingandcohesion.This could take the form of virtualplatforms or use existing meetings and/orotherprocesses.

The goal is for this enhanced partnershipmodel to play a pivotal role in moving for-wardtheHRHagenda,asitwillprogressivelyempowerandshiftresponsibilityforactivities


18

to members and partners, who are responsi-bleforachievingthehigherlevelresultsoftheAlliance Strategy, allowing the Alliance gov-ernancestructures to focuson theircatalyticandenablingrole.

Inadditiontoimprovedmobilizationofmem-ber and partner strengths, the Alliance willenhanceitsoperations(Annex 7)by:

> improvingthegovernanceworkofitsBoardanditsoversightoftheoperationsconductedbytheSecretariat;

> adaptingtheSecretariatstructureandoperationstothenewobjectivesandpartnershipmodel;and

> furtherstrengtheningtheprogrammaticpartnershipandhostingrelationswithWHO.

Phase 1 (2006–2012) Phase 2 (2013–2016)

Overallframework:KD-AGAaspartofMDGagenda

Overallframework:responsivetonewchallenges,environmentandplayersDevelopnewagendaaspartofuniversalhealthcoverageandpost-MDGframework

Advocacyprimarilyaimedathealthsectoraudience

Advocacyincreasinglyfocusedonintersecto-ralactionandhigherpoliticallevel

Emphasisondevelopmentofnewknowledgeproductsthroughtaskforces

Greateremphasisonuptakeanduseofexistingandemergingknowledgethroughadvocacyandsharing

Noexplicitstrategyavailabletofacilitatecountryactions

CCFprinciplesapplied,basedoncountrydemand,andadaptedforstrongerlinkageswiththehealthsystemsstrengtheningagenda

Focuson57HRHcrisiscountries FramingtheHRHcrisisasaglobalissueforallcountriesandfocusingonthe75countriesoftheUNGlobalStrategyforWomen’sandChildren’sHealth

First(basic)attempttomonitorKD-AGAprogressin2011

Evidence-basedandresults-orientedmonitor-ingofwiderHRHdevelopmentforincreasedaccountability

DiffuseresponsibilitieswithintheAllianceandprocess-orientedapproach

ClarityinrolesofAlliancegovernancestructures,membersandpartnersforgreaterresults

5objectives,46indicators 3objectives,24expectedresults

Membersandpartnersinvolvedinsomeinitiatives

SystematicempowermentandengagementofmemberstodriveforwardHRHagenda

Table 3

Key changes from the first to the second phase of the Alliance

Anewapproach

5

19

ThisStrategicPlanpresentsarenewedvalue-addedpropositionforthesecondphaseoftheAlliance,characterizedby:

> empoweringmembersandpartnerswithincreasedleadership,responsibilityandownership;

> advancingandrefininganHRHagendainthedynamichealthdevelopmentlandscape;

> influencingpoliticalandpolicychoicesthroughsharinganduptakeofevidenceandbestpracticesonHRHcoordination,policy,planningandinnovation;

> translatingcommitmentsintosynergisticinter-sectoralactionsincountriesthroughhigh-leveladvocacy,andstrengthenedaccountabilitymechanisms;and

> achievingmorethroughapartnershipmodelthatenablesgreaterexpres-sionandmoreeffectivecoordinationofeffortbymembers,partnersandotherstakeholders.

During2013–2016,theAlliancewillmakethefollowingimportantcontributionsbyadaptingitsmodusoperandi(Table 3):

> Asamulti-constituencyandmulti-stake-holderpartnership,theAlliancewillcon-veneandcreateaspaceforinclusivepolicydialogue,coordinationandexchange.Thiswillbeinstrumentalinidentifyingoppor-tunitiesforsynergy,inpreventingdupli-cationandinmatchingdemandforandsupplyoftechnicalproductsandfinancialsupport.

> AsanentityhostedbyWHOandwithitsgoverningBoard,theAlliancewillunder-takehigh-level,evidence-basedadvocacy,usingitscriticalcapacitytoworkwithcivilsociety,privatesector,professionalasso-ciationsandregionalnetworks.

> Asafacilitatorinagendasettingandreviewingprogress,itwillreinforceaccountabilityinthecurrentHRHdevel-opmentchallenges,andreflectemergingprioritiesandareasoffocusintheuniver-salhealthcoverageandpost-MDGagenda.

ANNEXES

AnnexThefirstphaseoftheAlliance

1

21

The Joint Learning Initiative report,6 releasedin2004,playedasignificantroleinhighlight-ing thegrowingHRHcrisis.Buildingon that,inFebruary2005,ahigh-levelconsultationinOslobroughttogetherkeystakeholders,whorecommended that a new global partnershipforHRHshouldbecreatedforthemanyplay-ers that were routinely involved, or could beconstructively engaged, in health workforce-relatedprocesses.Coordinationamongtheseplayers was considered crucial, both withinthe health sector (e.g. government, privatesector, civil society, development partners),and across different sectors (health, educa-tion,finance,civilservice,etc.).Whileasingleorganization could not offer all the requiredsolutions, a common platform for players tocollaboratecouldcontributetoaddressingtheglobalandmulti-facetedHRHcrisis.

Specifically, an “alliance” was chosen (asopposed to a formal “partnership” or an“organization”), reflecting the vision of amovement engaging and energizing differentorganizations, without formal and bindingarrangementsthatwouldconstrainindividualmembers and partners. To develop this newinitiative,atechnicalworkinggroupdrewupaStrategicPlanofwhateventuallybecametheGlobalHealthWorkforceAlliance.

ThefindingsoftheWHOWorldHealthReport(WHR) 2006 indicated a critical shortage ofover 4 million health workers worldwide,compoundedbymaldistribution,unevenper-formance and quality, insufficient incentivesand remuneration, poor working conditions,and inadequate management practices andsupport. Launching the WHR 2006 on WorldHealth Day, WHO set out a 10-year plan to

6 TheJointLearningInitiative,HarvardUniversityPress,“OvercomingtheCrisis:ReportoftheJointLearningInitia-tive2004”,Availablefrom:http://www.healthgap.org/camp/hcw_docs/JLi_Human_Resources_for_Health.pdf

address the crisis, calling for the establish-ment of alliances among partners at global,regionalandcountrylevels.

The Global Health Workforce Alliance (theAlliance)wasformally launched inMay2006at theWorld Health Assembly with a 10-yearmandateaspartof the“DecadeofactiononHRH”. Itsoughttoaddressthe lackofatten-tiontoHRHontheglobalhealthdevelopmentagenda, and the challenges related to theshortage, maldistribution, retention, migra-tion and the inadequate working and livingenvironment of health workers prevalent inmanydevelopingcountries.TheAlliancevisionwas that “all people, everywhere, will haveaccesstoaskilled,motivatedandsupportedhealthworker,withinarobusthealthsystem”.

Since then, a wide-ranging programme ofactivitiesunfoldedaimedatcatalysingactionon health workforce development at everylevel. In March 2008 the Alliance Secretariatconvened the First Global Forum on HumanResources for Health, which resulted in theadoption of the Kampala Declaration andAgenda for Global Action (KD-AGA), whichbecame an overarching framework of refer-ence for HRH development. The Alliancedeveloped its 3-year strategy for 2009–2011(“MovingForwardfromKampala”)tofacilitateand accelerate the operationalization of theKD-AGA.

TheSecondGlobalForumonHumanResourcesfor Health, held in Bangkok, Thailand, inJanuary2011,providedanopportunityfortheglobal HRH community to review progressand renew the momentum and commitmentto health workforce development and to theprinciplesandstrategiesoftheKD-AGA.

AnnexKeyachievementsofcountries,members,partnersandAllianceSecretariat(2006-2012)

2

22

TheAlliancecontributescentrallytodevelop-ment of the health workforce through thefunctions of advocacy, brokering knowledgeand convening partners to promote synergyandcoordinatedactionforawidermovementinvolvingmanyorganizationsandplayers.TheSecretariat activities have been undertakenin the context of a hosting relationship andMemorandum of Understanding with WHOthat has also enabled close programmaticcollaboration and mutual reinforcement ofactions. Significant achievements of the Alli-ance,atthelevelofitsmembersandpartnersas well as the Secretariat, include globalbreakthroughsaswellasprogressinspecificcountries.Examplesof importantprogress inanumberofareasareprovidedbelow.

Countries, members and partners driving progress:

> Malawi,withthesupportoftheUnitedKingdomDepartmentforInternationalDevelopment(DFID),theGlobalFund,theJointUnitedNationsProgrammeonHIV/AIDS(UNAIDS)andothers,implementedanemergencyhumanresourcespro-grammethatusedinnovativeapproachestoenhancetraining,deploymentandretentionofhealthworkers.Thisinitiativeiscreditedwithsaving13000lives,largelythroughincreasedcoverageofreproduc-tive,maternal,newbornandchildhealthinterventions.

> NorwayandThailandspearheadedeffortstodevelopandadopttheWHOGlobalCodeofPracticeonInternationalRecruit-mentofHealthPersonnelin2010.

7 MuskokaInitiativeonMaternal,NewbornandChildHealth(http://canadainternational.gc.ca/g8/summit-som-met/2010/mnch_isne.aspx?lang=eng&view=d,accessed17July2012).

> TheUnitedStatesPresident’sEmergencyPlanforAIDSRelief(PEPFAR)isworkingtowardstraining140000additionalhealthworkersthroughmedicalandnursingeducationpartnershipinitiativestargetingsub-SaharanAfrica.

> TheGovernmentsofJapan,ItalyandFranceledtheG8commitmentsin2008,2009and2011respectivelytosupportHRHdevelopmentbasedontheKD-AGA;inaddition,Japanisworkingtowardsthetrainingofanadditional100000healthworkersindevelopingcountriesaspartofitsglobalhealthstrategy,whileFranceandCanadaareprovidingextensivesupporttostrengthenthehealthworkforceinanumberofcountriesaspartoftheirinvest-mentsintheMuskokaInitiative.7

> Accordingtoitsestimatesfor2008–2009,DFIDspendsapproximately25%ofitshealthbudgetonHRH,inlinewiththerec-ommendationsoftheHighLevelTaskforceonInternationalInnovativeFinancingforHealthSystems.

> WHOhascontributedglobalpublicgoodsofgreatvaluetoHRHdevelopment,includingtheGlobalCodeofPracticeontheInternationalRecruitmentofHealthPersonnel,guidelinesforruralretentionofhealthworkers,andatoolkitformonitor-ingandevaluatingHRH.

> MembersoftheHealthWorkforceAdvo-cacyInitiative,suchastheAfricanMedicalandResearchFoundation(AMREF),theAfricaPublicHealthAllianceand15%+


23

campaign,Merlin,andSavetheChildren,havecontributedtoanunprecedentedlevelofattentiontoHRHissues(e.g.throughthe“Handsup”,“Frontlinehealthworkerscoalition”and“PublicHealth15%”awarenesscampaigns).

> TheUnitedStatesAgencyforInterna-tionalDevelopment(USAID)BureauforGlobalHealthhassupportedCapacityProject/CapacityPlusandotherinitiativesimplementedbyorganizationssuchasIntraHealthInternational,ManagementSciencesforHealth,AbtAssociates,whichhaveprovidedopportunitiesforinstitu-tionalcapacity-buildingforHRHinprioritycountries.

> MembersoftheWorldHealthProfessionsAlliance(WHPA),inthecontextofthePosi-tivePracticeEnvironmentcampaign,haveworkedtoraiseawarenessandimproveworkingconditionsforhealthprofession-alsinvariouscountries.

The Secretariat driving progress:

TheachievementsreportedbelowreferlargelytoactivitiesdirectlycoordinatedbytheSecre-tariatinsupportofwideractionsbymembersandpartners,andrecognizedbyanindepend-entexternalevaluationconductedinlate2011.

> Atthegloballevel,HRHhasbeenmain-streamedintothehealthpolicyanddevel-opmentdiscourse.Newhealthworkforcetargetsandcommitmentshavebeenmadeinpoliticaldeclarationsandoutcomedocu-mentsglobally8.

> HRH-specificlanguageandtargetswereincludedintheUNGlobalStrategyforWomen’sandChildren’shealth9,whichinturntriggeredHRHcommitmentsbyspecificcountries,cascadinginmanyinstancesdowntonationalhealthandHRHresponsesandstrategies.

> Stakeholdershavebeenbroughttogethertosupportpolicydialoguearoundthedevelopmentandimplementationofsus-tainableHRHsolutionsthroughtwoglobalforums10onhumanresourcesforhealth,organizedincollaborationwithAlliancemembersandpartners.Regionalconfer-encessuchastheAsiaPacificActionAlli-anceforHumanResourcesforHealth11andtheAfricanPlatformonHumanResourcesforHealth12,heldinpartnershipwiththeheadquarters,regionalandcountryofficesofWHOandothernetworks,haveprovidedaplatformforpolicydialogueandexchangeofbestpracticesamongcountries.

> Thematictaskforces13,convenedbyorinpartnershipwiththeAlliance,andwithtechnicalcontributionsfromAlliancemembers,haveledtoground-breakingknowledgeproductsonhealthworkforcedevelopment.Theseincludeseminalworkonhealthworkereducation,HRHfinanc-ing,migrationofhealthpersonnel(culmi-natingintheadoptionoftheWHOCodeofPracticeontheInternationalRecruitmentofHealthPersonnel),taskshiftingandtheroleofcommunityhealthworkers,anduniversalaccesstoHIVpreventionandtreatmentservices.

8 http://www.un.org/en/ga/ncdmeeting2011/9 http://www.who.int/pmnch/topics/maternal/201009_globalstrategy_wch/en/index.html10http://www.who.int/workforcealliance/forum/en/11 http://www.aaahrh.org/conference.php12 http://www.who.int/workforcealliance/media/events/2010/africanplatformcons/en/index.html13http://www.who.int/workforcealliance/about/taskforces/en

AnnexTheunfinishedHRHagendainanevolvingglobalhealthanddevelopmentlandscape

3


24

> Actionatthecountrylevelwasstrength-enedwhentheSecretariatrefineditssupportstrategy,developingandrollingouttheCountryCoordinationandFacilita-tion(CCF)approach.Thishascontributed

tostrongercollaborativeplatformsatthenationallevel(seealsoAnnex 5),operat-inginsynergywithhealth-sectorcoordina-tionmechanismsandprocessessuchastheIHP+.

14http://www.who.int/workforcealliance/knowledge/resources/kdagaprogressreport/en/index.html

TheAlliancehelpedtocreateandsubsequentlyspearhead a wide movement which has ledto increased recognition of health workforceissuesatnational,regionalandgloballevels.

Attention at global level has in many casesbeenfollowedbysignificantprogressmadebycountriesinaddressingtheirhealthworkforcechallenges.TheAllianceasawholehasplayeditspartinthesesuccesses.

Despite this welcome progress, HRH chal-lenges remainoneof the largestbottleneckstoachievethehealthMDGsandtheuniversalhealthcoveragegoal.MuchmoreisneededtorealizethevisionoftheAllianceandthestrate-gicobjectivesoftheKD-AGA.ThisisreflectedintheAlliance’s2011trackingreport14(Box 3).

Theon-goingchallengeistoaddressthepastandpresentgapswhilesimultaneouslyantici-pating the transformative actions requiredin the future. In developing this Strategy,

the Alliance Board has taken account of thischanged and changing scenario with respecttoHRH,todefineaclearroleandprogrammeof work of the Alliance. It also recognizesthatthisstrategywillunfoldinthecontextofcompeting attention for political capital andresources, significant changes in health caresupply and demand, and an unstable era ofglobalhealthanddevelopment,including:

> climatechange,foodprices,globalsecu-rityandsweepingpoliticalchanges;

> financialandspendingadjustmentsintheglobaleconomy–withreductionsinhealthandofficialdevelopmentassistance(ODA)expenditures;

> populationgrowth,toaworldof9–10bil-lionby2050;

> ageingpopulationsandanemergingcrisisinnoncommunicablediseases;


25

The unfinished HRH agenda

> there is uneven progress across and within countries in addressing shortage and inequitable distribution of health workers;

> training capacities for health workers are often inadequate and the potential for innovative skills mix approaches under-exploited;

> countries have not yet developed or fully implemented their health workforce strategies, often due to insufficient technical and financial resources;

> incomplete information on health workers’ availability, distribution and perfor-mance, as well as limited understanding of HRH labour markets, continues to limit effective planning and policy–making;

> political attention has only partly been translated into revised policies and addi-tional resources for HRH;

> the role of the private sector is poorly understood, and its potential positive contribution remains to a large extent untapped;

> addressing the specific needs of fragile states and vulnerable population groups remains a key challenge.

Box 3

> newdiscoursesonhealthanddevelopment:> broadeningofthehealthMDGframe-

worktoawiderparadigmofuniversalaccesstohealthservices,andtakingmoreexplicitlyintoaccountthesocialdeterminantsofhealth

> the20thanniversaryoftheInterna-tionalConferenceonPopulationandDevelopment(ICPD+20)

> post-2015sustainabledevelopmentgoalsanduniversalhealthcoverage;and

> demandfortransparency,accountabilityandresultsinaidexpenditures.

Thisevolvingcontextdemandsrenewedatten-tion,andstrategic intelligenceandactiononHRH. The Alliance Board and Secretariat, incollaborationwithitsmembersandpartners,will accordingly develop activities and inter-ventions and measure results in a way thatresponds to this new reality, as reflected intheobjectivesanddeliverablesoftheStrategy(Section 3).

AnnexAlearningAlliance

4

26

The Alliance is committed to reflection andlearning and strives to provide its members,partners and stakeholders with feedbackopportunities.Resultsfromaself-assessmentin2010andamembersurveyin2011identifiedthatmembersandpartners:

> valuetheAllianceasacollaborativemechanismandseeitsabilitytoconvene,catalyseactionandsecureconsensusonimportantpolicyandtechnicalHRHissuesasitskeystrength;

> expect,atthesametime,greatercoordi-nationandstewardshipoftheireffortsintermsofjointmessaging,communications,tools,advocacytargetsandbenchmarks;

> wouldliketohavemorevenuesandmechanismsforregularinteractionandnetworking,andencouragetheBoardandSecretariattoinvolvemoreeffectivelythewiderAlliancemembership(now400+strong)andpartnerstoaddresstheHRHcrisis.

Similar findings surfaced through an inde-pendentexternalevaluationcommissionedbytheBoardin2011,whichalsoidentifiedareasforimprovement(Box 4).

Theexternalevaluationdidnotaddressspe-cifically the counterfactual question, “Whatwould have happened if the Alliance hadneverbeenestablished?”However,theBoard

Key issues emerging from the external evaluation

In reviewing whether the Alliance met initial expectations, the external evaluation:> concluded that the Alliance work in its first five years represented good value for

money; > recognized the critical contributions made by the Alliance Secretariat in moving

forward the health workforce agenda at global and country levels through its advocacy, brokering knowledge and convening functions; and

> noted that the Alliance Secretariat’s work was highly relevant at all levels, and considered its support to countries through the Country Coordination and Facilita-tion (CCF) approach to be highly effective.

The evaluation identified the following areas that required attention:> better harnessing Alliance member contributions; > wider use of knowledge products and improved visibility and brand recognition;> a review of the Board’s effectiveness;> streamlined administrative procedures and relationship with WHO; and> more stable income flows.

Box 4

AnnexCoordinatingandfacilitatingcountryHRHpolicydialogue

5


27

Country coordination and facilitation has tofollow a set of principles to ensure inclusiveHRH policy dialogue, which have been illus-tratedinbox2inthestrategydocument.

The Board considers that this broad frame-work of principles and behaviours should beadaptedtocountrycircumstancesandnationalhealth policies, and not be interpreted as ablueprint of prescribed activities. Alliance-related support provided according to theseprinciples since 2010 is yielding results (seeBox 5onCamerooncasestudy):greaterinclu-sivenessinhealthworkforcecoordinationandplanning processes; greater integration ofHRHinnationalhealthsystemsstrategiesandplans;andimprovedqualityofHRHsituation

analyses and development plans and strate-gies. Accelerated implementation of HRHplans and strategies is evident, for example,from scaled-up training and production ofhealthworkers,establishedorrevampedtrain-ingcentres,improvedhealthworkercapabilitythroughrevisedtrainingcurriculaandcontinu-ousprofessionaldevelopmentinitiatives,andincreasedlevelsofresourceallocationtoHRHfrombothdomesticandinternationalsources(Figure 1).

The Alliance Board and Secretariat, buildingon the positive experience to date, are alsokeentorefinetheapproach,incorporatingles-sons learnt and recommendations that haveemergedduringthefirstyears.

believes that the Alliance was indeed funda-mental in making HRH a more recognizedand better supported element of the healthdevelopment agenda at global, regional andcountry levels,andincatalysingandacceler-atingspecificactionsandcommitments.

TheBoardheldaretreatspecificallytoreflecton the external evaluation and plan the way

forward.BuildingontheexperienceofPhaseI,and in consultation with countries, membersand partners, this resulted in realigned stra-tegic priorities to ensure that the Alliancecontinuestoplayauniquecatalyticroleinthefuture.TheBoardwillalsotakeactionwhererequired to improve the coordination andmanagement of the Alliance structures andgovernanceprocesses.


28

Strengthening HRH development in Cameroon

Applying country coordination and facilitation principles in Cameroon has led to: > greater political commitment to HRH issues;> a clear framework of collaboration between the Ministry of Health, WHO and the

Alliance, regulated through a tripartite Memorandum of Understanding;> more inclusive HRH coordination processes, involving the private sector and the

education sector (previously not involved);> an updated HRH situation analysis and HRH tracking system;> increased resource allocation from domestic sources (additional US$ 6 million

mobilized) and international partners (French Development Agency, US$ 1.4 million mobilized);

> the scaling-up of training capacity for midwifery personnel.Source: Global Health Workforce Alliance, CCF case study in Cameroon (2012).

Box 5

Figure 1

Embedded and integrated in national health policy dialogue and national health strategy.

Major steps on HRH in the CCF process

Step 2HRHSituationanalysis

Step 1HRHcoordinationmechanism

Step 3HRH plandevelopment

Step 4Resourcemobilization

Step 5HRH planimplemen-tation

Step 6M&Eof HRH plan

S1

S2

S3

S4

S5

S6

0

5

10

15

20

Basline 2009 * total 20 countries supported

Num

ber o

f cou

ntri

es *

end 2011

2

5

3

0 0 0 0

18

9 9

12

17

Results to date of CCF support to HRH development in countries

AnnexDefinitionofroles

6

29

Achieving the 2013–2016 objectives andrelated results through the enhanced part-nership model requires effective collabora-tion and a more careful understanding ofthe delineation of roles and responsibilitiesamong countries, the Alliance members andpartners, theSecretariat,andtheBoard.TheAllianceenvisagesthat:

Countries are the primary drivers of HRHaction,intermsof:> ensuringcoherentnationalleadershipfor

healthworkforcesolutions;> developingcapacityforanevidence-based

response;> scalinguphealthworkereducationand

trainingtomeetnationalneeds;> retaininganeffective,responsiveandequi-

tablydistributedworkforce;> managingpressuresoftheinternational

HRHlabourmarketanditsimpactonmigration;and

> securingadequateinvestmentsandpro-ductiveuseofresourcesforhealthwork-forcedevelopment.

The wider membership of the Alliance willtakeactionstosupportcountriesinimprovingavailability, accessibility, quality and perfor-mance of the health workforce. Examples ofactions expected by members and partnersinclude:> advocacytoensureadequaterecogni-

tionofHRHdevelopmentprioritiesatalllevels,accordingtotherespectiveareasofinfluence;

> adoptionofnew,andhonouringexist-ingcommitmentstosupportHRHdevelopment;

> adoptionofandsupportforappropriatepolicies,regulationsandproceduresofdirectrelevancetoHRHpriorities;

> commitmenttoinclusiveHRHmultisectoral

dialogueandcoordination,asanintegralcomponentofnationalhealthplansandprocesseslikeSWAPsandIHP+;

> provisionoftechnicalsupporttocountriestoensurethatevidence-andneeds-basedhealthworkforcedevelopmentplansaredevelopedandimplementedasanintegralpartofnationalhealthstrategies,andthathealthworkforceinformationandevidenceareavailable,throughmechanismslikeobservatories,andusedforplanningandmonitoring;and

> provisionoffinancialsupporttohealthworkforcedevelopment(forcountriesrequiringexternalassistance)alignedtonationalhealthpriorities,whichispre-dictable,long-termandflexible,allowingforbothinvestmentandrecurrentcosts,includingpre-servicetraining,anddeploy-mentandretentionofhealthworkers.

TheroleoftheSecretariatundertheoversightof theBoardwillbeessentiallyenablingandfacilitating processes and inputs to countryactionsandoutputs.ExamplesofSecretariatfunctionsinclude:> developingandconveyingjointmessag-

ingandpositionsonHRH,byconveningconsultationprocesses,high-levelpolicydialogueandforumsthatbrokerconsen-susonpriorityHRHtopics;

> collatingandsharingstrategicinforma-tiontoenablemembersandpartnerstoadopttheminpolicyandprogrammaticinterventions;

> providingcatalyticsupportandfacilitationtostrengthentheHRHcoordination,plan-ningandpolicymanagementenvironment,andleveragingthetechnicalandfinancialcontributionsofpartnersandmembers;

> documenting,disseminatingandcel-ebratingbestpracticesandexamplesofsuccess;


30

> providingcatalyticsupportonpriorityactionsundertakenbynetworksandplat-formsdrivenbymembersandpartners;and

> collatingandsharinginformationtomaxi-mizesynergy,avoidduplicationsandfosteraccountability.

TheBoard,inconstantconsultationwithmem-bers and partners, takes lead responsibilityfor:> providingstrategicguidanceoftheAlli-

anceandmonitoringprogressinachievingtheAlliancevisionandtheHRHagenda;

> capitalizingontheinfluenceofBoardmemberstodefine,advocateandpromotetheHRHagendaathighlevels;

> ensuringeffectivegovernanceofAlliancestructuresandoversightoftheSecretariat;and

> mobilizingsufficientfinancialresourcesforefficientoperationoftheSecretariat.

Complementarity with WHO

TheAllianceisabroad-basedpartnershipcre-ated to serve as a collaborative platform formany different organizations representing avarietyofconstituenciesandHRHstakehold-ers.Accordingly,theAllianceBoardiscommit-tedtocontinueaddingvaluetotheworkofallmembers and partners. Specifically, it recog-nizes that among its functions,WHO plays akeyroleinsupportingministriesofhealthandgovernmentsatlargeonmatterspertainingtohealthsystemsstrengthening,includingHRH.

DuringthefirstphasetheAllianceSecretariatoperationswereundertakeninthecontextofthehostingrelationshipwithWHO,regulatedbyaMemorandumofUnderstanding.Thishas

provided the basis for close programmaticcollaboration and for mutual reinforcementof activities. Examples of the positive col-laborationincludetheleadingnormativeandtechnical role played by WHO in all the taskforces convened by the Alliance Secretariat,the joint work on international migration ofhealthworkersculminatingintheadoptionoftheWHOCodeofPracticeontheInternationalRecruitment of Health Personnel, and thesuccessfulorganizationoftheSecondGlobalForumonHumanResourcesforHealth,jointlyconvenedbytheAlliance,WHO,theJapaneseInternational Cooperation Agency and thePrinceMahidolAwardConferenceofThailand.

At the same time, the external evaluationhighlightedtheneedtopursueandcommuni-catemoreclearlythecomplementarityoftheAllianceworkandthatconductedbyWHOintheareaofhumanresourcesforhealth.WHOhasapermanentseaton theAllianceBoard:through this role, WHO has the opportunityto review and endorse all Alliance strategicdocuments and workplans and, importantly,is well positioned to flag areas that requirecoordination,betterclarityanddistinctdefini-tionofroles.Inaddition,regulardialoguewillbe increasingly sought on common prioritiesand areas of complementarity, such as theWHOCode,HRHaspectsoftheMDGs,theNCDresponseandHRHtrainingandretention.Thiswill result in improved and consolidated col-laborativerelations,andtheabilitytoexploitopportunities for greater synergy in therespectivemandatesandactions,particularlyinsupportingcountriestoovercomeHRHchal-lenges as an integral component of nationalhealth system plans and related processeslikeIHP+.

AnnexStrengthenedgovernanceofAlliancestructures

7

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Board effectiveness

TheAlliancewillstreamlineandstrengthenitsgovernanceandmanagementmechanisms:intermsoftransparentandaccountablegovern-ance, theBoardwillundertakereviewsof itsowneffectivenessaccordingtotheprovisionsof its governance handbook. This stipulatesthattheBoardshouldregularlyseekmemberfeedback on the inclusiveness, effectivenessandusefulnessofBoarddecision-makingandoversightprocesses.TheBoardwillundertakea first review of this type in the first half of2013, and will analyse and discuss in depthvanymodificationsthatmayberequiredtoitssize, composition, competency mix, govern-ance and by-laws, as well as its relationshipwithandoversightof theSecretariat.Subse-quentreviewsoftheBoardeffectivenessandperformancewillbeundertakenaccordingtoaschedulebasedonneedsandthemodifica-tionsrequired,but inanycaseat leasteverytwoyears.The Board is confident that the documentedeffectiveness of the Alliance during the firstphase and the re-definition of its strategicapproach in its second phase will bring theexpectedresults.Focusingonselectedareas,together with an enhanced business model,will be the pre-conditions for developing anattractivevalueproposition.

A resource mobilization strategy will bedeveloped to enable the Alliance to mobi-lize and sustain sufficient predictable andflexible income to meet its responsibilities.Board members, especially those represent-ing development partners and internationalagencies,sharetheresponsibilityforsecuring

adequatefinancialsupportforthecoreopera-tionsoftheAllianceSecretariat.

Secretariat oversight, management and administration

Support to core functions contributes to theachievement of the Alliance objectives andexpectedresults,andtheenhancementofitspartnershipmodel,through:> themanagementandadministrationofthe

Secretariat,responsibleforimplementingAllianceactivitiesandthuscontributingtotheresultsdescribedinthisstrategydocument;

> theeffectiveorganizationofcoregovern-anceprocesses,andmeetingsformem-bersandpartners(including,butnotlimitedto,theHRHglobalforums);

> resourcemobilization,grantmanagement,administrationandreporting;

> theproductionofcorporatepublicationsandotherproductsthatdemonstrateandprovideevidenceontheeffectivenessoftheSecretariatoperations.

The Secretariat size and competency mixwill be reviewed by the Board in the secondpart of 2012, following the finalization andapproval of the Strategy. Changes will bemadeasrequiredtoadapttothenewStrategyandtoensureadequatecapacity todeliveratransformedsetofobjectives,accordingtotheenhancedpartnershipmodel.

ItisenvisagedthattheSecretariatwillretainitscurrentsizefollowingthereductionsagreedbytheBoardin2011,butre-adaptingtheskillsmix to the revised functions. In this context,a relative reduction of staff responsible for


32

management and support functions is fore-seen, along with an increase in staff directlyresponsible for the delivery of Secretariatactivities.Forthis,therewillbelowerempha-sis on developing new knowledge products,higher focus on promoting results andaccountability, and profiling at a higher leveltheagenda-settingandadvocacyfunctions.

Hosting relation with WHO

ThecollaborationwithWHOiscriticalalsoinrelationtothefactthattheAllianceSecretariatis hosted at WHO headquarters in Geneva.WHOhasrecentlyinitiatedaprocesstoreviewthetermsandconditionsforhostingpartner-ships;relatedtothat,theexternalevaluation

report has raised the option of consideringalternative hosting arrangements. While atthis point there are not sufficient elementsofspecificitytoassesstherevisedtermsandconditions that WHO will propose to formalpartnerships,theBoardbelievesthatthereisa value in retaining the hosting arrangementwithWHO,andalleffortsshouldbemadebytheAllianceBoardandWHOtoensuremutualsatisfaction both in relation to collaborationon specific programmatic areas, and in thecontextoftheemergingcorporateapproachofWHOonhostingformalpartnerships.TheAlli-anceBoardwillevaluateanyactionsthatneedtobetakenasandwhenadditionalspecificityis provided by WHO on any changes to thehostingarrangements.

Launchedin2006,theGlobal Health Workforce Allianceisapartnershipdedicatedtoiden-

tifyingandcoordinatingsolutionstothehealthworkforcecrisis.Itbringstogetheravariety

ofactors,includingnationalgovernments,civilsociety,financeinstitutions,healthworkers,

internationalagencies,academicinstitutionsandprofessionalassociations.TheAllianceis

hostedbytheWorldHealthOrganization.

For further information, please contact:

Global Health Workforce Alliance

WorldHealthOrganization

AvenueAppia20

CH-1211Geneva27

Switzerland

Tel:+41-22-7912621

Fax:+41-227914841

Email:[email protected]

Web:www.who.int/workforcealliance

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