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From recognition to action: reflections from the Global Forum on Human Resources for Health

5 April 2023

“What needs to be done to support health workers is understood. What we now need to talk about is how this is going to happen,” argued Dr Lindiwe Makubalo at the 5^th Global Forum on Human Resources for Health. Exactly.

Moving beyond rhetoric

Marking more than five years since the adoption of the Global Strategy on Human Resources for Health: Workforce 2030, the focus of this year’s Forum is #ProtectInvestTogether. The theme might be well-trodden, but these discussions feel more critical than ever against a set of devastating intersecting global crises. Health workers are at the centre of a tsunami, created in part by COVID-19 and in part by the current cost of living crisis, but underpinned by consistent underinvestment in health services stretching back more than a decade. Across the globe, we see major gaps in the health workforce and persistent issues around pay, support and protection for those delivering on the frontline. Stories underlining the urgency of these issues have been all around me here in Geneva, in the lived experience of the health workers attending the Forum, as it is at home in the UK.

We know what is happening. We even know what needs to be done. Beyond Applause, Health Workers Need Much More, in the words of Dr Tedros Adhanom Ghebreyesus.

Professor Francis Omaswa has been an energising force in workforce discussions at a global level for over twenty years as a former Director of Workforce at the WHO. All we need to know is expressed in the Joint Learning Initiative launched in 2002, which he oversaw. It can be read in 2008’s Kampala Declaration and the Global strategy on human resources for health: Workforce 2030, launched in 2016.

A changing landscape for international action towards better health

International meetings of this kind are technocratic, sometimes frustratingly so. Yet they are also critical blocks in movement-building. There were 18 international conferences on HIV/AIDS before anti-retroviral treatment became widely available across Africa in 2010. The Global Forum on Human Resources for Health has not met since 2017. Sometimes, things must be said again, and again, and again, before the tipping point is reached.

Of course, there are significant differences between the AIDS Conferences of the 90s and 00s, and this Forum on the Workforce. We are living through a crisis which is having the most profound impact on us all, rich countries and poor alike. Yet over the last few days, few voices have been raised in anger. The voice of civil society has been especially subdued. One side event on advocacy focused on the theoretical and couldn’t help but feel like a missed opportunity to galvanise and revive international efforts, which have never been the same since the Global Health Workforce Alliance. Another civil society plenary roundtable focused almost exclusively on service delivery.

It is almost as if the health community, caught up in the trauma of recent years and busy organising unprecedented levels of industrial action, is too tired to act globally.

Looking ahead to a critical year for global action on UHC

Chatham House’s Commission for Universal Health Coverage (UHC), due to report at the High-Level meeting on UHC on the side-lines of UNGA this September, highlighted this point: “History shows that many of the world’s universal health systems emerged from public health emergencies, financial crises or major conflicts.”

On the margins of this year’s Forum we are seeing exciting seeds of real change.

One idea I am passionate about seeing brought to life is a new global fund for health workforce. This fund would share the DNA of successful multilateral mechanisms like the Global Fund to Fight AIDS, TB and Malaria, applying this model to the complexity of human resources for health.

A joint funding mechanism like this would be established by the countries benefiting most from international recruitment. The flow of skilled workforce from low-income countries has subsidised the delivery of health to high-income countries, providing untold savings to the cost of training the health workforce domestically. It is time to call this out. Like footballers, argued Professor Omaswa, it’s time to levy transfer fees and put this money at the disposal of the countries that can’t afford to lose such workforce.

I, for one, and THET more generally, will raise our voices to make this happen.