Opening Speech by Minister of Health, Dr Manto Tshabalala-Msimang and Chairperson of the African Union Conference of Ministers of Health Bureau (CAMH3) Pre Global Health Workforce Alliance Conference briefing meeting, Southern Sun-Cape Sun Hotel, Cape Town

Professor Francis Omaswa
His Excellency (HE) Dr Sigrun Mogedal
HE the ambassador of Gabon
Distinguished ladies and gentlemen

It is a pleasure for me to welcome you to the Republic of South Africa for this important meeting. I particularly wish to express appreciation for your positive response to my invitation even though it came at short notice.

As you may have heard that the context of this meeting is in line with the implementation of the Africa Health Strategy which earmarks certain priority areas for implementation. Without adequate human resources for health such implementation cannot be achieved.

We are therefore grateful to Professor Omaswa and Dr Mogedal who offered to brief the delegates of Africa before the Kampala Global Forum on Health Work force development in March 2008. This meeting should enable you to get back to your capitals and brief Ministers before they go to Kampala Uganda in three weeks' time. They will be made wiser by the discussions that the facilitators will share with you here in Cape Town.

In the Kampala forum, the whole world will be converging to discuss the issue of human resource shortage which seems to be plaguing the whole world - both developing and developed countries. Unfortunately it is the poorer countries with weak currencies and infrastructure that tend to lose their well-trained scarce human resources to the wealthier countries who can pay higher salaries.

It therefore becomes critical that sub-Saharan Africa speaks with one voice at these international fora in order to encourage the receiving countries to engage in ethical recruitment or even consider remuneration or compensation for the countries of origin that trained the heath workers so that they cold have the resources to train more.

All of the priority health programmes depend on adequate, well-trained and fully functional healthcare worker pool for effective implementation. It is important that African countries develop human resource plans and cost them. This will enable us to have better knowledge on how to manage the scarce human resources and further guide us in training and retaining health workers. However the health sector depends on the availability of resources in order to determine the size of the pie that can be divided into remuneration packages.

In developing countries, where the size of the cake is small, no amount of increment will be enough to satisfy all workers. It is for this reason that the role of the private sector, which also drains the public sector of human resources, ought to be scrutinised. Sharing of resources should be promoted within and among countries in Africa so as to minimise the effect of shortages of highly skilled health work force.

As the chairperson of the Bureau of Ministers of Health of the African Union and on behalf of the Bureau and according to the Africa Health Strategy, I wish to state that the issue of human resources should be viewed in context of the whole spectrum of diseases. This includes communicable, non-communicable as well as accidents and injury, as against focusing only on a few special diseases.

I also appeal to all of us as 30 years of Alma Ata Declaration of the importance of public health is being commemorated this year, to move beyond the disease model of health into prevention of many diseases through Healthy Life Style promotion.

Sometimes there are internal distortions of human resource distribution because some programmes get a lot of financing and offer much higher salaries than the regular programmes. In this regard some international development partners need to reassess how they support countries by supporting national human resources for health plans as a component of their support.

Some of the thoughts that need to be considered to alleviate this problem of health worker shortage due to migration include entering into bilateral agreements with receiving countries on ethical recruitment - South African has entered into such Memorandum of Understanding (MOU) with the United Kingdom, providing incentives for health workers that agree to work in rural areas, promoting good career-pathing to avoid losing good professionals to management jobs just in order to get high salaries.

The role of international agencies in advocacy cannot be overemphasised. In this regard we applaud the World Health Organisation (WHO) and other partners for the role taken to provide a platform to interrogate these issues at the assembly and in the recent World Reports on Human Resources.

Developing countries also need to train for their needs so that they are not short of health workers. The developing countries can consider training for them at a pre agreed formula for remuneration. As the issue of training health workers is discussed, it is important to also think of the extra resources to train more in every category needed by each country and even train for export (maybe with compensation). Developing countries can send their students for training in Africa.

Africa took a decision to train the type of health worker who would fulfil the necessary function of care without lowering standards of care. It is incumbent upon each of our countries to find the most appropriate cadre needed and embark on training and design retention strategies. It is also important for all of us to monitor the human resource needs and the skill mix needed to provide good quality care.

We welcome the development of the proposed Global Action Plan /Road Map on Human Resources for Health. The strategies in this action plan need to consider that developing countries are disadvantaged by the weak economies and weak health systems. This poses a further challenge since not all health workers' problems can be solved by a sector. The finance and public service sectors are important.

Other sectors that affect the environment under which health workers work, include the infrastructure and other communication issues over which the health sector has no control.

I am happy to state that in solidarity with other African countries, South Africa pledged not to recruit from other African countries that have human resource shortage. This is a principled decision that was taken so as to avoid worsening each others' situation. Further to this, we offer a certain number of postgraduate training facilities as an effort to ease the shortage of highly specialised health workers. If similar interventions could be used by other countries, it could help those countries with no medical universities.

The other area that has been under-explored is the engagement of the diaspora for certain periods of time to work particularly in their countries of origin The African Ministers of Health are very keen to explore this avenue.

In conclusion, I would like to urge you all to consider that, whilst there may be global strategies to solve the human resource challenge, Africa and indeed each region or country may need to modify these further to implement what works for Africa. As you deliberate on this important issue, I wish to remind you all that the heads of state and government eagerly await strategies that halt the ongoing imbalance of human resource distribution. We should not be afraid to be innovative and use methods and interventions that will benefit Africa.

I wish you all robust deliberations so that we can go to Kampala with clear objectives to be achieved by Africa for Africa.

I thank you for your attention.

Issued by: Department of Health
12 February 2008