Speech by Hon. Dr Manto Tshabalala-Msimang, Minister of Health of the Republic of South Africa and Chairperson of the Bureau of African Union Ministers of Health (CAMH3)at The Global Health Workforce Alliance HRH Action Conference, Kampala Uganda, 2 to 7 March 2008

Your Excellency General Yoweri Museveni, President of Uganda,
Your Excellency Ban Ki Moon, Secretary General of the United Nations,
Your Excellency Dr Asamoa-Baah-Deputy Director General of WHO,
Honourable Colleague Ministers of Health and other sectors,
Advocate Bience Gawanas, African Union Commissioner for social affairs
Members of the diplomatic corps,
Developing partners,
Members of the civil society
Distinguished health workers here present,
Ladies and gentlemen

It is an honour and privilege to be part of this first ever Global Conference on Human Resources for Health. We are indeed excited that this historic occasion is hosted in Africa, a continent most beleaguered by human resource challenges. The theme of this conference emphasises the urgency with which we need to respond to these challenges and it galvanises all of us concerned into taking action on the health workforce.

As we converge here, there is high expectation that the outcome of this conference should bring about practical solutions to the challenges of shortage and inequitable distribution of skilled workforce. As you know all of the priority health programmes depend on adequate numbers, well trained and appropriately deployed and managed healthcare workers for effective implementation. It is therefore important that each country has an appropriate human resource plan and mobilise the amount of human, technical and financial resources needed to attain the objectives of the plan.

The first ever global conference on human resources for health coincides with the 30th anniversary of the Alma Ata Declaration on Primary Healthcare. Many countries are still struggling in establishing robust primary healthcare systems largely because of the inadequate training and orientation of health workers to preventive health care approaches.

Human workforce development is therefore a critical element in developing a responsive health system that seeks to achieve:
* equity in access to services as well as allocation of resources
* community participation and involvement
* intersectoral action and
* decentralised management that is able to respond to the needs of communities.

This approach should be complemented by allocation of adequate resources, provision of a package of prescribed essential health services and involvement of civil society as agent for health promotion and disease prevention efforts. The issue of human resources should be viewed in context of the whole spectrum of diseases that includes communicable, non-communicable diseases as well as accidents and injuries. Strengthening of human resources will enable us to respond in a more sustainable manner to all these three causes of morbidity and mortality in the world. Mere task shifting cannot be the answer. The necessity of appropriately trained personnel for effective healthcare delivery cannot be overemphasised.

We also need to acknowledge that vertical programmes, whilst aimed at responding to specific health challenges, tend to aggravate the human resource imbalances. This is largely due to the recycling of healthcare workers within programmes instead of increasing production over time. We need to develop broad capacity and skills that should strengthen the ability of our health systems to respond to relevant health challenges. The need to develop sustainable human resource capacity should be a central element of the support provided by our development partners. Development partners play a major role in supporting countries and this support should complement country led programmes in line with the Paris Declaration on Donor Effectiveness. Developed countries committed themselves at Monterrey to devote 0.7% of the Gross Domestic Product (GDP) to Official Development Assistance (ODA). There is now an urgent need to deliver on this commitment if we are to reduce the major inequities that exist in the world.

The contribution of socio-economic factors to health outcomes is an established fact. As we work tirelessly in the health sector to achieve the goals of universal care, attention should also be paid to ancillary factors that are critical to achieving good health outcomes, particularly the eradication of poverty, underdevelopment and gender inequality. The role of the multilateral institutions in advancing macroeconomic policies that impose severe constraints in the delivery of social services therefore requires a serious reflection. Whether we term it downsizing or rightsizing, such policies adversely affect the delivery of health service particularly to the poor.

Programme director, it is pleasing to note that the World Health Organisation (WHO) is responding positively to the concerns about human resource challenges that were highlighted by Health Ministers from Africa and the rest of the developing world at successive sessions of the World Health Assembly. One such response was to launch a Global Health Workforce Alliance (GHWA) which has been central in convening this forum. African ministers of health appreciate the consultation process in the build up to this conference. One such consultation was the meeting of the countries of the Bureau of the African Union and some Southern African Development Community (SADC) member-states which was held in Cape Town nearly a month ago. This meeting discussed extensively the action plan that I believe we are going to be able to finalise and adopt at this conference. This action plan should highlight a few issues that we should all commit to act on as developing and developed countries as well as development partners and international agencies.

Through the Africa Health Strategy for 2007 to 2011 which has been adopted by Heads of States, Africa laid particular emphasis on the health workforce development as essential in the attainment of all the other health goals and in meeting the health needs of our citizens. The health needs of the local population should inform the training and development of human resources including the ensuring the relevance of the health training curriculum. It is within this context that we need to finalise the debate that face many countries with regard to the location of health training institutions between health and education sectors. Health sector seems to be better placed to assist these facilities to demands of health service delivery.

Africa took a decision to train for the type of health worker who would fulfil the necessary function of care without compromising the standards of care. It is incumbent upon each of our countries to find the most appropriate cadre needed and embark in training of these health workers. This should not be done at the expense of highly specialised health care provision. It is also important for all of us to monitor the human resource needs and the skill mix needed to provide good quality of care.

Programme director, as we continue with strengthening the education and training of prospective health professionals in our countries, it is disturbing to note that the recruitment of these prized assets of our health systems to developed and better resourced settings continues unabated in many countries. Whilst we acknowledge individual rights to freedom including the freedom of movement, we urge that developed countries be restricted by ethics in the recruitment of health workers. At this forum, we hope to come out with a commitment from the developed or receiving countries to development of their own human resource plans that do not undermine the health systems of other countries. This then could be a firm basis for a transparent exchange of expertise and continued education development of human resources for health.

We believe that a mutually beneficial formula to train and distribute health human resources can and needs to be explored. Our view as Africa is that receiving countries should consider reparations for the countries of origin that trained the heath workers. This should be done through initiatives aimed at strengthening the health systems of countries of origin, guided by the priorities of the affected country. Africa Infrastructure Fund (AIF) which is an initiative by Africa aimed improving health infrastructure, provides an ideal platform for channelling of such resources. However, this investment in countries of origin should not be viewed as a blanket approval for continued unethical recruitment practices.

Developing countries also have to find innovative ways of overcoming the human resource shortage through a variety of interventions including the government negotiated exchange programmes among themselves. We need to establish and implement home grown strategies and incentives that are sensitive to our conditions so that we can recruit the best students into the health sciences and retain them in our health systems. This can then be complemented by exchange programmes that are of mutual benefit to parties involved. South Africa, for instance, entered into such agreement with the United Kingdom in 2003 allowing for health professionals of one country to work in another for a specified period as just but one element of the agreement. This approach was based on the concept of code of conduct that was initially developed at the Commonwealth Health Ministers' meeting in New Zealand and later endorsed in Geneva.

There is also a need for solidarity amongst African and developing countries themselves. We pledged as South Africa not to recruit from other African countries that have human resource challenges. This is a principled decision that was taken so as to avoid worsening each others situation. We also reserve opportunities for undergraduate and postgraduate training for students from fellow African countries. Upon graduating, they are required to go back to serve in their countries of origin. If similar interventions could be used by other countries including developed countries, it could help those nations with no medical universities. Through government to government agreements, we are benefiting as a country from the services of doctors from Cuba, Iran and Tunisia. These are structured recruitment initiatives that are guided by the spirit of South-South co-operation.

Programme director, 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 overburdened health systems due to changing epidemiology.

In conclusion, I would like to urge you all to consider that, whilst there may be global strategies to solve the human resource challenges, different regions of the world may need to modify these strategies and implement them in manner that is relevant to those respective regions. Considering the important role that we believe Africans in diaspora can play as partners in Africa's development, the African Union will in the near future organise a diaspora conference to further explore issues of mutual interest. As we deliberate on this critical issue in the delivery of health services, we should not be afraid to be innovative and use methods and interventions that will benefit our countries.

The Kampala Agenda for Action should serve as a guide in our action on health workforce. The time to take that action is now.

Thank you

Issued by: Department of Health
2 March 2008