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Let's Talk Tactics

Photo by Alfredo Fort

Ever since the first two global gatherings in Kampala in 2008 and Bangkok in 2011, human resources for health—or HRH, as this field has come to be known—has matured into one of the world’s biggest development bastions still to be conquered. I had the good fortune to attend the Third Global Forum on Human Resources for Health in sunny Recife, Brazil, last week and moderate a couple of sessions and events. Whenever I join thousands of participants at such global conferences, I look back and wonder: Did I learn something? Was it worth the time and effort? And now what? In this case, the answers are “Yes,” “Absolutely,” and “We still have a lot to do.”The forum was surprisingly positive. Clearly the various fields related to HRH and universal health coverage have acquired depth and come a long way since Kampala. New analytical tools and instruments—from community-based curricula to quantitative discrete choice experiments for evidence-based retention packages—are great signs of progress. And many countries—such as Brazil, Thailand, Ethiopia, Canada, Kenya, and Senegal—have plenty of health-sector achievements to celebrate. But have all the commitments and resolutions made by the G20, the UN General Assembly, the World Health Assembly, and many others been met? Are we close to the global goal of having 2.3 health workers for every thousand people? Well, not yet. But by 2030, we should be very close. 

Where Was the Private Sector? 

It seemed that at least 90% of the forum participants in Recife were from the public sector, foundations, or academia. There were few representatives from ministries of finance, education, or civil service. The forum carried the taste of preaching to the converted (though there are more and more converted, to be sure). Where were the decision-makers from the fields of economics, trade, and science and technology? I hope that at the next global forum, we find hundreds of representatives from employers, unions, hospitals, health care corporations, insurance companies, and pharmaceutical and medical technology firms. All are major actors when it comes to employment and demand for more of the health workers we are, after all, advocating for.

Two other observations from the forum worried me as well: 

  1. The relative absence of a long-term HRH vision. 
  2. The lack of forward thinking when it comes to the way health workers’ roles and skills will need to change over time. 

Shifting tasks (such as those for treating diabetes, cancers, and cardiovascular disease) from highly skilled urban health workers to rural community health workers is a short-term solution, and very different from increasing the number of rural community health workers. The plans discussed at the forum for both health services and education seemed to be insubstantial and short-term. 

The Double Punch

The global HRH movement has acquired both gravitas and momentum and has grown into a global health development force. The double punch of Recife’s Third Global Forum and Bangkok’s upcoming Prince Mahidol Award Conference in January could make HRH front-page news.  But then what? Where is the post-2015 vision? Where is the global health HRH strategy for 2030? 

Strategy without tactics is the slowest route to victory; tactics without strategy is the noise before defeat.

While the Third Global Forum on HRH focused on technical issues, the upcoming Prince Mahidol Award Conference has a reputation for focusing on policy. It should do so by opening a dialogue about what the HRH world should look like by 2030. This includes discussions of twenty-first-century health professionals (many of whom will be practicing into their sixties and seventies), the new global health academia (where massive online open courses are changing the way health workers learn), and all cadres of health workers, current and future (for example, many countries do not yet have mental health workforces, but will build them soon). To paraphrase Lao Tzu and Napoleon, “Strategy without tactics is the slowest route to victory; tactics without strategy is the noise before defeat.” And Lawrence Freedman phrases it nicely in his book Strategy: A History: “It is about getting more out of a situation than the starting balance of power would suggest. It is the art of creating power.” The global HRH community deserves leaders and structures that can get more out of what has already been achieved, lay the groundwork for the world’s new HRH comprehensive strategy, and create powerful, realistic plans. I believe that given the support of the World Health Organization, the Global Health Workforce Alliance, the U.S.’s long-term global health commitments, and the new leadership at the World Bank, the International Monetary Fund, and the Regional Development Banks, countries such as Brazil and Thailand should be able to agree on such leaders and structures—be they led by government, academia, foundations, industry, or the private sector.

I came away from Recife impressed by how far we have come and how strong we have grown when it comes to HRH. And while I remain concerned about the lack of long-term direction and focus, I am hopeful about our opportunities to reposition the HRH agenda as part of a post-2015 strategy and our mid-twenty-first-century future.