Where We Work
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The evidence is clear—our world population is changing. Today, more than ever before in history, our population is largely young, urban, and on the move.
And for the first time, the majority of people on Earth live in urban areas. Many of us now go to work every day in the cities and then return home to the suburbs to sleep.
Our old systems are no longer adequate for our increasingly urbanized and mobile populations. The urban poor, in particular, often do not get the health care they need. Proximity to health care services does not translate into access or use.
Last month, I was happy and honored to be invited to speak at the annual meeting of the Partners for Population and Development (PPD) in Beijing, China. We talked a lot about these changes in the world and the new challenges they have created—one of the greatest of which is the demand for high-quality health care. And that is why I spoke to the assembled ministers of health and finance about the vital role of the health workforce. Investing in frontline health workers, I explained, may help us finally traverse the last mile in providing health care services to those who are in desperate need of them.
My hope is that those ministers will return home to their countries and lobby for greater investment in their own health workforces.
PPD is made up of 25 member countries (including eight of the sub-Saharan African countries where IntraHealth works). Together, these countries make up 58% of the world population. On each of those member countries’ agendas is universal health coverage. And each one is coming to understand that success or failure in achieving it will hinge on their countries’ health workforces.
We will be talking more about these issues this week in Recife, Brazil, at the Third Global Forum for Human Resources for Health. I believe that if we are to achieve the universal health coverage we all so want, we must embrace a rights-based approach—that is, we must believe that access to basic health care is a human right. And we must allocate resources to the people who will be providing the care.
A Voice for the Global South
We have made so much progress globally. We know what works. Now it's all about scaling up and learning from each other.
At the global level, we tend to talk a lot about the global shortage of health workers—we are deficient by more than 4 million—but we don't talk much about how to get the best out of the ones we have. And given the limited resources countries are working with, this is essential. Some countries have done better than others. Ethiopia’s health extension workers come to mind; by investing in a new cadre of frontline workers, the country was able to make rapid progress in reducing child mortality to achieve Millennium Development Goal (MDG)
4. Other great examples include Kenya, Malawi, Nigeria, and Tanzania, countries in which governments are reforming policies and investing in their health workforces in innovative ways.
The donor and global development community can build momentum by setting goals to achieve better health outcomes, but nothing is more powerful or motivating than watching your neighbor make progress and achieve goals. Over the next few years, the kind of South-to-South collaboration the PPD promotes—wherein countries across the global South come together to exchange ideas and resources—is going to become more and more important. Because as 2015 approaches, we’re all asking ourselves: What will come after this target date for the United Nations’ Millennium Development Goals?
And what about the shifting donor community? The largest donors are pushing for greater country ownership, wherein governments exercise their authority—and take on more responsibility. We see changes already in PPD-members China, India, and South Africa, countries which are, in some cases, becoming donors themselves.
At the PPD annual meeting, the African Population and Health Research Center presented lessons learned in four countries that are working to address urban reproductive health. One of these countries is Senegal, where I grew up and where IntraHealth is currently working to support family planning in the densely populated areas in and around the capital city, Dakar. And what have we found? That even in urban areas, instead of waiting for communities to come to health clinics for care, we need to take family planning and reproductive health services to these communities. We need to take into consideration the specific socio-cultural context to ensure that care is offered in acceptable ways. And we need to support members of the community as frontline health workers.
There are so many global initiatives today—there is Every Woman Every Child from the United Nations Secretary General, a promissory note from USAID on saving children, and of course, Family Planning 2020, which is an effort to give access to contraception to an additional 120 million women. But for us to reach the goals of these initiatives, we must have three things.
The first is a platform such as PPD that provides a voice for its members and allows countries in the global South to exchange experience and ideas. The second is a focus on the world’s young people, including embracing all the technologies available to us to reach them.
And third, we must ensure that health workers remain at the center of all of our efforts to tackle global health challenges.
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