Human resource management
The crisis in human resources is nothing new in health problematics in developing countries, but the AIDS epidemic has shown the real extent of it. Indeed, in some countries AIDS badly affects health personnel while health systems are overwhelmed by the flow of patients. In addition to AIDS-related issues, one of the most acute problems the health system must face is the migration of public sector staff to both the private sector and from South to North countries. This trend may not be systematically quantified but it has been increasingly apparent over the past years. North countries face huge shortages in medical and nursing staff and offer executives from South countries a sustainable opportunity to practise.
The issues in human resource management
According to the latest estimations by the World Health Organization (WHO) 57 countries currently face an acute labour shortage, including 36 in Sub-Saharan Africa. This corresponds to a lack of 2.4 million doctors, nurses and midwives. Africa is by far the worst hit. The continent bears 24% of the global disease burden but has a mere 3% of human resources for health.
A poor geographical distribution of staff is a problem: many doctors practise in administrations and qualified staff is not equitably divided up (doctors, midwives and experienced nurses are concentrated in the big cities). Finally, the quality of healthcare provided by staff has considerably worsened over the past ten years due to a lack of investment in initial and continuous training.
The reasons for this crisis are deeply-rooted in the structural adjustment policies of the 1980s. Budgetary restrictions imposed on overindebted States led to a drastic reduction in staff recruitment in public health, a reduction in real salary, an end to training for staff members in certain fields and lower quality in existing training. The gap in wage levels between the public and private sectors can partly explain malfunctioning in public health services, in particular absenteeism, as well as the widespread practice of overbilling, parallel private practice, the “race” to follow training sessions with per diems and clientelism.
The international community became aware of the need for an emergency response to this crisis. WHO devoted its 2006 annual report to this issue and launched the decade of human resources (2006-2015). The “Global Health Workforce Alliance” launched in May 2006 aims to help countries analyze situations and design human resource development plans. In France the National Aids Council (CNS) made recommendations which go much further than the issue of fighting AIDS. The European Union is launching a strategy to react to this crisis and proposes to member States to adopt a code of good conduct in terms of recruiting health staff from South countries. Another emblematic example is shown with British cooperation (DFID) and the government of Malawi which launched a 6 year emergency programme in 2004 based on financial and non-financial incentives to attract and keep human resources.
There is nowadays international consensus on the priority given to developing human resources. AFD has made it a strategic priority in all intervention countries, particularly in Francophone Africa which is lagging in terms of diagnostics and remedial action.
Prior to any intervention the first stage consists in supporting governments in designing, when they do not exist, human resource development plans for health. These tools are essential to managing sector staff and provide a short and medium term diagnostic of needs and the means required. They cover the issues of planning, financing, management and training. Support to design and implementation of these plans is provided in collaboration with the French Ministry of Foreign Affairs which is in charge of projects targeting higher education.