#WHA76 Strategic Roundtable - Protecting and investing in the health and care workforce

hello yep we've got sound

um

good afternoon everybody

um director General Dr Ted Ross

excellencies ministers distinguished

guests and delegates

good afternoon

I am sir David B and I'm the

non-executive director of NHS in England

and formerly the chair of health

education England and it's my great

pleasure to be your moderator for

today's strategic Roundtable on

protecting and investing in the Health

and Care Workforce

this is a topic of global interest and

in my own country the UK it is an area

that is occupying considerable attention

by governments employers and

stakeholders

ladies and gentlemen

there are no Health and Care Services

without the workforce

whether the aim is to deliver on

universal health coverage

emergency preparedness or healthy lives

and well-being

every Health and Care system is about

people

Those Who deliver care and those who

benefit from that care

prior decisions of the World Health

assembly confirmed the global consensus

on the need to take action to protect

and invest in the healthcare Workforce

the focus of this session is therefore

what are we

what are you going to do in the second

half of the sdg era

our experience in the UK demonstrates

that Solutions require political

leadership and engagement across

government sectors

in England the government commissioned

the development of a strategic

multi-year Workforce plan which looks

ahead for the next 5 10 and 15 years

the plan anticipates how demographic

demands and the developments in science

technology digital and data will shape

the future of integrated services and

the workforce

it is intersectional and was co-produced

with contributions from thousands of

Staff experts academics

educationalists analysts

we took advice from other countries and

from the World Health Organization

there is a consensus that we need to

grow the workforce and retain the

current Workforce

we need to invest in the human capital

of health and the healthcare Workforce

and in the UK this needs to be primarily

through our domestic efforts

we also need to create new roles

redesign current roles and maximize the

use of skill mix across

multi-disciplinary teams

the strategy will be published by a

government imminently and is one example

of the actions that can be taken and

delivered within High income countries

I am very keen to learn from our

distinguished panelists on which actions

they will take

but before that it's my great honor to

invite Dr Tedros to give his opening

remarks Dr Tedros

thank you thank you thank you thank you

so much

sir David our

moderator

your excellencies minister rafila

Minister Tom

and Ambassador minta Soma

UNICEF executive director

Catherine Russell

and director Dr Johan Pablo ribe of the

World Bank

professors

excellencies dear colleagues and Friends

health workers are the lifeblood of our

health systems

everything we are discussing this week

universal health coverage global Health

security the sdgs all depend on health

workers

we have a major challenge before us

globally we Face a projected shortage of

10 million health workers by 2030.

this is a substantial Improvement on the

shortfall of 18 million we anticipated

in 2016. but it's still far too many

in parts of the world

Africa the Middle East and small island

developing States

progress is stagnating

the poorest Nations have as little as

one tenth of the health workers as the

richest

in early April ministers and delegates

joined us here in Geneva for the fifth

global forum on human resources for

health

many are with us today

three key themes informed that meeting

and are at the core of my call for

action

protect

invest together

first I call on all countries to protect

Health and Care workers from violence

and discrimination

to protect their labor rights and to

protect them with decent pay and working

conditions

second I call on all countries to invest

in the education employment and career

development of Health and Care workers

and with women making up the majority of

the Health and Care Workforce we must

address entrenched inequalities

concerned action by low and

middle-income countries with the

greatest shortages could double their

health Workforce in the next 10 years

doing so would enable real progress on

universal health coverage and emergency

preparedness

third we must act together

action and investment decisions require

political leadership

coordination across the education

employment gender and finance sectors as

well as engagement with professional

associations labor unions civil society

and the private sector

their excellencies and colleagues these

assembly is an opportunity to align our

work

agree on actions

and accelerate to achieve the health

Workforce targets of the sdgs

there is no better way to honor the

legacy of Health and Care workers who

lost their lives to covet 19. I thank

you and moderator back to you

um now I would like to um

uh move to

firstly provide apologies from Professor

issane Ben yahaya the president of the

FDA World Dental Federation who's not

able to be with us today but I'm very

pleased that Enzo bondioni who's the

executive director of the FDA FDI will

represent

um Professor yahar

he is going to speak in French so if you

could turn to

um your headphones colleagues then he

will now address you so the world Dental

Federation and the member of the World

Health Professions Alliance represents

the voice of more than 41 million

Healthcare professionals worldwide so

um Enzo will outline what actions we

must take to protect and invest in

health workers ends off please

thank you

as you said I will speak French to honor

Professor Ben Yaya

your Excellency Dr Ted Rose

honorable participants it is my

privilege to represent the international

Dental Federation

at this round table in the framework of

the program in order to obtain the sdgs

the strength of Healthcare of

personnel's health

is very important for health security

and for sustainable development it is

unfortunate to note that the F3 is c a

goal on the healthcare Personnel in the

sdgs which has been the focus of our

engagement since 2015 in increasing

recruitment as well as education and

retention of healthcare Personnel in

developing countries especially in the

least developed countries and in small

island development states have not in

fact been a priority the impact of the

covid-19 pandemic was felt across the

health care profession and by The Who

and we note that unfortunately the

health conditions working rather

conditions and the psychological health

of personnel as well as the lack of the

risk of lacking 10 million Healthcare

Personnel in the world by a 2030 are all

to be a noted and we note that this lack

of Health Care as staff is a effect even

in the wealthiest countries a recent

report from the

Who and the world Healthcare Personnel

Association noted that most of the

Urgent needs with respect to a safe

working conditions and psychological

Health were not sufficiently taken in to

account what is more Healthcare

Personnel are exposed to a violence and

in the workplace this is especially true

of women and a youth

it is necessary to take action at all

levels including in decision making on

rules and services of Health Care during

pandemics

unfortunately despite all of the

activism and participation of healthcare

Personnel in developing countries they

did not have these countries did not

have equal access to vaccines

now we can note that a number of dental

offices were required to close and

illnesses involving dentistry and the

mouth were unable to be fully treated

Healthcare Personnel considers that the

lack of a systematic mechanism and the

impossibility of ensuring constant care

is a grave a problem and we would like

to recall to governments that all of the

Applause for healthcare Personnel cannot

replace the fundamental need to invest

and to act we

are in favor of a safe or working

conditions along with the career

perspectives and decent pace so that we

can pay tribute to the health care

professionals that we have lost due to a

decade of inaction we ask for

regulations and policies that respond to

the needs of Health Care personnels

governments must also invest in

education and protection of healthcare

Personnel in order to ensure that there

is sufficient Staffing at the national

level finally we call upon a government

to take in to account Health and Care

Personnel in all Health reforms

including in a systemic and UHC reform

as well as in coordinating response to

pandemics there are 41 million Health

Care Professionals in the union and we

join together in asking that as soon as

possible the sdgs be accomplished thank

you very much

thank you Enzo

let me now turn to Dr rafila the

minister of Health for Romania Dr

rafaeli has been a leading policy

actions within Romania and in March this

year hosted 50 member states of the

World Health Organization European

region to adopt the Bucharest

Declaration on Health and Care Workforce

doctor refiller let me acknowledge your

National and Regional leadership on the

health Workforce the floor is yours

thank you

thank you very much honorable director

General Dr Tedros uh

distinguished panelists

dear invited person and representative

of member countries of who I think we

are now in a turning point regarding one

of the most important challenges

we have is the

Health Workforce in Our member states

and the challenges and the pressure put

on the health system

because this is not only a problem of

investment in the health sector and it's

a more complex problem because we

discuss about retaining educating

making this profession more attractive

in a environment when the big pressure

on the health Workforce worldwide was

very important during this covid-19

pandemic and we have

faced many problems in our countries

because of the

burnout of many of our colleagues even

some some of them lost their lives

fighting covid-19 and I think this is a

very important moment to change the

interest of the our national government

on this issue if we want to be able

until 2030 to accomplish our third

millennium development goals the

sustainable development goal

for the health sector I think we have to

work together and to to try to do

something uh and to to to to transmit

very clear messages from a meeting like

this one or a meeting like we organized

in Bucharest it was the high level

Regional mythical Health and Care

Workforce organizing Bucharest we ended

by signing a declaration but signing a

declaration is not enough we we need to

to act nationally so so that our common

Vision become a priority at the level of

each member State and this uh this is

maybe the most difficult in the more

difficult

action action we have to to do in our

countries because Ministry of Health are

not enough the government should be

involved and the resources should be

allocated why I I tell you this because

it's a more complex problem we we have

to think that attractive attractiveness

of this profession we discuss about

medical doctors but in the same um in

the same time we discuss about nurses we

discuss about the majority of women who

are part of the health Workforce and the

responsibility of women are more than

working it's they're familiar it's

educating their children and the

involvement of

a country or local authorities in

solving their typical problems I think

it's one of the key issues we have to

answer in our countries because the

revenues of Health Workforce is not the

only one we have to we have to act we we

have to act also on the professional

comfort and also the social one

I I am glad to be here and to say that

um

our position it's uh it's a position of

construction and to a position in which

we try to find the best way

internationally and nationally in the

same time and there is something else I

have to act and I have to mention its

violence violence against health

professional it's a it's a reality in

many countries and it's a discouraging

factor for starting and maintaining a

career in healthcare and I think there

is uh no compromise on this issue and we

have to act commonly to to to to to be

able not to allow this to happen again

in in our countries I am I am glad also

to to find that big interest it's in not

only in our region in the European

region about this subject here here at

the table are representative or is a

regional director from cro and our other

colleagues from International

Organization dealing with the health

Workforce and

this common approach Under the Umbrella

of who and under the

umbrella and the work of our

general director I think it's essential

to have a real

commitment and future

favorable future to solve this complex

problem thank you very much

for your key leadership

um

so now let's hear from The Honorable Dr

Lino Tom who's a minister of Health for

Papua New Guinea Dr Tom's political

leadership has secured longer term

financing to strengthen the national

Workforce capacity

he also brings a particular perspective

of the actions required for small island

developing States

Minister Dr Tom please share with us

your thoughts thank you

thank you

thank you uh said David ban uh director

General Dr Tedros esteemed analysts

excellencies

honorable ministers distinguished

delegates I will briefly reflect on key

actions being taken by my country by

point you need to strengthen our health

care Workforce and the unique challenges

faced by small island developing States

is on the verge of facing a health work

for Christ Workforce crisis we currently

have a ratio of 0.1 doctors per thousand

population this ratio is significantly

lower than the one doctor pay a thousand

population recommended by who

we produce less than 50 doctors per year

for a population of almost 10 million

people based on current estimates with

an estimated annual population growth

rate of 3.1 percent it's the same for

all other Cadets wealthwork force on top

of that we are experiencing two types of

brain drain Geographic and

organizational with our clinical health

workers taking up opportunities which

come with significantly more attractive

renumeration packages than what our

national health system can offer apart

from our health Workforce shortage we

are faced with another significant

challenge to delivering Health Services

Papua New Guinea as an extremely rugged

topography 80 percent of our population

live in rural areas often with no Road

access some communities have to walk

through mountain ranges for days to

access their nearest health facility as

such strengthening our health Workforce

is one of our top priorities as part of

our L system reform as Minister for

health I have advocated at the highest

level for an increased budget allocation

to the health sector to fill critical

positions across Health Workforce

including Village Health assistance in

remote communities

we are prioritizing interventions to

strengthen capacity and capability of

our health Workforce which include

establishing a standalone Medical

University to increase the number of

locally trained doctors and other health

Cadets

working with Partners to enable

professional development opportunities

for both overseas and in country

exploring the use of digital Health

technology to improve communication and

access to telemedicine for health

workers especially in remote areas

introducing incentives to recruit and

retain health workers including a rural

incentive package and improving staff

housing we are also finalizing our

health Workforce Development plan with

updated data to inform policy

small island developing states share

unique challenges our health Workforce

sottage are intensified by an increasing

outward migration of healthcare workers

from an already small pool to meet

Global demand we are highly vulnerable

to climate change and among the highest

prevalence of non-communicable diseases

in the world further accessibility by

climate change the impacts of climate

change and their cascading effects on

small island developing states are acute

placing a significant strain on our

health and health systems and health

Workforce this calls for immediate and

Collective action last month the Pacific

island the Pacific Edge of Health held a

forum to address specific persistent

Health Workforce challenges and develop

joint recommendations for hexen however

policy alone is insufficient we need to

work collectively to share resources and

knowledge to tackle climate change and

its impact on Health in small island

developing States bridge the gap between

data policy and of course action take

multi-sexual action to address the

social determinants of Health

and help deliver interventions and

incentives to support our health

Workforce before we reach crisis point

thank you true

um thank you Minister Dr Tom

um let me now invite ambassador to Summa

the commissioner for health humanitarian

Affairs and Social Development at the

African Union

um the Ambassador will speak in French

so again could I invite colleagues to

use a headphones

Ambassador Who projects that by 2030 the

global shortage of health workers will

be most concentrated in the afro and

emerald regions uh please show with us

your Reflections on the actions that the

continent can take in the second half of

the sdgs thank you

thank you very much moderator director

general of the who

honorable

Minister

distinguished a panelist ladies and

gentlemen it is an honor for me to

participate in this afternoon's meeting

and I'd like to thank the ewho and

instructor General and all of the

organizers of this opportunity to

discuss such an important issue for us

as you said Mr moderator it's important

to take in to account the fact that

Health and Care Personnel need

resources because

this stuff is really the spine that

carries

the profession

and the importance of this issue was

emphasized by our heads of state and

government they have noted a deficit in

Health and Care a personnel and

they took the decision that they would

be too uh

2

000 additional health care or Community

personnel and there is rather The

Interpreter protect

corrects herself to million additional

health care workers will be deployed in

the area of the African Union and this

is a very important if the agenda 2063

and of the African Union on the 2030

agenda of the United Nations will be

fulfilled

African States

have the distinction of having the most

vulnerable

persons and the ideps

that is internally displaced persons are

especially vulnerable as our migrants

the covid-19 pandemic only made the

situation more difficult and we are also

facing challenges such as

desertification uh flooding and others

which increase the need for us to

further invest in Health and Care

Personnel we have seen the work that has

been done

we lost many lives during the pandemic

and we saw the work and the importance

of the work of healthcare Personnel

during the covered pandemic and during

the Ebola outbreaks and I would like to

emphasize the fact that this Health and

Care Personnel they are working

in a manner that risks their own lives

many times they give their own lives in

order to save other lives we must not

forget this and National efforts ladies

and gentlemen in Our member states must

be sustained efforts that must be

supported so that we can achieve these

goals I believe that we should also pay

special attention to the situation of

women and Youth

there are special dangers there

67 percent of the Health and Care of

personnel Workforce are women and Youth

Africa is a young continent and we need

to take this into account so that we can

find Solutions

we need new actions

beginning with strengthening capacities

on the part of a women

including women working in the field who

are risking their lives and we also need

Innovation youth needs to be able to

make its own contribution to improve

care in Africa

let me also note the importance of

decent pay unfortunately currently

Health and Care Personnel do not have

sufficient salaries and we must appeal

to member states to act in this area so

Healthcare personalities also a victim

to harassment and other mistreatment

there is segregation there are gender

disparities in Pay we must pay attention

to these issues we need

equity and

inclusiveness if we hope to make up for

the deficit of Health and Care or

Workforce

this means that we require leadership

and as this is a cross-cutting issue

urgent measures must be taken in order

to protect and invest

in Health and Care

personnel and so I call upon member

states to Heed These words I am

convinced that if we take concerted

efforts and work together we can find

the necessary financing to reach our

goals in strengthening

Health and Care Personnel in Africa and

why not around the world thank you very

much moderator and thank you for giving

the African Union the opportunity to

speak

yeah

thank you Ambassador let me now turn to

Ms Catherine Russell the executive

director of Unicef Ms Russell I

mentioned earlier that Solutions require

actions across government sectors

this is a core part of unicef's work to

protect and invest in Children and

adolescents their education their health

and their future livelihoods please the

floor is yours thank you

thank you very much David to Excellence

these colleagues my friend Dr Tedros

good afternoon it's really great to be

here with you for this important

discussion women are at the heart and

soul of the healthcare Workforce they

account for 70 percent of all health

workers 90 percent of nurses and

midwives and nearly 75 percent of

community health workers they are

responsible for improving health and

survival outcomes for millions of people

every single day and they are critical

to accelerating progress towards

universal access to health care and

ultimately achieving the sdgs yet women

in health care workers continue to face

challenges and barriers to undermine

their efforts to provide care

first among these is gender inequality

women are pillars of Health Care

delivery but in many countries girls and

women's access to Quality education

training and learning tools remains

woefully inadequate

adequate compensation for Women Health

Care workers is also a serious problem

on average women are paid 24 percent

less than their male counterparts and

just as all of us here are compensated

for our efforts so too should community

health workers be paid fairly for theirs

and women health workers are more likely

to experience violence sexual abuse

exploitation and harassment at work many

face unsafe working conditions with a

lack of adequate infection control

measures or personal protective

equipment

quite simply we cannot achieve Universal

Health Care and the sdgs more broadly if

we do not address gender inequities in

the health Workforce to start

governments must make educating

empowering and protecting women and

girls a top priority

doing so will help to strengthen

communities improve productivity and

boost economies and it will help to

increase the number of women health

workers in communities of need we must

also do a far better job of recruiting

and retaining women workers in the

health sector this means compensating

women health care workers with equal pay

for equal work and it means ensuring all

health workers can do their job safely

and free from violence exploitation and

sexual harassment

governments in the private sector should

step up with the financing needed to

ensure that in addition to compensation

women health workers have consistent

access to the supplies and support they

need to do their jobs this includes

medical supplies and equipment PPE clean

water electricity Transportation digital

tools technical guidance and mental and

physical health support

meeting these standards will make Health

Systems more resilient and effective it

will also help to erode gender related

discrimination by opening the door for

more women and girls to serve in a range

of Health Care roles like nurses doctors

administrators or policy makers

and as more women gain visibility and

influence in Health Systems there is a

greater likelihood that gender barriers

in other sectors will be overcome as

well

critically we must also strengthen

support for women community health

workers they are uniquely placed to save

and improve lives in the hardest to

reach and most marginalized communities

places we must reach to achieve the sdgs

across the globe community health

workers serve as important sources of

trusted knowledge in their communities

as providers of Integrated Primary

Health Care and as advocates for local

priorities and needs in many contexts

they are the only health care providers

for vulnerable populations especially in

humanitarian settings where their own

safety may be at risk

over the past year I've met with

community health workers in the Sahel

and Horn of Africa and seeing their

incredible work firsthand this includes

their heroic efforts to reverse the

backsliding in children's vaccine

coverage a consequence of the pandemic's

devastating impact on health systems and

Service delivery

as the United Nations agency with the

largest multi-sectoral Workforce on the

ground UNICEF is playing a unique role

in taking this agenda forward across

both humanitarian and development

contexts we are supporting secondary

education

and skills development for adolescent

girls and we are working with Partners

to expand apprenticeship opportunities

for girls within the health sector an

initiative we hope will make careers in

healthcare a promising option for young

women including as community health

workers more broadly UNICEF supports and

trains community health workers to

provide essential Services prevent the

spread of disease and respond to

humanitarian crises we also work with

governments and other developmental

organizations to elevate Community

Health in National agendas

our approach integrates Service delivery

across multiple sectors including health

and nutrition early childhood

development social protection water and

sanitation and hygiene

but this is not enough Excellence is the

bottom line is that in order to reach

the sdgs we need to support and invest

in community health workers and we need

to support and invest in girls and women

this means expanding access to Quality

Education and Training ensuring equal

pay for equal work and providing

consistent funds for the tools needed to

do their jobs in this way we can build

healthier societies and make the sdgs a

reality thank you very much

thank you

thank you very much Catherine Russell I

now give the floor to Dr Yuan Pablo

Uribe Dr Uribe you are the global

director for Health Nutrition and

population of the world bank and the

former minister of Health for Colombia

please if you can share your own

experience from Latin America and in

your current role at the World Bank on

investing in education and jobs for

universal health coverage and emergency

preparedness thank you thanks thanks to

you and and to

um all the panelists and Dr Terrors let

me start by quickly congratulating who

for the leadership in this field in the

recent global forum and the messages

coming out of it that um director

General Otero summarized I think are

extremely important for all of us and I

I do believe that we need to work with

them and it's going to be very useful

let me share two very brief thoughts of

things that we are seeing countries are

doing and we're supporting from the

World Bank

in this endless purpose of strengthening

our health Workforce and they come from

the implementation of of a very robust

and big portfolio of investment projects

in in all type of countries around the

world

um

the first thought coming from there is

that

the health Workforce requires

intentional Investments

intentional Investments Investments that

are tailored to specific objectives that

are focused that are sustained

and for those Investments to be

successful they need to be also properly

managed

they need to be managed with stronger

day by day institutional capacity with

stronger tools and more developed

technology

like the most important investment

project in a health system in a country

and second those Investments

should be aligned and we're seeing that

in many countries with the ongoing

priorities for those Health Systems to

give an example as was mentioned with

the community of Workforce in

strengthening Primary Healthcare

Catherine or with ongoing Healthcare

delivery reforms that intend to be more

patient-centered

or as we speak about pandemic

preparedness and prevention and future

response to crisis and having a health

Workforce more suitable and capable to

respond to basic Public Health functions

just to give concrete ideas so this is

the first message intentional

Investments that need the proper

management for being effective and

transformative the second one that we're

seeing is a big Challenge and it's that

there's nothing better for us in the

health Workforce than a strong health

system and vice versa there cannot be a

strong health system without a strong

Health Workforce but strengthening the

health system is a challenge today

given the fiscal and economic reality of

many of our countries and our health

systems and sustaining that financing

and being able to maintain that

sustained intentional investment in the

health Workforce is going to be critical

in the process of strong Health Systems

so we need

to enable

to support to facilitate the success on

the day-to-day of the workforce in the

responsibilities that they assume I

believe personally as a physician that

there's nothing more satisfactory than

being able to go to a safe environment

to do your work the work that you chose

to do with the inputs that you need to

deliver the results that you promised

the people that you're serving and that

you do want to achieve and that note I

do want to finish with a very personal

note from my past life

visiting Public Health hospitals or

across my country and talking to nurses

and technicians and also to Citizens and

patients in this public hospitals in

very

difficult situations

what I found in all of them hundreds of

them

is that most of us who are in the health

field we chose intentionally to be here

because we wanted to serve

and when we are able to serve with

recognition

with visibility

with appreciation

and with respect

we will continue doing it better day by

day thanks so much

thank you Dr Uribe now let's hear from

Professor

Sanai fisaya the vice president of the

global programs of the Susan Thomas

Buffett Foundation

the professor fazia please if you could

share your thoughts and particularly on

the role of philanthropic partners and

Global Health initiatives to support

National and Regional actions thank you

thank you David good afternoon everyone

thank you esteemed colleagues

when you're the seventh person in a

panel mostly everything you are about to

say has already been saved so I probably

will start out by endorsing everything

that has been said particularly protect

invest and together

and Catherine and I almost had the same

talking points right so uh whether it is

scaling up training uh safe working

environment migration retention equal

pay those are all critical things and I

think the need to acknowledge and

renumerate role of women health workers

and the role they play is profound so

I'm really glad and grateful to

Catherine and and frankly over the last

decade a shout out for women in global

Health who have been relentlessly

advocating to put the agenda on the

global stage to acknowledge the role of

women health workers

um maybe briefly I think Health

Workforce is a challenge globally there

is no question about it but we need

particular attention in low and middle

income countries particularly Africa

we've heard for so long that you know

Africa has only four percent of the

workforce and 25 of the disease burden

and sort of you get desensitized but I

think one key statistics maybe if you

look at who support and Safeguard list

37 out of 55 countries are in Africa

so I think that just sort of shines a

light so let me go back to what I was

asked or tasked to do which is talking

about the financing piece and the role

of philanthropy so I think there is no

question that domestic financing is

going to be the key and the only

long-term sustainable solution and I'm

so glad I'm sitting next to the leader

from a Development Bank but as a donor

where I would like to build is on the

comment my colleagues have made about

what external funders like financing

institutions and private philanthropy

can do to complement the efforts of

government

the reality is that donors have not

always supported the long-term

investment goals of governments

and the need to create a robust

well-trained protected and paid

Workforce Health Workforce and in some

cases we have actually disincentivized

these outcomes

you know take for example the

conditionality on International

financial institutions like the wedge

Bill caps right this directly inhibits

countries ability to spend on the health

Workforce they also have been shown to

decrease Health financing overall

so this approaches need and overhaul we

simply cannot continue asking

governments to increase their health

Workforce spending while not allowing

them to make the long investors the

Investments they need to make to

maximize their return

similarly I think in private

philanthropy we chronically have created

parallel systems that will give us the

short quick outcomes we need as opposed

to aligning with governments long-term

strategy I understand we all have

whether it is parliaments or Congress or

you know whoever that we are accounted

accountable for to deliver results but I

think the need to align

um and and align with government and not

allowing a long-term investment has been

a challenge

short-term and service training that has

become

uh the main approach in in development

and in global Health we sort of kind of

quickly uh fly in and oftentimes take

the limited Workforce and incentivize

them through top-ups and other things

for short-term training I think is

continually eroding the workforce

strategy so imagine instead if we align

the majority of our funding to

government's Health Workforce strategy

and institutions they need to support

this work comprehensive that can work

comprehensively in this country so for

the last five years at the buffet

Foundation that's exactly what we've

been doing in fact we started that work

very early when Dr Tedros was a health

minister in Ethiopia and looking at The

Chronic shortage of Workforce I mean he

reached out to us and he said this is a

simple a simple supply and demand issue

right so he said we can't train a small

number of people knowing that they're

going to leave looking for has called

Green pasture was the word he used so

what he came up with was what he called

flooding strategy right where he

increased you know the number of doctors

nurses midwives but in a state of

waiting the entire time it takes to

train a doctor for example to be able to

provide cesarean section in a country

where there was only two percent access

for C-section he trained what is an

equivalent to a PA in the U.S somebody

with a ba degree a nurse was three-year

training for integrative surgical

officers and by doing this and training

40 000 women community health workers

with support of Partners

um you know like usaid Global fund

diffid and others through a poor funding

mechanism he was able to lead his

country to achieve mdgs a couple of

years ahead of Target so I don't think

we need to reinvent the wheel I think

there are lessons to learn on how to do

this but it's going to create a

cohesive and intentional strategy to

support uh national leaders we're trying

to do the same in Rwanda currently

Rwandan government has told us if they

continue at the current Pace it will

take him about 185 years to meet the

Whos goal of having four providers per

1000 so they have come up with a

strategy called 4x4 where in the next

four years they want to scale up and

Achieve that objective this is going to

require right Partners to align around

the strategy so I think there is a lot

to be learned from the ground about how

countries are achieving these objectives

and when we approach countries like this

we've also seen many are interested in

mechanisms such as matching funds

because at the end of the day we're

helping them deliver on their National

strategy

um

the other Maybe

idea to to sort of reflect and and focus

on is community health workers a lot has

been saved by Catherine uh but you know

for me uh looking at the experience of

Ethiopia Liberia Ghana just so many

countries where new train large number

of women in a community and give them

the tools and

skills they need this is really a

pathway to instant gender equality

poverty reduction and economic growth

but you know Workforce investment is a

long-term strategy if we are looking for

getting quick results in a year or two

we end up sabotaging ourselves so how do

we make commitments that last four five

ten years to get this outcome so maybe

lastly I will wrap up we should consider

what Workforce is needed and where right

how we account for them a lot can be

done by Community Based providers like

chw but currently we're not even

including them in who's Workforce

estimate today so we are really excited

to be working with the who with Africa

CDC focusing on taking an Institutional

approach to supporting countries we know

that scaling up chw is not a Panacea

countries need a mix of skills at every

level of health facility but we also

know they have the highest return on

investment in delivering primary primary

health care so uh you know ultimately

there is a lot of progress we can make

on the health Workforce over the next

seven years as we approach the sdgs

provided that were following the leads

of government

and allowing them to the flexibility

they need to drive progress and we need

to continue to see a health Workforce as

a long-term investment and not a

short-term so thank you very much

see ya

I'll now invite Dr Poonam Singh the

regional director of The Who southeast

Asia region to share with us Hair

Reflections from the discussion so far

Dr Singh thank you David

let me share with you what we in the

southeast Asia region have done

after adopting a resolution on a decade

of Health work for strengthening this

resolution was adopted in 2014 by the

regional committee it comes up every two

years for a review by the regional

committee to see what progress has been

made therein

what are the lessons we take from that

let me share that with you

the first is that we need to increase

numbers if possible

and we in the southeast Asia region have

been able to do that the credit goes to

the countries of the region who have

been able to increase the density of

doctors nurses and midwives

by over 30 percent since 2014.

now how did that happen

first through strategic public

Investments

and these public Investments not only

increased seats in educational

institutions but they also strengthened

equitable distribution

third by better managing stewardship of

private Investments

then we also learned that it is not only

important to increase numbers it's

equally important to increase skills

which can be improved and transformed

almost all member states in the region

have in recent years enacted key reforms

which are aimed at improving Health

Workforce quality with a focus on

transformative education

and strengthening multi-skilled

Primary Healthcare teams

because we know it is not just about

additional Investments and that has been

mentioned by many panelists

we do feel it is all about smarter

Investments Investments that are aligned

to current and Future Health needs

Investments that account for labor

market dynamics and which match Health

worker Education and Training with

health system and population movements

we have also learned that as important

as numbers and skills is managing the

available Health Workforce with a focus

on driving National Health priorities

for this special attention needs to be

given to optimizing the health Workforce

that is closest to communities to

accelerate team-based management

this was the current focus of a

path-breaking 2021

tri-regional policy dialogue which was

held between three regions of who

the southeast Asia region Eastern

Mediterranean region and the European

region