Global public health experts Agnes Binagwaho, Githinji Gitahi, John Nkengasong and Vanessa Kerry discuss a new plan for investing in the health workforce in Africa, where 36 out of 57 countries face severe shortages.
By Agnes Binagwaho, Githinji Gitahi, John Nkengasong and Vanessa Kerry
The current Covid-19 pandemic has once again revealed the acute shortage of human resources for health in Africa. Covid-19, like Ebola in West Africa in 2014 and countless other disease threats in history, has underscored an inalienable truth: our world cannot survive without a well-trained, well-distributed and endowed with sufficient resources in the world. Recognizing this reality, during the recent 35and Ordinary Session of the African Union Summit Assembly, President Cyril Ramaphosa, African Union Champion for Covid-19, has proposed the establishment of the Union Health Workforce Task Force Africa, which was endorsed by the Summit.
This will be an unprecedented health effort for Africa, mobilizing billions of dollars and aligning efforts to prioritize health and health systems – a necessity for health security and economic growth and recovery, including the need has only accelerated during Covid.
Throughout the pandemic, health workers in all settings have served on the front lines of Covid surveillance, diagnosis and care, as well as safeguarding essential services and administering vaccines. However, in many places, the lack of health workers has tested the resilience of fragile health systems under stress. The data demonstrated that decades of progress have been lostand inequalities perpetuated and accelerated worldwide. Africa knows this story well.
As we enter the third year of the pandemic, more than 180,000 health workers died. These deaths are compounded by workforce attrition, as health workers are burned out, demoralized and underinvested. Annette Kennedy, President of the International Confederation of Nurses recently share that nearly half of the nursing workforce is set to disappear in the next ten years and twenty percent in the next two, for example. These collective losses contribute to already significant global shortages, which are expected to be pre-pandemic 18 million by 2030, according to the World Health Organization. Africa is one of the most vulnerable regions with 36 of its 57 countries badly need health workers. Global shortages have further plagued the continent as wealthier countries facing health workforce crises have recruited aggressively from African and other nations.
As we seek to recover from Covid and ‘build back better’ (something the UN coined before US President Joe Biden), Africa can set its agenda for the future – and the standards for the world – for the health workforce and investments in the health system.
By building on existing institutions like Africa CDC and the African Union, Africa can fashion a centralized framework – a social compact for countries, donors, stakeholders – to train and retain African human resources for health. The pact can establish a program and objectives for progress in the development of the health workforce. It can define the specific but ambitious human resource needs for the continent, including skilled health professionals, community health workers, public health specialists, manufacturing capacity, administration and management. The framework can not only include the clinicians and direct caregivers most needed, but also train other leaders in public health, science, technology, drug and vaccine development, management and public service to support and guide these systems. A workforce fit for Africa deserves.
A centralized Africa-led approach will critically mobilize, consolidate and align large-scale, long-term and comprehensive investments to support the training and retention of well-distributed health workers. Throughout Covid, governments and multilateral agencies increasingly understood the need to target meaningful support towards health system strengthening activities and human resources for health. However, no single donor or agency can do this in a meaningful way. An Africa-led framework can align governments and partners towards a single vision that is jointly executed, ensure the longer critical timelines needed to deliver results in this sector, and create accountability and results through the alignment of vision, resources and comprehensive and dedicated measurement.
The compact can support meaningful accountability for national resources from governments as well as support from partners. Countries can be encouraged to develop investment cases that: respond to and build on existing infrastructure, technology and human resources; addressing disease burdens; align partners and donors and their priorities; galvanize national budget allocations and boost national health policies; and offer a detailed understanding of the main constraints that require investments from both domestic resources and development assistance. Investment cases structure tailored implementation plans that can guide each country in designing workforce training and retention, costing the plan over the years of the program and program implementation.
The power of the compact lies in its ability to maximize economies of scale to invest in infrastructure and technology, but also in data. Continent-wide measurement and data would powerfully set an equity agenda through the measurement of inclusive and broad quantitative and qualitative metrics across all countries. The data collected may not only relate to the number of people trained and retained, but also include measures of demand and supply in health labor markets, policies that hinderr strengthen social sector support and national budget expenditures, and general measures of social inclusion, gender parity and economic impact. Data and metrics can be used to help define the power of these investments across sectors and shift the value of health to wellness. Through the compact, there is an opportunity to create peer accountability not just among country-specific plans, but globally in how all partners engage in the complex task of changing development paradigms. ‘today.
The pact is ambitious and will require historic up-front investments as well as investments in universal health coverage based on the principles of access, quality and financial protection, but without this kind of comprehensive plan, Africa – and the world – will continue to lose in economic potential, through growing inequality gaps, and in the number of lives lost. Beyond the enormous setbacks of Covid, there are well-documented Data that systematically link health to development, education, economic growth and well-being.
As we look to the horizon after Covid, we must not simply build back better. We need to build back better in a transformative way. Africa can be at the forefront of this transformation through a large-scale vision of more resilient health systems and the workforce that supports them. To achieve the health goals of Agenda 2063, Africa’s blueprint for the continent’s transformation and inclusive and sustainable development – the Africa we want – however, this vision must be realized.
Dr. Agnes Binagwaho is Chair of the Resource Mobilization Task Force for the Africa COVID Commission and Vice-Chancellor of the Global Health Equity University.
Dr Githinji Gitahi is Chair of the Africa COVID Commission Recovery Task Force and Chief Executive of Amref Health Africa Group.
Dr John Nkengasong is the director of the Africa Center for Disease Control.
Dr. Vanessa Kerry is CEO of Seed Global Health, director of global public policy at Harvard Medical School, and physician at Massachusetts General Hospital.
Full coverage and live updates on the coronavirus