PHR Library

January 1, 2005

FOR IMMEDIATE RELEASE

Cost Estimates: Doubling the Health Workforce

Doubling the Health Workforce in Sub-Saharan Africa by 2010

The figures in this report were calculated by a group that included Lincoln C. Chen, MD, MPH, the Director of the Harvard University Global Equity Initiative and co-chair for coordination of the Joint Learning Initiative (JLI) and Eric A. Friedman, JD, Policy Analyst for Physicians for Human Rights.

Urgent action is needed to overcome the crisis of health workers. None of the global health goals, especially tackling HIV/AIDS, will make headway without massive mobilization of an adequately motivated, skilled, and supported workforce. For sub-Saharan Africa, it is within our reach to double the health workforce by 2010ⁱ, including by expanding training capacity, deploying trained and supervised community-based workers, extending coverage in under-served communities, and strengthening management, planning, safety, and support systems. An immediate infusion of resources could jump-start the workforce to reverse the spiral of avoidable death, sickness, and human suffering. The G8 Summit presents a key opportunity for the United States to commit to this goal, and leverage financial support from other nations. This investment in health workforce strengthening is a necessary complement to ensure the success and sustainability of historic U.S. investments to fight AIDS. Health workforce strengthening can be a cornerstone of an expanded U.S. initiative for health in Africa.

An initial investment of an estimated $2.0 billion in 2006, rising to an estimated $7.7 billion annually by 2010, is needed from African governments and the collective donor community to double sub-Saharan Africa's health workforce while increasing its effectiveness, thus making significant progress towards developing the workforces required for countries in sub-Saharan Africa to achieve national and global health goals.

Variability of country circumstances, strategies, and capacity to absorb and effectively use resources will determine the actual investment size, pace, and pattern in any given country. At the country level, strategies and their costs should be based on rationally gathered data and intelligence at the national and sub-national levels. Donor support for health workforces should occur through funding these national strategies.

Investments in health workforces will need to be accompanied by donor and country-level policies that increase the size, skill, motivation, and support for the health workforce, especially in the rapid launch of and the development of proper support and supervision for community-level health worker initiatives. The majority of the new funds required will have to come from the donor community. Further, it is critical that the fiscal space for these investments be available, which will require reforms of macroeconomic policies and their implementation, as well as more predictable donor funding.

The U.S. share would be approximately $0.65 billion in 2006 rising to $2.6 billion in 2010, commensurate with the U.S. percentage of the world's economy. Having already made a strong commitment to improving health in the 15 PEPFAR focus countries, 12 of which are in Africa, the United States could focus resources for health workforce strengthening in these countries, whereas other donor countries could take the lead elsewhere, as the United Kingdom has done in Malawi. Even if one country is a primary donor on health workforce strengthening in a certain country, its efforts will likely need to be complemented by the Global Fund to Fight AIDS, Tuberculosis and Malaria and other donors and development partners.

The approximate break-down of the $2.0 billion required in 2006:

• 35% for health worker compensation, including stipends for community health workers and raising health workers out of poverty wagesⁱⁱ
• 10% for incentives to health workers to serve in rural areas
• 25% for health worker pre-service education and continuous learning ⁱⁱⁱ
• 30% for human resource management and planning; health workplace safety; training, supervision, and support for community health workers and caregivers; human resources support for human resources support to the not-for-profit NGO and faith-based sectors; global and regional support and learning

The approximate break-down of the $7.7 billion required in 2010:

• 45% for health worker compensation, including stipends for community health workers and raising health workers out of poverty wages
• 15% for incentives to health workers to serve in rural areas
• 15% for health worker pre-service education and continuous learning
• 25% for human resource management and planning; health workplace safety; training, supervision, and support for community health workers and caregivers; human resources support for human resources support to the not-for-profit NGO and faith-based sectors; global and regional support and learning

These are the categories of investments in the workforce required to educate, recruit, and retain the numbers of health workers necessary to double the health workforce and progress towards minimum coverage densities; to enhance health worker coverage in rural and other under-served areas, and; to increase the effectiveness of the workforce by improving health worker motivation and making the best use of health workers' skills. Actual funding allocations will vary by country.

Note that one of the factors frequently identified as a source of poor health worker morale that is not addressed in this estimate is the shortage of essential medicines, supplies, and equipment – shortages that will need to be resolved. For this vital health workforce strengthening initiative to be successful and result in significant improvements in the health of people in Africa, it must be complemented and balanced by major investments in fighting AIDS and by other aspects of strengthening health systems, such as service delivery, information management, and other health system inputs such as essential medicines. Investments in health workers are absolutely necessary to achieving health goals; other investments are needed as well.

The vast majority of African countries need more doctors, nurses, and pharmacists. It will take some time to graduate these health professionals. Each country will have to determine the mix of health workers that will best deliver equitable and quality health care to its population. In many cases, the skills mix that will most effectively enable the rapid expansion of health service coverage will involve a restructuring of the workforce by significantly expanding the role of less intensely trained health workers, such as community and village health workers. This expansion must be done mindfully, ensuring that community-level health workers have the necessary support and supervision from professionals. With this support and supervision, as well as community-level accreditation, community health workers, along with people living with HIV/AIDS and home and community caregivers – who are already providing services in an unpaid, untrained, and unsupported manner – can be rapidly mobilized to help quickly scale up access to health services.

ⁱThe Joint Learning Initiative on Human Resources for Health and Development determined that Africa has slightly less than 1.0 health worker/1,000 population, whereas a minimum health worker density of 2.5/1,000 population is required to make significant progress on global health goals. Doubling the health workforce by 2010 would make significant progress towards this goal. Investments will need to continue beyond 2010.

ⁱⁱThe estimated needs for health worker compensation as well as incentives to serve in rural areas are based on WHO figures on public health expenditure in sub-Saharan Africa. Public health expenditures by South Africa have been excluded from these estimates because of its uniquely large health budget compared to the rest of sub-Saharan Africa. Additional investment in South Africa's health workforce is required, but to have included South Africa in the estimate for wages and rural incentives would have significantly distorted the estimate.

ⁱⁱⁱPre-service education costs are derived from preliminary World Health Organization estimates.  

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Physicians for Human Rights (PHR) mobilizes the health professions to advance the health and dignity of all people by protecting human rights. As a founding member of the International Campaign to Ban Landmines, PHR shared the 1997 Nobel Peace Prize.