The Case for Human Resources for Health in Realizing the Sustainable Development Goals

In the past years and decades, many efforts have been made to increase access to healthcare on a global scale, yet even today, one in seven people will never see a single health worker in their entire lives. In fact, the crisis in human resources for health (HRH) has recently surpassed health system financing as the most serious obstacle to realizing the right to health within countries, calling for urgent upscaling and a drastic change in global priorities.

<Dominique Vervoort>

The World Health Organization (WHO) estimates that, globally, over 4 million additional health workers are needed to overcome the health workforce shortages in the 57 countries with the most critical needs. [1] However, the actual number is expected to be much higher (when including global disparities and countries with less critical shortages), with the deficits expected to rise to 12.9 million health workers by 2035. [2] In addition to the absolute shortages of healthcare providers, there is a severe imbalance in the distribution thereof between and within countries. Most healthcare workers, especially specialists, concentrate in urban areas, creating increasing challenges for rural populations to access healthcare services. As a result, one billion people worldwide will never see a healthcare worker in their entire lives, with the far majority residing in lower- and middle-income countries (LMICs), which are faced by (1) lower rates of training health workers, (2) fewer overall resources for health, and (3) brain-drain of trained health workers to high-income countries (HICs).


Today, modern globalization and resulting liberalization of markets lead to a complex health workforce migration pattern from LMICs to HICs. Moreover, the demand for healthcare is rising as a result of the large ageing population in more developed countries and the increase in the world’s population. Simultaneously, low-income countries continue to struggle with an unfinished agenda of infectious and non-communicable diseases. As a result, the HRH crisis is sustained and expected to worsen in upcoming years unless urgent measures are taken. To work towards the attainment of the Sustainable Development Goals (SDGs), health workforce and systems strengthening is needed on a global level.

 

Scaling up human resources for health is key in addressing the third Sustainable Development Goal (SDG3: Ensure healthy lives and promote wellbeing for all at all ages by 2030), especially with a focus on reducing global maternal mortality rates, neonatal and child mortality rates, reducing the number of deaths and injuries from road traffic accidents. The WHO estimates that at least 23 health workers per 10,000 population are needed to achieve the SDGs, yet 83 countries still fall under this threshold. [2] Of these, the African region has the highest burden in terms of workforce density, whereas the absolute shortages are highest in Southeast Asia, as a result of the larger population. [3]

 

Despite reduced maternal mortality rates in the past few years (with a 44% drop from 1990 to 2015), 830 women worldwide continue to die from preventable causes during childbirth every day, of which 99% occurs in the developing world and rural areas. [4] In LMICs, mortality rates are as high as 239 per 100,000 live births, whereas HICs face only 12 deaths per 100,000. As such, the SDGs aim to further reduce mortality rates to less than 70 per 100,000 live births, through adequate antenatal care, availability of skilled health workers during childbirth (including obstetricians or trained healthcare workers if a caesarean section is needed), and proper follow-up after birth.

In the developing world, only little over half of all mothers and children have access to skilled healthcare professionals during and shortly after childbirth, not only putting a mother’s health at risk, but also that of the newborn. [5] Neonatal (less than 28 days old) deaths account for 45% (2.7 million) of under-5 mortality, with 75% taking place in the first week after birth, and almost half within 24 hours. Of these, up to two-thirds could be prevented if access to skilled health workers was available, in order to prevent and limit complications (e.g., infections, asphyxia) and perform adequate health measures in the beginning of the newborn’s life (e.g., promote breastfeeding, keeping the baby warm).

 
When looking at all children under 5, approximately 5.9 million children continue to die on an annual basis worldwide, of which roughly half could be prevented through preventive or curative measures. [6] These rates are much higher in LMICs compared to HICs, with, for example, sub-Saharan Africa suffering from 14x higher child mortality rates compared to industrialized countries. Access to health workers is crucial in reducing child mortality, through proper education, prevention (e.g., vaccines), timely treatment and surgical care.


Lastly, every year, 1.25 million people die on the roads and another 20 to 50 million people remain injured or disabled as a result. Shockingly, 90% of road traffic mortality occurs in LMICs, especially the African region, despite having “only” 54% of the world’s vehicles. Road traffic injuries pose a major economic burden, not only for individuals and their families, but also for entire nations, costing them up to 3% of their gross domestic product (GDP). Although prevention and increased road safety should be the main focus in addressing these mortality and injury rates, timely access to health and surgical care is needed to adequately treat victims of road traffic crashes and limit morbidity and mortality thereof.

 
If we are to achieve the health-focused Sustainable Development Goals by 2030, emphasis should be put on human resources for health, which are a key component in improving access to healthcare and the delivery of healthcare services. With a rapidly increasing world population -especially in those countries needing improved access to healthcare the most- urgent upscaling is needed on a global level in order to prevent the human resources for health crisis to turn into an expanding global nightmare.

NB: This article was originally published in the 36th edition of Medical Students International (MSI36), the biannual online magazine of the International Federation of Medical Students’ Associations (IFMSA).

References:
1. World Health Organization. The World Health Report 2006 – Working Together for Health. 2006. Geneva: World Health Organization.
Available at http://www.who.int/whr/2006/whr06_en.pdf

2. Global Health Workforce Alliance, World Health Organization. A Universal Truth: No Health Without a Workforce. November, 2013. Geneva: World Health Organization.
Available at http://www.who.int/workforcealliance/knowledge/resources/hrhreport2013/en/

3. World Health Organization. Health Situation in South-East Asia Region 2001–2007. 2008. New
Delhi, India: World Health Organization.

4. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016; 387 (10017): 462-74.

5. World Health Organization. Newborns: Reducing Mortality. 2016. Geneva: World Health Organization.
Available at http://www.who.int/mediacentre/factsheets/fs333/en/

6. World Health Organization. Children: Reducing Mortality. 2016. Geneva: World Health Organization. Available at http://www.who.int/mediacentre/factsheets/fs178/en/

7. World Health Organization. Global Status Report on Road Safety 2015. 2015. Geneva: World Health Organization. Available at http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/

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