Global public health experts Agnes Binagwaho, Githinji Gitahi, John Nkengasong and Vanessa Kerry discuss a new plan to invest in the healthcare workforce in Africa, where 36 out of 57 countries face dire shortages.
The present Covid-19 pandemic has once more exposed 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 unalienable truth: our world cannot survive without a well-trained, well-distributed, and well-resourced health workforce in adequate numbers globally. Recognizing this reality, at the recent 35th ordinary session of the Assembly of the African Union Summit, President Cyril Ramaphosa, the African Union Champion for Covid-19 proposed the establishment of the African Union Health Workforce Task Team, which was endorsed by the Summit.
This will be an unprecedented healthcare 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, the need for which has only accelerated during Covid.
Throughout the pandemic, health workers of all cadres have served on the frontline of surveillance, diagnosis and care of Covid, as well as protecting essential services and vaccine delivery. However, in many places, the lack of health workers tested the resilience of fragile health systems under stress. Data have demonstrated that decades of progress have been lost, and inequities perpetuated and accelerated across the globe. Africa knows this story well.
As we enter the third year of the pandemic, over 180,000 health workers have died. These deaths are compounded by attrition from the workforce as health workers are exhausted, demoralized and under-invested. Annette Kennedy, President of the International Confederation of Nurses recently shared that almost half the nursing workforce is expected to be lost in the next ten years and twenty per cent in the next two for example. These collective losses contribute to already significant global shortages, projected pre-pandemic to be 18 million by 2030, according to the World Health Organization. Africa is among the most vulnerable regions with 36 of its 57 countries in dire need of health workers. Global shortages have further undermined the continent as wealthier nations facing health worker crises have recruited aggressively from African and other nations.
As we look to recover from Covid and “build back better”(which the U.N. coined prior to U.S. President Joe Biden), Africa can set its agenda for the future — and the standards for the world — for the health workforce and health system investments.
Leveraging existing institutions like Africa CDC and the African Union, Africa can shape a centralized framework — a social compact for countries, donors, and stakeholders — to train and retain Africa’s human resources for health. The compact can set an agenda and targets for progress in health workforce development. 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 and administration and management. The framework can be inclusive not only of the deeply needed clinicians and direct caregivers but ensure the training of other leaders in public health, science, technology, drug and vaccine development, management and civil service to sustain and guide these systems. A fit for purpose workforce Africa deserves.
An African-led centralized approach will critically mobilize, consolidate, and align large scale, long-term, and comprehensive investments to support the training and retention of the well distributed health workforce. Throughout Covid, there has been growing to understand among governments and multilateral agencies for the need to target meaningful support towards health system strengthening activities and human resources for health. No one donor or agency though can do this meaningfully alone. An African-led framework can harmonize governments and partners towards a single vision that is jointly executed, ensure the critical longer timelines required for results in this sector and create accountability and results through alignment of vision, resources and comprehensive, dedicated measurement.
The compact can support meaningful accountability for governments’ domestic resources as well as partner support. Countries can be encouraged to develop investment cases that: respond and build on existing infrastructure, technology, and human resources; address disease burdens; align partners and funders and their priorities; galvanize domestic budget allocations and spur domestic health policies; and offer a detailed understanding of the chief constraints that require investment from both domestic resources as well as development assistance. The investment cases structure the bespoke implementation plans that can guide each country through the design of the training and retention of the workforce, costing the plan over the lifetime of the program years and implementation of the programs.
The power of the compact lies in its ability to maximize economies of scale to invest in infrastructure and technology but also data. Continent-wide metrics and data would powerfully define an equity agenda through the measurement of inclusive and broad quantitative and qualitative measures across all countries. The data collected can not only be in numbers trained and retained but include measures of demand and supply of health labour markets, the policies that hinder girding social sector support and domestic budget spending, and broad measures of social inclusion, gender parity, and economic impact. Data and measurement can be used to help define the power of these investments across sectors and change the value of health for wellbeing. Through the compact, there is an opportunity to create peer accountability not only among the country-specific plans but globally in how all partners engage in the complex task of changing the development paradigms of today.
The compact is ambitious and will require historic up-front investment as well as investments in Universal Health Coverage grounded in the principles of access, quality and financial protection but without this type of comprehensive plan, Africa – and the world – will continue to lose in economic potential, through growing inequality gaps, and in number of lives lost. Beyond the tremendous setbacks of Covid, there is well-documented data that consistently link health to development, education, economic growth and wellbeing.
As we look to the horizon past Covid, we must not just build back better. We must build back better transformatively. Africa can be at the lead of this transformation through a large scale vision for stronger resilient health systems and the workforce that sustains them. To achieve the health objectives of Agenda 2063, Africa’s blueprint for transforming the continent and inclusive and sustainable development – the Africa we want – this vision though must be reality.
Dr. Agnes Binagwaho is the Chair of the Resource Mobilization Working Group for the Africa COVID Commission and Vice-Chancellor of the University of Global Health Equity.
Dr. Githinji Gitahi is the Chair of the Recovery Working Group for the Africa COVID Commission and Group Chief Executive Officer of Amref Health Africa.
Dr. John Nkengasong is the Director of the Africa Center for Disease Control.
Dr. Vanessa Kerry is the CEO of Seed Global Health, Director of Global Public Policy at Harvard Medical School and a physician at Massachusetts General Hospital.