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[afro-nets] Call for G8 commitments on human resources for health (2)

  • From: Eric Friedman <EFriedman@phrusa.org>
  • Date: Wed, 1 Jun 2005 23:11:50 -0400

Important additional information on G8 sign-on statement on hu-
man resources for health

Dear All,

Several days ago, I emailed you about a sign-on statement urging
strong G8 action on human resources for health. Many thanks to
those of you who have already responded with your endorsements.
I had said that we would be emailing a US-specific statement
shortly, and indicated (though not very effectively) that the
statement was specifically for signatures from the South.

Both these things have now changed. The statement that I emailed
last week (and copy again below) is now the only statement we
will be collecting signatures on. We will be collecting all US
signatures on this statement, signatures from other G8 countries
and other developed countries, and as before, signatures from
the Global South. So the statement is open for signature to all
health workers ­ from any country ­ and we take a very broad
view of health workers ­ as well as to all NGOs, again, from any
country. We would welcome your assistance reaching deeper into
your country than we are able to through international

We still anticipate sending out a French version of the state-
ment on Friday, or more likely early next week, to listservs
where we expect there to be a number of recipients who speak

As before, to sign this statement (or if you have questions),
please email me at mailto:efriedman@phrusa.org. The deadline for
signing is Monday, June 20, though we encourage early sign-on.

If you are a health worker, please include your name, institu-
tional affiliation, and country. Please indicate your exact pro-
fession/job (nurse, doctor, community health worker, etc.). We
will also include any advanced degrees if you provide them (so
degrees are optional).

If you are representing an NGO, please include the NGO's name
and country. When signing on behalf of an NGO, please clarify
that you are signing on behalf of the NGO, as opposed to on your
personal behalf.

If you are a government official, please include your name, po-
sition, and country. Please also indicate whether you are sign-
ing in your individual capacity (in which case your affiliation
will be for identification purposes only) or whether you a sign-
ing as a representative of the Ministry of Health or of the full
Government of your country.

Please help us spread this statement. The statement (unchanged
from when I sent this out a few days ago) is below. Many thanks.


Eric A. Friedman
Physicians for Human Rights
1156 15th Street, NW, Suite 1001
Washington, DC 20005, USA
Tel: + 1-202-728-5335 ext. 303
Fax: + 1-202-728-3053

Statement for Group of 8 meeting in July 2005 on actions needed
to support human resources for health to achieve the Millennium
Development Goals

We are nurses and doctors, pharmacists and laboratory techni-
cians, medical assistants and community health workers. We are
non-governmental organizations. We are [members of] govern-
ment[s]. We are people with HIV/AIDS. Some of us sit in govern-
ment ministries, some of us work in rural health facilities, and
some of us work wherever it is we find people in need. We share
in common a deep concern for the health and well-being of the
members of our communities and citizens of our own and other
countries. Yet despite our best efforts, health systems in many
developing countries are in crisis, and millions of people whose
lives we could save and whose health we could preserve are dying
and becoming seriously ill.

Health workers are at the core of these health systems. Health
systems collapse where there are too few health workers, or
health workers without proper training, supervision, and manage-
ment and support structures, or health workers who are separated
from their community structures and needs, or health workers who
are themselves ill and dying and working in unsafe conditions.
Yet this is the situation many of our countries face. Annual
health budgets that are often $10 or less per capita, the exodus
of health professionals, failure to prioritize human resources,
and the HIV/AIDS pandemic, both through the disease burden it
creates and its impact on health workers themselves, have com-
bined to create a crisis. Until we surmount this crisis in human
resources for health and health systems, preventable death and
suffering on a massive scale will continue.

Overcoming this crisis will require the joint efforts of your
countries and ours. We will take the lead, but require coopera-
tion and support in what must be a global response to a problem
of global proportions. Together, we must develop and implement
sustainable and greatly expanded responses that address underly-
ing causes to the health worker crisis, that improve health sys-
tems, and that dramatically improve access to quality health
services for people in underserved areas.

Everyone has the right to the highest attainable standard of
health. Fulfilling this right requires addressing the crisis in
human resources for health and in health systems. The efforts of
our countries alone will not be enough to resolve this crisis
and secure for every person the dignity she deserves. We there-
fore urge your governments to meet your obligations under the UN
Charter and other human rights law to join us in taking the ac-
tions required to resolve this crisis.

To enable our countries to have the health workforces we require
to meet our people's health needs and achieve the Millennium De-
velopment Goals, we urge the members of the G8 to make the fol-
lowing commitments:

1. Strengthening national health systems

1.1 We urge you to support African and other developing coun-
tries that are experiencing crises in human resources for health
by providing the necessary financial and technical support to
enable our countries to develop and fully implement national
strategies on human resources for health as a central part of
any overall plan to improve service delivery and strengthen na-
tional health systems so as to achieve the Millennium Develop-
ment Goals.

1.2 We urge you to ensure that through your efforts and those of
others, the resources required to fully fund these strategies
are available.

1.3 We urge you to coordinate your investments and those of
other donors and organizations with those of regional communi-
ties and developing country governments, and to use local tech-
nical resources where possible.

1.4 Strategy development should be led by national authorities
with broad stakeholder participation that engages civil society
and responds to local needs.

1.5 Assistance in the development of strategies should not delay
the provision of urgently needed financial assistance and other
technical assistance.

2. Supporting and enlarging health worker capacity

2.1 We urge you to support, with financial and technical assis-
tance, national efforts to create conditions that facilitate
health worker retention and deployment to underserved areas, in-
cluding adequate compensation; improved health worker manage-
ment, planning, and information systems; incentives; continuous
learning opportunities; and; safe working environments for
health workers through universal precautions and other forms of
infection prevention and control, universal access to post-
exposure prophylaxis, and workplace HIV treatment and prevention

2.2 We urge you to support models of education and care that re-
spond to national circumstances and priorities, providing qual-
ity health care to the maximum number of people and expanding
health services in underserved areas. The models of care will
often include the development of high quality mid-level and com-
munity health worker cadres, effective competency-based training
strategies, and policies, training, supervision, and adequate
compensation to enable nurses to engage in advanced nursing
practices. We urge you to further support the development of ca-
reer pathways for mid-level and community health worker cadres,
permitting competence- and skills-based movement up the hierar-
chy of the health system.

2.3 Community members, including people living with HIV/AIDS,
have a vital role in supplementing the care provided by health
professionals. We urge you to support local, regional, and na-
tional efforts to empower community health workers and caregiv-
ers, including by enabling them to have the compensation, train-
ing, accreditation, supervision, and support structure required
to maximize their effectiveness. We urge you to support local
efforts to increase community awareness and capacity to partici-
pate in a comprehensive scale-up of prevention, care, and treat-
ment programming through activities such as treatment prepared-
ness, treatment literacy, and treatment adherence support.

2.4 We urge you to support expanded capacity of health profes-
sional training institutions including through incentives and
other support for faculty, expanded physical space, and creation
of new training institutions as needed, and to support these in-
stitutions in reviewing curricula to assure that the skills are
relevant to required public health needs and competencies.

2.5 We consider it a tragic irony that many of the same coun-
tries facing enormous human resources deficits have in our midst
large numbers of unemployed health care workers. We urge you to
take all necessary steps, working with our governments and other
parties, including international financial institutions, to en-
able their rapid re-engagement.

3. Overcoming macroeconomic challenges

3.1 We urge you to seek agreement with the International Mone-
tary Fund and other international financial institutions, fi-
nance, health, and other ministers, and central banks to in-
crease fiscal space for expanded funding from external and do-
mestic sources, including debt cancellation, for health and
other forms of human development. Civil society must have a
voice in this process. Macroeconomic challenges should not and
need not impede the flow of the required resources.

3.2 We urge you to ensure that new and existing developing coun-
try agreements with the IMF and other international financial
institutions do not require or lead to freezes in health worker
recruitment, prevent payment of wage levels required to retain
health workers, or prevent the hiring of unemployed health work-
ers. Programs critical to public health should be exempt from
budget and wage ceilings contained in such agreements.

3.3 Long-term, sustainable economic growth requires investments
to reduce poverty and hunger, improve health and expand educa-
tion at all levels, empower women, and ensure environmental sus-
tainability, including through improving living conditions in
rural and slum areas and universal access to clean water and

3.4 We urge you to commit to providing your assistance in a
long-term and predictable manner, including for both bilateral
and multilateral mechanisms, such as the Global Fund to Fight
AIDS, Tuberculosis and Malaria.

4. Addressing health worker needs in high-income countries

4.1 We urge you to meet your country's own health care needs
without reducing the capacity of developing countries to meet
our health needs.

4.2 We urge you to meet your obligations under World Health As-
sembly Resolution 57/19, "International migration of health per-
sonnel: a challenge for health systems in developing countries".

4.3 We urge you to evaluate the recruitment practices of public
and private health providers in your country, and implement
strategies that will protect the health human resource base of
our countries. The strategies may include ending active recruit-
ment from certain countries and working with developing country
governments and regional and international organizations to de-
velop satisfactory policies on recruitment, such as through man-
aged migration with mutual benefits to both source and destina-
tion countries.4.4 We urge you to take the necessary measures to
increase your country's supply of domestically-trained health
care workers.

5. Supporting international organizations

5.1 The technical capacity and normative role of the World
Health Organization gives it a special role in addressing the
human resources for health crisis. We urge you to provide WHO
the additional funding it requires to support expanded and ac-
celerated large-scale technical assistance in this area; to
build its own capacity at headquarters, regional, and country
levels, including through interdepartmental collaboration and
nationally led teams, and; to enhance national capacities to de-
velop and implement strategies to meet Millennium Development
Goals, including effective development and management of the
health workforce. We further urge you to ensure that WHO has the
funds to develop and sustain a human resources for health obser-
vatory in Africa. All funding to expand WHO capacity should be
in addition to the funding WHO requires to support anti-
retroviral therapy scale-up.

5.2 The Global Fund to Fight AIDS, Tuberculosis and Malaria sup-
ports health system strengthening, including human resources. We
urge you to ensure that the Global Fund is fully funded, includ-
ing so that it can renew all deserving proposals from previous
rounds, fully fund Round 5, and launch Round 6 in a timely man-
ner. We further urge you to make available technical support to
help applicants develop ambitious proposals in the area of AIDS,
including treatment, tuberculosis, malaria, and health system

5.3 We urge you to support regional health and development or-
ganizations in their effort to address the human resources for
health crisis through regional and sub-regional interventions.

6. Ensuring soundness of donor programs

6.1 We urge you to ensure that your own funding mechanisms and
programs strengthen, and do not weaken through resource diver-
sion or other means, public health systems and their human re-
source capacities. Bilateral programs should help build local
capacity and utilize and catalyze local capacity wherever possi-