Investing in human resources for health: the need for a paradigm shift.

Editorials 799 Development partner strategies and support in the area of human resources for health (HRH) have been shaped by key reports and events over the past decade. Since 2004, when The Lancet published the Joint Learning Initiative's call to overcome the HRH crisis, 1 the global health community has been trying to address the critical issues surrounding HRH. The 10-year action plan on HRH proposed in The world health report 2006 2 and the establishment in the same year of the Global Health Workforce Alliance have drawn unprecedented attention to HRH. Thanks to a growing body of evidence, 2 HRH issues have gradually made their way into the global health arena. Consensus has emerged on the " power of health workers " 1 and their critical importance to health system strengthening and disease control programmes. 2 Increased international resources have flowed towards HRH over the past decade, either directly through targeted HRH funds or indirectly through programmes for disease control or health system strengthening. In some countries, development partners have contributed to the achievement of tangible results. Rwanda's performance-based payment to health workers and Ethiopia's health extension programme have both been heralded as successes. 3 In spite of these efforts , however, global investment in HRH has suffered setbacks that have undermined its effectiveness and impact. Such investment remains uncoordinated and fragmented. International programmes sometimes compete for the few existing HRH, which exacerbates the HRH crisis. Furthermore, investment in HRH has been largely focused on short-term solutions to the crisis rather than on building sustainable HRH systems. The global health community needs to think strategically about how to make investments in HRH more efficient, effective and relevant to country needs. The following paradigm shifts will be critical to future international investment in HRH: i) From a global to a country-specific approach. HRH issues are not only multifaceted, but also specific to each country. Although this is not a new idea, it has yet to be fully translated into investment practice. International efforts first need to focus on helping countries to develop an HRH strategy reflective of specific domestic contexts and international best practices. Development partners then need to jointly align their resources with the country strategies while building on the experience of the International Health Partnership. ii) From short-term solutions to long-term system-building. Although health workforce remuneration and in-service training – the forms of support most commonly offered by …