Human resources for universal health coverage: leadership needed.

Editorials 800 Global leaders have recently reaffirmed their commitment to the principle of universal health coverage (UHC). 1 The experience of the health-related Millennium Development Goals (MDGs) has taught us, however, that to translate such a principle into reality, health systems must be strengthened. Key to such strengthening and to improving health service coverage and health outcomes is the availability of a sufficient, equitably distributed, skilled and motivated workforce. 2 Yet in many countries health workforce shortages and poor worker distribution, training and performance hinder the attainment of the health-related MDGs and UHC. Human resources for health (HRH) challenges are complex. Piecemeal solutions , such as short-term in-service training initiatives, abound. However, strategies to systematically address deep-rooted human resource problems require a long-term perspective and collaboration among many stakeholders and constituencies , brokered and led by national governments. 3 Several different paths towards strengthening the health workforce are possible, as the following examples illustrate. In Brazil, the Unified Health System, grounded in the national constitution, has brought improved HRH policy-making and management. It took intersectoral and interagency collaboration to secure the required thrust and resources. No single HRH plan was developed, and yet Brazil succeeded in achieving sustained growth and more equitable worker distribution. Between 1990 and 2007 physician density rose from 1.17 to 1.74 per 1000 population and family health teams were deployed to rural areas. 4 In Indonesia, the HRH agenda was bolstered by the decentralization reforms of 1999, whereby almost 2.4 million central government civil servants were successfully reassigned to local governments. 5 To overcome persistent worker shortages, maldistribution and dual practice, the government has enacted measures for improving health workforce education, equitable deployment and performance. HRH information systems have been strengthened. Coordination of national stakeholders has improved and resource allocation from both domestic and international sources has increased. 6 The national density of physicians, nurses and midwives has risen from 1. In Zambia, important innovations took place in HRH development, including initiatives to upgrade the training of existing staff, create new cadres to formalize task delegation and provide direct access to mid-level specialist training. 9 A new national HRH strategy, built on lessons learnt in the last decade, complements the traditional focus on producing new health workers with improved worker management, performance, distribution and retention. Brazil and Indonesia are on track to achieve MDG 4 and are making progress towards MDG 5 targets. 10 Zambia has …