HRH Overview

The disparity is staggering. Africa bears one-quarter of the burden of disease around the world yet has barely 3 percent of all health workers. Millions of people across the continent thus suffer needlessly because they cannot obtain medical care from trained personnel. In sub-Saharan Africa, where the crisis is most acute, fully 820,000 additional doctors, nurses, and midwives are needed to provide even the most basic health services. To meet this shortfall, most of the region’s countries would have to increase the size of their health workforce by 140 percent. [author’s description]

A worldwide shortage of health care workers, coupled with a disproportionate concentration of health workers in developed nations and urban areas, stands in the way of achieving such key public health priorities as reducing child and maternal mortality, increasing vaccine coverage, and battling epidemics such as HIV/AIDS. [author’s description]

This report reviews the literature, published and unpublished, available on HRH in Mozambique. It also carries out some secondary data analysis and presents data from interviews and focus group discussions with key informers and stakeholders. The study of the human resources situation in Mozambique followed a frame of reference that addressed key issues related to the context, professional policies, labour market, management of human resources, and performance and coping. [from executive summary]

The focus of McKinsey’s research effort is on the HRH constraint, faced by many developing countries, in absorbing development aid and scaling up urgently needed health programs. HRH in this context is defined as the health workers at the front line of healthcare service delivery. The field work necessary to diagnose the problem and identify possible solutions has been initiated in Tanzania. We believe these findings, accounting for certain differences, will be broadly applicable to several developing countries. [from author]

This report provides an overview of the public health situation across the 46 Member States of the African Region of the World Health Organization. The report charts progress made to date in fighting disease and promoting health in the African Region. It reviews the success stories and looks at areas where more efforts are needed to improve people’s health. [author’s description] Chapter 6 includes a discussion of the human resources for health crisis and approaches to filling the gap as well as health information systems.

This edition covers topics such as: migration of skilled health workers, investing in human resources for health, strengthening human resources for health in Africa, and the economic cost of health professionals brain drain in the African region. [author’s description]

This document briefly describes HRH-related issues common to many countries and proposes ways to address them. It gives examples of strategies applied successfully in specific local contexts, as well as constraints and challenges often encountered. [from introduction]

Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of each health care system and of reform and policy initiatives in progress or under development. [publisher’s description] Each report contains a section on human resources for health including an overview of the situation and specific health workforce statistics.

The starting point for this online database was a comprehensive health workforce survey conducted by the WHO Regional Office for Africa in collaboration with WHO department of human resources for health in Geneva in 2004/2005. All 46 member states of the African Region have contributed to this data collection. The data base presented here is the best available information base on the health workforce in the African Region to date and it will be continuously updated. Data is provided for 23 different types of health care cadres, both as total numbers and densities per 1000 population.

This chapter of the Global Health Watch focuses on the global dimension of health migration, although it recognizes that the agenda for coherent and comprehensive health systems development must place human resources at its centre. [author’s description]

Section 6, “Developing Human Resources for Health,” describes the dire shortage of human resources in the health systems of low and middle income countries and the special challenges posed by this crisis. It touches on ways of addressing shortages of qualified staff and gives several examples of how countries can use technical support to build stronger a health workforce. [author’s description]

The health worker crisis is particularly acute in rural and hard to reach areas, where 80% of the population in Africa live. The resultant low capacity at the peripheral level of the health system is a crucial barrier to good health. AMREF believes that developing capable, motivated and supported health workers at all levels of the health system is essential in ensuring the delivery of accessible and effective health care across Africa… This briefing draws on AMREF’s experience to look at three key issues: the importance of appropriate training, task-shifting to lower cadres of worker, and training and supporting community health workers (CHW) in order to bring health care closer to communities.

The importance of human resources in health systems needs not to be over-emphasised. Expenditure on health workers forms a significant proportion of total health expenditure in many countries. In order to effectively implement cost-effective interventions, health workers must have the appropriate skills, competencies, training and motivation to do so. However, current evidence suggests that health systems in developing countries are understaffed and exhibit maldistribution of health workers. Health workers are generally demotivated and less productive due to inappropriate incentive environment.

The quality and quantity of health care services delivered by the Malawi public health system is severely limited, due to, among other things the shortage of adequate numbers of trained health care workers. In order to suggest policy changes and implement corrective measures, there may be need to describe the perceptions of the legislature on how they perceive as the cause of the problem, which could be the solutions and an evaluation of those solution. In this paper, I present the finding from a qualitative study of Hansards (official verbatim record of parliamentary speeches) analysed by discourse analysis.

Whether one is ill, in need of urgent care but denied access to essential services due to the absence of a health worker – or looking from the perspective of an over-stretched health worker who is inadequately equipped and supported, and brings barely poverty-level wages back to the family – the crisis in human resources for health (HRH) is an old problem which has developed right in front of us, and has now been exposed and accentuated by fresh forces. [author’s description]

Too often capacity building becomes merely a euphemism referring to little more than training. This paper argues that it is more important to address systemic capacity building, identifying a pyramid of nine separate but interdependent components.

Although the [critical shortage of health care workers] is not new, recent international efforts to vaccinate children and to fight HIV/AIDS, malaria, tuberculosis, and other diseases have brought it into sharper focus. The worker shortage derives from a combination of underproduction, internal maldistribution, and emigration of trained workers (“brain drain”). Fortunately, many African countries have begun attacking the problem by implementing innovative programs that may serve as models for other countries. Once effective pilot programs have been identified, scaling up will be the next hurdle: programs that are found to work on a small scale or in a particular environment may not be easy to expand or replicate.

This conference aimed to address the global health care workforce shortage: what has been done and what steps are still needed to solve this critical problem. The meeting linked research, policy and action for global human resources for health. [publisher’s description]

The report of the Africa Working Group (Joint Learning Initiative) is in 4 main parts covering a situation analysis, opportunities that arise and the preconditions for effective strategies.

The Capacity Project worked with health sector leaders to develop the Emergency Hiring Plan (EHP), an innovative rapid response staffing and training model. Designed to increase the number of qualified health professionals available to work in public health facilities, the EHP is helping the MOH to expand access to treatment and care through the rapid hiring, training and deployment of 830 health workers. [from author]

This document outlines the Programme for Development of Human Resources for Health (HRH) in the WHO South East Asia Region, whose overall aim is to collaborate with the Member Countries to correctly plan, effectively train, efficiently deploy and optimally utilize the types and numbers of health personnel that they require to meet the needs of their health systems. [from introduction]

Addressing the current state of human resources in health, the paper highlights the critical situation of the health workforce in sub-Saharan Africa. It examines the most recent workforce statistics and trends, including geographical distribution. The factors that have and are influencing the availability of human resources are briefly reviewed, focusing on the workforce motivation, the serious brain drain of health professionals, and the increasing impact of HIV/AIDS.

The study of the health workforce has gained in prominence in recent years, as the dynamic interconnections between human resource issues and health system effectiveness have come into sharper focus. This paper reviews lessons relating to strategic management challenges emerging from the growing literature in this area. [from abstract]

This consultation was convened jointly by the Global Health Workforce Alliance, the World Health Organization and the Swedish International Development Agency to discuss issues relating to the current crisis in human resources for health. The objectives of the Consultation were: to provide information on the global and regional crisis in human resources for health and propose activities based on the main recommendations of the World Health Report 2006; to share experiences in human resources for health, including issues related to priority programmes such as HIV/AIDS in the countries represented; and to present the African Human Resources for Health Platform and discuss possible solutions to the alleviation of the crisis in the African region.

The HRH Action Framework presented here is designed to assist governments and health managers to develop and implement strategies to achieve an effective and sustainable health workforce. By using a comprehensive approach, the Framework will help you address staff shortages, uneven distribution of staff, gaps in skills and competencies, low retention and poor motivation, among other challenges. [publisher’s description] This website guides users through the HRH development process using indicators, resources, tools and guidelines.

Many countries in Latin America and the Caribbean have too many specialists and too few primary care providers and community health workers. These countries need to overhaul their training and payment practices to address this imbalance, say human resources experts. [author’s description]

While the scale of the [health worker shortage] crisis is huge, solutions do exist. Many countries and communities around the world have begun to develop and implement innovative initiatives to sustain and build the health workforce. Several such examples are highlighted here. They address such issues as retention in rural areas, AIDS treatment for health workers, and the deployment of paraprofessionals to extend health care access deeper into communities. Many of these examples focus on rural areas, which typically have only a fraction of the number of health workers as urban areas due to more difficult living conditions, social and professional isolation, and weaker health infrastructure. [publisher’s description]

This is a glossary of terms commonly used in the field of Human Resources for Health.

This presentation was part of a USAID Mini-University session in October 2007. It gives an outline of healthcare worker issues and shortages, including worker density by region, and a breakdown of the reasons for the HRH crisis in Africa. The presentation also presents solutions to address the problem.


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Even though the situation of human resources in health varies between the countries of the Region of the Americas, all of them are confronted by deep imbalances in the availability, composition, and distribution of the work force. These imbalances can be present as acute shortages of health personnel, chronic and persistent problems of inappropriate distribution of the work force with regard to needs, or inequities in composition of health providers in relation to the population served.