Towards more and better jobs in health
German support for human resources in health: Lessons and recommendations
Technical Lead: Esther Werling, supported by Regina Winter. Contributors (in alphabetical order): Michael Adelhardt, Achille Bela, Sanja Kruse, Massa Mamay, Michaela Michel-Schuldt, Laura Nieweler, Anna- Maria Pufal, Nee-Alah Varpilah, Antonia Wellmann. Editor: Anna von Roenne
published by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH in May 2021.
Reviewing and reflecting upon learnings from implementation to date, the GIZ Community of Practice on Health Workforce has formulated the following lessons and recommendations:
- German support for health worker education and training- and capacity building measures must take health workers’ professional development- and career cycle as a whole into account. Experiences of projects that supported distinct educational and training measures for health workers at different stages of their training- and career cycle show that these are less effective if participants come insufficiently prepared, be it due to poor secondary schooling or poor pre-service training. In the same vein, the effects of distinct capacity building measures will not be sustained if health workers lack opportunities to continuously update and complement their knowledge and skills throughout their working life. Capacity development for health workers needs to look at their schooling, vocational training and their professional development throughout health worker careers, e.g. through systems of professional registration, certification and obligatory periodic re-certification.
- German-supported health workforce interventions need to tackle gendered constraints and barriers limiting women’s chances to succeed in their careers in the health sector. Interventions need to strengthen the gender-responsiveness of workforce planning, development and management systems in the health sector to create an environment that enables women to go further through gender-responsive workforce strategies, human resources (HR) data systems as well as coaching for key officials in ministries of health.
- Health workers in fragile settings and in countries dealing with public health emergencies must be protected: Continued investments in the International Health Regulations core capacities, including skills development of national and international health workers in humanitarian settings and public health emergencies, both acute and protracted, are essential components of health workforce strengthening. German policy advice in fragile countries and in countries facing health emergencies should underscore that health workers and health facilities must be kept safe and that measures that ensure their physical and mental health must be put in place.
- German-supported capacity development measures for the health workforce need to consider all cadres and disciplines needed for a functioning health system. Where measures narrowly target only one cadre the impact of capacity development measures will likely remain limited because health system effectiveness depends on the effective interplay between many different cadres/disciplines. To avoid creating imbalances, development cooperation should support partners a) in getting an overview of demand, supply and geographical distribution of different health system professionals; b) in setting up efficient digital real-time health worker registries that are interoperable with the health system’s digital ecosystem; and, on that basis, in c) developing a health system-wide capacity development strategythat encompasses interrelated capacity development measures for all health system professions.
- German policy advice to partner governments should underscore the economic rationale for creating decent jobs in health and for paying health workers adequate salaries: To motivate and retain human resources in national health systems, ministries need to take into account salary levels and working conditions in domestic public and private health facilities compared to jobs they can find abroad. Ministries of finance should consider the positive effect of a sufficient number of adequately paid health professionals on the population’s state of health and, thus, on its productivity. In addition, functioning health systems create jobs and purchasing power for the local economy. Development cooperation can support the required research, policy development and inter-ministerial consultations to promote investments in the health workforce based on macro-economic evidence.
- Health workforce strengthening requires long-term political commitment and leadership and governance capacities of national Ministries of Health: Health workforce interventions supported by German development cooperation are based on innovative approaches requiring strong national leadership. Despite close alignment and harmonisation with national health strategies and policies, some interventions are jeopardized as soon as German development cooperation support ends. Building robust ownership and leadership among national partners to ensure tools are used continuously throughout national planning processes and policies will enable sustainability beyond the limited time frame of project support.