Addressing the health workforce crisis: towards a common approach.

The challenges in the health workforce are well known and clearly documented. What is not so clearly understood is how to address these issues in a comprehensive and integrated manner that will lead to solutions. This editorial presents--and invites comments on--a technical framework intended to raise awareness among donors and multisector organizations outside ministries of health and to guide planning and strategy development at the country level.

Addressing the health workforce crisis: towards a common approach.

The challenges in the health workforce are well known and clearly documented. What is not so clearly understood is how to address these issues in a comprehensive and integrated manner that will lead to solutions. This editorial presents--and invites comments on--a technical framework intended to raise awareness among donors and multisector organizations outside ministries of health and to guide planning and strategy development at the country level.

Tuberculosis control in the era of HIV.

Without HIV, the tuberculosis (TB) epidemic would now be in decline almost everywhere. However, instead of looking forward to the demise of TB, countries that are badly affected by HIV are struggling against a rising tide of HIV-infected patients with TB. As a consequence, global TB control policies have had to be revised and control of TB now demands increased investment. This paper assesses what is being done to address the issue and what remains to be done.

Human resources for health: overcoming the crisis.

In this analysis of the global workforce, the Joint Learning Initiative-a consortium of more than 100 health leaders-proposes that mobilisation and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world's poorest countries and for building sustainable health systems in all countries. Nearly all countries are challenged by worker shortage, skill mix imbalance, maldistribution, negative work environment, and weak knowledge base. Especially in the poorest countries, the workforce is under assault by HIV/AIDS, out-migration, and inadequate investment. Effective country strategies should be backed by international reinforcement. Ultimately, the crisis in human resources is a shared problem requiring shared responsibility for cooperative action. Alliances for action are recommended to strengthen the performance of all existing actors while expanding space and energy for fresh actors.

Responding to the global human resources crisis.

The global community is in the midst of a growing response to health crises in developing countries, which is focused on mobilising financial resources and increasing access to essential medicines. However, the response has yet to tackle the most important aspect of health-care systems--the people that make them work. Human resources for health--the personnel that deliver public-health, clinical, and environmental services--are in disarray and decline in much of the developing world, particularly in sub-Saharan Africa. The reasons behind this disorder are complex. For decades, efforts have focused on building training institutions. What is becoming increasingly clear, however, is that issues of supply, demand, and mobility (transnational, regional, and local) are central to the human-resource problem. Without substantial improvements in workforces, newly mobilised funds and commodities will not deliver on their promise. The global community needs to engage in four core strategies: raise the profile of the issue of human resources; improve the conceptual base and statistical evidence available to decision makers; collect, share, and learn from country experiences; and begin to formulate and enact policies at the country level that affect all aspects of the crisis.

Scale up: meeting targets in global tuberculosis control.

Despite great progress, global targets for tuberculosis case detection and cure might not be reached by 2005. In particular, there is a serious case-detection gap between estimated annual incident cases and those reported under the strategy for tuberculosis control branded as DOTS. Delays in reaching targets result in lack of effect on incidence of disease, which is of particular concern in regions where incidence is increasing-eg, sub-Saharan Africa and the former Soviet Union. Four key actions will speed up progress towards reaching global targets: 1) equipping national tuberculosis programmes to have a stewardship role in engaging all health providers in implementing the DOTS strategy; 2) establishing the feasibility of national certification systems of DOTS coverage; 3) promoting community action to contribute to patient care and to voice demand for the DOTS strategy; and 4) increasing support to sub-Saharan Africa for implementation of a strategy of expanded scope to counter HIV-1-fuelled tuberculosis.