"More money for health - more health for the money": a human resources for health perspective

Human Resources for Health More money for health - more health for the money: a human resources for health perspective James Campbell 2 Iain Jones 1 Desmond Whyms 0 0 Senior Health Adviser, DFID , London , UK 1 Economic Adviser, Department for International Development (DFID) , London , UK 2 Instituto de Cooperacion Social , Integrare (ICSI), Barcelona , Spain Background: At the MDG Summit in September 2010, the UN Secretary-General launched the Global Strategy for Women's and Children's Health. Central within the Global Strategy are the ambitions of more money for health and more health for the money. These aim to leverage more resources for health financing whilst simultaneously generating more results from existing resources - core tenets of public expenditure management and governance. This paper considers these ambitions from a human resources for health (HRH) perspective. Methods: Using data from the UK Department for International Development (DFID) we set out to quantify and qualify the British government's contributions on HRH in developing countries and to establish a baseline. To determine whether activities and financing could be included in the categorisation of 'HRH strengthening' we adopted the Agenda for Global Action on HRH and a WHO approach to the 'working lifespan' of health workers as our guiding frameworks. To establish a baseline we reviewed available data on Official Development Assistance (ODA) and country reports, undertook a new survey of HRH programming and sought information from multilateral partners. Results: In financial year 2008/9 DFID spent 901 million on direct 'aid to health'. Due to the nature of the Creditor Reporting System (CRS) of the Organisation for Economic Co-operation and Development (OECD) it is not feasible to directly report on HRH spending. We therefore employed a process of imputed percentages supported by detailed assessment in twelve countries. This followed the model adopted by the G8 to estimate ODA on maternal, newborn and child health. Using the G8's model, and cognisant of its limitations, we concluded that UK 'aid to health' on HRH strengthening is approximately 25%. Conclusions: In quantifying DFID's disbursements on HRH we encountered the constraints of the current CRS framework. This limits standardised measurement of ODA on HRH. This is a governance issue that will benefit from further analysis within more comprehensive programmes of workforce science, surveillance and strategic intelligence. The Commission on Information and Accountability for Women's and Children's Health may present an opportunity to partially address the limitations in reporting on ODA for HRH and present solutions to establish a global baseline. - Background At the MDG Summit in September 2010, the United Nations Secretary General (UNSG) launched the Global Strategy for Womens and Childrens Health [1]. The strategy sets out the key areas where action is urgently required to enhance financing, strengthen policy and improve service delivery. It represents, in the UNSGs own words, an opportunity to improve the health of hundreds of millions of women and children around the world, and * Correspondence: 1Instituto de Cooperacin Social, Integrare (ICSI), Barcelona, Spain Full list of author information is available at the end of the article in so doing, to improve the lives of all people [2]. Central within the Global Strategy are the ambitions of more money for health and more health for the money. The objectives aim to leverage more resources and more results. They refer to the additional financing required to achieve the Millennium Development Goals for health ("spending on health in low-income countries needs to be raised from an estimated US$ 31 billion [in 2009] to US$67-76 billion per year by 2015 (more money for health)) and the necessity to improve the use of existing financial resources to strengthen health systems and scale-up efficient, effective and equitable services that result in improved health outcomes (more health for the money). Both are core tenets of public expenditure management and governance; equally applicable to domestic and international expenditures (see Figure 1). This paper responds to the two ambitions in the UNSGs Global Strategy from a human resources for health (HRH) perspective. It draws upon formative monitoring and evaluation activities within the United Kingdom of Great Britain and Northern Ireland (United Kingdom) Department for International Development (DFID) to quantify and qualify the British Governments support to HRH. To paraphrase the Global Strategy the paper reviews issues related to more HRH for the money and more money for HRH. A key purpose of the research was to address the feasibility of establishing a baseline from which to measure more. The paper is presented in three parts. In the first we describe the methodology employed in establishing a baseline. The second part presents a short overview of the results before focusing on the quantitative component related to Official Development Assistance (ODA) for HRH. This leads to a discussion, drawing on the peerreviewed literature, of the OECDs Creditor Reporting System (CRS) in relation to HRH strengthening in the final part. Methods In order to determine whether activities and financing could be included in the categorisation of HRH strengthening we adopted two guiding frameworks: the Agenda for Global Action on HRH [3] (see Figure 2) and WHOs approach to the working lifespan of health workers [4] (see Figure 3). The Agenda for Global Action on HRH and the accompanying Kampala Declaration [5] were prepared by the Global Health Workforce Alliance (GHWA) in 2008. These have since been recognised by the G8 as tools to guide collective action [6,7]. Comparing Britishfunded activities against the Agenda for Global Action served a dual purpose: to be one of the first bilateral agencies to classify British activities against each of the six action areas in the Agenda (thus evaluating whether UK Figure 1 More money for health - more health for the money. Source: Global Strategy for Womens and Childrens Health [3]. Figure 2 Six action areas from the Agenda for Global Action on HRH. Source: Global Strategy for Womens and Childrens Health [3]. programming is consistent with this widely-adopted consensus for action on HRH) and for subsequent internal and external reporting (i.e. for reporting UK activities on HRH to the G8 as required by their annual Accountability Framework). The World Health Organization (WHO) working lifespan strategies is promoted as a roadmap for training, sustaining and retaining the workforce [4] and provided a visual tool to assess and categorise UKsupported activities (see Figure 2 and 3). Three components were included in the research: a desk-based analysis of ODA, an in-depth review in four countries and a survey of HRH programming across twelve countries. We conducted a desk-based analysis of the British ODA (...truncated)