The vexing issue of the chronic and severe lack of health professionals worldwide is devasting for those countries where millions of people are without access to appropriate health services, principally primary care. This is the most critical challenge to achieving universal coverage of health services. If competent appropriately skilled health professionals are not available in adequate numbers and distributed proportionately to the population, many citizens will not receive the services corresponding to their health needs.
The World Health Report 2006 estimated that an additional 2.4 million doctors, nurses and midwives were needed globally (WHO, 2006a). There is no indication that this deficit has been significantly reduced since that estimate was first published. The health workforce is one of the six building blocks of the health-care system that countries need to strengthen if the objective of universal equitable access to good quality health services is to be achieved (WHO, 2007). Producing more health professionals alone will not be sufficient; what a population needs is a health workforce with the right competencies to respond to its evolving needs. In most countries, rich and poor, the education of health professionals has traditionally been isolated from health service delivery needs and has not been adapted to rapidly changing population health profiles. The excessive focus on hospital-based education and education that is segregated into professional silos do not prepare health professionals for team work, and for leadership skills required in 21st century health services (Joint Learning Initiative, 2004; WHO, 2006a; GHWA, 2008; Frenk, et al., 2010).
Undoubtedly, more health professionals are needed with new competencies and motivation to serve the needs of society. The transformation of health professionals’ education can be achieved by competent and dedicated leaders focusing on health needs and the objectives of the health services system. The WHO Initiative on transforming and scaling up health professional education and training is a contribution to this difficult but inspiring task.
Policy discussions on health workforce education initially focused on the need for increased educational capacity and production. The problems of insufficient health workers were perceived to be exacerbated by migratory flows, largely from low-income to high- income countries, which resulted, in 2010, in the adoption by the WHA of a WHO Global Code of Practice on the International Recruitment of Health Personnel (WHO, 2010a). A related issue, the inequitable geographical distribution of the available health workers, led to the publication of the WHO policy recommendations on Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention (WHO, 2010b). Soon, the need was raised to address the shortcomings in current approaches to the education of health professionals in a more systematic manner. The Independent Commission on Education of Health Professionals for the 21st Century (Frenk, et al., 2010) directly addressed the issue.
As a global normative and technical health agency, WHO has assumed responsibility for providing guidance to countries on the transformative scaling up of health professionals' education. In 2009, WHO began collaboration with the United States President's Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID) who shared the objective “to strengthen the quality and capacity of nursing, midwifery, and medical education in Africa” with sound policy and technical guidance in order to build a quantitatively stronger health workforce with a greater capacity to respond to the health needs of individuals and communities.
Scaling up education and training is a critical component of the strategies to strengthen the health workforce, but much of its effectiveness will be lost if it is not complemented with policies to retain graduates, and to provide them with working conditions that will enable them to use their knowledge and skills productively (GHWA, 2008).
A strategic decision was made by the WHO Secretariat and endorsed by the Guidelines Development Group to broaden the range of health professionals from doctors, midwives and nurses to cover a wider range of health professionals (Annex 1), and not to confine the geographical focus to Africa, despite the high concentration of countries in human resources for health (HRH) crisis in the region. The intent of the guidelines is to serve the needs of a variety of groups: government leaders and policy-makers in health, education, finance, labour and the civil service; public and private education and training institutions; students, health practitioners; educators and researchers; professional associations and regulatory bodies; health services managers; civil society, and development partners intervening in the health sector.