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Health Workforce
Measurement: Seeking
Global Governance and
National Accountability
Marilyn A. DeLuca, PhD, RN,
Principal, Global Health – Health Systems-Philanthropy
Research Assistant Professor, School of Medicine
Adjunct Associate Professor, School of Nursing
New York University
Sofia Castro Lopes, MS, RN,
Research Associate, Instituto de Cooperacion Social Integrare
Barcelona, Spain
Correspondence may be directed to:
Marilyn A. DeLuca
Email: marilyn.deluca@gmail.com
8
World H ealtH & P oPulation • V o l . 16 no. 1
Urgent Need for Health Workforce Data
Efforts to improve global health continue to
draw needed attention to health systems
strengthening (HHS) and human resources
for health (HRH). The urgency to grow and
retain a competent and supported health
workforce, the backbone of health systems, in
low-, middle- and high-income settings is
even more pressing, given the increasing
prevalence of non-communicable diseases,
devastating outbreaks of infectious diseases
and calls for democratization of access to
health services through universal health cov-
erage (UHC) and equity. These factors,
together with the expanding provision of
health services by the private sector in low-
and middle-income countries (LMICs) and
pressure for transparency, are fueling the
demand for HRH data that are: (1) reliable;
(2) efficient to collect; (3) frequently
updated; (4) inclusive across cadres and
settings; and 5) supported by inter-operable,
open-source information systems.
In 2014, on the heels of the 2013 Third
Global Forum on HRH in Recife, UN member
states and the WHO charged the Global
Health Workforce Alliance (GHWA) to lead an
inclusive consultative process to draft recom-
mendations for a Global Strategy for Human
Resources for Health to be presented to UN
member states at the 69th Session of the World
Health Assembly (WHA) in May 2016 (WHA
2014). The evidence reported here was gener-
ated as part of a review for the Global Strategy
consultation process by several members of
Technical Working Group 3 (TWG3 2015).
Since 2000, resolutions of UN member
states and the WHA, reports and initiatives of
the WHO, and advocacy by global, regional
and country-level stakeholders document the
need to grow and retain adequate numbers of
competent and motivated health workers
Abstract
Health workers are essential to population health. This paper addresses needed
global and country-level action to build human resources for health data, systems
and impact measurement. Using a conceptual framework drawn from theories on
political prioritization (Shiffman 2007) and public mandates as mechanisms for
reform (Kingdon 1984), we argue that increasing global health needs are driving
political action to develop human resources for health data and measurement
systems. To assess the evidence of past calls for health workforce data measure-
ment, we conducted a systematic review of documents published between 2000
and 2014, searching for evidence of explicit calls for building health workforce data
and measurement systems. Sources of evidence include World Health Assembly
Resolutions and documents and events generated by key stakeholders: global
organizations, civil society, donors, non-governmental organizations and profes-
sional organizations. We found that few World Health Resolutions contain specific
language that addresses human resources data or systems. Stakeholder documents,
however, contain more evidence of calls to expand health worker data systems.
The Sustainable Development Goals, national commitments to implement
universal health coverage and efforts to increase the health workforce and
strengthen global governance and accountability are recent initiatives with poten-
tial to improve access to health services. We posit that the temporal convergence
of these initiatives is opening a window that will accelerate global and country-level
receptivity and action to improve health workforce data and impact measurement
necessary to build better health systems and improve population health.
9
World H ealtH & P oPulation • V o l . 16 no. 1
Health Workforce Measurement: Seeking Global Governance and National Accountability
(AAAH 2012; WHOAfro 2005; AHWO 2010;
APHRH 2011; CfWI 2010; Chan et al. 2010;
DeLuca and Soucat 2013; FHWC 2012; G8
2008, 2011; GHWA 2010a, 2011b, 2012c; H8
2010; Middleberg 2010; Ottersen et al. 2014;
Scheffler et al. 2009; Spero et al. 2011;
Speybroeck et al. 2006; UN 2000, 2001a,
2010b; WHO 2006, 2008d, 2010d, 2012a) . Yet ,
despite the glaring shortage of health workers
in LMICs, and real, but less severe shortages
across high-income countries, calls for and
development and implementation of HRH
data systems and related impact measurement
have been markedly lacking. Defining the 2000
United Nations Millennium Development
Declaration on Millennium Development
Goals (MDGs) (UN 2000) as the starting point
for analysis, we conducted a systematic review
for evidence that addressed the need for HRH
data systems and impact measurement found
in documents from 2000 through 2014 and
categorized that evidence across nine themes.
Sources include WHA Resolutions (WHA
2000-2014) and documents and activities of
key stakeholders: global organizations; advo-
cacy groups; civil society; donors;
non-governmental organizations (NGOs);
and professional organizations.
The lack of reliable and current HRH data
is problematic in health service delivery,
education and training, strategic planning and
organizing health workforce responses to
emergencies. In addition to healthcare service
provision, HRH data are necessary to evaluate
health system investments, efficacy and popu-
lation health needs. Despite numerous calls,
UN member states and stakeholders have been
slow to act on HRH data as a political priority.
Indeed, the lack of timely and accurate HRH
data and the availability of interoperative data
systems are the most limiting factors in
projecting, managing and evaluating country-
level and global health workforces. While
technological capacity, connectivity and big
data management have advanced in other
sectors, health systems across all income
settings lag behind sectors such as finance and
manufacturing in the use of data systems. The
health sector’s lag in use of HRH data
constrains its capacity to plan and project
stock, evaluate competency, measure produc-
tivity and evaluate health workforce in the
context of health outcome and impact metrics
(ITU 2013; Jamison et al. 2013; Paris21 2000;
WHO 2008c, 2011a, 2012d, 2013a, 2013b,
2014a).
Attention to changing demographics,
increasing prevalence of chronic health condi-
tions, ubiquitous outbreaks of communicable
diseases and focus on prevention, measure-
ment and outcomes research are escalating
the need to accelerate improved governance
and accountability for HRH data systems
that serve local, national, regional and
global health needs.
Framework
Political agenda setting and public policy are
complex processes that require a number of
inter-connected conditions. The conditions
can exist when: (1) national political leaders
express sustained concern for an issue
(Shiffman 2007); (2) the government enacts
policies and strategies to address the prob-
lem; and (3) the government allocates ade-
quate budgets to support the issue (Ibid).
Kingdon (1984) suggests that receptiveness
for major policy change depends on the pres-
ence of a strong public mandate. Building off
these constructs, we posit that the increasing
focus on the health workforce from 2000
through 2014 generated global and national
policy imperatives to develop and implement
HRH data, systems and impact measure-
ment. Shiffman’s and Kingdon’s perspectives
underpin our conceptual framework:
increased focus on HRH has capacity to
generate policy imperatives that advance
global governance and national accountabil-
ity for national, regional and global HRH
data, systems and impact measurement.
10
World H ealtH & P oPulation • V o l . 16 no. 1
Health Workforce Measurement: Seeking Global Governance and National Accountability
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World H ealtH & P oPulation • V o l . 16 no. 1
Health Workforce Measurement: Seeking Global Governance and National Accountability
Questions that underpin the study are:
Question 1: What influence has the
focus on the health workforce between
2000 to 2014 had on generating policy
imperatives at global and national
levels to (a) develop, collect, report
and utilize HRH data; (b) build HRH
data systems; and (c) use these data in
impact measurement?
Question 2: Will the convergence of the
2015 MGD target dates, setting forth
the SDGs and post-2015 agenda and
global consensus in support of UHC
and equity, drive policy imperatives
to develop and implement global and
national HRH data systems and impact
measurement?
Proposition 1: The increasing frequency
and volume of evidence focused on
the global health workforce found in
multiple sources from 2000 to 2014 is
fostering national and global entities to
build local, national and global infor-
mation systems to capture, store and
generate HRH data and develop impact
measures.
Proposition 2: The convergence of the
2015 MGD target dates and post-2015
agenda and global consensus in support
of UHC and equity is generating robust
policy mandates among global national
and global stakeholders to develop and
implement HRH data, systems and
impact measurement.
Methods
We conducted a systematic review and
process tracing for evidence that calls for
HRH data measurement and categorized the
evidence found in source documents, donor
reports, interviews and focusing events gen-
erated by (1) the WHA and (2) key stake-
holders: global organizations, civil society,
donors, NGOs and professional organiza-
tions. The stakeholder evidence reviewed
represents a select sampling and is not
inclusive of all stakeholder documents
and activities.
Consistent with the consultative process
used in developing the Global Strategy on
HRH, we utilize the same eight themes in the
health labour market framework outlined by
Sousa and colleagues (2013, 893, Figure 1)
along with one additional category, “other
enablers, research”, to categorize the themes
contained in the WHA Resolutions. We cate-
gorized the actions described in the WHA
HRH-related resolutions and stakeholder
documents among one or more of the
following themes: (1) demand; (2) supply,
education; (3) data, measurement; (4)
accountability, alignment post-2015; (5) lead-
ership, governance, policy alignment; (6)
supply, demand/fragile states; (7) produc-
tivity, performance; (8) supply
non-professionals; and (9) other enablers,
research.
Explicit
calls for data and measure-
ment are defined here as language that
addresses health workforce data and/or meas-
urement.
Implicit
calls for data are defined
here as language that suggests or implies
that data are needed to assess or report on
activities or programs.
Findings: Evidence 2000–2014
WHA Resolutions
The review of WHA Resolutions generated
between 2000 and 2014 reveals an increasing
frequency of recommendations that call
for strengthening the health workforce (WHA
2000–2014) (Figure 1). During this period,
WHO member states generated
374 WHA Resolutions. Of the total number
of Resolutions, 209 are categorized as
health-related in nature and are further
analyzed. The 165 non-health resolutions,
categorized as financial and/or regulatory
in nature, were excluded from further
analysis.
Of the 209 health Resolutions, 109 (52%)
relate, at least in part, to HRH and associated
action(s) in one or more of the nine themes
described. The most frequent themes of the
WHA Resolutions are theme 5,
leadership,
governance, policy alignment
(26%),
followed by theme 2,
supply/education
(24%),
and theme 7,
productivity performance
(16%).
theme 3, data and measurement, represented
4% of the total themes addressed (Table 1).
While a majority of the 209 health resolu-
tions includes language and references to
health workforce, explicit language and
evidence calling for the development of
HRH data, systems and impact measurement
are sparse. Further, of the 109 health/HRH
resolutions, only seven address explicit actions
related to HRH data, systems and impact
measurement, reflecting the low presence that
HRH metrics occupied in the global policy
architecture of the WHO.
Over the examined period, there is a
notable trend from 2005 through 2014, as the
number of resolutions with HRH actions
markedly increased (2005, 2007, 2010, 2011
and 2014) (Figure 1). However, despite the
period between 2000 through 2014 being
marked by HRH “crises” and “scale-up” activi-
ties, recognition of the centrality of health
workers, and urgency to strengthen health
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World H ealtH & P oPulation • V o l . 16 no. 1
Health Workforce Measurement: Seeking Global Governance and National Accountability
Table 1. Sample WHA resolutions by theme, order of frequency and extract/action
Theme WHA resolution (yr) Extract/action
(5) Leadership, govern-
ance, policy alignment
55.11 (2002)
67.14 (2014)
“3) to accelerate development of an action plan to address the ethical
recruitment and distribution of skilled health-care personnel, and the need
for sound national policies and strategies for the training and management
of human resources for health;” “9) to adopt policies that create healthy
workplaces, protect workers’ health and, consistent with national and
international law, prevent transfer of hazardous equipment, processes and
materials;”
“11) to emphasize the importance of strengthening health systems,
including the six building blocks of a health system (service delivery; health
workforce; information; medical products, vaccines and technologies;
financing; governance and leadership), to progress towards and sustain
universal health coverage and improved health outcomes;”
(2) Supply, education 62.12 (2009) “5) to train and retain adequate numbers of health workers, with appro-
priate skill mix, including primary care nurses, midwives, allied health
professionals and family physicians, able to work in a multidisciplinary
context, in cooperation with non-professional community health workers in
order to respond effectively to people’s health needs;”
(7) Productivity,
performance
55.12 (2002) “6) to build and strengthen partnerships between health-care providers,
both public and private, and communities, including nongovernmental
organizations, in order to mobilize and empower communities in the
response to HIV/AIDS;”
(9) Other enablers,
research
55.23 (2002)
60.27 (2007)
“3) to monitor scientific data and to support research in a broad spectrum
of related areas, including human genetics, nutrition and diet, matters
of particular concern to women, and development of human resources
for health;”
“6) to strengthen the capacity of health workers to collect accurate and
relevant health information;”
(1) Demand 56.6 (2003) “2) to strengthen human resource capability for primary healthcare in order
to tackle the rising burdens of health conditions;”
(3) Data, measurement 59.27 (2006) “5) to provide support for the collection and use of nursing and midwifery
core data as part of national health-information systems;”
Figure 1. Stakeholder evidence: documents and events by year
Years
Health/HRH Documents/Events
14
12
8
0
2
4
6
10
2000 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
13
World H ealtH & P oPulation • V o l . 16 no. 1
Health Workforce Measurement: Seeking Global Governance and National Accountability
systems, specific WHA Resolutions focused on
health workforce data and measurement are
remarkably few in number. And, while effec-
tive implementation and evaluation of most
health and the HRH-related resolutions
implicitly
rely on the availability of HRH data,
explicit evidence
in support of implementing
and use of data, systems and impact measure-
ment is sparse. The lack of explicit calls for
HRH data suggests that a concerted,
global movement for health workforce
measurement systems would be impactful.
Stakeholders
The focus of stakeholders – global organiza-
tions, civil society, donors, NGOs and profes-
sional organizations – on the global health
workforce steadily increased over the period
studied (Figure 2). Evidence includes the
WHO and GHWA reports, documents and
events generated by other stakeholders,
namely, civil society, donors, NGOs and pro-
fessional organizations.
There is a notable increase in the generation
of health and HRH associated evidence by
stakeholders from 2008 through 2014 with
2008, 2010, 2011, 2013 and 2014 showing
spikes in activity. Generation of health and
HRH-associated evidence accelerated from
2008 through 2014. The most frequent themes
addressed in the stakeholder evidence are: 5)
leadership, governance (14.5%); 2) supply,
education (13.4%); 7) productivity, perfor-
mance (13%); 1) demand (12.7%), and 6)
supply, demand, fragile states (12.7%). theme
3, data and measurement, accounted for only
5.56% of stakeholder evidence.
Interestingly, the several stakeholder spike
years temporally align with WHA resolution
spike years. And, years 2005, 2007, 2008, 2012
and 2013 follow and/or are followed by one or
more major global HRH initiatives: World
Health Report (2006); creation of the GHWA
(2006); 1st Global Forum on HRH and
Figure 2. WHA health/HRH resolutions by year
Years
Health/HRH Resolutions
16
14
12
2002 2008
8
0
2
4
6
10
2000 2001 2003 2004 2005 2006 2007 2009 2010 2011 2012 2013 2014
Kampala Declaration,
Agenda for Global Action
(GHWA 2008); UN consensus statement on
UHC (UN 2012) and Recife Declaration
(GHWA 2013c); and Global Strategy on HRH
(WHA 2014). These temporal associations
between HRH-related WHA Resolutions,
stakeholder evidence on HRH data and
major global HRH initiatives suggest multi-
directional relationships across actors
(see Appendix A and Appendix B at http://
www.longwoods.com/content/24295).
Of the
explicit
HRH data evidence,
civil
society
, a constant advocate for growing HRH
and the need for workforce data systems,
generated the major proportion of the
evidence (Capacity Plus 2014; Center for
Global Development 2014; DeLuca and Soucat
2013; FHWC 2014; GHWA 2013b
[Stakeholder Commitments]; HWAI 2014;
IOM 2009; Health Metrics Network 2011;
Soucat and Scheffler 2013; Sousa et al. 2013),
followed by GHWA (21%) (GHWA 2010b,
2011a, 2013a, 2013b [53 Country
Commitments], 2014) and the WHO (21%)
(2000, 2006a, 2007, 20011d, 2011e).
Established in 2006, the GHWA convened
three global meetings on HRH during the
study period. Third Global Forum on HRH
held in Recife in 2013 elicited numerous
commitments on HRH from 53 member states
and 27 other constituencies (GHWA 2013b).
Solicited to accelerate progress on the global
HRH agenda and the essential role of the
health workforce to attain MDGs targets,
implement UHC and post-2015 health devel-
opment priorities, many of the commitments
address HRH data systems implicitly and/or
explicitly.
Donors supported seminal initiatives that
addressed health workforce issues (JLI 2004)
and continue to provide needed resources to
advance HRH. Donor stakeholders generated
8 of 67 sources of the evidence on HRH
(Global Fund 2008; OGAC 2003, 2008, 2012;
JLI 2004) and Reports of Ministries (Omaswa
and Boufford 2010; US GHI 2009; World
Bank 2014). NGOs have been constant advo-
cates for the health workforce and generated a
significant portion of the evidence. Among
professions, nurses and midwives stand
apart in their advocacy to build and monitor
HRH data. The evidence includes the Report
of the State of Midwifery (UNFPA 2014),
a Recife Commitment by International
Confederation of Midwives (ICM) and
the International Council of Nurses (ICN)
(GHWA 2013b) and the Triad Communiqué
(2014) by government chief nursing officers,
midwifery officers, representatives of national
nursing organizations and regulatory bodies
(Table 2).
One study limitation is the sampling of
stakeholder sources, which is not inclusive of
all sources of HRH data evidence generated by
stakeholders. In addition, we limited our
review to major global HRH sources and did
not review national documents due to
resource and time constraints.
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World H ealtH & P oPulation • V o l . 16 no. 1
Health Workforce Measurement: Seeking Global Governance and National Accountability
Breakfast with the Chiefs is an educational
session that provides invited “Chief Executives”
the opportunity to share new ideas, policies
and/or best practices with colleagues.
Our speakers are CEOs, notable researchers,
cabinet ministers, deputies, or leaders from the
academic community.
breakfastwiththechiefs.com
Longwoods.com
15
World H ealtH & P oPulation • V o l . 16 no. 1
Health Workforce Measurement: Seeking Global Governance and National Accountability
Conclusions and Opportunities
1. The evidence is striking for what is not
included, notably the sparse language
in WHA Resolutions that explicitly
calls for development of HRH data/
systems and their use in health impact
measurement. This finding heightens
the need for effective global govern-
ance mechanisms to foster expansion
and utility of health workforce data.
2.The approaching MDG target
dates, adoption of the Sustainable
Development Goals (SDGs) and
the post-2015 agenda appear to be
contributing to a mandate on HRH
data measurement.
3. A cross-section of global, national and
local leaders and stakeholders recog-
nize the inconsistencies and gaps in
HRH data reporting from member
states and call for actions to improve-
ment in the quantity, quality and
frequency of HRH data and impact
metrics.
4. Progress in information technology
and systems, and the movement for big
data across sectors, including health,
are adding fuel to the argument for
improved and frequent national HRH
data to assess health impact measure-
ments.
5. Improvements and innovations in
the use of information systems and
connectivity in low- and middle-
income settings enable health data
exchange and health informa-
Table 2. Sample stakeholder evidence by frequency of theme and extract/action
Theme Source/year Extract/action
5) Leadership, govern-
ance, policy alignment
Joint Learning
Initiative (JLI), 2004
p 137 “Effective action, both urgent and sustained, requires solid informa-
tion, reliable analyses, and a firm knowledge base. But data, analyses,
and research on human resources for health and technical expertise are
underdeveloped, in part due to chronic underinvestment. National and
global learning processes must be launched to rapidly build the knowledge
base – essential for guiding, accelerating, and improving action. A culture
of science-based knowledge building must be infused into the human
resources community.”
2) Supply, education Soucat and Scheffler,
2013, The Labor
Market for Health
Workers in Africa
p 12 “Overall we know very little of the supply and distribution of health
workers in Africa The information deficit is staggering...A major investment
is required to generate the evidence needed to support effective policies.”
7) Productivity,
performance
UNFPA, et al., State of
Midwifery Report 2014
p 41 “Every country needs a minimum HRH data set on their midwifery
workforce...this includes headcount;...”
1) Demand GHWA, 2013 Third
Global Forum HRH,
Recife
“14, ii enhance HRH information systems to facilitate labour market
analysis in HRH forecasting and link needs-based planning and projections
to innovative practices;”
“18. We commit to addressing transnational issues and work towards
strengthening health systems, including global HRH governance and mecha-
nisms, by: (i) disseminating good practices and evidence; (ii) strengthening
data collection from all countries...”
6) Supply, demand
fragile states
GHWA, 2010, HRH:
Country Coordination &
Facilitation
p 10 “It is also imperative that monitoring of HRH programmes of partners
complies with the national HRH plan, strengthens human resources infor-
mation systems and involves the national health workforce observatories.”
3) Data and
measurement
Frontline Health
Workers Coalition,
2014, A Commitment
to Community Health
Workers
P 10 “Create a minimum data set on CHW enabling governments to make
evidence-based decisions...“; “Create national registries and integrate them
into the nation human resources information system.”
tion systems; however, they require
resources and a number of inputs and
conditions.
6. Changing demographics, increasing
prevalence of chronic health condi-
tions, focus on prevention and
measurement and outcomes research
are coalescing and advancing policy
imperatives for data systems to assist
local, national and global entities
assess, plan and evaluate the health
workforce.
Recommendations
Convergence of 2015 MDG target dates,
adoption of the Sustainable Development
Goals (SDGs) and post-2015 agenda and
population health needs are driving a grow-
ing global mandate, opening a window for
global and national actions for health work-
force data, systems and impact measurement.
The evidence described suggests that all
stakeholders increased the frequency of and
calls for HRH data measurement over the
time period studied. The following actions
have potential to actualize health workforce
data systems going forward:
1. Global governance and leadership
by UN member states, WHO and
stakeholders are essential to advance
national and global HRH data and
systems development. Ongoing
consultation with interest groups and
stakeholders is key to member state
engagement and future adoption of
HRH data.
2. National governments have a respon-
sibility to invest in HRH data systems.
Countries should identify local HRH
data champions and, with multi-
sectoral and multi-stakeholder engage-
ment, build national HRH data centres
for HRH data, systems and impact
measurement.
3. Investments by national governments,
global organizations and donors
are needed to develop and imple-
ment HRH data, systems and impact
measurement. Private-sector donor
support can accelerate rapid develop-
ment and implementation of HRH
data systems. Needed resources go
beyond fiscal capacity and include
infrastructure and human resource
support for training and ongoing
technical support. The expanding
corporate sector development in
LMICs presents opportunities for
them to invest in national health
systems.
4. Leadership and oversight to develop
and implement global and country-
level HRH data programs should be
placed with an appropriate entity such
as the GHWA or a new multi-sectoral,
multi-stakeholder entity sufficiently
empowered and resourced. This entity
would work with regional and national
HRH data observatories and engage
key stakeholders and sectors.
5. Establish regional support struc-
tures or observatories for HRH data
systems and impact measurement,
which will provide data management
and technical support to ensure relia-
bility of data. Functions would include
support and systems enhancement for
data efficiency, security and integrity.
6. Technical obstacles need to be
flattened to improve data quality
and interoperability. These include:
(a) adopt common definitions,
nomenclature and minimum data
sets that are inclusive of workforce
cadres and consider local definitions;
(b) establish mechanisms to resolve
emerging taxonomy problems; (c)
increase frequency of data reporting
to quarterly; (d) improve validity and
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World H ealtH & P oPulation • V o l . 16 no. 1
reliability of data; and (e) coordinate
action with new processes such as civil
registration and vital statistics systems.
7. Use of incentives to accelerate action
by countries eager to build HRH data
systems could prove beneficial and
serve as implementation models for
other settings.
8. Future WHA Resolutions and
donor-driven health initiatives should
contain specific language and resource
appropriations for health workforce
and support related HRH data,
systems and impact measurement.
Two initiatives that address health work-
force data followed the inclusion period that
defined our review and are noteworthy.
The Measurement and Accountability for Results
in Health
(MA4H) Summit convened in
Washington, DC, in June 2015, organized by
the World Bank, USAID and the WHO focused
sharply on health worker data and impact
measurement. The MA4H Summit proposed
an ambitious five-point call to action for meas-
urement and accountability for health in the
post-2015 era health in LMICs (World Bank,
USAID and WHO 2015) that aligns with our
recommendations and aims to accelerate
health workforce data systems (Box 1).
In July 2015, the landmark report on
community health workers (CHWs),
Strengthening Primary Health Care through
Community Health Workers: Investment Case
and Financing Recommendations
, was published
(Dahn et al. 2015). Supported by a consortium
of funders, the MDG Health Alliance, Clinton
Foundation, Partners in Health, the World
Bank Group and African Leaders Malaria
Alliance, along with the governments of
Ethiopia and Liberia, this report is remarkable
for the recommendations it lays out for invest-
ment in CHWs and a model of financing. Here
too, health workforce data on CHWs are
essential to assess stock, capacity and impact
measurement of this vital and typically under-
recognized cadre.
Over the past 15 years, the collective efforts
of stakeholders in global health have moved
health workforce up front and centre in the
discussions on population health. In the
coming months, we will witness two landmark
events as UN member states act on the post-
2015 SDGs and the Global Strategy on HRH.
The SDGs intensify the urgent need for global
governance and national accountability mech-
anisms on data and measurement. The Global
Strategy on HRH promises to coalesce the
necessary consensus among global leaders,
national governments and stakeholder to
actualize HRH data systems. Going forward,
stakeholders must stay mindful that imple-
mentation of HRH data systems is an ongoing
and iterative process that requires vigilance
and nimble structures to support improve-
ments over time. The September 2015 United
Nations General Assembly and the May 2016
WHA are two key opportunities for represent-
atives of member states and stakeholders to
recognize health workforce measurement as
the key priority needed to improve population
health. If we measure it, we can improve it.
Health Workforce Measurement: Seeking Global Governance and National Accountability
Box 1: Measurement and accountability for results
in health (MA4H): Five-point Plan
1. Increase the level and efficiency of investments by
governments and development partners to strengthen
the country health information system in line with
international standards and commitments.
2. Strengthen country institutional capacity to collect,
compile, share, disaggregate, analyze, disseminate
and use data at all levels of the health systems.
3. Ensure that countries have well-functioning sources for
generating population health data, including civil
registration and vital statistics systems, censuses and
health surveys tailored to country needs, in line with
international standards.
4. Maximize the effective use of the data revolution,
based on open standards, to improve health facility and
community information systems including disease and risk
surveillance and financial and health workforce accounts,
empowering decision-makers at all levels with real-time
access to information.
5. Promote country and global governance with citizen’s
and community’s participation for accountability through
monitoring and regular, inclusive transparent reviews
of progress and performance at the facility, sub-national,
national, regional and global levels, linked to health-
related SDGs.
Source: World Bank, USAID and WHO 2015.
Acknowledgements
The authors gratefully appreciate the com-
ments provided by colleagues, especially to
James Campbell, Executive Director GHWA
and Director, WHO HRH, for his vision and
leadership.
Sections of this manuscript are reported in
an unpublished background paper for
Technical Working Group 3 (DeLuca,
Campbell and Lopes 2015) for the
Global
Strategy on Human Resources for Health
(TWG3
2015) and included in the Synthesis paper for
the
Global Strategy on Human Resources for
Health
(GHWA 2015). This manuscript is the
first publication of the complete and updated
paper.
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23
World H ealtH & P oPulation • V o l . 16 no. 1
Health Workforce Measurement: Seeking Global Governance and National Accountability
World H ealtH & P oPulation • V o l .16 no. 1
ATTACHMENT A. Timeline: Key global HRH events + WHA resolutions and select stakeholder documents that explicitly
address health workforce data
Health Workforce Measurement: Seeking
Global Governance and National Accountability
Marilyn A. DeLuca and Sofia Castro Lopes
Global Health Workforce
Alliance Strategy 2013-16
2nd Global Forum on
HRH, Bangkok
World Health Report,
Working Together for Health
HRH: Country Coordination
and Facilitation
3rd Global Forum HRH,
Recife + Declaration
Follow-up on the
Reife Declaration on HRH
Keeping Promises
Measuring Results: CoIA
GHWA
WHA Resolutions
Key HRH Events
Select Stakeholder Events
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
WHA
Resolution
55.23
WHA
Resolution
59.27
WHA
Resolution
64.6
WHA
Resolution
64.7
WHA
Resolution
63.15
WHA
Resolution
63.16
WHA
Resolution
63.27
MDGs JLI
Asian-Pacific Action
Alliance on HRH
African Platform
for HRH
Health Workforce
Alliance Initiative (HWAI)
1st Global Forum HRH and
Kampala Declaration and
Agenda for Global Action
HRH Observatories:
Evidence-Informed
HRH Policies
Global Code of Practice
International Recruitment
of Health Personnel
Action Plan to
Prevent Brain Drain
Everybody’s Business:
Strengthening Health Systems
ORLD HEALTH & POPULATION
W
World H ealtH & P oPulation • V o l .16 no. 1
ATTACHMENT B. CHRONOLOGY:
7 WHA resolutions + 25 select stakeholder documents explicitly address health
workforce data
Health Workforce Measurement:
Seeking Global Governance and
National Accountability
Marilyn A. DeLuca and Sofia Castro Lopes
WHA Resolutions Year Select Stakeholder Document/Event
2000 • WHO Report: Health Systems (WHO)
WHA 55.23 2002
2003
2004 • Joint Learning Initiative (JLI) HRH: Overcoming the Crisis (JLI)
• Action Plan to Prevent Brain Drain (Physicians for Human Rights)
2005
WHA 59.27 2006 • World Health Report, Working Together for Health (WHO)
2007 • Everybody's Business: Strengthening Health Systems (WHO)
2008
2009 • IOM The US Commitment to Global Health (IOM)
WHA 63.15
WHA 63.16
WHA 63.27
2010 • HRH Country Coordination & Facilitation (WHO)
WHA 64.6
WHA 64.7 2011
• Keeping Promises, Measuring Results: Commission on Information and Accountability
Women's and Children's Health (WHO)
• Second Global Forum HRH, Bangkok, From Kampala to Bangkok: Reviewing Progress
Renewing Commitments (GHWA)
• Country Health Information Systems (Health Metrics Network)
• HRH Observatories: Evidence Informed HRH Policies (WHO)
2012 • Independent External Review Group Established (iERG) (WHO)
2013
• Population Dynamics: Dhaka Declaration (Global Leaders)
• Comprehensive Health Labor Market Framework (Sousa and Scheffler)
• Labour Market for Health Workers in Africa (Soucat and Scheffler)
• Transforming the Global Health Workforce (DeLuca and Soucat)
• 3rd Global Forum on HRH, Recife, Political Declaration on HRH (GHWA)
• Recife, Country and Stakeholder Commitments (GHWA)
• A Universal Truth: No Health without a Workforce (GHWA)
2014
• Delivering on the Data Revolution in Sub-Saharan Africa (Center for Global
Development)
• A Commitment to Community Health Workers (FHWC)
• 19 Countries save $149m on health worker info systems (Capacity Plus)
• Follow-up of the Recife Political Declaration on HRH (WHA)
• Health Workers Count: Civil Society Pledge (HWAI)
• State of Midwifery Report 2014 (UNFPA)
