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WHA69: A New Delegate’s Perspective

This guest blog was written by Dr. Indira Paharia, Individual GHC Member

As a first time delegate at the World Health Assembly (WHA) in Geneva last week, I had an incredible opportunity to peer inside the inner workings of global health policy and even participate in the action.  When I first stepped into the Palais des Nations, I was struck by how large the structure was, consisting of Buildings A through E.  At the opening plenary, obtaining a seat in the upper observatory was an accomplishment, and seeing WHO Director-General Dr. Margaret Chan open the 69th WHA was a privilege.  The Assembly Hall was packed and the passion and excitement for the days ahead was evident.  The hall was filled with Ministers of Health, WHO and UN senior leadership, member state delegates, US officials, and NGO executives – all coming together around a common purpose of improving the lives and health of the world’s citizens.

As the days wore on, several topics were discussed in Committees A and B, and many of these meetings went on into the late evening. By the last day, I was quite familiar with how to use the lifesaving WHA app on my iPhone, as many of us were trying to track which items were moved from Committee A to B and vice-versa, in order to be present to speak on the Committee floor.  And I had the great privilege of presenting to Committee A on a Framework Convention on Global Health (FCGH) on behalf of the GHC. In between sessions and numerous side-events, I wondered the halls of the UN, stopping to admire the beautiful art work, gifts bestowed from many member states, and several WHO exhibits focused on some of the most important health issues of our time.  And of course, I also spent time in the Serpent bar vying for a power outlet and a chair like so many others!  I stayed until the very end when DG Chan closed the WHA at 7 PM on Saturday, May 28.

As a clinical psychologist and a national advisor to the Substance Abuse and Mental Health Services Administration (SAMHSA), I was initially struck and disappointed by the lack of inclusion I saw for mental health and substance use disorders. However, as I engaged in many of the topics, such as communicable diseases, violence prevention, Universal Health Coverage, and emergency preparedness, I began to appreciate how such life and death issues must take precedence.  Nevertheless, within non-communicable diseases, an integrated health systems framework, and women’s and children’s health, I do believe strongly that there needs to be more explicit inclusion of behavioral health. In moving from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs), WHO has broadened the focus of healthcare’s impact to include the social determinants of health, an important step in achieving global health equity.  Behavioral health plays a key role in this given that mental disorders are the leading cause of years lived with disability globally. We must harness the power of behavioral health in achieving SDG Goal 3.  Put simply, behavioral health is essential to overall health.

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Towards the Right to Health

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This side event will introduce participants to two strategies towards health equity. First is the Framework Convention on Global Health (FCGH), a proposed global treaty based on human rights and aimed at achieving and enshrining the concept of health equity to institutionalize the right to health throughout national and global governance. And second, civil society platforms can enable countries to better implement universal health coverage (UHC) as a key approach to the right to health. We will present analysis and experiences that speak to these concepts at both a national level – including case studies – and at the individual level, highlighting the health inequities that the FCGH and UHC-related civil society platforms will help overcome, as well as the synergies between the two. We will share how in each of people’s different realities, more effective UHC advocacy and the FCGH could be transformative.

A substantial portion of the session will be set aside for feedback and discussion. We hope that this event is part of an extended dialogue towards advancing the right to health, on ensuring empowered civil society platforms for UHC, and on generating support for and understanding of – and beginning a formal process towards – the FCGH.

Speakers Include

Bruno Rivalan, Global Health Advocates/ Action Santé Mondiale
Oladapo Awosokanre, African Development and Advocacy Centre
Case Gordon, IMAXI Cooperative
Lusiana Aprilawati, IMAXI Cooperative
Eric Friedman, O’Neill Institute for National and Global Health Law, Georgetown University
Christine Sow, Global Health Council

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20 Years of Evolution in Human Resources for Health

This guest blog was cross-posted from Chemonics, and written by Marc Luoma

From the 69th World Health Assembly, Marc Luoma describes how human resources for health transformed from a rudimentary idea to a robust field of practice.

From the 69th World Health Assembly, Marc Luoma describes how human resources for health transformed from a rudimentary idea to a robust field of practice.

The 2016 World Health Assembly (WHA) presents a significant milestone for those of us who work in human resources for health (HRH): HRH has finally been recognized as a foundational principle in reaching world health goals.

This year, the WHA will formally adopt the WHO Workforce 2030 strategy, and designate the National Health Workforce Accounts as the basic data set for HRH informatics worldwide. The WHO Health Data Collaborative is creating an HRH working group, and fit-for-purpose HRH was recently recognized as a necessary condition to reach the Sustainable Development Goals (SDG 3).

With HRH in the spotlight, it’s easy to forget that as recently as the mid 1990s, the public health community had only a rudimentary understanding of how to strengthening the health workforce. At that time, paying attention to HRH meant little more than training health care providers. In these 13 years we have seen elemental changes in the sophistication and effectiveness of our HRH research and interventions.

This transformation began in the late 90s with the realization that training alone wasn’t enough to help providers deliver the best care. The health community began promoting performance improvement approaches to ensure an enabling environment for health care workers, yet the focus was still on improving the individual provider.

Human resources for health milestones since 2004, according to the World Health Organization.

Human resources for health milestones since 2004, according to the World Health Organization.

In the early 2000s a visionary group from WHO called the Joint Learning Initiative (JLI) began to collect data on the health workforce. The group analyzed the number of providers as compared to the population, and the effect on health outcomes. In 2003 the JLI published Human Resources for Health—Overcoming the Crisis, framing HRH as a lynchpin of the health system. With it came the provider/population ratios that we still use today: in order to reach the Millennium Development Goals, a country needs at least 2.8 health care providers per 1000 people. Compared to the National Health Workforce Accounts’ 250 indicators, the 2.8 ratio seems today a blunt instrument. But in 2003 the JLI report served as a wake-up call.

Now, simple provider/population ratios have given way to forecasts of disease burden, provider competencies, geographic distribution, and migration trends. The world of health informatics has evolved from converting paper files to simple databases, to building interoperability among existing government systems such as Civil Service databases, DHIS-2 health databases, and social security insurance data. Beyond basic provider training, we now seek to help existing providers be as productive as they can be. Likewise incentives and pay-for-performance schemes are being coupled with research to maximize the intrinsic motivation providers already feel in serving their communities.

For those of us who have been on this HRH bullet train from the mid-90s to the mid-2010s, it may be tempting to pause for a moment and take satisfaction in how far we’ve come. But let’s only allow ourselves a moment, before digging in for what we hope will be even more accelerated progress in the next two decades.

Marc Luoma is a director and human resources for health advisor at Chemonics International. By promoting meaningful change around the world, Chemonics helps people live healthier, more productive, and more independent lives. 

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