Six Reasons Ministries of Finance Should Invest in Health Workers

This blog was cross-posted from VITAL and written by Misrak Makonnen and Kate Tulenko

Last week’s high-level talks about human resources for health in Addis Ababa, Ethiopia, resulted in the Addis Ababa Call to Action on financing the health workforce, signed by the nine ministries of health that participated.

The call to action is a powerful tool that ministries of health, national health professional associations, and other health systems and health workforce champions can now use to advocate to their ministries of finance to invest more in health workers as the most direct way to meet their countries’ health goals.

Yet the fact that none of the ministries of finance that participated in the Addis health financing meetings earlier in the week participated in the later health workforce meeting highlights the challenge we face in simply getting the attention of ministries of finance, much less persuading them to act.


“We need to ensure that the offices that manage health workers have the resources they need to function properly.”


We must take our messages directly to the ministries of finance. As Ethiopian Minister of Health Dr. Kesete-Birhan Admasu reminded us at the event, many different sectors and other ministries are competing for their attention, so we must deliver messages that stand out and speak to ministries of finance in the terms they understand: dollars saved, gross domestic product (GDP) growth, efficiencies created, productivity increased.

And we must reach out to all ministries of finance, not just those in low- and middle-income countries.  All countries have imbalances of health workers, and poor and rural communities have less access to health workers and less access to careers in the health sector. Global aging and the rise of noncommunicable diseases will aggravate these challenges even more.

Here are a few key messages for ministries of finance on why they should invest in health workers. Please spread the word:

  1. On average, health worker wages represent 45% of ministry of health budgets. This resource must be maximized through increased productivity. We need to ensure that the offices that manage health workers have the resources they need to function properly.
  2. Health worker wage bills can be driven down over time by deploying more community health workers and midlevel providers (such as midwives, clinical officers, and advanced practice nurses). Not only does the evidence show that they deliver equivalent quality work, but they are faster and more cost-effective to train and more likely to be retained in-country and in underserved communities.
  3. Evidence from the World Bank shows that countries that invest more in health workers have greater overall GDP growth, even when correcting for all other factors. Healthier workforces are more productive. Increasing budgets for health workers should be viewed as an investment in national productivity, not an expense.
  4. It’s no coincidence that the Ebola epidemic occurred and spread out of control in Liberia, Sierra Leone, and Guinea. These countries have some of the lowest health worker densities and weakest health systems in the world. The Ebola epidemic shattered their economies and set them back decades. Health workers and health systems pay for themselves.
  5. Evidence from BRAC and the World Bank shows that the cost of training midwives is more than paid for in the lives they save and improved health they bring about. Midwives are a best buy in health care and can deliver services for family planning, HIV/AIDS, maternal health, and newborn care.
  6. In many low- and middle-income countries, up to 30% of government workforces are ghost workers. This includes the health sector. Eliminating ghost workers can free up funding to train and hire real health workers. An increasing roll call of countries—including the Dominican Republic, India, Bangladesh, and the Democratic Republic of Congo—is holding their health workers accountable for their presence at their assigned posts. This is one concrete way to demonstrate a commitment to good governance.

Let’s make sure ministries of finance hear these messages. Investing in their countries’ frontline health workforces is a sound investment in health, well-being, and financial stability—the data support it.

Misrak Makonnen, IntraHealth’s country director in Ethiopia, participated in and helped plan the Investing in Human Resources for Health for Sustainable Development in Africa High Level Ministerial Meeting.