M Tshabalala-Msimang: Conference of Ministers of Health

16 November 2007

HE the African Union (AU) Commissioner for Social Affairs, Advocate
Gawanas
HE Lord Crisp Co-chairperson of the meeting
Your Excellencies the Ministers present
Distinguished ladies and gentlemen

I wish to thank the Commissioner for her kind invitation to address this
meeting as the Chairperson of the CAMH3 Bureau. Africa which has 25% of the
global disease burden has only three percent of the global workforce and
accounts for only one percent of the global health resources spent annually. It
is well known for example that there is a strong positive correlation between
immunisation coverage and the number of health professionals in a country. For
Africa to make significant progress in the achievement of the Millennium
Development Goals, we need to be able to quickly scale up production and
retention of the health workforce.

The contribution of human labour into the production of health is large and
cannot be substituted by technology. Health workers are the pillar of the
health system which, if weakened as it is by unregulated migration that has
been going on for the last decade, results in the collapse of the healthcare
provision and the consequent deterioration in health outcomes.

As African Ministers of Health we must acknowledge that there are both push
and pull factors that result in health workers migrating from developing to
developed countries, from rural to urban areas and from the public to the
private health sector. The consequence of this migration results in significant
inequities between nations and within countries. This is particularly a
challenge for developing countries where the majority of the population depends
on the public health sector for health services.

These inequities are further aggravated by the fact that in most developing
countries, the education of health professionals is financed from general
taxation. The poor therefore are doubly disadvantaged! There have been many
calls for developed countries to do more. What should they do? In the spirit of
freedom of movement they can enter into memoranda of agreements on ethical
recruitment. They can ensure that they invest in training their own citizens
and not ride on the backs of developing countries. They can compensate
developing countries for recruiting their nationals in various ways. They can
ensure that international financing instruments like the International Monetary
Fund (IMF) and World Bank remove personnel limits in the public health
sector.

Developing countries too can do our part. We must do everything we can to
eliminate the push factors like improve conditions of employment of health
professionals, improve human resource management, etc. Africa is still
searching for solutions and ways of mitigating this severe loss of the health
personnel to developed countries whilst respecting the rights of individuals to
migrate. Off course we recognise that it is not just health workers that are
migrating from developing countries to developed countries, this is part of a
larger problem.

At the Third Session of the Conference of African Union (AU) Ministers of
Health (CAMH3) that was held in April 2007, the Ministers of Health lamented
the ongoing imbalances that negatively affect the performance of our health
systems. At that meeting Ministers of Health recognised that the issue of
health–work force development and retention needs a multi-sectoral approach
involving among others ministries responsible for Finance, Public Service
administration and Education. As well the Ministers appealed for special
consideration to be given to the dire health work-force deficits in conflict
and post conflict countries.

For Africa to scale up health work-force training there is a need to
mobilise adequate resources. We appeal to the developed world which has largely
benefited from this exodus of health workers, to consider financially
supporting Africa to train more health workers. Additional resources will also
be required to rebuild the health infrastructure in some instances as well as
training our lecturers, tutors and researchers.

I am pleased to note that the call by the Ministers of Health in Africa for
the African Union Commission to work together with the World Health
Organisation (WHO) to develop a work plan for the development of Health Workers
in Africa is bearing fruits. On behalf of the African Union Ministers of Health
we hope that this high Level Consultative Meeting will result in strong
linkages with the Implementation of the Africa Health Strategy as well as
result in resolutions that are implemented nationally, on the continent as well
as globally.

We support the strategic areas proposed by the WHO in the document that
analysed Human Resource for Health in the African Region and way forward
(Document AFR/RC57/9).

These strategic areas include:

* creation of Fiscal space for innovative ways of developing the health
workforce
* acceleration of formulation and implementation of comprehensive policies and
plans that are evidence–based and forecast supply and demand
* production of more human resources for health. This needs resources as well
as partnerships
* improving Human Resources Management Systems by improving skills, equipment,
and the status of the workforce development
* developing and implementing retention strategies
* generating evidence of health workforce distribution by having a workforce
database that can be used for health workforce planning and management
* fostering partnerships with the private sector, non-governmental
organisations (NGOs), and the diaspora under the stewardship of the national
authorities.

We further believe that the African Health Workforce Observatory should
co-ordinate with the countries in getting information to help monitor the
workforce situation in the countries, regions and the continent. In conclusion,
it is important that whatever interventions are planned for at this level must
be harmonised and strengthen national plans. The mandate of providing high
quality accessible and affordable healthcare cannot be achieved if the health
workforce is not increased, capacitated and retained. For this we need all the
stakeholders to play an active and positive role.

I thank you for allowing us to participate.

Issued by: Department of Health
16 November 2007
Source: Department of Health (http://www.doh.gov.za)