Table Of ContentScaling Up, Saving Lives
Task Force for Scaling Up Education and Training for
Health Workers, Global Health Workforce Alliance
S caling Up, Saving Lives
Task Force for Scaling Up Education and Training for
Health Workers
Global Health Workforce Alliance
2008
Scaling Up, Saving Lives … urgent action to tackle worldwide shortage
of health workers … Scaling Up, Saving Lives … thousands die or are
disabled every year … Scaling Up, Saving Lives … immediate investment
in community- and mid-level health workers … Scaling Up, Saving Lives …
part of a comprehensive scaling up of the whole health workforce … Scaling
Up, Saving Lives … education and training based on the health needs of
the country … Scaling Up, Saving Lives … quality-, community- and team-
based … Scaling Up, Saving Lives … long-term national and international
commitment and funding … Scaling Up, Saving Lives … US$2.6 billion a
year to educate and train 1.5 million health workers in Africa … Scaling Up,
Saving Lives …
Foreword
Health workers are the cornerstone and drivers of health systems. And yet the world is
facing a serious shortage of health workers – a shortage that is identified as one of the most
critical constraints to the achievement of health and development goals.
This crisis is impairing the provision of essential, life-saving interventions such as childhood
immunization, safe pregnancy and delivery services for mothers, and access to treatment for
HIV/AIDS, malaria and tuberculosis.
New and innovative initiatives are urgently needed to increase the numbers of trained health
workers. This requires scaling up investment in education, skill mix and remuneration of the
workforce as laid out in the Kampala Declaration and Agenda for Global Action, endorsed in
March 2008 at the First Global Forum on Human Resources for Health.
In March 2007, the Director General of the World Health Organization, Dr Margaret Chan,
launched the Task Force for Scaling Up Education and Training for Health Workers, under
the auspices of the Global Health Workforce Alliance (GHWA), to look at these critical issues
and report back with solid recommendations and guiding principles for action.
Its report – Scaling Up, Saving Lives – calls for a rapid and significant scaling up of
the education and training of health workers as part of a broader effort to strengthen
health systems. It highlights the importance of training to meet a country’s own health
needs and the great opportunity represented by the increased use of community- and
mid-level workers.
The Task Force’s analysis also demonstrates that this scaling up is affordable. Countries such
as Brazil and Ethiopia are already implementing the model and reaping improvements in the
health status of their populations.
The evidence is there. We must learn from the examples of best practice we are seeing in
the world. Sustained political commitment and investment to train more health workers and
reduce the global shortage is critical to turning the recommendations laid out in Scaling Up,
Saving Lives into reality.
This is a global problem needing global solutions. GHWA thanks the Task Force for its
leadership, dedication and commitment in the research and production of this report. Its
recommendations are an important and exciting development for the health workforce
community. GHWA urges all those involved in resolving the health workforce crisis to
learn from and implement the recommendations from the report, to bring us closer to our
vision that every person, in every village, everywhere has access to a skilled, motivated and
supported health worker.
Let us all unite to uphold GHWA’s call for ‘all for health workers and health workers for all’.
Dr Lincoln Chen Dr Sigrun Møgedal
Founding Chair Chair
Global Health Workforce Alliance Global Health Workforce Alliance
Foreword v
P reface
The desperate shortage of health workers in the world means that millions of people die
or are disabled unnecessarily. A large part of the problem is simply that not enough health
workers are being educated and trained.
We were asked by the Global Health Workforce Alliance to bring together an international
group of people to review the experience of countries and research from around the world,
and draw up practical proposals for how to scale up massively the education and training of
health workers.
Scaling Up, Saving Lives is the result.
The good news is that there is now plenty of evidence and many examples of what can be
done – practically and effectively.
So why – as we have heard political leaders ask – are we not seeing the same improvements
everywhere?
We could, and the proposals set out in this report will lead to results, but only if we work
together with determination and sustained commitment. More needs to be done to turn
existing knowledge into action at national and international level. The global political climate
provides a moment of opportunity which should not be missed.
Everyone has a part to play in dealing with the global health workforce crisis – governments,
education leaders, international development partners and donors, local partners, and the
public and private sector. Political leadership, backed by predictable and long-term financing
to support well-constructed national scale-up plans, is critical.
Scaling Up, Saving Lives has benefited from the experience and wisdom of many people
from around the world. We would like to thank the members of the Task Force, the many
people we consulted, and particularly Imogen Sharp – the Task Force Director – who led the
work and the production of this report, Peter Walker who developed the work on education
and training, Manuel Dayrit and his team at the World Health Organization, and the many
colleagues at the World Bank who provided their support so willingly.
Now is the time to act!
Lord Nigel Crisp Commissioner Bience Gawanas
Co-Chairs, Task Force for Scaling Up Education and Training for Health Workers,
Global Health Workforce Alliance
Preface vii
A cknowledgements
Co-Chairs
Lord Nigel Crisp, House of Lords, United Kingdom, and Commissioner Bience Gawanas, African
Union Commissioner for Social Affairs
Task Force members
• The Honourable Stephen Mallinga (Minister of Health, Uganda)
• The Honourable Marjorie Ngaunje (former Minister of Health, Malawi)
• Professor Miriam Were (African Medical & Research Foundation)
• Peter Loescher and subsequently Dr Stefan Oschmann, with Dr Jeff Sturchio (Merck & Co)
• Professor Srinath Reddy (Public Health Foundation of India)
• Dr Cristian Baeza and subsequently Dr Julian Schweitzer, with Dr Alex Preker (World Bank)
• Judith Oulton (International Council of Nurses)
• Dr Anders Nordström (formerly World Health Organization)
• Kathy Cahill (Bill & Melinda Gates Foundation)
• Dr Francisco Campos (Ministry of Health, Brazil)
• Sarita Bhatla and subsequently Louise Holt (Canadian International Development Agency)
• Ann Keeling and subsequently Dr Ernest Massiah, with Peggy Vidot
(Commonwealth Secretariat)
• Dr Michèle Barzach (Adviser on Health Strategy, France), with Dr Gustavo Gonzalez-Canali
(Ministry of Foreign Affairs, France)
• Dr Francis Omaswa, Executive Director, Global Health Workforce Alliance (ex-offi cio)
Task Force Secretariat
Imogen Sharp (Task Force Director)
Dr Amy Gardiner (Task Force Officer)
Dr Peter Walker (Technical Working Group Coordinator, University of Ottawa)
Emily Sangster (Research Assistant, Technical Working Group)
Dr Manuel Dayrit (Director, Department of Human Resources for Health (HRH),
World Health Organization (WHO))
Dr Hugo Mercer (WHO Department of HRH)
Dr Carmen Dolea (WHO Department of HRH)
Rebecca Bailey (WHO Department of HRH)
Sarah Brick and Patrick Ney (Administrators)
The report was produced under the overall direction of Imogen Sharp, with background
research and specific chapters produced by the teams in Ottawa, Geneva and London as well
as at the World Bank.
The Task Force is also grateful to the many other people who contributed to the development
of Scaling Up, Saving Lives, and provided valuable inputs including policy advice and technical
support, who are acknowledged on pages 111 and 112.
viii Scaling Up, Saving Lives
C ontents
Executive summary and recommendations 1
C hapter 1 Scaling up: A vision for the future 5
C hapter 2 Meeting the challenges 13
C hapter 3 Country-led action towards a national road map 19
C hapter 4 W hat types of health worker should be scaled up? 37
C hapter 5 H ow to build strong education and training systems 45
C hapter 6 What international action is needed to implement change? 65
C hapter 7 T he cost of producing and employing health workers 73
C hapter 8 Measuring success 83
References 91
Case study summaries 101
Acknowledgements 1
Terms of reference for the Task Force 113
Contents ix
x Scaling Up, Saving Lives
