Building a Fit-for-Purpose Health Workforce for Africa
Summary
Amref and Seed Global Health committed to helping African countries establish strategic roadmaps for ministries, stakeholders, and other partners to construct a robust fit-for-purpose health workforce. As part of the initiative, they will provide strategic support in identifying shared targets for investments, and programming and policy priorities required for complete investments in the continent’s health workforce and towards the African Union Agenda 2063 and the Africa CDC’s New Public Heath Order.
Approach
Leveraging the Africa CDC platform, Amref and Seed Global Health commit to helping country governments establish strategic roadmaps for ministries, stakeholders, and other partners to construct a robust fit-for-purpose health workforce for Africa. Additionally, we will help determine shared targets for investments, programming and policy required for complete investments in the continent’s health workforce and towards of the African Union Agenda 2063 and the Africa CDC’s New Public Heath Order.
Amref and Seed Global Health will work with member states to support high quality instruction and training across a range of health care professionals from fully-licensed physicians to nurses to community health workers to field epidemiologists at successive levels of their education (e.g. student, apprenctice, in-practice) with a focus on gender equity and empowerment of women.
Specifically, Amref and Seed Global Health commit to supporting country partners in the following areas:
Assisting the MoH of Zambia to scale up recruitment of new health workers, strengthen human resources management to support and retain HRH, and operationalizing a new national digital health strategy.
Assisting the MoH of Sierra Leone to scale up a dynamic nursing and midwifery workforce capable of delivering quality, safe, evidence-based and comprehensive services to improve maternal and child health care.
Assisting the MoH of Uganda to ensuring dedicated human resources for emergency care through training, capacity-building and review of the HRH structure of health facilities and prehospital levels in the country.
Assisting the MoH of Malawi to increase financial resources to secure availability, retention, performance, and motivation of human resources for effective, efficient, and equitable health service delivery.
Amref, Seed Global Health, and their partners have expertise in process facilitation of cross-sectoral stakeholder dialogues that co-create country-led, and country owned initiatives in the health professional education sector. These capabilities will enable the partnership to overcome possible challenges associated with working in diverse geographies across sub-Saharan Africa and building consensus among numerous vested stakeholders across public and private sectors.
Action Plan
The duration of Amref’s and Seed’s commitment will be five years. It is anticipated that other partners will have different engagement durations depending on scope and based on accomplishment of country-defined, specific HRH goals. Each partnering country will have defined a specific HRH gap/need that it seeks to prioritize and systematically address through this commitment. The success of this commitment will require a comprehensive, collaborative assessment of needs which will drive implementation, targets and subsequent metrics. Therefore, the following general action plan and timeline for each country is anticipated:
Year One: Supporting specific country-led HRH assessments and convening all relevant stakeholders necessary to define the full scope of the activities and set evidence-based and locally driven targets. Programs already planned will begin or continue with implementation.
Year Two: Develop a consensus-driven strategic roadmap for each country with specific actions and deliverables, socialize same within country with all relevant stakeholders and finalize the full multisector coalition to produce deliverables and results in years three through five. Programs already in planning will begin implementation and/or continue.
Years Three to Five: Step-wise implementation of the strategic roadmaps with comprehensive measures/metrics agreed upon and regularly monitored and evaluated to ensure targets are met or necessary adaptions made – both within and across countries. We will work with country ministries to best define and disseminate realistic and contextually sensitive metrics and key performance indicators for the health workforce to ensure progress, accountability and transparency.
Background
There is indisputable urgency to train and maintain a robust, well-motivated, equitably distributed, protected and empowered health workforce in Africa which is fit-for-purpose for Universal Health Coverage (UHC) , COVID-19 recovery and future emergency preparedness. The African continent bears just under 25% of the world’s health burden with only roughly 3% of the global health workforce. Therefore, sizable investments in human resources for health (HRH) are needed to protect essential services and meet the growing health needs from globalization and climate change. The health workers needed to deliver basic essential services worldwide will reach 80 million by 2030. To achieve UHC, the number of health workers needed is even higher; as of 2019, the estimated number needed was already 147 million with a shortfall of over 43 million, disproportionately in low-income countries. This demand has further been exacerbated by COVID-19 related deaths among health workers, estimated to be 115,000 as of May 2021.
In 2022, the World Health Assembly adopted a resolution which called on member states to implement the World Health Organization’s (WHO) Working for Health 2022-2030 Action Plan, and enhance national, regional and global efforts to invest in, protect and strengthen the health workforce. Regional institutions formalized new structures for responding to health workforce needs, like the African Union/Africa CDC’s Health Workforce Task Team. Donors launched global efforts like the US Government’s Health Workforce Initiative. Existing multilateral structures like the Global Financing Facility have sharpened their focus on aligning stakeholder efforts to strengthen HRH.
Today, African countries with critical HRH shortages are primed and motivated to make tangible progress in building up a fit-for-purpose health workforce. They need committed and conscientious partners who can comprehensively support broad-based, country-led initiatives that elevate and prioritize locally pressing needs.
Progress Update
Achievements this year included:
Amref Health Africa partnered with Malawi’s Ministry of Health (MOH) to launch a new year-long program to train and certify Health Surveillance Assistants (HSAs) nationwide. In total, 497 community-based HSAs completed coursework in essential family health, disease management, and nutrition, then provided integrated health services to 480,000 people through their practicums. Inspired by the first cohort’s success, donors have already committed to supporting the next cohorts – including 1,500 more HSAs who will complete training this year.
Amref launched two new programs in Uganda to train health workers to deliver quality primary healthcare, with a focus on immunization. Amref also completed a project to build the capacity of 2,426 Community Health Workers to increase vaccination coverage. As a result, 3 of 5 project districts achieved the highest performance level in the Expanded Program on Immunization classifications. A CHW that Amref trained was named Uganda’s CHW of the Year by the MOH.
Seed Global Health trained over 10,519 physicians, nurses, and midwives in 2024, partnering with health facilities that serve more than 76M people with quality health care. In that time, Seed trainees supported nearly 80,000 births across Malawi, Sierra Leone, Uganda, and Zambia, most of those in high volume referral hospitals that receive the most challenging medical and emergency cases regionally.
In Makeni, Sierra Leone – which is the largest city in the northern region of the country and a hotspot for maternal mortality – Seed is the sole nonprofit partner in the maternity unit of the Makeni Regional Hospital, where they are working to increase the quality and quantity of midwives providing care to drastically decrease the number of maternal deaths. Between January and December 2024, there was a ~66% drop in maternal deaths since 2021, just before Seed began their partnership.
Partnership Opportunities
The existing partners will specifically seek more financial resources for in-country activities and plan to use this Commitment to help galvanize more support. Amref and Seed Global Health would also welcome: media support to bring more focus to the necessity of investing in HRH; expertise and systems to capture data, measure progress and help build the case for investment from different sectors; more implementing partners; high level integration and alignment from international multilaterals, governments, coalitions and foundations.,The partners plan to spend the first year of the Commitment adding new partners to support the countries’ priorities and objectives. This approach would offer new partners the chance to pool individual efforts in response to countries’ needs, ensuring that our collective work is both driven by government priorities and coordinated to achieve maximum results. The types of partners might include:
Additional countries (Ministry of Health) that wish to sign on to the Commitment
Additional ministries or other government entities in the existing countries
Multi-lateral institutions
Donors (foundations, corporations, etc.) to support activities
NGO partners with relevant expertise
A monitoring, evaluation, adaption and learning (MEAL) partner
As Amref and Seed Global Health help grow momentum for their commitment, they will seek to draw funding, in-kind commitments, holistic planning and implementation that can help support and attract new partners. There is significant potential for new partners to join this commitment.
Additional countries (Ministry of Health) that wish to sign on to the Commitment
Additional ministries or other government entities in the existing countries
Multi-lateral institutions
Donors (foundations, corporations, etc.) to support activities
NGO partners with relevant expertise
A monitoring, evaluation, adaption and learning (MEAL) partner
As we help grow momentum for our commitment, we will seek to draw funding, in-kind commitments, holistic planning and implementation that can help support and attract new partners. There is significant potential for new partners to join this commitment.