非洲卫生人力投资宪章：实现可持续的卫生人力投资以实现我们想要的非洲的全民健康覆盖和卫生安全（英文）

2024

AfricaHealthWorkforce

InvestmentCharter

EnablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

PRIORITISE•ALIGN•INVEST•SUSTAIN

Supportedbythe

ILO-OECD-WHO

WorkingforHealth

Multi-PartnerTrustFund

2024

AfricaHealthWorkforce

InvestmentCharter

EnablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

PRIORITISE•ALIGN•INVEST•SUSTAIN

AfricaHealthWorkforceInvestmentCharter:enablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

ISBN:9789290314998

©WHOAfricanRegion,2024

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AfricaHealthWorkforceInvestmentCharter:

enablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

Contents

Glossaryiv

ProcessforDevelopmentoftheAfricaHealthWorkforceInvestmentChartervi

Abbreviationsviii

1.ContextoftheHealthWorkforceInvestmentCharter1

1.1Globalsocioeconomicdownturn:consequencesforAfrica2

1.2HealthsystemstatusandperformanceintheAfricaRegion:theroleofhealthworkers2

1.3Acceleratedinvestmentsinthehealthworkforce3

2.RationaleoftheAfricaHealthWorkforceInvestmentCharter4

3.TheGoaloftheAfricaHealthWorkforceInvestmentCharter8

4.ExpectedoutcomesoftheAfricaHealthWorkforceInvestmentCharter10

5.HealthWorkforceInvestmentPrinciples12

6.TheoryofChange14

7.Commitments16

8.CoordinationandAccountabilityMechanism22

Partnersandcollaborators24

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enablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

Glossary

ÎInvestmentCharter:

Aformalcommitmenttoadheretoagreedprinciplesininvestmentandtopursueacommonpur-posethroughinvestmentactions.

ÎHealthworkforceinvestmentplan:

Evidence-informedinvestmentprioritiesthatarecostedandappraisedagainsttheexpectedbene-fits,withthefundingsourcesforimplementationclearlyidentifiedwiththefundingpartiesmakingformalcommitmentsonthevolume,duration,andflowofthefunds.Ithasclearaccountabilitymechanismsintermsoffinancialmanagementandexpecteddeliverables.

ÎSocialPartners:

Thesocialpartnersinhealthservicesareinprinciplepublicauthoritiesasregulatorsorasemploy-ers,privateemployers’andworkers’organizationsinthehealthsectorthatcooperateinworkingrelationshipstoachieveamutuallyagreed-upongoal,typicallyforthebenefitofallinvolvedgroups.

ÎHealthworkforce(HWF):

Allpeopleengagedinactionswhoseprimaryintentistoenhancehealth.Theymaybepaidstafforvolunteersworkingfull-timeorpart-timeinthepublicandprivatesectors.Theymaybedeliveringhealthservices,managingtheservicesofferedbythesystem,oraddressingsocialdeterminantsofhealth.Thatmeansthatthehealthworkforceincludes:allpersonneltrainedinhealthoccupationsdeliveringclinicalworkinhealthfacilities(suchasmedicaldoctors,nurses,ordentists);allnon-healthprofessionalsemployedinthehealthsector,publicandprivate,regardlessoftheiroccupa-tion(suchasmanagers,ambulancedriversorteachersofhealtheducation);andallthosewhoseworksupportsthedeliveryofhealthservices,eveniftheyareemployedbyothersectorsorindus-tries(suchascleaning,catering,securityoragencystaffworkinginthehealthsector).

ÎHealthLabourMarket(HLM):

Thestructurethatallowstheservicesofhealthworkerstobesought(demanded)andoffered(supplied).Thehealthlabourmarketcanbecharacterizedaccordingtogeographicalarea(local,nationalorinternational);occupation(byoccupationtitleorcategory,specializedorunspecialized);andsector(privateorpublic,formalorinformal).Thedynamicbetweenthenumberandthekindofjobsofferedonthemarketandthenumberofhealthworkersiscentralindeterminingtheconfigu-rationofthehealthlabourmarket.

ÎPopulationhealthneeds:

Interventionsrequiredtopromote,maintain,andsecurethehealthandwell-beingofthepopulationalongtheirlifecourse.Thistypicallycoverstherangeofdiseaseburdenandriskfactors,stratifiedbythepopulation’sdemographics,takingintoaccounteffectivehealthinterventionsandprofes-sionalstandardsandcompetencefordeliveringthoseinterventions.

ÎAlignment:

Ensuringaclearpolicyandinvestmentintentthatallpartieshavediscussedandagreedto,en-suringpolicycoherence,promotingmutuallyreinforcingpolicyactionsbetweengovernment,theprivatesector,developmentpartners,andacrosshealth,labour,education,financingsectors.

ÎInvestment:

Channellingfinancialresourcesintoahealthworkforce-relatedcourseofactioninlinewithidenti-fiedprioritiesinwhichitsexpectedreturnisclearlyunderstood.

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enablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

ÎStimulatinginvestment:

Committingnewfinancialresourcesorunlockingunusedfundingtowardsahealthworkforce-relat-edcourseofactionalignedwithidentifiedpriorities.

ÎInnovativefinancing:

Arangeofnon-traditionalmechanismstoraiseadditionalfundsforhealththrough“innovative”projectstofillidentifiedfinancialgapssuchasmicro-contributions,taxes,public-privatepartner-ships,andmarket-basedfinancialtransactions,amongothers.Aninnovativefinancingmechanismcomplementsexistingfundinganddoesnotsubstitutethemorhavea“crowding-outeffect”onpre-existingbudgetarycommitments(additionalityorraisond’être);ensurestherightandbetteruseoftheadditionalfunds(effectiveness);andensuresvaluefortheuseoftheadditionalfunding(efficiency).

ÎSustainability:

Ensuringthathealthworkforceinvestmentdecisionsarefocusedonthelongterm,addressingmechanismsforintegrationandcontinuityandtakingfuturegenerationsintoaccount.

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enablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

ProcessforDevelopmentoftheAfricaHealthWorkforceInvestmentCharter

1.RegionalPolicyDialogueforBuildingConsensustoDeveloptheHealthWorkforceInvestmentCharter:

In2022,theWHORegionalOfficeforAfrica,withsupportfromtheILO-OECD-WHOWorkingforHealthProgramme,convenedaRegionalPolicydialogueonhealthworkforceinvestmentandpro-tectionfromNovember15to17,hostedbytheGovernmentofGhanainAccra.policydialoguewasattendedbytwenty-sixmemberstates1,theInternationalLabourOrganization(ILO),USAID,theGlobalFundtoFightTB,HIVandMalaria(GlobalFund),theWorldBank,AFREHealth,AfricanCen-treforHealthandSocialTransformation(ACHEST),theEastCentralandSouthernAfrican(ECSA)HealthCommission,andtheSouthernAfricanDevelopmentCommission(SADC).ThedialoguerecommendedthedevelopmentofanAfricaHealthWorkforceInvestmentCharterlayingtime-test-edprinciplestoaligneffortsandstimulateinvestmentsincountriestoaddresstherootcausesofhealthchallenges.

2.ExpertWorkingGroup(EWG)DraftingoftheCharter:

WHOAFROconvenedhealthworkforceexpertswithkeymemberstatesfromDecember19to22,2022,attheWHORegionalOfficeinBrazzaville,RepublicofCongo,todrafttheInvestmentCharter.TheExpertWorkingGroupismadeupofindependenthealthworkforceexperts,memberstates,keypartners,academicinstitutions,andWHO.

3.Consultationwithpartners:

InJanuary2023,WHOengagedpartnersbilaterallytobriefthemabouttheCharterandtogetfeed-backonthedraftcharter.SuchbilateralmeetingswereheldwiththeWorldBank,USAID,GlobalFund,andtheHarmonizationforHealthinAfrica(HHA)partners-attendedbytheJapaneseInter-nationalCorporationAgency(JICA),theGlobalFinancingFacility(GFF),UNICEF,theAfricaDevelop-mentBank(AfDB),FrontlineHealthWorkersCoalition,andtheAfricaFrontlineFirst(AFF).

4.WrittenfeedbackfromPartners:

InJanuary2023,theDraftCharterwassharedwithpartnersthroughtheWHOLiaisonOfficeinAd-disAbabafortheirreview,input,andfeedback.WrittenfeedbackwasreceivedfromCOMESA,theInternationalFederationoftheRedCross(IFRC),JICA,USAID,andtheGlobalFund.

5.ResolutionbyMinistersofHealthofECSA-HealthCommunity:

Duringthe71stConferenceofHealthMinistersheldinLesothoinFebruary2023,discussedthedraftCharterandmadearesolution(ECSA/HMC71/R2)tonoting“theongoingeffortsofWHOAFROindevelopingtheAfricanHealthWorkforceInvestmentCharter”andurgedtheMemberStatesto“supportthedevelopmentoftheWHOAFROAfricanHealthWorkforceInvestmentCharter”.

6.MemberStatesconsultation:

OnMarch282023,afterofficiallysharingthedraftcharterandrequestingtheirparticipationintheconsultationtoprovidefeedbackandinput,avirtualconsultativesessionwithMemberStateswasheld.Fifty-fiveparticipantsfrom35MemberStatesandselectedexpertsattendedandprovidedfeedbackandinput,whichwereusedtorevisethedraftcharter.

1Benin,CentralAfricanRepublic,Chad,Congo,CoteD’Ivoire,Ethiopia,Gabon,Ghana,Guinea,GuineaBissau,Kenya,Liberia,Malawi,Mali,Mozam-bique,Niger,Nigeria,Rwanda,Senegal,SierraLeone,SouthAfrica,Tanzania,Togo,Uganda,Zambia,andZimbabwe

AfricaHealthWorkforceInvestmentCharter:

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enablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

ECSAMinistersofHealth

Resolution

ExpertWorking

Groupdrafting

session

AfricaHealth

Workforce

Investment

Forum

&

Charter

Launch

Windhoek

Namibia

May2024

February2023

December2022

stakeholder

and

&

DraftCharter

openedfor

Public

Feedback

FINALAfrica

HealthWorkforce

Investment

Charter

Regional

Policy

Dialogue,

AccraGhana

7.GlobaldiscussionandsupportfortheCharter:

Duringthe5thGlobalForumonHumanResourcesforHealth,heldfrom3rdto5thApril2023inGe-neva,theprinciplesoftheCharterwerethebasisofaroundtableonhealthworkforceinvestment.Thisroundtablewasattendedbyabout40globalhealthleadersandMinisters.ThegloballeadersreflectedontheCharter’sprinciplesandaffirmedsupport,notingthatitwastimelyandneeded.

8.WHOAfricanRegionopenedtheCharterforPublicFeedback:

TheCharterwaspublishedandopenedforpublicfeedbackforsixmonths.Twenty-five(25)entrieswerereceivedfromorganizationsandindividuals,whichwerereviewed,synthesized,andincorpo[1]ratedbytheExpertWorkingGroupbeforetheCharterwasfinalized.

9.GlobaldiscussionandsupportfortheCharter:

TheExpertWorkingGroupwasexpandedandre-convenedinApril2024tofinalizethetextoftheCharter.

AFRICAHEALTHWORKFORCEINVESTMENTCHARTERProcess

Member

States

consultation

March2024

Keypartnerenga

gement

consultati

on

5thGlobalForumonHuman

ResourcesforHealth

November2022April2023May2023April2024

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Abbreviations

COVID-19

CoronavirusDisease2019

GDP

GrossDomesticProduct

HLM

HealthLabourMarket

HRH

HumanResourceforHealth

HWF

Healthworkforce

HWIC

HealthWorkforceInvestmentCharter

IHR

Internationalhealthregulations

IMF

InternationalMonetaryFund

SADC

SouthernAfricanDevelopmentCommunity

SDG

SustainableDevelopmentGoals

UEMOA

UnionEconomiqueetMonétaireOuestAfricaine

UHC

UniversalHealthCoverage

WHO

WorldHealthOrganization

AfricaHealthWorkforceInvestmentCharter:

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enablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

1.

Contextofthe

HealthWorkforce

InvestmentCharter

1.ContextoftheHealthWorkforceInvestmentCharter

Smartandsustainedinvestmentsinthehealthworkforcearecrucialforimprovinghealth,economicandsocialoutcomes.TheAfricaHealthWorkforceInvestmentChartermaterializesthejointcommit-mentofinvestmentpartners–includinggovernments,keystakeholders,anddevelopmentandfinanc-ingpartners–toaligntheirprioritieswithpopulationhealthneeds.Together,investmentpartnerscansecureanddeliverstrategicinvestmentsinthehealthworkforceandachievelastingimpact.

1.1Globalsocioeconomicdownturn:consequencesforAfrica

AccordingtotheInternationalMonetaryFund(IMF)2andtheWorldBank3,globaleconomicactivityisexperiencingabroad-basedandsharper-than-expectedslowdown,withthehighestinflationratesinseveraldecades.Publicdebtsustainabilityhasbecomeaconcern;thecostoflivinghasriseninmanyAfricancountries,thusincreasingtheriskofmanypeoplefallingintopovertywithconstrainedaccesstohealthservices,especiallywhereadequatefinancialriskprotectionisnotavailable.Thishasaffectedtheavailabilityofsocialprotectionmeasuresforthehealthworkforce.

TheIMFhasprojectedgradualeconomicrecoveryinsub-SaharanAfricaasfrom2023,butitmaytakeseveralyearstoreachitspre-pandemicprospects.4Africancountriesmaynothavetheneededbudget-aryspacetoinvestmoreinthehealthsector,especiallyinthehealthworkforce,giventheadoptionoftighterfiscalpolicies/strategiesbygovernments,increasinginflationandassociateddifficultiesinget-tingfundingfromtheinternationalmarkets.ArmedconflictandotherhumanitariancriseshavefurthercomplicatedtheeconomicprospectsoftheRegion.

Nonetheless,theCOVID-19pandemicandprevioushealthemergencieshavedemonstratedthathealthworkersprimarilysavelivesandrestoreopportunitiesforeconomicactivitiesandtorevivebusinesses.Thus,thesechallengesareaclarioncallforsolidarity,alignment,andsynergisticeffortstoinnovativelyinvestincost-effectiveprioritiestobuildbackbetterhealthsystemsandeconomies

1.2HealthsystemstatusandperformanceintheAfricaRegion:theroleofhealthworkers

TheAfricanRegionhasrecordedincreasedservicecoverageoverthedecadesbutataslow-er-than-neededpace.TheSustainableDevelopmentGoal(SDG)indicator3.8.1onservicecoverage,asmeasuredbytheuniversalhealthcoverage(UHC)servicecoverageindex,increasedintheAfricanRegionfrom24%to44%from2000to2017,andfrom44%to46%from2017to2019.5However,therearedisparitiesbetweencountries,rangingfrom28%inChadand75%inAlgeria,andtheoveralltrendisnotfastenoughtoreachtheUHCtargetof80%by2030.Also,among40countriesintheAfricanRegionthathadcompletedindependentjointexternalevaluations,nonewasfoundtohavetherequiredcapac-itiestofullyimplementtheInternationalHealthRegulations(IHR(2005))toaddresshealthsecurity6.

2InternationalMonetaryFund,‘WorldEconomicOutlook:CounteringtheCost-of-LivingCrisis.’,InternationalMonetaryFund(IMF),October2022.

(

/downloadpdf/books/081/460116-9781513577524-en/460116-9781513577524-en-book.pdf

.)

3WorldBank,‘WorldDevelopmentReport2022:FinanceforanEquitableRecovery’TheWorldBank,2022.

4InternationalMonetaryFund,‘WorldEconomicOutlook:CounteringtheCost-of-LivingCrisis.’

5WorldHealthOrganizationandWorldBank,‘TrackingUniversalHealthCoverage:2021GlobalMonitoringReport’Washington,DC:WorldBank,13December2021.(

/handle/10986/36724

).

6AmbroseTalisunaetal.,‘JointExternalEvaluationoftheInternationalHealthRegulation(2005)Capacities:CurrentStatusandLessonsLearntintheWHOAfricanRegion’,BMJGlobalHealth4,no.6(1November2019):e001312,(

/10.1136/bmjgh-2018-001312

).

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Lifeexpectancyincreasedfrom51yearsin2000to64yearsin2019.Healthylifeexpectancy,whichshowsthenumberofyearsoneisexpectedtoliveingoodhealth,increasedfrom45yearsin2000to55yearsin2019.7Neonatalmortalitydeclinedfrom40.90per1000livebirthsin2000to26.68per1000livebirthsin2020,andunder-fivemortalitydeclinedfrom154per1000livebirthsin2000to71.86per1000livebirthsin2020.8Nonetheless,theRegionstillfacesmultiplehealththreats,includingchangingpatternsofcommunicablediseases,agrowingburdenofnoncommunicablediseases,adisproportion-ateshareofglobalhealthemergenciesandarisingburdenofinjuries.Thehealthworkforceshortfallputsaseverestrainonthesystem.

BeforetheCOVID-19pandemic,Africawasnotontracktoachievethehealth-relatedSDGtargets,andthepandemicsettheRegionevenfurtherback.9However,theCOVID-19pandemicilluminatedthees-sentialroleandimpactoftheworkforceindeliveringessentialpublichealthfunctions;theseconsider-ationshadlargelybeenoverlookedortakenforgranted,andledtodisparitieswithinandacrosscoun-tries,aswellasfragmentedapproachestopublichealthworkforcedevelopmentintermsofpolicies,planning,implementationandmonitoring.HealthworkforcechallengeshavebeenacriticalbarriertomaintainingessentialhealthservicesanddeliveringCOVID-19responseactivities.Increasingandopti-mizinginvestmentinthehealthworkforceisthereforerequiredtoimprovehealthsecurityandachievetheUHCtarget.

1.3Acceleratedinvestmentsinthehealthworkforce

ThechallengesposedbyCOVID-19generatedaddedimpetusandnewopportunitiestoinvestinthehealthworkforce,andtriggeredatrendofinvestmentinterestfollowingdecadesofchronicunderin-vestment.Governmentshavelaunchednewinitiativestodevelop,employandretainhealthworkers.Majordevelopmentpartnershaveannouncedlargehealthworkforceinvestmentinitiatives,andinter-nationalfinancialinstitutionshaveexpandedtheirhealthandinfrastructureinvestments,whichwillimpactthehealthworkforce.Toensurethatalltheseinvestmentsrespondtopopulationhealthneeds,thereisneedforbetteralignmentwithconcreteprioritiesandstimulationofadditionalinvestments.

7WorldHealthOrganizationRegionalOfficeforWHO/AFRO,‘PeopleAreLivingLonger,butAreTheyLivingHealthier?AnalyticalFactsheet’(DataAnalyicsandKnowledgeManagement(DAK),2022),(

/ind/af?ind=2&dim=62&dom=Life%20Expectancy&c

-c=af&ci=1&cn=Afro%20Region).

8WorldHealthOrganizationRegionalOfficeforWHO/AFRO,‘IntegratedAfricanHealthObservatory(iAHO)-DatabaseofIndicators’,accessed13January2023,

/ind/

.

9WHO,‘TrackingUniversalHealthCoverage:2023GlobalMonitoringReport’Geneva,Switzerland:WorldHealthOrganization,2023(https://www./publications-detail-redirect/9789240080379).

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2.

RationaleoftheAfricaHealthWorkforce

InvestmentCharter

2.RationaleoftheAfricaHealthWorkforceInvestmentCharter

Thehealthworkforcehasbeenandremainsevenmorecriticalinhealthandsocioeconomicdevelop-ment.Theattainmentofthehealth-relatedSDGsandguaranteeinghealthsecurityareintricatelylinkedtoequitableaccesstohealthworkerswithinresilienthealthsystemsthatarebuilttoprevent,predict,timeouslydetect,andpromptlyandeffectivelyrespondtoallpublichealthemergencieswhilemain-tainingtheoptimalprovisionofroutinehealthservices.Inrecognitionofthisreality,morethan50%oftheinvestmentsrequiredtoachieveSDG3areestimatedtobespentonhealthworkforceemployment(wagesandsalaries)10andcouldreach80%iftheinvestmentneededfortheirtrainingisconsidered.Additionally,itisestimatedthataddressingfuturepandemicsrequiresadditionalspendingofatleastUS$5percapitaperyear,11ofwhich66%mustbespentonworkforcecapacitiesforprevention,detec-tionandresponse.12Fromthehealthworkforceperspective,itisimperativeforUHCandhealthsecuritytobepursuedasajointinvestmentobjective.

Overtheyears,healthworkforceinvestmenthasmadeadifference,butremainswoefullyinadequatetoclosethegaps.Pastinvestmentinthehealthworkforcecontributedtoimprovedhealthworkforcestockbyonemillionworkersbetween2013and2020,culminatingina32%increaseafteradjustingforpopulationgrowth.13,14However,despitetheseadditionalhealthworkersbeingneededonthefrontlinesofservicedelivery,oneineverythreegraduatesrisksfailingtogetdecentemploymentaftergraduatingduetoinadequateinvestmentsintherecruitmentoftrainedhealthworkers.Despitetheprogressinhealthworkforcedensity,morethan70%ofAfricancountriesstillfacecriticalshortages–withneeds-basedestimatesshowingthattheAfricanRegionwillneedbetween5.3and6.1millionadditionalhealthworkersby2030.15,16Country-levelandgeographicalmaldistribution,deficitsinworkingconditions,andmigrationofhealthworkersremainlongstandingchallengesglobally,buttheyarehigherinAfricancountriescomparedtotherestoftheworld.17Withincountries,primaryhealthcarefacilities,especiallyinruralareas,areunderstaffedandunderresourced,andunlessinvestmentisexpandedtorecruitandretainhealthworkersintheseareas,merelytrainingmorewillnotimprovethesituationbecausethetrainedhealthworkerswillsimplyleavetoworkelsewhere.18Forevery10doctorsornursesworkinginAfrica,atleastoneotherisworkinginanothercountry.19Retaininghealthworkersinnationalhealthsystemsischallengingduetodecentworkdeficits,lowsa