非洲衛(wèi)生人力投資憲章：實(shí)現(xiàn)可持續(xù)的衛(wèi)生人力投資以實(shí)現(xiàn)我們想要的非洲的全民健康覆蓋和衛(wèi)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

?InvestmentCharter:

Aformalcommitmenttoadheretoagreedprinciplesininvestmentandtopursueacommonpur-posethroughinvestmentactions.

?Healthworkforceinvestmentplan:

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

?SocialPartners:

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

?Healthworkforce(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).

?HealthLabourMarket(HLM):

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

?Populationhealthneeds:

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

?Alignment:

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

?Investment:

Channellingfinancialresourcesintoahealthworkforce-relatedcourseofactioninlinewithidenti-fiedprioritiesinwhichitsexpectedreturnisclearlyunderstood.

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enablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

?Stimulatinginvestment:

Committingnewfinancialresourcesorunlockingunusedfundingtowardsahealthworkforce-relat-edcourseofactionalignedwithidentifiedpriorities.

?Innovativefinancing:

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

?Sustainability:

Ensuringthathealthworkforceinvestmentdecisionsarefocusedonthelongterm,addressingmechanismsforintegrationandcontinuityandtakingfuturegenerationsintoaccount.

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v

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:

vi

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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enablingsustainablehealthworkforceinvestmentsforuniversalhealthcoverageandhealthsecurityfortheAfricawewant

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