Human Resources for Health

Leadership (f)or participation?
Development policies
on Human Resources for Health
from Alma Ata until today
by Maren Bredehorst, MPH
International Conference “global – gerecht – gesund“
Forum V, Workshop “Health workers: Ethical Aspects and
Berlin, 17-16 September, 2010
Historical perspective
on development policies in health
and their implications for
Human Resources for Health (HRH)
Example: Republic of Malawi
Focus on the concepts of leadership,
professionalism and community participation
contradictions of underlying principles?
challenges and options for health professionals / experts?
‘Human Resources for Health’ policies in Malawi
(1964-1993, Banda-era)
• post-independence: manpower and facilities
• under-five clinics 1973-75
• Primary Health Care 1978
(pilot: paid PHC workers; then turn to
volunteers / Health Surveillance Assistants)
• Increased sensitivity for workforce profile (skills)
and management in 1986-95 National Health Plan
• College of Medicine 1991, emphasis on community health
‘Human Resources for Health’ policies in Malawi
(1994-present, multi-party system)
• HIV/AIDS: increasing workload
and health worker attrition
• attempts at strategic HR planning
• Academic training: Bachelor and
Master programmes
– but no formal career paths
• Health Sector-Wide Approach with
Human Resources Emergency Plan
• Global Fund applications
(incl. Health Systems Strenthening)
Volunteering and professionalism
Alma Ata Declaration incorporates both:
a) spirit of self-reliance and
self-determination; participation;
community health workers
b) train existing health cadres
for PHC implementation;
develop a scientific base
• Malawi’s Health Surveillance Assistants: ambivalent role,
core cadre for service delivery in communities
• Professional view: Who regulates and supervises increasing
numbers of volunteers and auxiliaries? (Dräger et al. 2006)
Leadership concepts in health
• shift from ‘social dimension of PHC’ (Flahault 1986)
towards capacity development / governance / stewardship
• ‘good practice’ principles for leaders:
Health outcomes, Evidence-based, Aligned, Long-term,
Transformational, Harmonized (WHO 2007)
• leaders as ‘brokers’ for PHC
and moderators of political processes;
participation as ‘transparent processes’,
‘empowerment of health professionals’
(WHO 2008)
WHR 2008: Primary Health
Care – now more than ever
Challenges and options
for health professionals / experts
Approach to health: needs vs. rights
- from professionally-led to user-led initiatives?
- empowerment?
Professionalisation: organizational vs. occupational
- third logic besides market and bureaucracy
- collective action under the global aid regime?
Rappaport (1981)
Evetts (2006)
Escobar (1995)
Knowledge systems: standardisation vs. openness
- information needs of development institutions
- social research for alternative knowledge / value
Leadership and community participation (and their link)
have often been neglected in HRH policies
Participation should be established as a value / principle
in the process of professionalisation
in Public Health
Reflective practice is required
Political nature of health has to
be recognised by all stakeholders,
at all levels
- Thank you for your kind attention! -
References :
Dräger S, Gedik G, Dal Poz MR (2006) Health workforce issues and the Global Fund to
fight AIDS, Tuberculosis and Malaria. Human Resources for Health 4:23
Escobar A (1995) Encountering Development. The making and Unmaking of the Third
World. Princeton University Press
Evetts J (2006) Short Note: The Sociology of Professional Groups : New Directions.
Current Sociology 54: 133
Flahault D, Roemer MI (1984) Leadership for Primary Health Care. Levels, functions and
requirements based on twelve case studies. WHO, Geneva
Rappaport J (1981) In Praise of Paradox. A Social Policy of Empowerment over
Prevention. American Journal of Community Psychology 9 (1): 1-25
WHO (2008) World Health Report 2008: Primary Health care – now more than ever.
WHO, Geneva
WHO (2007) Towards better leadership and management in health.
WHO/HSS/healthsystems 2007.3
M. Bredehorst 2009; Map and flag of Malawi :
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