Webinar Title: The Global Health Workforce (HWF) Crisis; moving from conflict to collaboration

Health workforce must be prioritised as a global public health good in order to achieve Universal Health Coverage(UHC), global health experts have said.

While speaking at the webinar on global health workforce crisis recently, the experts urged countries to implement and comply with the WHO Global Code of Practice and in general abstain from recruiting health professionals from countries that are currently facing critical shortages. This would ensure sharing a global pool of skilled and portable health workers through a global accreditation system, and thus social justice equity and health systems strengthening.
Adopted in 2010, the Code aims to establish and promote voluntary principles and practices for the ethical international recruitment of health personnel and to facilitate the strengthening of health systems.

The webinar was hosted by the African Center for Global Health and Social Transformation (ACHEST) in partnership with the African Forum for Research and Education in Health (Afrehealth), under the theme: “Global Health Workforce Crisis: Moving from Conflict to Collaboration.”
It comes on the heels of a compelling blog by Prof Francis Omaswa, in which he raised alarm on the clandestine movements of health workers inspired by the rich and powerful countries. The blog COVID - 19 EXPOSES A GLOBAL SCRAMBLE FOR HEALTH WORKERS shows that countries are recruiting health workers without regard to maldistribution, shortages, ethics and the WHO Code.

To many young medical graduates, joining the job market can be daunting. They are not familiar with how the health sector operates and what is expected of them; what the government policies and health worker entitlements and benefits are among others.
Without proper guidance, one is at risk of being stressed and burnt out, which could lead to mental health problems and poor patient care.
Against this background, the African Center for Global Health and Social Transformation (ACHEST) in conjunction with the Ministry of Health and Makerere University College of Health Sciences,Health-Professional Education Partnership Initiative (HEPI) recently held an induction course for over 100 newly qualified newly qualified doctors, nurses and pharmacists in Uganda.
The March 2020 induction course was the first part of the two sessions planned this year. Another session will be announced in due course.
The objective of the course is to enable the young doctors to be conversant with the Ugandan health system and the Ministry of Health Vision and Mission; to understand the basics of government procedures and rules and quality assurance in the health care system. Other objectives are to ensure that medical interns are prepared to work in the Ugandan health system and understand the referral system, job market, career progression and postgraduate training; and how to take good care of themselves.
Internship is the transition period between being a student and a fully-fledged professional.

The Executive Director of the African Center for Global Health and Social Transformation (ACHEST), Prof. Francis Omaswa has been named on the 15-member committee appointed by President Yoweri Museveni to oversee Uganda’s National Response Fund for COVID-19.
The committee, is tasked with mobilizing, managing and ensuring transparency of the money and other donations towards the fight against the pandemic in Uganda.
Eng. Emmanuel Katongole, the Chairman Board of Directors, Uganda National Oil Company, was appointed to head the committee while General Duties Minister in the Office of the Prime Minsiter Mary Karooro Okurut was tasked with the political oversight role.
Other members are Robert Kabushenga, Managing Director of Vision Group, Apollo Makubuya a city lawyer, Kishor Jonanputra the chairman Picfare Group, Patrick Mweheire, the Regional Chief Executive Officer of Standard Group and Gustavas Bwoch, the Centenary Bank Board Chair.
Also on the committee are: Bishop Joshua Lwere from the National Alliance of Pentecostal and Evangelical Churches; Aga Sekalala, the Managing Director Ugachick; Dr. Ian Clarke, Chairman Uganda Healthcare Federation; Keith Muhakanizi, Permanent Secretary to the Treasury; Dr. Diana Atwine, Permanent Secretary to the Ministry of Health and Dorothy Kisaka, the Deputy Head of Delivery Unit
While unveiling the team, Uganda’s Prime Minister, Rt. Hon. Dr. Ruhakana Rugunda, said: “This is a team of eminent people who will be looking after these resources.”
“The target is building the health sector and empowering the frontline workers in the health sector,” Dr Rugunda stressed.
Speaking about the appointment, Prof. Omaswa said: “I applaud the government of Uganda for engaging prominent members of the Private Sector in Uganda in the control of COVID-19. It is a good example to other countries. I will provide technical support to the Task force and reach out to partners.
As of April 8, 2020 the number of confirmed COVID-19 cases in Uganda were at 53. In a bid to stop the spread of the infection, the country is currently under lockdown with several businesses closed and movement of Ugandans restricted. President Museveni also announced a 14-day curfew that began on April 1, where Ugandans were ordered to stay in their homes from 7:00pm to 6:30am.
As all this is being observed, the Ministry of Health is carrying out surveillance for 18,860 people who travelled to Uganda through Entebbe Airport between March 7 -22 , 2020
Compiled by Carol Natukunda, Communications Specialist, ACHEST

The African Center for Global Health and Social Transformation (ACHEST) is one of the 200 organizations around the world that are featured in this year’s Global Health 50/50 report.
The report titled “Power, Privilege and Priorities’ reviews gender-related policies and practices of organisations that aim to promote health and/or influence global health policy.
Now in its third year, the report publishes a Gender and Health Index across four dimensions:
1) Commitments to equity
(2) Presence of workplace gender equality and diversity policies
(3) Gender and geography of global health leadership, and
(4) Whether gender is addressed in health policies and programmes.

The Index shows that ACHEST commits to gender equality, with gender referring to men and women or gender mainstreaming in policy and planning; has gender equality affirmative policy with specific measure(s) to improve gender equality and/or support women's careers.
 The index also shows that ACHEST commits to non-discrimination in line with national laws; and highlights gender parity in the organization’s senior management.

The Health Systems Advocacy Partnership (HSAP) has been running for five years with an aim of contributing health systems so that people in sub-Saharan Africa gain better access to sexual and reproductive health services. The Partnership focuses on strengthening human resources for health and access to essential sexual and reproductive health commodities, while advocating for good governance and equitable health financing.
The project is being implemented by the African Center for Global Health and Social Transformation (ACHEST), AMREF and HEPS- Uganda as key partners in the Ugandan context.
Below, are some of experiences from the HSAP project.

SHRH COMMODITIES –
Call her a woman on a mission. Jennifer Atim, a midwife frantically paces up and down the maternity ward at Amach HC IV in Lira District with a purpose: To make sure that every mother who reports for antenatal care or even childbirth is checked for preeclampsia and other pregnancy related complications.
Better known as a silent contributor to maternal deaths, Preeclampsia is a life-threatening condition among pregnant women.
Thanks to HSAP, Atim is one of the health workers Lira who is well equipped with information on detecting preeclampsia before it is too late to claim a life or lives.

The African Center for Global Health and Social Transformation(ACHEST) successfully hosted the Annual Reflection meeting of the Health Systems and Advocacy partnership(HSAP) in Kampala from March 11-13th 2020.
Now its fifth and final year, HSAP has been focusing on four building blocks for strong health systems namely; strengthening human resources for health and access to essential sexual and reproductive health commodities, while also advocating for good governance and equitable financing.Annual Reflection Meeting In Kampala
In the Ugandan context, the project has been implemented by ACHEST in partnership with AMREF and HEPS-Uganda.
During the Annual Reflection Meeting in Kampala, partners deliberated on the project outcomes, the progress made so far and impact made in as far as strengthening Uganda health system is concerned..
Some of the achievements highlighted were: strengthening capacities of stakeholders, bringing CSOs on board to push for Sexual Reproductive Health Rights, documentation and evidence-based advocacy; and strong collaboration at the national, regional and global level among others.

Remarks for Professor Francis Omaswa
Convocation of the Aga Khan University
Kampala, February 8, 2020

President Firoz Rasul,
Ambassador Amin Mawji
Members of the Board of Trustees of the Aga Khan University,
Members of Government and the Diplomatic Corps,
Faculty and staff of the University,
Distinguished guests,
And, most importantly, our graduating students:

Good morning to you all. It is a pleasure to be here with you today to celebrate the graduation of the Class of 2019.

Prof. Omaswa Francis at the graduation ceremonyI am aware of the outstanding reputation of the Aga Khan University here in Uganda, and of its hospital in Nairobi where my wife and I worked during our days in Nairobi. The establishment of a new Aga Khan University Hospital in Kampala is a most welcome development. It should help to raise the standard of care, to educate health care leaders, and to generate knowledge that is needed to address some of Uganda’s critical health challenges. I want to thank His Highness the Aga Khan for his commitment to improving quality of life in East Africa, and the very significant long-term investments that he has made in Uganda over many years.

I should tell you that my first encounter with HH the Aga Khan was also the first time that I saw an aero plane that brought him to the town of Soroti in Eastern Uganda where I was a school boy around 1956/7

My remarks today are addressed to the happy graduands as they commence their respective journeys as health professionals here in Uganda, Africa and globally. Imagine your selves 20 to 30 years from today; where will you be? What will you have achieved professionally and in your personal life? I have no doubt that you have all been thinking about this and what I will do now is to share with you thoughts based on my own 50years experience on my own professional journey. I graduated as a medical doctor in 1969 at Makerere Medical School as you have been told. Health my dear friends, is not only my area of expertise but is more than anything else my passion. Here are some suggestions for your consideration:

First, you have to take good care of your selves through personal discipline. Ordinary matters such as being clean and smart, eating well, having adequate sleep and having peace of mind cannot be taken for granted. I have also found having a spiritual life to be empowering and an anchor that keeps me on course. You have to cultivate these habits purposefully and deliberately. Keep friends and seek to work with people who will advance your career and life not those who will award you PHD; in full “pull her down”. Please join and be active memebrs of your professional associations where will meet professional colleagues who will lift you up and not pull you down.

Second, I call upon you to pursue excellence in whatever you do. Everything that you do must be done to the highest achievable standard taking into account your personal capability. This includes the big and the small things in your work and life. If you bathe a patient it must be done the best way possible. If you clean the floor, apply a dressing to a wound, teach others or lead the way, it must be to the highest possible standards. Keep in mind that what you are doing well today can be done event better tomorrow and the next day. This is known as “Continuous Quality Improvement” in Total Quality Management principles. In this way you are getting better and better all the time in your daily life both professional and social.

Third, you need to cultivate your people skills on how to get on in a complex world. When I was a school boy, I was introduced to a book titled “How to win friends and influence people”. I found this book to be useful and I still recommend young people to read and use it. In your life, you are going to meet all types of people; nice and friendly, nasty and aggressive, generous and greedy. You will have to manoeuvre your pursuit for excellence among all these characters and succeed.

What I have found helpful is to be positive and helpful to all people. If you can help someone, why not do it? I have also found it helpful to work for the common good and not my own personal good. Once it is known that you work for all people including of course yourself, you will be given more things to do on behalf of the community from which you can also benefit. That is the best route to becoming a leader.

The African Center for Global Health and Social Transformation (ACHEST) coordinated the AfricanNursing Now Board meets Health Minister Dr. Jane Ruth Aceng Nursing Now Regional Board meeting in Kampala on February 3-4, 2020
Nursing Now is global campaign that seeks to improve health globally by raising the status and profile of the nurses and midwives.
Launched in 2018, the campaign has over 528 Nursing Now groups in over 112 countries, actively working to influence policy and to empower nurses and midwives to take their place in tackling the 21ST century health challenges.
The African Regional Meeting in Kampala was attended by the Co-chairs of the Nursing Now Campaign Global Board Lord Nigel Crisp and Professor Sheila Tlou. Other Board members were Professor Annette Kennedy, President of the International Council of Nurses, Munashe Nyika from Zimbabwe who represents young Nurses and midwives on the Board and Professor Francis Omaswa who was host to the Board meeting. The meeting also attracted Nursing and Midwives’ leaders from Kenya, Malawi, Rwanda, Uganda and Zambia who gave first-hand insights into the challenges they face that often leave them feeling undervalued.
During group discussions, it was noted that the problems go beyond limited political support and health budgets to lack of personal attributes such as lack of self-confidence, communication and public speaking skills. Nursing Now Board meets the Prime Minister Rt Hon Dr. Ruhakana Rugunda
The meeting strongly urged nurses and midwives to confront the challenges and organize themselves into professional associations which would help advance their careers.
Prof. Francis Omaswa, particularly encouraged the various Ugandan nurses groups to form a federation that incorporates all the current sub-specialized associations.
He stressed that such an alliance would promote professionalism, service standards, quality of the training, mentorship and succession issues among others.
Currently, there is only a Nurses and Midwives Union in Uganda, which is basically advocates for labour rights.

In 1999, the Uganda government established staffing norms – a human resource planning tool that gives indication of the number and caliber of staff required in a given health facility.
Two decades later, the outdated norms are still being used to recruit health workers. They have not been revised to match the rapid population growth, the changing disease burden and rapidly changing global health situation. Uganda’s population has more than doubled from 21 million people in 1999 to over 40 million in 2019.

This is one of the disturbing revelations in a new report of the study titled ‘Health Workforce Financing in Uganda: Challenges and Opportunities’ that was launched on January 29,2020 by the African Center for Global Health and Social Transformation(ACHEST), conducted in partnership with Wemos, a global health advocacy CSO.
The report is part of ACHEST and Wemos’ contribution to the Health Systems Advocacy Partnership programme.
The findings show that despite efforts made by the Uganda government and its partners, the shortage of health workers still persists. Insufficientfunding and poor management of funds are the underlying factors that require to be addressed before the improvement and retention of health workers isrealized. The report also shows that the total health expenditure has been decreasing in the last decade. A large share of the health budget in Uganda is funded by development partners, yet in most cases, these funds cannot be used to pay health workers salaries.The delayed National Health Insurance Scheme process, means the household out of pocket spending on health remains high and catastrophic.
The report gives the following recommendation:
• Update the staffing norms of the health sectortaking into account the population growth, increasing disease burden of the country and internationally agreed standards. The on-going review of the Human Resources for Health Strategic Plan should prioritise the issue of updating the staffing norms.
• The training of health professionals should be adjusted to address the cadres that have highest shortages. Government should implement the WHO recommended Country Coordination and Facilitation (CCF) mechanism, that brings together the ministries of Education, Health, Local Government, Public Service, Finance and other relevant stakeholders to forecast and plan the training of health professionals according to needs. In addition, Government should ensure the timely disbursement of resources to the MoH, to facilitate fresh recruitment of trained and currently unemployed health workers to address prevailing staffing shortages.

• Government should reverse the declining per capita expenditure on health by incrementally moving towards the internationally recommended allocation of 5% of GDP to health.

• Government should expedite the passage of the National Health Insurance Scheme Bill to minimise the exposure of the population to the exorbitant cost of health care.

• The Government should undertake tax reforms to reduce leakages, tax evasion, unfair tax exemptions and capital flight. In addition, Government should expand the tax base by tapping into hard-to-reach economic activities, as well as improve efficiency of revenue administration mechanisms.

• Development partners should increase and expand support for health workforce development, including recruitment and salaries, through more flexible and dependable funding.The previously strong Sector-Wide-Approach(SWAps) in the health sector should also be revived.
Development partners should also increase the share of funds channelled through the Government and support the plan for a Joint Action Fund.

During the launch of the report, participants acknowledged that investing in health was crucial to a country’s gains.
The Ministry of Health represented by a member of the Human Resources for Health technical working group said the ongoing human resources strategic planning would address challenges in leadership management ,performance, induction, registration of health workers and professional development among others.
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Find the link to the report here********

topLower fertility rates, coupled with reduced mortality and investing in human capital development, will enable African countries to achieve the demographic dividend.
This was emphasized by Dr. David Okello, the Director of Non Communicable Diseases and Health Ageing at the African Center for Global Health and Social Transformation(ACHEST), as he participated on the panel that discussed the newly launched report: Foresight Africa: Top Priorities for the continent 2020-2030.
Published by the Brookings Institution's Africa Growth Initiative, the report, among other topics, discusses how the Sustainable Development Goals (SDGs) will shape policy priorities for African governments and their partners in the next decade. The report shows that one of the top challenges facing the continent continues to be the mismatch between demographic trends and job creation.
However, Dr. Okello told participants that there is an answer to this dilemma: an empowered population would be productive to the economy.
He gave candid observations on how the high fertility rate in Africa was a burden not just to the economy, but also to a woman’s health.
“We need to reduce our fertility urgently. The population pyramid shows that we are producing too many people. Yet, many are dying before they reach the productive age,” said Dr. Okello.
“In my village, some women are subjected to give birth to up to 10 children! No woman should be drained that far! 10 is a disservice to the woman! A lot of these children don’t grow to become economically active. Having 50 percent of the population below 15 years is an economic burden. You cannot achieve the demographic dividend,” he added.

Ensuring quality and sustainability of the health workforce is an essential element of the Sustainable Development Goals.
This is the strong message that came out of the 2019 Global Symposium on Health Workforce Accreditation and Regulation, held from December 10-12 2019, in Istanbul, Turkey.  
Dr. Elsie attending the 2019 Global Symposuin on Health Workforce Accreditation and Regulation in IstanbulCo-organized by the World Health Organization (WHO), Educational Commission for Foreign Medical Graduates (ECFMG), and the Global Health Workforce Network (GHWN), the symposium reviewed health workforce-related accreditation and regulation, enhanced data sharing across Member States, relevant stakeholders and institutional readiness in this area.

It also looked at consistency of the different approaches by member states regarding the adoption of the Global Strategy on Human Resources for Health: Workforce 2030 and its 2020 milestone.
It addressed policies and implementation strategies for the accreditation of health worker education institutions and health worker regulation to advance quality and sustainability.  Furthermore, it reviewed and addressed health worker accreditation and regulatory issues with a focus towards achieving Universal Health Coverage, as emphasized in the WHO’s 13th Global Programme of Work and the 2018 G20 Health Ministers Statement.

By Prof. Francis Omaswa

We as humans are by nature empathetic, social and capable of collaborating in mutuallyProf Francis Omaswa's message on UHC supportive ways for the individual and common good. Naturally, we are saddened when we see human suffering. Likewise, we are cheered when we witness success. Yes, we also have in us negative non-cohesive tendencies such as selfishness and greed, jealousy and aggression. Ultimately, however, the common good tendencies predominate. This is the reason why we have collectively overcome vices such as ending slavery and apartheid. Indeed, negotiating and adopting the Sustainable Development Goals (SDGs) is an example of the success of our cohesive tendencies. How is this interplay currently impacting the achievement of Universal Health Coverage (UHC)?

Previously, health was classified as a cost without economic returns. However there is sufficient evidence that proves that investing in health has high economic and social returns.

Let’s face it: Non Communicable Diseases (NCDs) are preventable. Yet, they claim millions of lives annually.

According to the World Health Organisation, NCDs kill 41 million people each year, equivalent to 71% of all deaths globally. Cardiovascular diseases account for most NCD deaths, followed by cancers, respiratory diseases and diabetes. Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from a NCD, according to WHO.
How can countries stop these depressing figures? Did you know that digital technologies could offer solutions by empowering people with basic health information?

Against this background, the African Center for Global Health and Social Transformation (ACHEST) was recently privileged to participate in the dialogue on curbing NCDs, at Wilton Park in London.

The meeting was convened to explore ways on how digital health can be used to tackle the growing burden of NCDs in low and middle income countries.

Dr. David Okello attends a meeting on how to combart NCDs using Digital Health at Wilton Park

Dr. Charles Olaro the Commissioner MoH Launches the Online PlatformSeeking a practicing license is now just a click away on the computer. The African Center for Global Health and Social Transformation (ACHEST) has successfully developed Uganda’s first ever online platform for the annual practicing licenses for health professionals and facilities.
With support from the World Bank Group, the online platform is a game changer in the health sector. It automatically means that professionals will no longer have to travel hundreds of miles to the capital Kampala to register or renew their annual practicing licenses.  
One only needs to create an account and register in the portal to acquire the registration certificate. For previously registered professionals, login credentials will be forwarded to them on their cell phones.
 The platform was developed over a period of three years and can be accessed through: www.ehealthlicence.go.ug

"My daughter told me she knew what condoms were. Yet, I had never spoken to her about them," disclosed Dr. Gaston Zulu, one of the panelists at the ICPD side event that was hosted by the African Center for Social Transformation (ACHEST) on November 13, 2019 in Nairobi.

Another panelist, Dr. Elizabeth Gitau from Kenya Medical Association also disclosed:
"My child keeps asking me, 'mummy what is HIV?' Yet she's only six years old. If I don't tell her, the next time she could be playing with a 14-year-old and he gives her wrong information."

These two personal stories shared by both Dr. Zulu and Dr. Gitau speak volumes on just how much children have an idea about sexuality health. Yet, many adults continue to burry heads in the sand, rather than face the reality and talk about sex education.

While delivering the key note address on gender equity gaps and health services for the youth, Dr. Anne Beatrice Kihara, the President at African Federation of Obstetrics and Gynaecology decried the high rate of teenage pregnancies that are putting adolescents at the risk of contracting HIV.

Dr. Kihara said 21 million girls aged 15 -19 in developing countries become pregnant every year. About half of these pregnancies (49%) are unintended. “Pregnancy is just a sign of another bigger problem: HIV. We also still have a problem of abortions, as girls resort to terminate unwanted pregnancies. Young women aged 15- 24 are twice more likely to be living with HIV than men," said Dr. Kihara.

Dr. Richard Mugahi, from Uganda's Ministry of Health said there is need to define safe spaces for adolescents to open up and seek help about issues affecting them. This, he emphasized, will curb on teenage pregnancies. “If gender-based violence is inflicted by our relatives in homes, where are the safe spaces in a patriarch society? A young girl from school walking through the boda-boda stage is not safe. If you say let them stay in school, we know that some teachers are defiling our girls!"

Dr. Mugahi added: "All women who are productive are as a result of a safe place. A safe place has to take into context the background and individual needs of the girl. It can't be universal. Adolescents, parents and guardians are key in defining this space."

Dr. David Okello, the Director of Non-Communicable Diseases and Healthy Ageing at ACHEST urged young people to speak up. “When HIV started, civil society were not talking until the people affected themselves started talking. How much are these girls involved? The children should get involved!"

Dr. Kihara agreed but was quick to note that it was not always easy for a girl who has conceived to speak out. "I would like to agree. However, how will they talk? You get pregnant and leave school to take care of the baby." Some participants argued that huge finances of were needed to achieve reproductive health and family planning needs.