Health supply chains need human resources; the missing link for universal health coverage



Thank you Dr Sachs for your article ‘Responding to Ebola’, where you challenge the developed world to engage seriously in Universal Health Coverage through a more aggressive approach to health systems strengthening. Within your article you focus on the need for more appropriately trained community health workers and the health commodities they need to complete their work. This is especially so for the current Ebola outbreak. This focus on clinical cadres often overlooks the enabling systems and associated cadres required to enable clinical cadres to do their work, for example health supply chains.



The Third Global Forum on Human Resources for Health (HRH) was held in Recife, Brazil, in November 2013. The aim of the forum was to seek ways to accelerate progress towards attaining the millennium development goals (MDGs) and how to better achieve universal health coverage. Although significant gains have been made since the 2006 World Health Report, a lack of focus on the human resources required to run public health supply chains sustainably, is a significant oversight that may be preventing further progress.



Up to a third of the world’s population has limited access to essential medicines, and the health supply chain workforce is crucial if the health-related MDGs are to be attained.1. Of the eight MDGs, four explicitly involve medicines or medical commodities and their availability at the primary care or service delivery point level.2.



Without access to and appropriate use of quality medicines and health commodities, health systems lose their ability to meet the treatment and prevention needs of the patients and clients they serve. The International Pharmaceutical Federation (FIP) Global Pharmacy Workforce Report (2012) focuses attention on the lack of human resources in this sector, making a link between a lack of pharmacy personnel and inequalities in access to medicines. Sub-Saharan Africa is of particular concern with an average of less than one pharmacist noted per 10,000 population.3.



Since the first Global Forum in Kampala in 2008, the focus of the HRH movement has been on the doctors, nurses, midwives and community health workers (CHWs) needed to provide healthcare interventions. There has been little consideration given to the human resources required to sustain the public health supply chains that are needed for healthcare personnel to be effective. A March 2013 Lancet article by Singh and Sachs provides an example of the insufficient focus in this area.4.



Singh and Sachs contend that scaling up the education and recruitment of CHWs is an intervention that would have a small comparative cost and help significantly address the existing health burden.4. This idea has merit, but the full effect of such an intervention will only work if an appropriate enabling environment exists, including the availability of medicines and medical commodities in the right place at the right time. Proposals made by Singh and Sachs acknowledge the importance of the WHO health system building blocks including ‘medical products’, while also stressing the underlying assumption that each CHW is provided with medications and diagnostics.5. This assumption requires more systematic and sustained attention. The supply of medicines and medical commodities is not a straightforward process in many developing countries.



This is articulated well in the new World Bank publication ‘The Labor Market for Health Workers in Africa: A New Look at the Crisis’, where it is suggested that consideration be given to the enabling environment of health workers so that new and existing healthcare personnel are used more efficiently. It is noted that investments in other parts of the healthcare system may be required, such as equipment, supplies or pharmaceuticals.5. When investing in medicines and medical commodities attention must also be given to the human resources required to sustain the supply chain that makes these items available.



Separate to the human resources for health crisis, there has been a rapid increase in health assistance from multilateral donors, with such initiatives as the Global Fund, the UN Commission on Life Saving Commodities, and the Global Alliance for Vaccines and Immunization. For these investments to have their greatest impact, the public health supply chains accommodating these interventions need to have sufficient capacity and be sustainable. It is important for these and other programmes to give adequate consideration to issues around human resources in public health supply chains. A simple focus on training is not sufficient.



Human resources are a key performance driver within public health supply chains. The effective management of a supply chain demands excellence in managing its human resources, an area particularly overlooked in resource-poor environments. By proactively managing plans, policies and procedures associated with people, an organization can improve supply chain performance. Such a systematic approach requires the planning, financing, development, support, and retention of the national workforces needed for the effective, efficient, and sustainable management of health supply chains.7.



Launched in 2011, the People that Deliver (PtD) Initiative is a global partnership of over 80 organizations who have the joint vision of a world where national supply chain workforces are planned, financed, developed and supported in a way that ensures equitable and sustainable access to the medicines and other commodities needed for optimal health outcomes (http://www.peoplethatdeliver.org/). We currently have activity underway in a number of focus countries including Indonesia, Burkina Faso, Ethiopia and Liberia. In these environments we are engaging with country governments to better assess and plan improvements to current HR approaches including better education approaches, improved career pathways and better performance management.



From the 27th to the 30th of October 2014, PtD will be hosting its 2nd Global Conference on HR in SCM, Copenhagen, Denmark with a focus on the need to strengthen HR in health supply chains as a key enabler of universal Health Coverage. We also call for increased global attention to a systematic approach to health system strengthening where health supply chains are a key component.



Sincerely,



Andrew N. Brown (corresponding author)

People that Deliver Executive Manager

UNICEF, Supply Division. Copenhagen, Denmark

executivemanagerptd@unicef.org



Benoit Silve

People that Deliver Chairperson

Bioforce, Lyon, France

b.silve1@gmail.com



Erin Hasselberg

People that Deliver Lead, Technical Working Group

Supply Chain Management System, USAID

Arlington, Virginia, United States of America

ehasselberg@pfscm.org



Pamela Steel

People that Deliver Lead, Research Working Group

Pamela Steele Associates LtD

Oxford, United Kingdom

pam@pamsteel.co.uk



Chris Wright

People that Deliver Lead, Advocacy and Knowledge Management Working Group

John Snow Inc., Arlington, Virginia, United States of America

chris_wright@jsi.com



Disclaimer:

The views expressed in this document do not necessarily reflect those of the U.S. Agency for International Development or of the U.S. government.



References:



1. WHO, The World Medicines Situation 2011 Medicines Prices, Availability and Affordability http://www.who.int/medicines/areas/policy/world_medicines_situation/WMS_ch6_wPricing_v6.pdf [accessed 31st July 2013]

2. UN. The Millennium Development Goals Report 2012 http://www.un.org/en/development/desa/publications/mdg-report-2012.html [accessed 31st July 2013]

3. FIP. FIP Global Pharmacy Workforce Report. 2012 http://www.fip.org/static/fipeducation/2012/FIP-Workforce-Report-2012/?page=hr2012 [accessed 31st July 2013]

4. Singh, P. Sachs, J. 1 million community health workers in sub-Saharan Africa by 2015. The Lancet, Volume 382, Issue 9889, Pages 363 - 365, 27 July 2013

5. WHO, Systems Thinking for Health Systems Strengthening http://www.who.int/alliance-hpsr/systemsthinking/en/index.html [accessed 31st July 2013]

6. Soucat, A. Scheffler, R. Ghebreyesus, T. The Labor Market for Health Workers in Africa: A New Look at the Crisis . Washington DC: World Bank

http://documents.worldbank.org/curated/en/2013/04/17657443/labor-market-health-workers-africa-new-look-crisis [accessed 31st July 2013]

7. USAID DELIVER PROJECT, Task Order 4. 2013. Human Resource Capacity Development in Public Health Supply Chain Management: Assessment Guide and Tool. Arlington, Va. http://deliver.jsi.com/dhome/whatwedo/capbuilding/cbhrscm

[accessed 31st July 2013]