Bellagio_outcome_statement_FINAL_11May16

Human capital for human security: Investing in health workforce education and training

1. We, members of the Strategic Advisory Group convened by the Health Professional Education Foundation of Thailand, gathered in Bellagio, Italy (26-28 April, 2016) to review evidence on transforming health workforce education and training towards Universal Health Coverage1 and to identify opportunities to strengthen the implementation of the Global Strategy on Human Resources for Health: Workforce 20302.
2. Mindful that the transformative education agenda seeks to ensure the sustainable expansion and reform of health professionals’ education and training to increase the quantity, quality and relevance of health professionals, and in so doing strengthen the country health systems and improve population health outcomes3.
3. Noting the G7 Ise-Shima Summit in Japan and its commitment to ‘Protect Human Security’ by linking global health security preparedness and response with health systems strengthening4, and the UN Secretary-General’s High-Level Commission on Health Employment and Economic Growth5 which aims to strengthen multi-sectoral policy dialogue and guide the creation of new health sector jobs and investment as called for in Sustainable Development Goal 3c: to “increase substantially…. the recruitment, development, training and retention of the health workforce”.
4. Recognising the resolutions adopted by the World Health Assembly and Regional Committees of the World Health Organization, including: WHA62.126;WHA63.167; SEA/RC65/78; WHA 66.239; WHA67.2410; SEA/RC67/2111and SEA/RC68/2612 which have adopted a decade of action (2015- 2024) on strengthening human resources for health in the South East Asia region.
5. Noting the momentum from the Joint Learning Initiative (2004); the Global Health Workforce Alliance (GHWA)13; and regional examples of coordination and evidence generation, e.g. from the Asia Pacific Alliance on HRH (AAAH), the Medical Education Partnership Initiative (MEPI)14, the Nursing Education Partnership Initiative (NEPI), and the Asia-Pacific Network on Health Professional Education Reform (ANHER).
6. Recalling the World Health Report (2006), the 2008 report of the Task Force on Scaling up Education and Training of the Health Workforce15, the 2010 report of the Independent Commission on Education of Health Professionals for the 21st Century16, the 2013 WHO Guidelines on Transforming and scaling up health professionals’ education and training17, and the Prince Mahidol Award Conference 2014 “Transformative learning for health equity”18.
7. Noting the ‘Global Strategy on Human Resources for Health: Workforce 2030’and its call for Member States to develop inclusive institutional mechanisms to coordinate an intersectoral health workforce agenda that takes account of and harnesses labour market dynamics; including the role of public and private (not-for-profit, for-profit and faith-based) providers in education and service delivery.
8. COMMIT to build on these foundations to promote an increased sense of urgency for collective action on national implementation in low- and middle-income countries: emphasising that health workers are the ‘human capital’ of the ‘human security’ agenda in global health preparedness and response, health systems and universal health coverage.
9. Further, based on the evidence of transformative education from national settings we recommend that Governments prioritise implementation and encourage decision-makers and partners in low- and middle-income countries, subject to the national context, to adopt actions to address the following issues:

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Human capital for human security: Investing in health workforce education and training

10. Leadership and Policy: Commitment to ensure that all countries have inclusive institutional mechanisms in place to coordinate an intersectoral health workforce agenda, with emphasis on:
    1. Leadership training in health workforce education and research at all levels;
    2. Connecting evolving local health needs to national priorities and the SDGs;
    3. Transformative education for health equity and integrated people-centred healthsystems19through collaborative institutional and instructional reforms;
    4. Institutional policies guided by social accountability;
    5. Generating and interpreting data with appropriate stakeholder input to informevidence-based policy and evaluate innovative new interventions;
    6. Developing a national health workforce plan which harnesses market forces towardscomprehensive primary health care.
11. Faculty Recruitment and Development: Innovative expansion of faculty through inter- professional, team-based, involving community-based clinicians and health workers as academics, focused on the evolving health needs of their communities through:
    1. Recruitment, appointment and promotion policies in education institutions which recognise, reward and support community-based clinicians as active faculty members and promotes their academic career development;
    2. Community context specific faculty development for all faculty focused on education and research about evolving health needs, leveraging information communication technologies and institutional production of a fit for purpose health workforce.
12. Curriculum Transformation: Adapt curricula to focus on population health needs, new models of service delivery and health team skill mix, with emphasis on:
    1. Social and contextual determinants of health in situ;
    2. Broader understanding of overall health system and roles of health workers;
    3. Community engagement, inter-professional health teams and immersion educationexperiences;
    4. Representation of communities, health service managers and health ministries oncurriculum planning committees.
13. Workforce Formation: Scale up of health workforce education programmes which have targeted admissions policies to increase the socio-economic, demographic, ethnic and geographical diversity of students reflective of local population diversity, through:
    1. Support programmes for underserved population groups to achieve entry to, and successfully graduate from, health workforce technical, vocational education and training programs;
    2. Admissions processes which favour applicants from underserved population groups, aligned with requisite academic standards and other desirable characteristics.
14. Accountability through Accreditation: Accreditation of health workforce education to be introduced where it does not exist and strengthened where it does exist through:
    1. Implementation of accreditation procedures which emphasize continuous improvement of quality educational processes and outcomes;
    2. Inclusion of social accountability as an essential accreditation standard;
    3. Encouraging mutual recognition between countries in health workforce accreditationstandards.
15. Adopted by acclamation to promote the urgent scale-up of collective action by Member States and all relevant stakeholders.

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Human capital for human security: Investing in health workforce education and training

ENDNOTES

1The Strategic Advisory Group was convened by the invitation of the HPEF of Thailand, representing Member States, national expertise and international agencies in health education and training. Further information available at: http://healthprofessionals21thailand.org/2016/04/global-action-on-transforming-health-workforce-education-and- training-towards-universal-health-coverage-2030/ Accessed, 28 April, 2016.

2WHO (2016).Global Strategy on Human Resources for Health: Workforce 2030.
3WHO (2013). Transforming and scaling up health professionals’ education and training: World Health Organization

Guidelines, 2013.http://apps.who.int/iris/bitstream/10665/93635/1/9789241506502_eng.pdf?ua=1
4 Protecting human security includes: 1) Enhance preparedness and response towards threats to human security, 2)

Achieve sustainable and high-quality health care systems, particularly in the context of NCDs and population ageing, and

3) Promote research and development, and system innovations.
5High-Level Commission on Health Employment & Economic Growth.http://www.who.int/hrh/com-heeg/en/ 6WHA62.12 (2009): Primary health care, including health system strengthening.

http://www.who.int/hrh/resources/A62_12_EN.pdf

7WHA63.17 (2010) Code of Practice for International Recruitment of Health Personnelhttp://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R16-en.pdf

8SEARO (2012).Strengthening Health Workforce Education and Training in the Region.

http://www.searo.who.int/about/governing_bodies/regional_committee/rc65-r7.pdf

9WHO(2013). Transforming health workforce education in support of universal health coverage.http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R23-en.pdfv

10WHO (2014).Follow-up of the Recife Political Declaration on Human Resources for Health: renewed commitments towards universal health coveragehttp://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R24-en.pdf

11SEARO (2014).Regional strategy on strengthening health workforce education and traininghttp://www.searo.who.int/mediacentre/events/governance/rc/rc67-21rev1_agenda_8.7.pdf

12SEARO (2015). Ministerial Round Table: Strengthening health workforce in South-East Asia in order to expand delivery of effective services. http://www.searo.who.int/mediacentre/events/governance/rc/68/rc68-26-14.1.pdf?ua=1

13 Including its three Global Forums on Human Resources for Health in Uganda (2008), Thailand (2011) and Brazil (2013) 14Goosby EP, von Zinkernagel D.The Medical and Nursing Education Partnership Initiatives.Acad Med. 2014 Aug;89(8

Suppl):S5-7.http://www.ncbi.nlm.nih.gov/pubmed/25072578
15GHWA (2008). Task Force on Scaling up Education and Training of the Health Workforce

http://www.who.int/workforcealliance/documents/Global_Health%20FINAL%20REPORT.pdf

16Frenk et al (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet.http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)61854-5.pdf

17WHO (2013). Transforming and scaling up health professionals’ education and training: World Health Organization Guidelines, 2013. http://apps.who.int/iris/bitstream/10665/93635/1/9789241506502_eng.pdf?ua=1

18Prince Mahidol Award Conference 2014.http://www.pmaconference.mahidol.ac.th/index.php?option=com_content&view=article&id=608&Itemid=207

19WHO (2016).Framework on integrated people-centred health services. Available at:

http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/