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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 Dimensions“

Berlin, 17-16 September, 2010

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Historical perspective on development policies in health and their implications for Human Resources for Health (HRH)

Example: Republic of Malawi

Introduction

Focus on the concepts of leadership, professionalism and community participation

contradictions of underlying principles?

challenges and options for health professionals / experts?

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‘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

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• 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)

‘Human Resources for Health’ policies in Malawi (1994-present, multi-party system)

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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

Volunteering and professionalism

• 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)

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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

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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?

Knowledge systems: standardisation vs. openness- information needs of development institutions- social research for alternative knowledge / value systems

Rappaport (1981)Evetts (2006)Escobar (1995)

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Conclusion

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

Leadership and community participation (and their link) have often been neglected in HRH policies

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- 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 PressEvetts J (2006) Short Note: The Sociology of Professional Groups : New Directions.

Current Sociology 54: 133Flahault D, Roemer MI (1984) Leadership for Primary Health Care. Levels, functions and

requirements based on twelve case studies. WHO, GenevaRappaport J (1981) In Praise of Paradox. A Social Policy of Empowerment over

Prevention. American Journal of Community Psychology 9 (1): 1-25WHO (2008) World Health Report 2008: Primary Health care – now more than ever.

WHO, GenevaWHO (2007) Towards better leadership and management in health.

WHO/HSS/healthsystems 2007.3

Photos: M. Bredehorst 2009; Map and flag of Malawi : www.wikipedia.org