Framing the Health Workforce Agenda Beyond Economic Growth

Document Type : Perspective


1 Maastricht Centre for Global Health, Maastricht University, Maastricht, The Netherlands

2 Institute of Tropical Medicine, Antwerp, Belgium

3 Wemos Foundation, Amsterdam, The Netherlands

4 Department of Health Ethics and Society, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands


The fourth Global Forum on Human Resources (HRH) for Health was held in Ireland November 2017. Its Dublin declaration mentions that strategic investments in the health workforce could contribute to sustainable and inclusive growth and are an imperative to shared prosperity. What is remarkable about the investment frame for health workforce development is that there is little debate about the type of economic development to be pursued. This article provides three cautionary considerations and argues that, in the longer term, a perspective beyond the dominant economic frame is required to further equitable development of the global health workforce. The first argument includes the notion that the growth that is triggered may not be as inclusive as proponents say it is. Secondly, there are considerable questions on the possibility of expanding fiscal space in low-income countries for public goods such as health services and the sustainability of the resulting economic growth. Thirdly, there is a growing consideration that economic growth solely expressed as increasing gross domestic product (GDP) might have intrinsic problems in advancing sustainable development outcomes. Economic development goals are a useful approach to guiding health workforce policies and health employment but this depends very much on the context. Alternative development models and policy options, such as a Job Guarantee scheme, need to be assessed, deliberated and tested. This would meet considerable political challenges but a narrow single story and frame of economic development is to be rejected.



Watch the Video Summary here.


Main Subjects

  1. Fourth Global Forum on Human Resources for Health. Dublin Declaration on Human Resources for Health: Building the Health Workforce of the future. World Health Organization; 2017.
  2. Working for health and growth: investing in the health workforce. Report of the High-Level Commission on Health Employment and Economic Growth. World Health Organization; 2016.
  3. Cometto G, Boerma T, Campbell J, Dare L, Evans T. The Third Global Forum: framing the health workforce agenda for universal health coverage. Lancet Glob Health. 2013;1(6):e324-325. doi:10.1016/s2214-109x(13)70082-2 
  4. Framing the health workforce agenda for the Sustainable Development Goals: biennium report 2016–2017 — WHO Health Workforce. Geneva: World Health Organization; 2017.
  5. Koon AD, Hawkins B, Mayhew SH. Framing and the health policy process: a scoping review. Health Policy Plan. 2016;31(6):801-816. doi:10.1093/heapol/czv128
  6. McNeill D, Ottersen OP. Global Governance for Health: how to motivate political change? Public Health. 2015;129(7):833-837. doi:10.1016/j.puhe.2015.05.001
  7. Boothman D. The sources for Gramsci’s concept of hegemony. In: Green M, ed. Rethinking Gramsci. New York: Routledge; 2017: 55-67.
  8. Lippmann W. Public Opinion. New York: Harcourt; 1922.
  9. Cometto G, Scheffler R, Liu J, et al. Health workforce needs, demand and shortages to 2030. In: Buchan J, Dhillon IS, Campbell J, eds. In Health Employment and Economic Growth: An Evidence Base. Geneva: World Health Organization; 2017:3-26.
  10. Vujicic M, Ohiri K, Sparkes S. Working in health: financing and managing the public sector health workforce. Washington: The World Bank; 2009.
  11. Soucat A, Scheffler R, Ghebreyesus TA. The labor market for health workers in Africa: a new look at the crisis. Washington: The World Bank; 2013.
  12. Ghebreyesus TA. Towards Universal Health Coverage: Tackling the Health Financing Crisis to End Poverty. Washington: The World Bank; 2018.
  13. McPake B, Maeda A, Araujo EC, Lemiere C, El Maghraby A, Cometto G. Why do health labour market forces matter? Bull World Health Organ. 2013;91(11):841-846. doi:10.2471/blt.13.118794
  14. Lauer J, Soucat A, Araujo E, Weakliam D. Pathways: the health system, health employment, and economic growth. In: Buchan J, Dhillon IS, Campbell J, eds. In Health Employment and Economic Growth: An Evidence Base. Geneva: World Health Organization; 2017:174.
  15. Lauer J, Soucat A, Araújo E, et al. Paying for needed health workers for the SDGs: An analysis of fiscal and financial space. In: Buchan J, Dhillon IS, Campbell J, eds. In Health Employment and Economic Growth: An Evidence Base. Geneva: World Health Organization; 2017:236.
  16. Labonte R. Health promotion in an age of normative equity and rampant inequality. Int J Health Policy Manag. 2016;5(12):675-682. doi:10.15171/ijhpm.2016.95
  17. Dal Poz MR, Sepulveda HR, Costa Couto MH, et al. Assessment of human resources for health programme implementation in 15 Latin American and Caribbean countries. Hum Resour Health. 2015;13:24. doi:10.1186/s12960-015-0016-4
  18. Dussault G, Badr E, Haroen H, et al. Follow-up on commitments at the Third Global Forum on Human Resources for Health: Indonesia, Sudan, Tanzania: "A commitment is a promise, a promise is a debt". Hum Resour Health. 2016;14:16. doi:10.1186/s12960-016-0112-0
  19. van de Pas R, Veenstra A, Gulati D, Van Damme W, Cometto G. Tracing the policy implementation of commitments made by national governments and other entities at the Third Global Forum on Human Resources for Health. BMJ Glob Health. 2017;2(4):e000456. doi:10.1136/bmjgh-2017-000456
  20. Jutz R. The role of income inequality and social policies on income-related health inequalities in Europe. Int J Equity Health. 2015;14:117. doi:10.1186/s12939-015-0247-y
  21. Milanovic B. What Next? Ten Short Reflections on the Future of Income Inequality and Globalizationin Global inequality. Harvard University Press; 2016:212-230.
  22. Hickel J. Five reasons to think twice about the UN’s Sustainable Development Goals. LSE Blog. 2015.
  23. Barroy H, Kutzin J, Tandon A, et al. Assessing Fiscal Space for Health in the SDG Era: A Different Story. Health Systems & Reform. 2018;4(1):4-7. doi:10.1080/23288604.2017.1395503
  24. Rodrik D. The Globalization Paradox: Why Global Markets, States, and Democracy Can't Coexist.Oxford University Press; 2011.
  25. Stubbs T, Kentikelenis A, Stuckler D, McKee M, King L. The impact of IMF conditionality on government health expenditure: A cross-national analysis of 16 West African nations. Soc Sci Med. 2017;174:220-227. doi:10.1016/j.socscimed.2016.12.016
  26. IMF Country Report Malawi No 15/345. Published 2015.
  27. Russo G, Bloom G, McCoy D. Universal health coverage, economic slowdown and system resilience: Africa's policy dilemma. BMJ Glob Health. 2017;2(3):e000400. doi:10.1136/bmjgh-2017-000400
  28. Ottersen T, Elovainio R, Evans DB, et al. Towards a coherent global framework for health financing: recommendations and recent developments. Health Econ Policy Law. 2017;12(2):285-296. doi:10.1017/s1744133116000505
  29. Woodward D. Incrementum ad absurdum: global growth, inequality and poverty eradication in a carbon-constrained world. World Econ Rev. 2015;4:43-62.
  30. Raworth K. Doughnut Economics: Seven Ways to Think Like a 21st-Century Economist. Chelsea Green Publishing; 2017.
  31. Milanovic B. The illusion of “degrowth” in a poor and unequal world. Global Inequality Blog. 2017.
  32. Stiglitz JE, Sen A, Fitoussi JP. Mismeasuring Our Lives: Why GDP Doesn't Add Up. The New Press; 2010.
  33. Hickel J. The Divide: A Brief Guide to Global Inequality and its Solutions. London:William Heinemann; 2017.
  34. Faki Mahamat M. Speech of the chairperson of the commission of the African Union. 5th African Union- European Union summit. Abidjan, Cote D’Ivoire: 2017.
  35. Rodrik D. Globalisation: New Deal on Labour Mobility. Social Europe; 2018.
  36. World Health Organization. Global strategy on human resources for health: workforce 2030. Geneva: WHO; 2016.
  37. Langer A, Meleis A, Knaul FM, et al. Women and Health: the key for sustainable development. Lancet. 2015;386(9999):1165-1210. doi:10.1016/s0140-6736(15)60497-4
  38. McCoy D. Critical global health: responding to poverty, inequality and climate change; Comment on "Politics, power, poverty and global health: systems and frames." Int J Health Policy Manag. 2017;6(9):539-541. doi:10.15171/ijhpm.2016.157
  39. No health workforce, no global health security. Lancet. 2016;387(10033):2063. doi:10.1016/s0140-6736(16)30598-0
  40. Smith RD, Woodward D. Global Public Goods for Health: Use and Limitations. Trade, foreign policy, diplomacy and health. World Health Organization; 2003.
  41. Ruger JP. Health capability: conceptualization and operationalization. Am J Public Health. 2010;100(1):41-49. doi:10.2105/ajph.2008.143651
  42. International Labour Organization. Recommendation concerning National Floors of Social Protection. International Labour Organization; 2012:202.
  43. Health Workforce Advocacy Initiative. Incorporating the right to Health into Health Workforce Plans: Key considerations. Physicians for Human Rights; 2009.
  44. Klosse S, Muysken J. Curbing the Labor Market Divide by fostering Inclusive Labor Markets through a Job Guarantee Scheme. Psychosociological Issues in Human Resource Management. 2016;4(2):185-219.
  45. Atkinson AB. Inequality, what can be done? Harvard University Press; 2015:133-154.
  46. Tcherneva PR. The Job Guarantee: Design, Jobs, and Implementation. Levy Economics Institute; 2018.
  47. Van de Pas R, Hill PS, Hammonds R, et al. Global health governance in the sustainable development goals: Is it grounded in the right to health? Global Chall. 2017;1(1):47-60. doi:10.1002/gch2.1022
  48. Bemelmans M, Philips M. New plan to tackle the global shortage of health workers fails to address economic constraints. The BMJ Opinion. July 24, 2017.