REGIONAL CONSULTATIVE MEETING:

TAKING THE HUMAN RESOURCES FOR HEALTH AGENDA

FORWARD AT THE COUNTRY LEVEL IN AFRICA
BRAZZAVILLE, CONGO

18-20 JULY 2005

FINAL REPORT

BRAZZAVILLE
 Contents

Page

Abbreviations 4

Summary 5

1. Introduction 7

2. Objectives and expected results 8

2.1 General objective 8
2.2 Specific objectives 8
2.3 Expected results 8

3. Methods of work 8

4. Session 1: Official opening 9

5. Session 2: Progress on HRH since the Abuja forum 10

6. Session 3: The platform and partnerships 11

7. Session 4: Reaching consensus on policy options, actions and the 11

HRH Observatory
7.1 Policy actions and options 12
7.2 The African Regional HRH Observatory 12
7.3 HRH workplace situation, migration and retention 13

8. Session 5: How to use priority programmes to ensure HRH at country 14

level
8.1 Linking HRH to health systems 14
8.2 Education and training of health workers in Africa 15
8.3 HRH in the context of priority health programmes 15

9. Session 6: Consensus on action to support HRH development and 16

implementation
9.1 Gaps that should be addressed 16
9.2 Remarks from development partners 16

10. Session 7: Consensus on establishment of a regional platform 17

10.1 Group work
10.2 Plenary discussions 17
10.3 Proposed actions and recommendations 18
19

2
11 Summary recommendations for action 20
11.1 Key cross-cutting issues 20
11.2 Establishing the African Regional HRH Observatory 20
11.3 Creating the African Platform on Human Resources for Health 20
Development
11.4 HRH policy analysis and options 20
11.5 Health workplace situation, management of migration and 20
retention of health workers
11.6 Education and training of health workers in Africa: Challenges 21
and prospects
11.7 Overcoming HRH constraints for implementation of priority 21
health programmes
11.8 Creating synergies in HRH and health systems 22
11.9 A research agenda for HRH in Africa 22

12. Closing session 22

13. Conclusion 23

Annexes 24

3
Acronyms and Abbreviations

ACOSHED African Council for Sustainable Health Development

AIDS acquired immunodeficiency syndrome
ALN Action Learning Network
AMREF African Medical and Research Foundation
AU African Union
CIDA Canadian International Development Agency
DFID Department for International Development (of United Kingdom)
EU European Union Commission
HIV human immunodeficiency virus
HLF high level forum
HRH human resources for health
HQ headquarters
GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria
GAVI Global Alliance for Vaccines and Immunization
JLI joint learning initiative
MDG millennium development goal
MOE Ministry of Education
MOEF Ministry of Economics and Finance
MOH Ministry of Health
MOPS Ministry of Public Service
MTEF Medium Term Expenditure Framework
NEPAD New Partnership for Africa’s Development
NGO nongovernmental organization
OECD Organisation for Economic Cooperation and Development
PEPFAR President’s Emergency Plan for AIDS Relief
PHP priority health programme
PRSP Poverty Reduction Strategy Paper
TBA traditional birth attendant
TWG transitional working group
UN United Nations
US United States
UNDP United Nations Development Programme
USAID United States Agency for International Development
VPD vaccine-preventable disease
WAHO West African Health Organisation
WFME World Federation of Medical Education
WHA World Health Assembly
WHO World Health Organization
WHR World Health Report

4
Summary

Following the second high-level forum for health millennium development goals held in
Abuja in December 2004, the Africa Dialogue jointly hosted by the African Council for
Sustainable Health Development and the Secretariat of the New Partnership for Africa’s
Development Global Consultation on Human Resources for Health held in Oslo in
February 2005, a regional HRH consultative meeting was jointly hosted by WHO,
NEPAD and ACOSHED in Brazzaville, Republic of Congo, from 18 to 20 July 2005.
The purpose of the Consultation was to take the agenda forward at the country level and
engage a broad range of stakeholders in a regional platform for dialogue and action on
this important issue. The meeting brought together diverse stakeholders and organizations
working with countries to discuss appropriate ways and means to increase collaboration
and harmonize support to countries so as to facilitate the development of HRH at country
level.

The meeting was organized around plenary presentations, discussions and group work. It
was attended by over 60 participants from 16 countries, representatives of regional
bodies, nongovernmental organizations, regional training institutions, agencies and
programmes of the United Nations and their collaborating centres as well as
representatives of development partners, including Department for International
Development, European Union, United States Agency for International Development,
Canadian International Development Agency, the World Bank and the World Federation
of Medical Education.

Participants discussed key cross-cutting areas and eight themes for effective
implementation of human resources action at country and regional levels. The need for
the action to build on existing knowledge and involve health and non-health sectors,
public and private sectors, as well as client and civil society groups was emphasized. In
addition, action should promote broad ownership as well as long-term political and
financial commitment from countries and partners.

HRH policy and options were examined. Participants recommended the development of
an African position paper on HRH development to serve as a general guideline for the
engagement of stakeholders. The need to establish policy units at country level to guide
HRH research, analysis, development and implementation was discussed. Evidence-based
HRH policies and strategies in a context of broader medium-to-long-term national health
policy and accountability for national HRH policy implementation at high political level
with reporting mechanisms were also identified.

The concept of an Africa Region HRH observatory was welcomed. The Observatory was
identified as a technical facility that can provide support for country networks and the
proposed Africa Regional Platform on HRH Development. It would also be a valuable
mechanism for experience sharing and the monitoring of both good and bad practice in
HRH in the Region. Participants recommended that the work of the observatory should
link with that of the African Platform for HRH Development and contribute to the
articulation of a common position and voice for Africa. A steering committee was
charged to take forward the most immediate and urgent actions of the Observatory and
Platform for a year, when the structures and functions of these mechanisms would have
been consolidated.

5
The meeting underscored the need to place HRH in a context of priority health problems
and overall health systems strengthening, share information on country examples of
“conducive work environment” as part of networks and observatory and integrate the
health position on migration with the African Union position on general migration from
the continent.

Participants devoted time to education and training of health workers in Africa. They
proposed open dialogue between ministries of health, education, economics, finance and
public service to coordinate decisions concerning training and production of key health
workers. This will involve a process for identifying competencies required through
thorough task analyses and prioritization of country needs, identification of deficiencies
in skills mix for actions, gearing training of lower level health care workers to meet
specific needs in service delivery and increase capacity of training institutions and the
supply of health workers.

In order to create synergies in HRH and health systems, participants identified the need to
test innovations in HR management that can strengthen and improve the performance of
health care systems in Africa. The gaps between production and absorptive capacity of
health systems need to be examined and the profile of health professionals developed to
suit African and individual country health systems. Issues of expansion of the fiscal space
for response, improvement in the efficiency with which existing HR resources are utilized
as well as the promotion of accountability and transparency in HRH and health systems
were also highlighted. It was identified that countries need to develop national health
plans that recognize the central role of HR in health systems strengthening and
performance.

To mitigate HRH constraints for implementation of priority health programmes, it was

agreed to establish a common platform to facilitate buy-in from global programmes into
national plans. Countries were urged to make more effective use of the funds available in
global initiatives such as the Global Funds to Fight AIDS, Tuberculosis and Malaria;
Global Alliance for Vaccines and Immunization; and the President’s Emergency Plan for
AIDS Relief. The Consultation further recommended that financing plans should include
budgets for developing HRH with concrete investments in pre-service training.

Research agenda for HRH development in Africa was accorded due attention.
Participants emphasized the need to collate the rich network of existing research findings
and information and make these accessible through wide dissemination and use of
technology. Identifying and coordinating African research centres of excellence that may
focus on key theme areas, focusing on priority evidence needs, including HRH and health
systems, and engaging health managers and policy-makers to generate common country
research aims and vision were also recommended.

A communiqué calling for brokering partnerships and immediate action on HRH at

country level was adopted and signed by the three hosts of the meeting. The meeting
concluded on the positive note that forthcoming forums such as the WHO African
Ministers of Health Conference in October 2005 and the third high-level forum in
November 2005 in Paris should be seized as opportunities to advocate and mobilize
resources for sustainable HRH development in Africa.

6
1. Introduction

Most African countries are challenged by a double crisis of fragile health systems and
weak human resources, the latter being an essential component for effective service
delivery. In spite of having 25% of the world’s burden of disease, African human
resources for health constitute only 1.3% of the total world health workforce. This
observation occurs within a paradox of continuing brain drain from Africa to the
developed countries. The Abuja high-level forum on health-related millennium
development goals (MDGs) considered action to avert the crisis in Africa. It proposed
platforms for action at global, regional and country levels.

The Oslo global consultation on HRH followed in February 2005 endorsing the platforms
for action and emphasizing enhancement of consultations, consensus and calls for action.
The meeting recognized the need for effective regional leadership and support in which
existing institutions can forge sustainable linkages with other stakeholders.

Noting the series of developments that have led to recognition of HRH as a crisis,
especially in Africa, and hence moving it to the top of the health development agenda,
concerns of African health ministers and the report of the Joint Learning Initiative on
Human Resources for Health have led to a progression of high-level consultative
meetings, including the subregional forum on HRH in West Africa hosted by the West
African Health Organisation (WAHO) for 15 countries and the identification of HRH as
the theme for The world health report 2006.

Following these events and internal consultations between WHO headquarters and the
Regional Office for Africa, important HRH follow up issues emerged. These include the
establishment of a regional Observatory for HRH, education and training for expansion of
the health workforce, motivation and retention of human resources, the use of priority
programmes such as HIV/AIDS and Making Pregnancy Safer to strengthen the HRH
component, improving the expert pool to provide timely support to countries and
fostering partnerships beyond the health sector.

Recognizing the urgent need for action at country and regional levels, a regional
consultation was jointly hosted by WHO, the New Partnership for Africa’s Development
(NEPAD) and the African Council for Sustainable Health Development (ACOSHED) to
bring together diverse stakeholders and organizations dealing with HRH and countries to
discuss appropriate ways and means to increase collaboration and harmonize support to
countries.

7
2. Objectives and expected results

2.1 General objective

The general objective of the meeting was to develop effective mechanisms for
strengthening collaboration among key stakeholders and countries so as to facilitate the
development of HRH at country level, taking into account the Abuja and Oslo agendas.

2.2 Specific objectives

The specific objectives of the meetings were:

(a) to provide an update of the progress made on the HRH agenda since the
forum held in Abuja;
(b) to reach consensus on the establishment of the regional platform for HRH
and on how to strengthen partnerships;
(c) to reach consensus on policy, options and actions including an HRH
observatory;
(d) to agree on how to use the priority health programmes to ensure the
availability of appropriate human resources for health at country level;
(e) to agree on practical actions to be taken to support HRH development and
implementation at country level.

2.3 Expected results

(a) Progress made on the HRH agenda shared;
(b) Consensus on the launch of the Regional Platform and building of
partnerships obtained;
(c) Consensus reached on the policies, options and modalities for establishment
of the Regional HRH Observatory;
(d) Consensus reached on the use of priority programmes to ensure the
availability of appropriate health workers at country level;
(e) Consensus reached on the actions to be taken forward at country level.

3. Methods of work

The meeting used a combination of participatory working methods including

presentations of selected topics, group work and feedback sessions, and plenary
discussions to address the identified HRH issues on the agenda (Annex 1). It was
attended by over 60 participants (Annex 2) from 16 countries, representatives of regional
bodies, nongovernmental organizations, civil society, regional training institutions, World
Health Organization (WHO) collaborating centres and some of the key partners such as
Department for International Development (DFID), European Union (EU), United States
Agency for International Development (USAID), Canadian International Development
Agency (CIDA), the World Bank and the World Federation of Medical Education
(WFME). Presentations, reports from group work and core reference documents of the
meeting were recorded on a CD and distributed to the participants. A press statement and
a communiqué signed by the three hosts were posted on various web sites, including
WHO, to share main highlights and recommendations of the meeting.

8
4. Session 1: Official opening

The consultative meeting was formally opened with keynote speeches of the WHO
Regional Director for Africa, Dr Luis Gomes Sambo; the NEPAD Health Advisor, Dr
Eric Buch; and the ACOSHED Executive Secretary, Dr Lola Dare, highlights of which
are reflected below. In the opening session, objectives were shared and themes were
introduced.

The Regional Director observed that the issue of HRH has attracted attention since 1998
when the Regional Committee for Africa passed Resolution AFR/RC48/R3 to adopt the
Regional Strategy for Development of Human Resources. The issue gained further
prominence with World Health Assembly resolutions WHA57.19 and WHA58.17,
calling for concerted actions on international migration of health personnel. Political
attention to this issue has also increased both globally and in Africa, with HRH being a
key action proposed in the report of the Commission for Africa and the passionate appeal
by ministers of health through the AU President to the G8 summit to put HRH issues at
the centre of health development in Africa.

The Regional Director also said that HRH policies are not always cast coherently within
the framework of national policies, a situation that results in low policy implementation
success rates. He stressed the need to address observed variations in training capacity of
countries which impact negatively on supply of HRH. A potential solution to improve
this unacceptable situation is to examine training institutions which have been declining
over the years. The Regional Director requested the consultation participants to critically
consider experiences on successful policies and strategies, reasons for the current
situation and determinants of success beyond policy. He concluded by remarking that
new ideas and recommendations that could be included in The world health report 2006
would be constructive contributions to the United Nations (UN) General Assembly
debate on migration in 2006.

The NEPAD Health Advisor expressed concern about chronic under-investment in

human resources for health, recalling the African Union Assembly request to Member
States to prepare interministerial costed development and deployment plans to address the
HRH crisis. Underlining the uniqueness of the consultative meeting, he stressed that it
was part of a global process and depended on cooperation from multilateral, political and
civil societies. He thanked the Regional Director for getting all administrative
arrangements in place despite the short notice and heavy schedule and concluded that the
consultation should be seen as an important working process.

The ACOSHED Executive Secretary recalled the appeal to the G8 to invest in Africa’s
efforts to stem the brain drain and produce the right multidisciplinary workforce. She
further pointed out that Africa does not simply need more health workers; investments
must also contribute to increase motivation, retention and accessibility of the workforce
to make a real difference. She underscored the importance of regional cooperation in
solving the crisis.

The consultation proceeded with its working sessions guided by themes of HRH policy
analysis and options, HRH development, workplace situations, migration, health systems
performance, education, training, challenges and prospects, implementation of priority
health programmes research agenda.
9
5. Session 2: Progress on HRH since the Abuja forum

A review of summary plans of action and agreements reached in Abuja and Oslo and the
establishment of a transitional working group to launch a global platform on HRH was
shared by Mrs Jennifer Nyoni. Critical challenges for supporting HRH development at
country level were highlighted. The Abuja forum in December 2004 outlined five core
principles and five action areas to address the HRH crisis in Africa. Core principles
include country-led action, global responsibility and collective solidarity, learning from
experience and building on it, going beyond the health sector in seeking solutions, seizing
opportunities (e.g. MDGs, AIDS etc) to train, retain and sustain. The forum proposed
actions to provide country-led leadership (political commitment, political management,
strategic policy, coalition etc); overcome macroeconomic constraints and recruitment
ceilings; explore mechanisms for educating health workers in Africa; coordinate technical
cooperation; and promote better information for HRH.

The Abuja HRH dialogue jointly hosted by ACOSHED and NEPAD outlined key
strategies for addressing Africa’s health workforce crisis. These included:
(a) Advocacy for human resources as a core asset for national development,
requiring urgent investments from all relevant sectors, especially in the
learning sector;
(b) Actions that go beyond generalized numbers and include country-based
targets and actions that strengthen the performance of health systems;
(c) Paradigm shifts by governments and partners to expand and improve fiscal
space for promoting joint accountability and stewardship;
(d) Support for an action learning network on human resources.

Major events were registered in the process of moving forward. The African Union
Assembly on the HRH crisis noted a chronic under-investment in human resources for
health and urged Member States to prepare cost development and deployment plans to
address the crisis (Assembly/AU/Dec.55(IV). The Oslo Consultation on HRH added a
sense of urgency in calling for action. The G8 summit referred to the crisis in relation to
poverty and constraining achievement of the health-related MDGs.

Participants were also briefed on some progress and follow-up actions to these
recommendations. For example, following the Abuja and Oslo meetings, stakeholders in
the Region have commenced actions aimed at generating improved African HRH
coordinating mechanisms consensus building and advocacy process. A regional
consultation process has also been designed for each of the regional economic zones in
Africa to assure that the actions are grounded in local context and reality.

6. Session 3: The Platform and partnerships

Professor Francis Omaswa made a presentation on building and strengthening

partnerships for HRH development. This was followed by Professor Buch’s presentation
on a regional platform for HRH development. They noted that this regional consultation
gave opportunity to make a decisive contribution on strengthening global, regional and
country partnerships for HRH development. Guiding principles of such partnerships
include inclusiveness, integration, clearly defined roles, respect for mandates, maximized
comparative advantages of partners, minimized attribution, good governance and
transparency.
10
The proposed regional platform for HRH development for Africa will provide momentum
and build consensus on what needs doing. It will foster an enabling environment for
technical work, sharing of experiences and best practices, facilitating collaboration and
harmonization, promoting advocacy for HRH. This platform will neither own nor direct
its members, but it must have the ability to drive some direct actions. It is not a conduit
for funding but will need to mobilize some funds to support its own core actions.

7. Session 4: Reaching consensus on policy options, actions and the HRH

Observatory

This session was guided by three presentations : policy analysis and options by Professor
Eric Buch from NEPAD; establishment of a regional HRH Observatory by Mrs Jennifer
Nyoni from the Regional Office; and HRH workplace situation, migration and retention
by Mrs Barbara Stilwell from WHO/HQ. Group work discussions for each of the
presentations were held. Each group was required to examine the presentation according
to the following questions:
(a) What needs to be done?
(b) How can it be done or helped along?
(c) Who needs to do it?
(d) When should it be done and with whose help?
(e) How do we know it has been done/it is being done/it is progressing?
(f) What resources are needed to do it?

The groups were further required to consider the issues and challenges related to
financing and political commitment, policy development, ownership and accountability,
leadership and technical competencies that may be required to implement action.

7.1 Policy analysis and options

About policy analysis and options, the consensus was built on what needs policy attention
as follows: addressing macroeconomic factors, HRH cadres and skills mix, regional
professional registration bodies, engaging NGOs and civil society effectively, effective
operational leadership of HRH, tackling international migration, tracking and improving
morale and motivation, effective training institutions, merging HRH development with
disease programmes, and closing HRH policy planning to implementation gaps. Possible
main policy actions to be tracked include policy options, analyses and review meetings;
sharing country experiences; accelerated action; development of experts, HRH training,
leadership, in-country dialogue and advocacy; other ministries research in support of
policy; and niche activities of an African platform.

Consultation participants made the following remarks/ observations in plenary:

• Moving forward HIV/AIDS, TB, malaria depends on functioning health
systems in which HRH is critical;
• A method of raising the HRH issues to the political leadership should be
identified in countries to assure due political attention is given, raising it to
head of state level;

11
 • Ownership and accountability on HRH issues should be underscored in light
of weakly developed civil society engagement in countries;
• HRH policy should be seen in a broader perspective, particularly to include
ministries of education and finance as well as the civil or public service;
• Intercountry sharing experiences on policy engagements that are moving
forward positively should be encouraged;
• On the retention issue, sharing differential experience that meets specific
needs, including sharing technical advice and expertise as opposed to
measures against poaching, will be helpful;
• Decentralization of HRH in government to the Ministry of Health needs
consideration.

7.2 The African Regional HRH Observatory

The African Regional HRH Observatory was defined as a cooperative initiative and
partnership of public sector, NGOs, civil society organizations, academia, professional
associations, international and subregional organizations and development partners to
improve human resources development through promoting and facilitating evidence-
based policy-making. Specifically, the Observatory is designed to:
(a) Develop national capacity for evaluation and monitoring of HRH situations
and trends;
(b) Provide information and evidence for the formulation of HRH development
policies, strategies and plans;
(c) Provide a forum for partnership, sharing of experience and advocacy in
HRH development;
(d) Facilitate the use of HRH data in policy development and planning and
informed decision-making at all levels of the health system.

Suggested functions of the African HRH Observatory include country monitoring and
information; as well as research and analysis, sharing and dissemination, national and
intercountry network, capacity building. The Observatory should be a technical facility
available to the Region and its countries. It should maintain an HRH database, process
information and present analyses to countries. It could provide an early warning system.
It should enhance decision-making, inform global and national communities, and monitor
indicators.

Participants also agreed that the Observatory should be neither an agency nor decision-
making entity. The view was shared that steering Observatory work should be left to the
initiative of countries. For an Observatory to be efficient and functional it will require
provision of resources (financial and human) and political support. Partners’ involvement
will need to be clear. Perhaps there should be an observatory at each level: regional,
subregional and country. Collaborative institutions could assume observatory status,
forming a network and coming together in a single forum where information is put
together and shared. An African Region observatory could be situated in a body that
already exists.

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7.3 HRH workplace situation, migration and retention

On HRH workplace situation, migration and retention, the participants noted that
migration is now shaped more by market forces than cultural ties, being deeply embedded
in uneven global development. The patterns of health worker migration have changed
over the last 30 years: health worker migrants from the larger states of South Africa,
Nigeria and Ghana went predominantly to a few developed countries outside Africa. The
scope of migration in Africa is now global and more complex. It involves many sub-
Saharan countries, includes intraregional movement (for example, from the Democratic
Republic of Congo to Kenya, and from Kenya to South Africa, Namibia and Botswana)
and increasingly results from targeted recruitment. Urgent action must be taken to
manage migration; invest in education; and develop policies on pay, incentives and good
governance.

There is a need for accurate data on migration, including from regulatory authorities.
Codes of practice need more evaluation but appear to have limited effect. Policy dialogue
is needed between all interested stakeholders. WHO is committed to working with
partners and Member States to facilitate this process.

There are other solutions for managing migration. These include investing massively in
education of health workers, supporting continuous professional development in source
countries, incentives schemes, rewarding health workers with good pay, recognition and
achievement awards as well as promoting planning and production mechanisms in both
source and receiving countries.

In plenary discussions, a question was raised as to what should be done to enhance HRH
management in countries. It was noted that the focus should be the country level and
good management of HRH. Joint action was underscored, including working out a global
plan to address the HRH crisis, consideration to bilateral agreements, networks and
closing existing implementation gap of resolutions from various meetings. Political
support is critical to highlight economic factors in migration and retention issues. The
AU’s position paper on the issue of migration observed a need to take the issue beyond
the health sector. However, most African health ministers do not yet support policy
positions on migration. Meetings between African ministers and the Organisation for
Economic Cooperation and Development would be helpful as would exposure to
countries outside Africa and tapping the private sector HRH.

8. Session 5: How to use priority health programmes to ensure HRH at country

level

Three presentations were made followed by plenary clarifications and discussions. They
included the education and training of health workers in Africa by Dr Akpa Gbary of the
World Health Organization; linking HRH to health systems by Dr Lola Dare of
ACOSHED and the role of priority health programmes in HRH in Africa by Dr Sam
Okiror from the Vaccine Preventable Diseases Unit of the Regional Office. The
presentations reflected the joint preparation from several programmes. Group work
followed with four themes:
(a) Overcoming HRH constraints for implementing priority health programmes;
(b) Educating and training health workers;

13
 (c) Links between HRH and health systems performance;
(d) Regional research agenda for HRH.

The groups discussed questions similar to those presented in Section 7.

8.1 Linking HRH to health systems

Dr Lola Dare from ACOSHED identified health systems as the vehicle for the delivery of
the key interventions of known benefits against the priority diseases in Africa. Human
resources are the main asset in this system. Key issues include the need to develop
integrated national health policies and the balancing of investments in service delivery
inputs and human resources. She also highlighted the need to examine the skills mix for
different care packages and the various health system levels. The presentation highlighted
the gaps between production and absorptive capacities in various countries, the fiscal
implication of reacting optimal HR targets and providing a conductive work environment
for performance. She confirmed that Africa falls short on delivery of MDGs mainly due
to the HRH crisis and yet HRH is the glue that holds the health system together as an
integral whole. Tension exists between production and absorption capacities, and the
budget implications are massive. She highlighted guiding principles for action, calling for
a better balance of investments in health systems and service delivery.

8.2 Education and training of health workers in Africa

Dr Akpa R. Gbary from the Regional Office highlighted education and training,
evidence-based planning, learner-centred training, gaps between current training methods
and curricula and priority health needs, and skills mix imbalances. Prospects are seen in
policy dialogue, anticipated increase in financial resources, training cadres more
responsive to health needs, promoting, monitoring and evaluation, and accreditation. He
underlined the need to revive training within a broader health policy context and macro-
economic environment.

8.3 HRH in the context of priority programmes

Dr Sam Okiror underscored that all the programmes and routine service delivery require
skilled HRH. Challenges and constraints to HRH shortages were presented. Key
messages concerned integration, coordination umbrella, policy guidelines, surveillance
and response, integrated training, management and logistics, monitoring and evaluation,
and community involvement.

Participants raised the issue of training retainable cadres unattractive to migration such as
traditional birth attendants (TBAs). Countries were encouraged to take the direction of
training retainable cadres. As regards TBAs, the views were divided, with initiatives left
to countries experiencing difficulty providing primary health care in rural and remote
areas. An accreditation process for health training institutions was welcomed. However,
participants stressed the need to support countries to make requisite corrections or
changes following accreditation visits.

Concerning massive training to fill the gaps caused by migration, participants

recognized that there is no single answer; absorption capacity of countries and
intercountry exchange of HRH should be considered. They also acknowledged the
14
HIV/AIDS impact on the health workforce and the need to provide a package of
HIV/AIDS care and treatment for health workers. Participants noted that there is a
discrepancy between training and health outcomes in countries; doctors and midwives are
trained, but countries lack funds to employ them. Loss from migration is very important
in countries such as Malawi. There is an urgent need to address these issues properly.
Participants advocated for optimal use of resources already available at country level.

Six challenges to HRH development were identified: shortage of skilled health workers;
inadequate funding with low, delayed or no pay; inadequate supervision made worse by
poor HRH management; competing priorities; inadequate pre- or in-service training; and
high staff attrition rates.

9. Session 6: Consensus on action to support HRH development and

implementation

It was observed that the HRH agenda is broad and that the inclusiveness principle should
be observed.

9.1 Gaps that should be addressed

It was observed in plenary that training of existing health workers is a concern that should
be addressed in view of emerging challenges. The training should emphasize
strengthening existing programmes. Training individuals to work in teams that can give
impetus to PHC will be critical for meeting the health-related MDGs.

9.2 Remarks from development partners

CIDA expressed that HRH is a high priority on their agenda. A number of concerns
merit consideration, such as taking stock of the mismatch between training and absorptive
capacity, gender equality and quality. With the process of democratization unfolding in
Africa, there is a need to pay attention to quality of graduates, given the massive numbers
of intakes. Importing health personnel from abroad (Cuba or Russia) should not be
perceived as a solution. CIDA also pointed out the need to rethink the strengthening of
training institutions and to take a closer look at countries and study how they attend to
integration of HRH. They underscored the need to monitor results on supported projects
as well as strengthen accountability.

For DFID, the HRH crisis was not only a numbers game. Extra resources to Africa in the
next 5-10 years as a result of recent EU and G8 initiatives need good preparedness,
including HRH development. It is necessary to tackle the challenge of offering good
quality services from a motivated workforce. The observatory idea is important and
should consider the health labour market requirements and improving productivity and
performance.

The USAID representative stated that their involvement in HRH is piecemeal, and a
comprehensive approach to HRH is new. She promised to take messages back to
decision-makers. A recent PEPFAR meeting reflected on limited capacity; hence, a
capacity building programme has been formulated and is available for use in countries.
Interested parties should contact USAID country programme focal points or the WHO
Regional Office.
15
The World Federation of Medical Education introduced themselves as a potential and
relevant partner concerned with training of doctors at undergraduate and postgraduate
levels as well as quality improvement, continued professional development and use of
standards for institution, self-evaluation and accreditation. They offered to share their
database on quality improvement processes and distance learning procedures. They have
partnerships with WHO, medical schools and associations in countries.

The World Bank emphasized the importance of HRH on its health agenda. Open
discussions with government ministers are ongoing. They are willing to participate in
future cooperation arrangements relevant to this issue.

Participants called for partner flexibility regarding country priorities and situations. The
CIDA collaborative project with Nigeria was referred to as an example worth emulating.
Support from development partners is a subject of intense ongoing discussions. PEPFAR,
the Global Fund and GAVI have HRH components within the health systems context.
The World Bank has launched an Africa health strategy. Countries need to be familiar
with these innovations.

10. Session 7: Consensus on establishment of a regional platform

10.1 Group work

This session was preceded by group work 3: The process for establishing an African
regional platform for HRH. Dr D. Dovlo, a consultant-facilitator, introduced key generic
questions for group work:
(a) Is there a need for an African platform for HRH development? If so, how
should it be different from existing institutions of HRH development? What
are likely to be the key overlaps?
(b) Which institutions should be part of the Platform?
(c) How can the Platform be used to strengthen partnerships and collaboration in
HRH work?
(d) How can countries best relate to the Africa Platform? How can the African
Platform best relate to the Global Platform?
(e) In a year from now, what specific actions would you like the platform to be
doing?
(f) How should the work of the Platform be monitored and evaluated?

Key observations and proposals made by the working groups are summarized below:
• Emphatic endorsement of a platform;
• Need to inform partners and governments;
• Need to share report of this meeting with ministers of health at the fifty-fifth
session of the Regional Committee and African Union (AU) meetings;
• Need for a working group on the Observatory;
• The Observatory would be a technical arm of the Platform;
• WHO should lead and house the Secretariat for the first year;

16
 • HRH should be an agenda at senior level, such as at AU and regional economic
communities;
• Clear criteria for membership of the platform should be drawn, with emphasis that
members must add value and should be multisectoral; a passive membership would
not be advisable;
• There should be strong representation of country members; a coalition of partners,
NGOs and other civil society institutions should be included;
• A subregional platform should relate to national platforms; limited capacity of
some subregional bodies was acknowledged; hence complementarity should be
encouraged;
• Cluster type governance in a multisectoral approach should be promoted;
• Discussion of migration should be taken at UN General Assembly level;
• Actions to be taken in a year’s time include development of terms of reference for
the Platform; advocacy and policy development; create office and appoint staff;
introduce to relevant bodies; solicit funds and establish the Observatory as soon as
possible;
• Develop relevant monitoring and evaluation tools; enhance evidence bases to
inform HRH development;
• Monitoring of implementation should be based on agreed identified indicators.

10.2 Plenary discussions

Presented below are the highlights of observations and suggestions made in the plenary
discussions.

There is clarity on the establishment of the Platform with minor variations. However, it is
not yet clear as to how to guide whomever is going to steer the Platform. The roles of the
Platform should be better defined; accountability for the Platform needs to be clear and it
should be responsive to country-led demands. The Platform already exists by virtue of
this meeting; inclusiveness should be expanded through further consultations; the AU
meeting in October 2005 is an opportunity for further dialogue and advocacy.

The Observatory is a noble idea, but participants cautioned on competing priorities in the
sectors; it was agreed to build on existing structures and look for synergies. The focus
should be on broader health system issues and HRH for more equitable access to quality
health services. Nothing that 15 countries were invited to this consultation, can this
constitute consensus on membership of the Region? How can we bring others who are
not here on board? The need for information sharing and capacity development make the
observatory idea relevant. Looking at functions justifies the need to engage in these
activities, but it is necessary to explore whether there are alternatives. What is the added
value? Migration, multisectoral approach and financing are important issues.

How do we coordinate partners to get the HRH agenda moving forward? WHO has a
mandate for HRH and a dedicated unit at the Regional Office; consideration should be
given to strengthening the HRH unit at WHO. There is a risk of watering down the HRH
issue unless a systematic approach is taken. One strategy could be to combine the WHO
mandate with political support. The Regional Committee meeting in Mozambique in
September 2005 and other forthcoming forums should be utilized to keep up the
17
momentum. Because of diverse issues and pressing country needs, a smaller group could
concretize these ideas and present them to higher forums, taking this agenda forward.
There is need for a stronger partnership that will foster coordination and minimize current
fragmentation.

Migration is a political and complex problem; broad political ownership should be

expected from the AU. The Observatory should not wait; it should move immediately.
The HRH crisis invokes urgency and sufficient organization. The Observatory is
technical and could be housed in the WHO Regional Office. An African-driven steering
committee should be established; this should be an initiating committee that will clarify
the terms of reference for the Platform and Observatory. The size of the steering
committee and its mandate, particularly in terms of resource mobilization, should be
determined. Ministers should be brought on board before going too far. Countries that are
not here should be consulted. The Platform could be hosted by different countries every
year, bringing in a competitive spirit. HRH planning capacity is the emphasis at country
level.

What countries will do immediately after this meeting is critical. It is especially important
to address countries that are not here. MOHs should be briefed on the outcomes of this
meeting. AU meetings of MOHs offer other opportunities. Delegates from countries who
are here should take the message home. Country support and preparedness in light of
anticipated new resource flows are critical. Countries should also mobilize resources. The
dissemination process should go beyond MOHs.

10.3 Proposed actions and recommendations

Actions for the African Platform were proposed as follows:

(a) Determine terms of reference for formation of the African Platform
including structure, reporting lines, role in promoting a common voice,
added value, how countries and global level will relate to the regional level;
(b) Create steering committee for the Platform and Observatory;
(c) Prepare a position paper on HRH migration;
(d) Coordinate experiences and relations.

The detailed recommendations for actions are given in Section 11. The participants came
to an agreement on procedures for establishing a Steering Committee.WHO, NEPAD,
ACOSHED and UNDP should form the core group. They are to take forward the
recommendations of this regional HRH consultation and operationalize the African HRH
Platform.

Members should include countries in subregional groupings (West African Health

Organisation, Southern African Development Community, Central Africa), partners and
international NGOs such as the African Medical and Research Foundation (AMREF).
Suggested geographical representation might include Benin, Ethiopia, Mozambique and
Zambia.

18
11. Summary recommendations for action

Participants made recommendations related to each of the cross-cutting issues and the
seven themes and for the creation of the African HRH Platform that would engage
countries in the Region as well as development and international partners. It instituted a
steering committee to take forward the most immediate and urgent actions and work
towards creating the Platform and HRH Observatory.
11.1 Key cross-cutting issues

(a) Countries should build on what exists and be the main focus of the HRH actions
and changes that need to happen in HRH;
(b) Country and regional partnerships involving health and non-health sectors, public
and private sectors, as well as client and civil society groups should be built or
strengthened;
(c) Financing and political commitment in support of health systems and HRH
development should be promoted;
(d) Good policy development for health and HRH should be promoted;
(e) Broad ownership and accountability for country HRH actions should be created;
(f) Leadership and the technical competencies required to carry things forward in
countries and within the African Region should be fostered.

11.2 Establishing the African Regional HRH Observatory

The main roles of the African Observatory on HRH include:

(a) Serve as a technical facility servicing country networks and the regional Platform
with information on HRH, and to monitor both good and bad experiences for
sharing;
(b) Serve as an “Early warning system” or ”whistle blower” on impending dangers of
HRH situations and health problems;
(c) Facilitate networking of expertise in HRH and health systems;
(d) Involve both private and public resources from both health and other sectors;
(e) Support the Observatory by mobilizing financial, human and logistic resources.
11.3 Creating the African Platform for Human Resources for Health Development

The Platform will be a network of key regional institutions. It will help articulate a
common position and voice for Africa on health systems and HRH issues. The Platform
will engage countries in the region as well as its development and international partners.
A steering committee will take forward the most immediate and urgent actions for the
next 6-12 months.

11.4 HRH policy analysis and options

(a) An African position paper on HRH development should be developed to serve as

a general guideline in order to engage all stakeholders, including civil society;
(b) Policy units must be established at country level to guide HRH research, policy
analysis, policy development and implementation;

19
 (c) Evidence-based HRH policies and strategies must be developed in a context of
broader medium-to-long-term national health policy;
(d) Accountability for national HRH policy implementation must be placed at high
political level with reporting mechanisms, e.g. to Cabinet or Parliament.

11.5 Health workplace situation, management of migration and retention of

health workers
(a) Country systems must place HRH in a context of priority health problems and
overall health system strengthening;
(b) Information sharing on country examples of conducive work environment should
be part of networks and the Observatory;
(c) Involvement of private sector non-health HR management in Africa is a great
resource to be sourced along with donors’ support;
(d) The health position on migration should be integrated with the AU’s position on
general migration from the continent .

11.6 Education and training of health workers in Africa: Challenges and

prospects

(a) Countries should open a dialogue between all relevant ministries to coordinate
decisions concerning training and production of key health workers;
(b) Countries should identify competencies required through thorough task analyses
and prioritization of country needs; they should identify gaps in skills mix for
actions;
(c) Training of lower level (mid-level) health care workers must be geared to meet
specific needs in service delivery and planned with monitoring and evaluation of
impact;
(d) African countries must be assisted to increase capacity of training institutions and
the supply of health workers;
(e) The African Regional Office and Observatory need to collate good practices in
education and training and encourage countries to build on these;
(f) The Platform and Observatory on HRH should enhance networking between
countries.

11.7 Overcoming HRH constraints for implementation of priority health

programmes

(a) A common platform should be established to facilitate buy-in from global

programmes into national plans for more effective use can be made of available
GFATM, GAVI, PEPFAR etc, and resources by increasing alignment with
national strategy and plans;
(b) Countries and the Region should encourage priority health programme financing
to include budgets for developing future HRH by investment or support for pre-
service training;
(c) Key HRH indicators should be identified to influence targets and milestones that
would be integrated into priority health programme plans.

20
11.8 Creating synergies in HRH and health systems

(a) Integrate HRH performance indicators into health systems performance reviews;
(b) Countries should improve the efficiency with which existing HRH resources are
utilized and create comprehensive performance management systems;
(c) Identify good practices and learning communities to test innovations and inform
HRH in health systems;
(d) Work with the African Observatory and relevant stakeholders to conduct periodic
health reviews;
(e) Promote accountability and transparency in HRH and health systems
management;
(f) Promote advocacy and stakeholder dialogue at all levels of HRH and health
systems in the context of broader public sector management and economic
reforms.

11.9 A research agenda for HRH in Africa

(a) The valuable existing research findings should be collated and information made
accessible through appropriate network technology;
(b) African research centres of excellence that may focus on key theme areas should
be identified and coordinated;
(c) Capacity should be built through development and use of research toolkits for
skills generation;
(d) In countries, national research forums must be developed as part of networks
linked to the proposed Observatory;
(e) There is need to focus on priority evidence needs, including HRH and health
systems, enhanced health sector performance, evaluation of HRH interventions
such as use of mid-level and substitute health workers, impact of brain drain and
HIV/AIDS on HRH;
(f) Researchers and research institutions must also engage health managers and
policy-makers to generate common country research aims and vision.

12. Closing session

A communiqué was read and adopted by the meeting participants. This was followed by
statements by the Chairperson, participants’ representative and partners and then closing
remarks by the WHO Regional Director. Dr Shehu Sule from Nigeria, the Chairperson,
recalled that the meeting dedicated itself to an important agenda for Africa. He thanked
all who participated in the deliberations. Professor Yayehyirad Kitaw from Ethiopia, on
behalf of the participants, remarked about an accelerated programme to increase health
service coverage with immense challenges emerging. The consultation had been an
opportunity for solidarity with African colleagues. Speaking with a common African
voice will help move the HRH agenda forward at this critical time.

Professor Lincoln Chen, WHO Special Envoy on HRH, thanked the Regional Office,
NEPAD, ACOSHED and country participants for a successful meeting which achieved a
breakthrough in terms of reaching consensus. He welcomed an emphasis on country-
based action that will be in harmony with anticipated expansion of overseas development
21
assistance. The challenge will be to use the additional resources effectively. The meeting
recommendations focus on these and other challenges. Mr Stevan Lee, DFID
representative, expressed his satisfaction that the meeting has looked at African countries
taking charge of HRH development in the continent. Dr Lola Dare, ACOSHED
Executive Secretary, commended WHO’s efforts and facilitation of a successful meeting.
She expressed delight on the outcome of this consultation and her willingness to continue
this fruitful collaboration. Professor Eric Buch, on behalf of NEPAD, thanked WHO for
making the consultation a success. The HRH Unit at the Regional Office was
acknowledged as well as the WHO Special Envoy, Special Advisor to the Director-
General and other partners for their dedicated participation.

In his closing remarks, Dr Luis Gomes Sambo, the WHO Regional Director, recalled the
deteriorating health indicators in many countries. He underscored the need to do
something differently in a new dynamic. He noted that WHO is faced with resource
constraints although the issue of HRH is high on the agenda. He observed that we are
now faced with a need to translate policy and resolutions to concrete actions and results.
He confirmed that we are not constrained with knowledge but resources. He offered that
WHO will be happy to play host to the Platform with full commitment towards
promoting realization of the MDGs. He pointed out the readiness of WHO to play a key
role in putting the coming additional resources to full use. He however underlined the
need for clarity about institutional arrangements. He stressed the need for clear processes
in partnerships according to the comparative advantage of each partner. To implement
new ideas, additional funding will be required. He declared WHO’s full commitment to
taking the HRH agenda forward at country level.

13. Conclusion

In this unprecedented partnership, WHO, a civil society organization (ACOSHED) and a

regional organization (NEPAD) were able to bring together a broad range of
stakeholders. Issues discussed went far beyond human resources for health and embraced
health systems and macroeconomics. The recommendations proposed by participants
focused on country-led action, brokering partnerships at country and regional levels,
strengthening implementation of technical components, making optimal use of existing
resources and mobilizing additional ones.

The advocacy for HRH development and health systems strengthening should be
maintained using regional and international forums and events. The recommendations of
the meeting need to be implemented and followed up to keep the momentum and move
the HRH agenda forward.

22
Annex 1: Agenda for the consultation

Day and time Session Responsible

Day 1: Monday, 18 July 2005: Chairperson Dr Simon Miti
8.00 – 9.00 Registration of participants
9.00 – 09.45 Session 1: Official opening
a. Welcoming and opening remarks WHO: Dr A.J. Diarra-Nama,
ACOSHED: Dr L. Dare, NEPAD:
Dr E. Buch
b. Opening address RD (WHO) Dr L. G. Sambo
c. Presentation of objectives and expected Director of Health Systems and
results Services Development (DSD) Dr
A.J. Diarra-Nama
d. Election of office bearers Dr A.J. Diarra-Nama
e. Introductory presentation on the 7 themes of Facilitator (Dr D. Dovlo)
the consultation
f. Group photo Secretariat
09.45 -10.15 Tea Break
10.15 -10.30 Security briefing Field Security officer
Administrative announcements Administrative officer-DSD
Session 2: Progress on HRH since the Abuja forum
10.30 – 12.30 a. Review of summary plans of action and a. WHO (Jennifer Nyoni)
agreements reached in Abuja and Oslo and the
establishment of a TWG and Global Platform

b. Discussion b. Facilitators (Dela Dovlo, Eric

Buch)
12.30 – 14.00 Lunch
14.00 – 15.00 Session 3: The Platform and partnerships
Building/strengthening partnerships for HRH Francis Omaswa
development

A regional platform for HRH development for Eric Buch

Africa

Discussion Facilitators
Session 4: Reaching consensus on policy options, actions and the HRH Observatory
15.00 – 16.00 a. Policy analysis and options a. Eric Buch
b. African Regional HRH Observatory b. Jennifer Nyoni/ Lola Dare
c. HRH workplace situation, migration and c. Barbara Stillwell/ Magda
retention. Awases
d. Discussion d. Chairperson
e. Group Work (Introduction to group work) e. Facilitators
16:00 – 16:30 Tea break
16:30 – 18:00 Group work Facilitators
Day Two, Tuesday, 19 July 2005: Chairperson Dr Benoit Faihun
8.00 – 9.30 f. Report back to plenary and discussion f. Group rapporteurs
9.30 -10.00 Tea Break Secretariat

23
 10.00 – 12.00 Session 5: How to use priority health programmes to ensure at HRH country level
10.00 – 11.00 a. Education and training of health workers in a. Akpa Gbary
Africa
b. Overcoming HRH constraints for b. Sam Okiror
implementation of priority health programmes
d. Discussions d. Chairperson
e. Group work (Introduction to group work): Ways e. Facilitators
and means to ensure availability of health
11.00-12.30 workers for health interventions at country level

12.30-13.30 Lunch break

13.30 – 14.30 Report back to plenary and discussions Group rapporteurs

Chairperson
4.30 – 16.00 Session 6: Consensus on actions to support HRH development and implementation
a) Collation to date Facilitators

b) Remarks by development partners CIDA, DFID, USAID, WFME,

WB
16.00 – 16.30 Coffee Break
16.30 – 18.00 Session 7: Consensus on establishment of a regional platform

Group work and Platform objectives, structure and Eric Buch

functions
Group work Facilitators
18.00 – 19.00 Cocktail Secretariat
Day three, Wednesday, 20 July 2005: Chairperson Dr Shehu Sule
08.00- 10.00 Session 7 continued: Group rapporteurs
Reports back to plenary
Discussions/reaching consensus
10.00- 10:00 Coffee Break

10.30-11.30 Summary of recommendations, actions, Facilitators

responsibilities and timelines
Discussions
11.30-12.00 Break
12:00– 13:00 Closing ceremony:
Presentation of recommendations 1. Chairperson: Dr Shehu Sule
Remarks by a representative of country participants 2. Prof. Yaye Kitaw
Remarks by WHO Special envoy on HRH 3. Dr Lincoln Chen
Remarks by a representative of partners 4. Mr Stevan Lee (DFID)
Closing address by the WHO Regional Director 5. Dr Luis G Sambo
13:00 – 14.00 Lunch
14.00 – 17.00 Informal consultations/departure

24
Annex 2: List of participants

1. ORGANIZATION/COUNTRY

BENIN MALAWI

Dr Bénoit Failhun Professor R Broadhead

Secretary General Dean College of Medicine
Fax 002581-321528 Private Bag 360 Chichiri
P.O. Box 882 Blantyre 3 Malawi
Fax No.(229) 339464 Fax No.1,674,700
Tel. (229) 331299 Tel. 01677291/245
benfaihun@yahoo.com rlbroadhead@sdnp.org.new

BURKINA FASO MOZAMBIQUE

Mr Benjamin Sanon Dr. J F Manuel Tomo

Director HRD (MOH)
03 B.P. 7009
Fax No. (226)50313659
Tel (226) 70264396
sanonbenji@yahoo.fr
Director HRD
Ministry of Health
Tel. 002581-321528
P.O. Box 264, Maputo
Tomolorge@hotmail.com

ETHIOPIA NIGER

Mr Yohannes Tadesse Mr Abdramane Salifou

Head of health services training Director General
(251)1 159976 Fax (00227)733570
P.O. Box 1234 Tel (00227)722531/997363
hstdfmoh@ethionet

Prof Yaye Kitaw NIGERIA

ACOSHED Chapter
5139 Center for National health
Development
Fax No.(251) 1 189897
Tel. (251)1 189818
yayehyirad@ethiopianet.et
Dr Shehu Sule
Director of learning P, R FEDMOH
Fax No. 234-95238367
Tel. 234-9-5238367
ShehuSule2@hotmail.com

Dr A Ladiran
GHANA HRD FEDMOH

Dr Ken Sagoe Mr E A. Arohunmolase

Ghana Health Services ACOSHED Chapter
Fax No. 23321670329
Tel. 23321670329 SOUTH AFRICA
kensagoe@yahoo.co.uk
Dr Phetsile Dlamini
ZAMBIA NEPAD/AU Adviser to Minister
of health RSA
Dr Simon Miti Private Bag X828
MOH Permanent Secretary Tel. 3120801
P.O. BOX 30205 dlamini@health.gov.za
FAX No. 01-250925
TEL. 01-252989
mitsk@yahoo.com

25
 UGANDA Veronica Mwiche
Pablic Service Management Div.
Prof Nelson K Sewankambo P.O. Box 30208
Dean of School of Medicine, Makerere Fax No. 260 1251920
P.O. Box 7072 Tel. 260 1 252676
Tel. 256(41)530020 veronica_mwicho@yahoo.co.uk
Sewankam@infocom.co.ng

2. Representatives of International NGOs

Dr Festus Ilako
Deputy Country Director, AMREF
African Medical and Research Foundation
P.O. Box 30125.001
Fax No. 606433
Nairobi, Kenya
Filako@amrefke.org

Prof Kayode Odusote

Director, HRD
WAHO/ECOWAS
01 B.P.153 Fax No. 20975546
Tel. 20969874
Bobo Dioulasso, Burkina Faso
Kodusote@yahoo.com
Kodusote@wahooas.org

Emily Sikazwe
Executive Director
Women for Change

Petrida Ijumba
P.O. Box 401
EQUINET
Fax No. 27313040775
Tel 27313072954
petrida@hst.org.za

Desiree Mhango
Representative
Christian Health Association for Malawi
P.O. Box 30378
Fax No. 265 1 775 406
Tel. 265 1 775 404
dmhango@cham.org.nnaw

3. Development partners

Dr. Neil Squires

Health AIDS and Population Human and Social Development Unit
European Commission Office G-12 05/93
BE 1049 Brussels Belgium
Fax No.32 2 296 3697
Tel. 32 2 295 90 95
Neil.Squires@.cn.int

Dr Karin Kanewske Turner

USAID Regional HIV/AIDS Program Southern Africa

26
43, Groenhloof
Fax 27 124522399
Tel 27124522218
Katurner@usaid.gov

Dr L Mukenge-Tshibaka
Senior health Specialist
Canadian Int. Dev. Agency 200,
promenade du Portage Gatineau (Quebec)
Canada K1A 0G4
Fax No.819 994-6174
Tel. 819 9532086
Leonard_mukengetshibaka@acdi-cida.gc.ca

Dr Peggy Thorpe
Health specialist Policy, planning & technical services
200 Promenade du Portage, Hull Quebec
Fax No. 011 18 199 53 58 45
Tel 011 18199530578
Peggy_Thorpe@acdi-cida.gc.ca

Stevan Lee
Economist & Team leader, DFID
1 Palace street London, SW 1E 5HE

Dr Laura Rose
World Bank
Task Team leader Ghana
M27 Accra

Dr Hans Karle
President, WFME
Fax No. 45 3 5327070
Tel 45 3 5327103
wfme@wfme.org

Professor Leif Christensen,

Senior Advisor to WFME

Prof Francis Omaswa

Senior Advisor to the Chief of Operations
Geneva
WHO HQ – EIP GFATM
omaswaf@who.int

Dr Zola Njongwe
Health policy and management
Uinversity of Pretoria
Fax: 27 1 28413328
Tel. 27 1 28413281
Zola.njongwe@up.ac.za

Daisy Mafubelu
Health Attache Geneva
South Africa Government
65 rue du Rhone 1204 Geneva
Fax No. 41 2 28495438
Tel. 41 2 28495442
Daisy.mafubelu@ties.itu.int

27
4. Others

Dr Delanyo Dovlo
Members (Multidisciplinary Group of experts for HRH) MAG
CT 5203 Cantonments, Accra Ghana
2.33245E+11
dovlod@yahoo.com

Ms K Mutirua

Prof César Akpo

P.O. Box 188
Fax 229 30 40 96
Tel. 229 30 50 19
fssciuf@intnet.bj

Prof Van Niekerk

Dr S Adebisi
University of Ilorin, Nigeria
WHO collaborating centre
Pm. B 1515
Fax: 23 4 031221615
Tel. 23 4 8033563489
Simeonadebisi2003@yahoo.com

Prof S. M. Mogotlane
UNISA, South Africa
WHO collaborating centre
P.O. Box 392
Fax: 012 429 66 88
Tel. 124 296 303
mogotsm@unisa.ac.za

Prof Khaled Bessaoud

IRSP
WHO collaborating centre
918 Cotonou, Benin
Fax: 229 341672
Tel. 229 341 673
bessaoudk@afro.who.int

Dr Lincoln Chen
Special Envoy of the Director General, WHO on HRH
lcchen@fas.harvard.edu

5. Secretariat

Dr A. J. Diarra-Nama
Director, Division of Health Systems and Services Development
Fax: 4 724 139 200
Tel. 4 724 139 200
diarraa@afro.who.int

Dr A Gbary
Regional adviser, Human Resources for Health
Fax: 4 724 139 511
Tel. 4 724 139 284
gbarya@afro.who.int

28
Mrs M Awases
Regional adviser, Human Resources for Health Systems Dev.
P.O. Box 6
Fax: 4 724 139 511
Tel. 4 724 139 273
awasesm@afro.who.int

Mrs M Phiri
Regional adviser, Human Resources Management
P.O. Box 6
Fax : 4 724 139 511
Tel . 4 724 139 261
phirim@afro.who.int

Ms J Nyoni
Regional adviser, Human Resources for Nursing
P.O. Box 6
Fax: 4 724 139 511
Tel. 4 724 139 236
nyonij@afro.who.int

Dr M Ovberedjo
Health systems specialist
P.O. Box 6
Fax: 4 724 139 511
Tel. 4 724 139 291

Dr P Tumussime
Regional adviser, District Health System
P.O. Box 6
Fax: 4 724 139 511
Tel. 4 724 139 247
tumusiimep@afro.who.int

Dr A Mawaya
Regional adviser, Long Term Development
(LHD) (DES)
mawaa@afro.who.int

Dr da Silveira
Medical Officer, Training for Malaria Control
Division of AIDS, Tuberculosis and Malaria control, MAL
Harare, Zimbabwe
dasilveiraf@whoafro.org

Dr Daniel Kibuga TUB (HRE)

Medical Officier, Tuberculosis Control (TUB)
Division of AIDS, Tuberculosis and Malaria control,
Fax: 4 724 138 008
Tel. 4 724 138 074
Harare, Zimbabwe
kibugad@whoafro.org

Dr Sam Okiror
Medical Officer, Vaccine Preventable Diseases
Division of Communicable Diseases Control, (DDC)
Fax: 4 724 138 004
Tel. 4 724 138 131
Harare, Zimbabwe
okirors@whoafro.org

29
Dr G Gedik
Department of Human Resources for Health, Headquarters
WHO/HQ, 1211 Genève 27 Switzerland
Fax: 41 2 27914747
Tel. 41 2 27912332
gedikg@who.int

Ms B Stillwell
Coordinator, Training and Migration of health workers, Headquarters
WHO/HQ, 1211 Genève 27 Switzerland
Fax: 41 2 27914747
Tel. 41 2 2791470
stilwellb@who.int

Prof. Eric Buch

Health advisor (NEPAD) University of Pretoria
1234 Halfway House, Midrand, 1685
Fax: 27 1 28413301
Tel. 27 1 28413215
Eric.buch@up.ac.za

Dr Lola Dare
Executive Director (ACOSHED)
28 Aare Av. New Bodija Ibadan, Oyo State
Fax: 234 28102405
Tel. 234 28102401
acoshed@yahoo.com

Mrs Jumoke Seweje

Programme Officers /Nigeria
29 Aare Av. New B0dija Ibadan, Oyo State
Fax: 234 28102405
Tel. 234 28102401
ACOSHE@yahoo.com

Mrs B. Salami
29, Aare Av. New Bodija Ibadan, Oyo State
Fax: 02 8102405
Tel. 02 8102401
bunmisalami2002@yahoo.com

Anne Githuku
UNDP/ Southern Africa Capacity Initiative
Johannesburg, South Africa
anne.githuku@undp.org

Dr Adzodo K. M. Rene
WHO Country Office, 1504, Lomé, Togo
228 221 78 32
228 221 33 60
adzodom@tg.afro.who.int

Dr Elihuruma Nangawe
WHO Country Office, 9292, Dar es Salaam, Tanzania
Tel. 255,744,784,405
nangawee@tz.afro.who.int

30
Honsou/Benin

Bruce/Benin

Simpson/Nigeria
19 Gnassingbe Eyadema Street, Asokoro, Abuja
Fax 93 1 41752
Tel. 93 1 41752

S Tettley/Ghana

31