{Photo credit: Todd Shapera}Photo credit: Todd Shapera

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Worldwide, there are severe shortfalls in the health workforce—not just in the quantity of doctors, nurses and other health workers, but in their management, performance and geographical distribution.

These shortfalls are particularly glaring in light of the global movement for universal health coverage, progress toward which will require a high-functioning workforce.

This month’s third Global Forum on Human Resources for Health, which convened global health policymakers in Recife, Brazil, trumpeted the need for political commitment to health workforce strengthening. With UHC a top priority of conference sponsors like the World Health Organization, conference discussions were framed as seeking solutions—such as improving retention and performance, or health workers’ advocacy—“toward UHC.”

When I worked in Smallpox eradication in the mid-1970s, I traveled all over northern India and Bangladesh. I never took malaria prophylaxis, because malaria had been cleared from those areas. Likewise, I did not take malaria prophylaxis when I worked in the Brazilian Amazon in the late-1970s. At that time, malaria was found only in gold miners in isolated tributaries of the Amazon. Now, due to our financial inability to continue high levels of malaria eradication activities worldwide in that time period, emergence of both anti-malarial and insecticide resistance, and spread of the mosquito vectors, all of these are heavily malaria endemic areas with a high mortality rate for pregnant women and children.

The World Health Organization (WHO) recently released the World Malaria Report 2012, summarizing 2011 data from 104 malaria-endemic countries and citing progress and challenges toward the eradication of malaria.

Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.

In the 1990s many Brazilian patients infected with tuberculosis (TB) were not being cured, despite starting treatment. Some patients stopped taking their medication, which led to the reemergence of TB. In 1993, the World Health Organization declared that TB was a global emergency. Eventually, a multi-resistant strain of TB surfaced, making it even more difficult to fight the disease.

These occurrences --- referred to as “chronic cases” --- became apparent in some Brazilian states, but health units lacked standardized management systems to treat these cases of TB.

Centro de Referência Professor Hélio Fraga (CRPHF), which is Brazil's National Tuberculosis Reference Laboratory, took control of TB surveillance in 1994. CRPHF defined a more effective treatment scheme and a national network to register and monitor the chronic cases in 1999. CRPHF builds human capacity through training and carries out operational and epidemiological studies. They also evaluate TB and other lung disease control activities and function as a Macro Regional Reference Lab.

A child born in Ghana today will most likely receive a full schedule of immunizations, and her chances of surviving past the age of five are far better than they were a decade ago. Today Ghana boasts a coverage rate for infant vaccination of 90 percent and hasn’t seen an infant die of measles since 2003.

Ghana has been expanding primary health care by bringing services to people’s doorsteps since the 1980s, and since the early 2000s has done so in the context of a commitment to universal health coverage. The secret to its success in child immunization has been both integration and decentralization of health services: Government funding for all health activities is provided through a "common pot." District-level managers are responsible for local budgeting and service delivery. Local staff provide comprehensive rather than specialized care.

Ghana is one of a growing number of low- and middle-income countries demonstrating that strong performance in immunization can go hand-in-hand with the aspiration of universal health coverage, access for all to appropriate health services at an affordable cost.

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