11 HUMAN RESOURCES

States Parties who invest in the development of competent and well-motivated health personnel at all levels of the health system put themselves in a stronger position to effectively implement the IHR. This involves deliberate and consistent planning, resourcing, management and evaluation to ensure the education and employment of a health workforce that is competent to prepare for, prevent, detect, assess, notify, report, respond to and recover from health emergencies.

The workforce includes, but is not limited to, public health specialists and related occupations (e.g. biomedical technicians, biostatisticians epidemiologists, laboratory scientists and technicians, etc.), the clinical professions (e.g. midwives, nurses, pharmacists, physicians, etc.) and others (e.g. social scientists, communications personnel, occupational health personnel, information technology (IT) specialists, etc.). There is a corresponding and overlapping workforce in the animal and environmental sectors (e.g. animal health professionals, environmental health personnel, veterinarians and para-veterinarians, etc.) that are essential for health security measures. The workforce also includes personnel from a wide group of other allied occupations beyond the health sector who contribute to addressing the determinants of health, such as personnel engaged in water and sanitation, food supply chains and road safety.

The pursuit of health security, universal health coverage and health-related development goals requires investment in national health system capacity, with a focus on primary health care and public health. National and subnational system capacity is dependent on an integrated, multisectoral and multidisciplinary workforce that can deliver all essential public health functions (EPHFs), including emergency preparedness and response. It is critical that countries develop multisectoral workforce strategies that are informed by mapping and measuring the occupations that contribute to EPHF delivery, as well as regular health labour market analyses to assess health worker capacity requirements for the delivery of routine services and the ability to readily mobilize (surge) health workers in the event of an emergency or disease outbreak, based on caseload weight and other defined measures.

IMPACT:

Prevention, detection and response activities (including health promotion, occupational health safety and security, and appropriate care of those affected) are conducted effectively and sustainably by a competent, coordinated, motivated and occupationally diverse multisectoral health workforce.

MONITORING AND EVALUATION:

(1) The availability of a competent, supported and motivated health workforce to implement the IHR. (2) Existence of a corresponding workforce in the animal sector.

Benchmark 11.1

An up-to-date multisectoral workforce strategy is in place

Objective To develop and implement a valid (recognized by law or official government protocols) and up-to-date (no older than 5 years) workforce strategy for a functional multisectoral health workforce

01 NO CAPACITY

  1. No multisectoral workforce strategy or governance and leadership mechanisms are in place.

02 LIMITED CAPACITY

  1. Identify a national coordination working group (with ToRs) including all relevant stakeholders and sectors who can contribute to the development, strengthening and maintenance of a multisectoral workforce strategy. *
  2. Assess and document the country’s current health workforce strategy, including the education, training and other capacity needs for strengthening of a multisectoral workforce. *
  3. Develop a draft or quasi-functional multisectoral workforce strategy. *
  4. Develop a One Health workforce strategy, if not already included, as part of the multisectoral workforce strategy. *
  5. Build capacity to develop or improve human resources for health policy and strategies that quantify health workforce needs, demands and supply under a variety of potential scenarios
  6. Develop a plan to fund and implement the multisectoral workforce strategy (animal and other relevant sectors) including donor and stakeholder contributions before and during a health emergency

03 DEVELOPED CAPACITY

  1. Develop protocols, SOPs and technical guidelines for regular review and updating of the multisectoral workforce strategy. *
  2. Conduct advocacy to relevant stakeholders, including ministries of health, finance, planning and administration/civil service, to implement the strategy *
  3. Establish a national case for investment in human resources for health as a vital component of the Sustainable Development Goals, universal health coverage, health security and universal access to healthcare. *
  4. Develop a framework to promote the social, legal and economic protection and rights of health and care workers in health emergencies including their occupational safety. *
  5. Create appropriate job classifications and descriptions for health workers at all levels of relevant ministries, with clear career progression *
  6. Develop minimum standards for human health staffing levels, using methods such as the Workload Indicators of Staffing Need.
  7. Develop minimum standards for the staffing levels of personnel addressing One Health issues.
  8. Form a governance and leadership body (with ToRs, embedded within a competent national structure) in charge of the management of human resources for health emergencies, bringing together government decision-makers, leaders in the health ministry and other health related ministries and community leaders.

04 DEMONSTRATED CAPACITY

  1. Monitor and evaluate the implementation of the multisectoral workforce strategy (including financing and operations) to track progress and barriers and document annual reports. *
  2. Allocate a sustained domestic budget to ensure implementation of the multisectoral workforce strategy. *
  3. Document and disseminate annual reports of the completed and implemented multisectoral workforce strategic plan. *
  4. Develop a strategic framework to nationally prioritize resources and investments in workforce development to support One Health activities. *
  5. Map and align investments in human resources for health with the current and future needs of the population and health systems. *
  6. Distribute health and care workers to enable maximum improvements in health outcomes, social welfare, employment creation and economic growth.

05 SUSTAINABLE CAPACITY

  1. Adopt, review and revise the multisectoral workforce strategy regularly. *
  2. Incorporate appropriate incentive packages and strategies to attract, train and retain competent personnel to meet national and subnational needs within the multisectoral workforce strategy. *
  3. Allocate funding for regular and fair payment of the health workforce at the national and subnational levels. *
  4. Establish national health workforce registries of competent and practicing personnel and collect key performance indicators.

Benchmark 11.2

Human resources are available to effectively implement IHR

Objective To develop a health workforce that is available and competent to prevent, detect, assess, notify, report and respond to health emergencies of domestic and international concern and health service provision (such as epidemic preparedness and control) at all levels of the health system to effectively implement IHR.

01 NO CAPACITY

  1. The country has negligible human resources capacity in relevant sectors required to prevent, detect, assess, notify, report and respond to health emergencies including epidemic preparedness and control.

02 LIMITED CAPACITY

  1. Identify a responsible unit and advisory committee for the development of human resource capacity to meet IHR capacity needs. *
  2. Conduct engagement meetings with relevant sectors to expand the multisectoral health workforce strategy to include IHR capacity needs. *
  3. Identify the needs, as well as current availability and distribution, of human resources for health capacities, including the workforce for IHR implementation. *
  4. Actively engage international organisations (IOs)/NGOs/civil society organized associate health worker groups (such as community first aid responders and Red Cross/Crescent volunteers). *
  5. Establish or strengthen national rapid response teams, ensuring they are multidisciplinary and multilevel. *
  6. identify the human resources needs that are required to support preparedness and response.
  7. Identify licensed professionals with veterinary or paraveterinary skills to incorporate into the national rapid response teams.

03 DEVELOPED CAPACITY

  1. Monitor policies and plans to increase the multisectoral animal and human health workforce and promote the recruitment and retention of qualified multidisciplinary staff. *
  2. Establish a database of human resources in relevant sectors and levels of the public health system that can provide multidisciplinary health personnel during health emergencies with SOPs for updating and maintenance. *
  3. Understand the size and profile of the workforce that contributes to the delivery of essential public health functions (EPHFs) by conducting mapping and measurement of occupations at the national and subnational levels. *
  4. Develop mechanisms to facilitate the rapid deployment of local and foreign health and care workers during health emergencies (including workforce from the Global Strategy Preparedness Network (GSPN) and Global Outbreak Alert and Response Network (GOARN)). *
  5. Establish ToRs and job descriptions for subnational level (provincial, district) rapid response teams and public health officers in charge of outbreak preparedness and response. *
  6. Develop and implement capacity-building packages and plans including basic training for community health workers and volunteers, civil societies and community based organizations on prevention, early detection, preparedness, readiness and response to health emergencies at community and local levels. *
  7. Establish a transparent process to select decision-makers and leaders who will be engaged in stewardship activities for effective management of human resources for health emergencies. *
  8. Initiate annual reporting of the total active stock of health and care workers in the national health workforce accounts.
  9. Recruit licensed professionals with veterinary or paraveterinary skills.
  10. Mobilize relevant workforces to increase the multisectoral workforce for IHR implementation.
  11. Provide information to the database of in-country multidisciplinary subject matter experts from relevant sectors.
  12. Provide relevant workforce for deployment during health emergencies

04 DEMONSTRATED CAPACITY

  1. Use the data obtained from mapping and measurement of occupations to identify gaps in the national workforce capacity, conduct evidence-based planning and policy making and create projections for future needs. *
  2. Mobilize resources to ensure each local level has the needed capacity for epidemiology, case management, laboratory services, One Health and other specialties. *
  3. Monitor and address public health workforce preparedness needs (quantity, quality) continuously at the national and subnational levels.. *
  4. Develop and implement guidance and procedures for health and care workers (including community health workers and health volunteers) to enable them to better contribute to emergency management activities including prevention, detection, assessment, notification and response.
  5. Provide resources at local levels to ensure One Health workforce capacity as needed.
  6. Empower strategic leaders of national public health agencies and/or equivalent to utilize communication channels with direct access to high level decision-makers in government relevant to human resources for health.

05 SUSTAINABLE CAPACITY

  1. Conduct annual data collection on the workforce which contributes to the delivery of EPHFs and progressively incorporate this reporting into the national health information systems and national health workforce accounts. *
  2. Use this data to update and inform the national multisectoral workforce strategy annually (Benchmark 11.1). *
  3. Review national preparedness and response plans as well as legal and regulatory frameworks and establish protocols, SOPs, technical guidelines and toolkits to send and receive multidisciplinary health personnel during health emergencies. *
  4. Review, evaluate and update policies or procedures for sustainable appropriate human resources in all relevant sectors according to IHR provisions. *
  5. Establish a sustainable mechanism to ensure the availability of health and care workers to cover IHR needs in routine circumstances and during health emergencies, at national and subnational levels. *
  6. Participate in regional/ international initiatives to support health emergency leadership coordination for human resources for health across countries by relevant sectors. *
  7. Conduct periodic health labour market analyses to understand key policy questions and devise strategies to address labour market gaps.
  8. Review, evaluate and update policies and procedures for sustainable appropriate human resources in relevant sectors according to the IHR provisions.

Benchmark 11.3

Fit-for-purpose competency-based education programmes are available for multisectoral workforce

Objective To develop functioning competency-based education programmes including workplace-based learning and in-service programmes aligned with the multisectoral workforce strategy at all levels

01 NO CAPACITY

  1. No formal multisectoral competency-based training programme(s) is (are) in place or efforts are ad hoc.

02 LIMITED CAPACITY

  1. Map the required workforce training needs for the different EPHFs and occupational groups aligning with the multisectoral health workforce strategy. *
  2. Identify and document existing preservice and in-service training programmes, including educational outcomes, specific to different health workforce occupational groups. *
  3. Identify and document all trainings related to contingency planning, management of emergencies, RCCE and joint exercises for multidisciplinary teams. *
  4. Identify and document the quality of existing training programmes and educational provisions, including accreditation and quality standards where known. *
  5. Publish a national list of competency-based training programmes leading to licensing or certification available in the country including national training institutes, professional bodies, schools of public health, nursing, midwifery, veterinary, medical colleges and universities that provide continuing professional education (CPE). *
  6. Map relevant public health multidisciplinary workforce curricula, with universities and partners, for all IHR human resource requirements (such as field epidemiology training programme curricula, materials, mentors, evaluation procedures and accreditation). *
  7. Develop competency-based training programmes to address the training needs at the national and subnational levels, including transitions to practice with supportive supervision as a pathway, for example. *
  8. Develop a mechanism to track training outcomes including the competence of learners, absorption and retention in the labour market. *
  9. Map required workforce competencies in relevant sectors to align with the multisectoral health workforce strategy and identify training needs for their workforce/cadres.
  10. Identify and document training programmes, curricula and educational programmes related to contingency planning, management of emergencies, RCCE and joint exercises for multidisciplinary teams.
  11. Contribute to the development of competency-based training programmes for One Health

03 DEVELOPED CAPACITY

  1. Establish competency-based standards for the workforce in each relevant sector to guide training. *
  2. Operationalize competency-based education programmes that address identified training needs, including content on surveillance, outbreak preparedness and response. *
  3. Develop and implement in-service competency-based training on surveillance, outbreak preparedness and response for specific occupational groups at the national level, at minimum. *
  4. Conduct at least one level of a field epidemiology training programme (FETP) (basic, intermediate or advanced) or comparable applied epidemiology training programme. *
  5. Organize trainings for managers and leaders to improve management and leadership skills in the workplace. *
  6. Define rules and incentives to facilitate and ensure the participation of all health workers in relevant in-service training programmes..
  7. Participate in competency-based education, trainings and programmes where relevant to the sector.
  8. Conduct at least one level of a field epidemiology training programme for veterinarians (FETPV) or comparable training programme including for other relevant One Health workforce occupations.
  9. Develop trainings for the legal workforce on public health law including public health emergency legal preparedness at the national level.

04 DEMONSTRATED CAPACITY

  1. Implement short competency-based trainings on surveillance, outbreak preparedness, response, incident command system and RCCE for specific occupations at the national and subnational levels. *
  2. Develop measures to assess and monitor the implementation of in-service training programmes that are aligned with the country’s training strategy. *
  3. Conduct at least two levels of FETP (basic, intermediate and/or advanced) or comparable applied epidemiology training programme(s) in the country, or in another country through an existing agreement. *
  4. Explore and implement measures to organize and finance advanced trainings and continued education programmes in public health, including epidemiology, laboratory, animal and environmental health. *
  5. Organize, at the national level at minimum, in-service joint-training programmes with the health sector on surveillance for professionals from relevant sectors, to help them better interact with health emergency experts.
  6. Conduct at least two levels of FETPV or comparable training programme including for other relevant One Health workforce occupations in the country or in another country through an existing agreement.

05 SUSTAINABLE CAPACITY

  1. Build mechanisms that ensure strict adherence to nationally or internationally recognized standards for competency-based training programmes where applicable. *
  2. Expand current public health and FETP to include refresher courses alongside induction programmes for field epidemiologists, regular in-service programmes and continuing professional development programmes. *
  3. Mobilize resources to ensure a trained workforce for all IHR relevant emergencies/hazards. *
  4. Lead or participate in peer-to-peer initiatives to strengthen capacities globally. *
  5. Continue and expand CPE trainings and retention programmes for specialized health personnel involved in IHR implementation in difficult to access areas.
  6. Document and share country experiences on competency-based training, programmes and education for the health workforce.
  7. Document and share experiences on competency-based trainings, programmes and education for the workforce.

Benchmark 11.4

Multisectoral workforce surge strategy for health emergencies is well established and functional

Objective To develop and implement a valid (recognized by law or official government protocols) an up-to-date (no older than 5 years) workforce surge strategy for health emergencies

01 NO CAPACITY

  1. The country does not have a national multisectoral workforce surge strategic plan for health emergencies, or is still under development.

02 LIMITED CAPACITY

  1. Initiate development of a multisectoral workforce surge strategic plan by the national coordination working group for multisectoral workforce strategy to staff, roster, prepare and train the workforce at the national level. *
  2. Conduct a situational analysis on existing policies/plans and methods for multisectoral workforce surge during health emergencies and identify gaps. *
  3. Identify relevant agreements and/or MOUs needed between different health programmes to ensure a cohesive multisectoral surge strategy for large scale activation. *
  4. Conduct a gap analysis of surge capacity and training needs required in health and relevant sectors for health emergencies. *
  5. Initiate plans to disseminate the multisectoral workforce surge strategic plan for health emergencies to all relevant staff and stakeholders. *
  6. Identify relevant agreements and/or MoUs needed between relevant sectors to ensure a cohesive multisectoral surge strategy for large scale activation.

03 DEVELOPED CAPACITY

  1. Implement the multisectoral workforce surge strategic plan for health emergencies at national level. *
  2. Develop or update policy for surge staffing for health emergency response for staff welfare, overtime and insurance measures. *
  3. Develop training packages to orient and build the capacity of the multisectoral surge workforce. *
  4. Develop and maintain a network of trained multisectoral surge teams at national level. *
  5. Document and implement the procedures for predeployment, deployment and postdeployment of the multisectoral surge workforce at national level. *
  6. Develop ToRs for all relevant units and departments based on the multisectoral workforce surge strategic plan at all levels. *
  7. Conduct SimEx/AAR/IAR (as relevant) to review the functionality of the multisectoral surge workforce strategic plan. *
  8. Develop and implement rosters for surge workforce in the health sector at national level.
  9. Develop rosters for surge workforce from relevant sectors for health emergencies.
  10. Identify training needs for surge workforce in relevant sectors health emergencies.
  11. Establish a mechanism for the workforce of relevant sectors to participate in multisectoral surge teams at national level for health emergencies.

04 DEMONSTRATED CAPACITY

  1. Implement a multisectoral surge workforce strategic plan for health emergencies at all levels. *
  2. Implement training packages and conduct training in advance of health emergencies for the multisectoral surge workforce at all levels. *
  3. Allocate a budget for welfare, overtime, insurance and transport facilities of surge workforce. *
  4. Use data driven planning tools to inform and revise surge workforce requirements. *
  5. Develop and implement methods to prioritize the mental wellbeing of the multisectoral surge workforce during and after health emergencies. *
  6. Establish capacity to send and receive multidisciplinary personnel within the country (shifting of resources), including workforce from government and nongovernmental partners, as applicable. *
  7. Develop and implement rosters for surge workforce in the health sector at subnational level.
  8. Establish a mechanism for the workforce of relevant sectors to participate in multisectoral surge teams at subnational level for health emergencies.

05 SUSTAINABLE CAPACITY

  1. Review and update the multisectoral surge workforce strategic plan at all levels, including incorporating the results from M&E. *
  2. Evaluate and update training packages and rosters of multisectoral surge workforce. *
  3. Document best practices and lessons learned from the implementation of the multisectoral workforce surge strategic plan. *
  4. Regularly participate in the review and updating of the multisectoral surge workforce strategic plan at all levels
  5. Sustain participation of the workforce from relevant sectors in multisectoral surge teams at all level for health emergencies.

* Participation and contribution of other sectors to action.

Tools