Dr Tin Tun, Chairperson, AAAH Steering Committee; Distinguished Member State representatives from the South-East Asia, Western Pacific and Eastern Mediterranean regions; Dr James Campbell, Director, Health Workforce, WHO HQ; partners, experts, colleagues and friends,
Good morning and my sincere gratitude to the Asia Pacific Action Alliance on Human Resources for Health (HRH) for inviting me to address this 12th bi-annual conference.
My thanks also to the Royal Thai Government and Ministry of Public Health for supporting this valuable mechanism, which continues to grow not just in members – from 10 in 2005, to 19 today – but also in influence and reach.
And so it must: Across the Asia Pacific, strengthening HRH research, planning and management capacity is critical to building equitable, effective and resilient health systems – health systems that achieve universal health coverage (UHC) and health security.
It is essential for enabling all countries to protect, safeguard and invest in HRH, with a focus on strengthening health worker education, skills, production, distribution, employment and protection, all of which are central to the WHO Working for Health Action Plan 2022–2030, launched in 2021, amid the COVID-19 response.
And while the COVID-19 pandemic has brought renewed global interest in strengthening HRH, since 2014, attaining that outcome has been one of two key areas of focus under the South-East Asia Region’s Flagship Priority on achieving UHC.
Since then, in alignment with the Decade for Strengthening HRH, the Region has increased the density of doctors, nurses and midwives by more than 30%.
Almost all countries of the Region have met and surpassed the original WHO threshold of 22.8 doctors, nurses and midwives per 10 000 population.
Three Member States have also surpassed the threshold density of 44.5 doctors, nurses and midwives per 10 000 population.
Almost all Member States have enacted a series of major reforms to improve health workforce quality and distribution, and to better align health workforce education with population health needs.
Crucially, throughout this period, we have witnessed a revolution in access to medical education.
To take just two examples, since 2010, Bangladesh has seen a doubling of medical and dental colleges, and a six-fold increase in nursing colleges.
Since 2014, India has achieved a 54% increase in medical colleges, a 67% increase in undergraduate medical seats – which now stand at 90 000 – and aims to ensure that at least one medical college serves every three districts.
Across the Region, these and other initiatives will significantly increase the number of health workers available. And with concurrent regulatory and health system reforms, they will also enable health workers to meet evolving population health needs.
Together, we are building the health workforce and systems of the future, and I thank the Action Alliance for its many contributions.
Last year, at the Seventy-fifth Session of the WHO Regional Committee for South-East Asia, I laid out in detail how we as a Region plan to build back better from the COVID-19 pandemic, focusing on two key pillars:
First, reorienting health systems towards quality, accessible, affordable and comprehensive primary health care (PHC), for which we have our Regional Strategy for PHC, launched in December 2021;
And second, strengthening health systems resilience and health security, for which we have our Regional Strategic Roadmap on Health Security and Health System Resilience for Emergencies, launched in September 2022.
Critical to both pillars of our build back better vision is strengthening HRH.
In all countries of the Region, additional investments in HRH are required. But amid intense fiscal pressures, equally important are smarter investments that are aligned with current and future health needs, that account for labour market dynamics, and which match health worker education and training with health system and population requirements.
Globally, 20–40% of all health spending is wasted, a significant proportion of which is caused by health workforce inefficiencies. Thus, by optimizing the existing health workforce – including by strengthening multi-skilled PHC teams – and by increasing accountability through better governance and oversight, countries can significantly increase savings and efficiency, while maximizing the quality and coverage of health services.
Improvements in health worker safety, motivation and satisfaction will also increase health worker retention and performance and accelerate progress on a range of development priorities, not least gender equality and decent work and economic growth.
Importantly, the South-East Asia Region – and Asia Pacific more broadly – must continue to lead globally on the ethical management of health worker migration, building on the path-breaking Tri-Regional Policy Dialogue held in 2021.
Over the last decade, there has been a 60% rise in the number of migrant doctors and nurses working in OECD countries, of which the WHO South-East Asia and Western Pacific regions comprise leading countries of origin.
In both sending and receiving countries, the health sector must actively promote WHO’s ‘health-in-all-policies’ approach, coordinating with ministries of labour, education, trade and other relevant ministries.
Diplomatic and legal issues in particular must be thoughtfully managed, leveraging innovative, out-of-the-box solutions that are grounded in the WHO Global Code of Practice on the International Recruitment of Health Personnel.
The issues are many, and our time together short.
But I am certain that over the course of this two-day conference, you will establish a detailed, forward-looking agenda that draws on the many lessons learned from the COVID-19 crisis, that responds to current fiscal and economic challenges, and which builds momentum in the lead up to the 5th Global Forum on HRH to be held in the first week of April.
I highlight several questions of focus, on which I request your careful, considered input.
First, you are aware of the critical need to optimize the existing health workforce, especially at the primary care level, involving not just doctors and nurses, but millions of community health workers, paramedical staff and medical assistants.
We must therefore ask: What management tools will be most effective in strengthening the capacities, performance and culture of PHC teams to deliver care that is truly people-centred?
Second, you are aware that across the Asia Pacific, disease burdens are changing, and that the health impacts of climate change are becoming increasingly acute.
So I ask: What key initiatives – educational or otherwise – must be implemented to ensure that health workers are future-ready, and can rapidly adapt as and when new challenges arise?
Third, the COVID-19 response has unleashed a raft of critical digital health infrastructure, as well as enabling regulatory provisions, for health worker education and management.
But as the dust settles, which innovations should be retained and scaled, and how best can we use them to support PHC workforce teams and overcome localized shortages, particularly in specialized health cadre?
And fourth, as this Action Alliance demonstrates, shared learning is immensely valuable, not just for strengthening HRH, but for accelerating action on each of the six health system building blocks.
For this, you may be aware: The South-East Asia Region has launched a new country-led Forum for PHC-Oriented Health Systems, the findings of which could prove immensely valuable, not just for this mechanism, but for countries across the Asia Pacific.
And so I close not by asking, but by urging: Let us continue to work together, in solidarity, to share experiences, evidence and innovations that strengthen HRH research, planning and management capacity, for health systems that achieve UHC and health security.
I once again thank the Action Alliance and Royal Thai Government and wish you productive, engaging and successful deliberations, for an Asia Pacific with strong health workforces for resilient health systems.
Thank you.