A Guide for Government Officials, NGOs, Health Workers and Development Partners
Linked with Chukwumuanya Igboekwu – Nigeria.
Published on Physicians for Human Rights.org, by Health Action AIDS, 91 pdf-pages, March 2008.
(page 85/91: … XII. Sustainability
Sustainability and human rights – continuing progress:
The right to health provides a solid platform on which to build sustainable, workable health workforce plans. Emphasizing, as it does, both “progressive realization” and avoiding “retrogressive measures” (moving forward continuously and not sliding backwards), the right to health is inherently concerned with ensuring sustainable, accessible and equitable health provision. For a health workforce plan to be faithful to human rights, and the right to health in particular, it must take as a non-negotiable principle that its implementation will result in health services that are progressively of higher quality and increasingly available to all population groups. Such continuing progress is consistent with human rights obligations. Commitments made by both national governments and international donors must reflect this understanding and account for the fact that once services have been implemented, withdrawing them is a violation of people’s right to health. This must be borne in mind when setting up programs and proposing funding so that initial investments are considered in light of the principle of non-retrogression. Backsliding is not an option.
Planning for sustainability:
Principles of progressive realization and non-retrogression demand constant progress, which means that efforts to strengthen the workforce should be sustainable. This, in turn, requires setting priorities. Infusions of cash to the health workforce sector, no matter how large, are unlikely to provide for all needs.295 Planning for sustainability means that difficult but important questions must be asked about donor and national government commitments to the health workforce. For instance:
- Are donors willing to commit to long-term investments that are supportive of the health workforce as a whole as opposed to particular disease ‘silos’?
- What is the country capacity to sustain health interventions if these outside commitments are not forthcoming or are withdrawn?
- How will electoral changes impact long-term planning and resource allocation dedicated to the health workforce?
As a practical matter, this implies that health workforce should be a priority within national budgets, so that health services can continue even if outside funding dries up or is withdrawn.296 Within the health workforce plan, the need for sustainability and the right to health offers a potential framework for priority setting, starting with the obligation of immediate effect to ensure non-discrimination and equity in health service provision,297 which must be a driving force behind any rights-based approach to health workforce planning. These plans must seek to promote achievement of human rights obligations in light of health needs on the ground. This may lead to prioritizing investment in nursing programs and community health workers ahead of increasing medical training slots. It may require significantly boosting salaries for health sciences faculty in order to attract and retain excellent candidates or investing in scholarships and funding for health students from rural areas. It may mean dedicating resources to training more laboratory technicians and investing in remote lab facilities in order to provide timely and accessible services to HIV and TB patients in rural regions … (full long text, 91 pdf pages).