Health workforce issues and the Global Fund to fight AIDS, Tuberculosis and Malaria: an analytical review

Recent studies have shown evidence of a direct and positive causal link between the number of health workers and health outcomes. Several studies have identified an adequate health workforce as one of the key ingredients to achieving improved health outcomes. Global health initiatives are faced with human resources issues as a major, system-wide constraint. This article explores how the Global Fund addresses the challenges of a health workforce bottleneck to the successful implementation of priority disease programmes. Possibilities for investment in human resources in the Global Fund's policy documents and guidelines are reviewed. This is followed by an in-depth study of 35 Global Fund proposals from five African countries: Ethiopia, Ghana, Kenya, Malawi and Tanzania. The discussion presents specific human resources interventions that can be found in proposals. Finally, the comments on human resources interventions in the Global Fund's Technical Review Panel and the budget allocation for human resources for health were examined. Policy documents and guidelines of the Global Fund foster taking account of human resources constraints in recipient countries and interventions to address them. However, the review of actual proposals clearly shows that countries do not often take advantage of their opportunities and focus mainly on short-term, in-service training in their human resources components. The comments of the Technical Review Panel on proposed health system-strengthening interventions reveal a struggle between the Global Fund's goal to fight the three targeted diseases, on the one hand, and the need to strengthen health systems as a prerequisite for success, on the other. In realizing the opportunities the Global Fund provides for human resources interventions, countries should go beyond short-term objectives and link their activities to a long-term development of their human resources for health.