Spotlight Interview
With Professor Lincoln Chen Conducted January 2007
Professor Lincoln Chen is the World Health Organization Special Envoy on Human Resources for Health and Chair of the Global Health Workforce Alliance (GHWA). He is a distinguished professional in international public health and a leader in the field of health human resources. Professor Chen has recently assumed the Presidency of the China Medical Board of New York.
	ICHRN: As Chair of the Global Health Workforce Alliance, what do you see as the most pressing challenge confronting health human resource policy makers and planners throughout the world?
Professor Chen: All countries face human resources challenges – shortages, inequitable distribution, inefficient skill-mix, and demotivating work environments, public and private. As countries move more vigorously into market economies, labour markets naturally also increase as workers seek opportunities. Public policy, therefore, is even more important in ensuring an adequate health workforce to meet national health goals.
	ICHRN: In your opinion, what needs to be done in order to successfully address this key challenge?
Professor Chen: Every country should have a human resource plan that engages the key stakeholders such as government, labour unions, finance leaders and professional associations so that consensus can enable partners to move together. These plans must also recognise the complementary roles of private labour markets and governmental/professional supplementation, since markets will always take the highest skilled for those most able to pay. These plans should be monitored and adjusted, as human resources requires a long investment timeline.
	ICHRN: The actual HRH management and policy capacity in many countries continues to be minimal; insufficient to support and sustain long term improvements. What has to be done to "scale up" HRH management and planning capacity?
Professor Chen: Across the board, countries often lack the capabilities to assess, measure, plan and monitor human resource strategies. Most countries still see human resources as a government personnel department, rather than a dynamic field where many parties are engaged and many instruments must be exercised. We need to develop centres where human resource leaders can be developed. These need not be academic degrees but they should inculcate an ethos of evidence-based policy and management.
	ICHRN: Much of the recent emphasis has been on the scale of the HRH challenge in Africa. Are the challenges and solutions similar in other developing regions?
Professor Chen: Africa, of course, faces the severest human resource shortages, exacerbated by weak economies and in some countries even conflict. There is no reason to believe, however, that nothing can be done, for experiences in Africa and elsewhere have demonstrated that innovations are feasible. The Chinese, for example, launched the barefoot doctor movement when their economy was rather modest. Africa, today, has many innovations in the use of paraprofessionals and community workers. These more established approaches can be energized by new capabilities that harness the capabilities of new information and communications technologies. There is no reason why every worker cannot have access to IT based backup for diagnosis, treatment, monitoring and support.
	ICHRN: Can you share with our readers some of the ways in which the Alliance plans to strengthen the global health care workforce, particularly nursing, over the short, medium and long term?
Professor Chen: The Alliance brings together stakeholders to accelerate country human resources work and to address interdependent global health problems like migration and financing. Nursing is an under-recognized profession that has enormous potentiality for leadership in countries, which can be promoted by and through the Alliance. Nurses not only provide direct care but are leaders of health teams, pursue research, and offer potentiality for outreach. Every country should be encouraged to re-examine and support the development of nursing to its full potential.
	ICHRN: Recently we have seen a shift in donor improvements in health worker pay and conditions of employment, such as DFID action in Malawi. What do you think is needed to make this an effective and sustainable support measure?
Professor Chen: The Malawi investment by the Government and key donors was very important because, through a massive expansion of resources, the health system and the workforce could be addressed in a more dramatic and forceful manner than incremental changes. While Malawi's long-term success has yet to be demonstrated, the accelerated investment has paved the way for experimentation and innovation that can break through low-level equilibrium trap, a common constraint of workforce development that is dependent upon so many forces.
	ICHRN: You have been instrumental, firstly with the Joint Learning Initiative (JLI), and now with the GHWA in getting HRH to the top of the policy agenda. Now that it is there, what has to happen to keep it there until the challenges are adequately addressed?
Professor Chen: Since health is a labour-intensive industry, it is remarkable that human resources have been so neglected in global health priorities. The JLI and GHWA are spearheads of the global movement to recognise the importance of human resources and to support all actors to address the problem. Such recognition is now growing. Since there are no "short-cuts" around having skilled, motivated and supported workers, we believe that human resources must assume a commanding role in health priorities. One of the missions of the Alliance is advocacy to continue the promotion of this priority for health workers.