Spotlight Interview
With Dr Manuel M. Dayrit Conducted June 2007
Dr Manuel M. Dayrit is the Director of the Department of Human Resources for Health at the World Health Organization (WHO). Dr Dayrit has close to 30 years experience in the health sector and, prior to joining WHO, was the Minister of Health of the Philippines.
	ICHRN: As the Director of the Department of Human Resources for Health at WHO, what are your key concerns in relation to the global health workforce?
Dr Dayrit: The World Health Report 2006 reported that there are 57 countries that have critical shortages of health workers; 36 of these countries are in Africa. In response to these realities, the World Health Assembly (WHA) last year passed two resolutions: Strengthening Nursing and Midwifery - WHA59.27 and Rapid Scaling up of Health Workforce Production - WHA59.23. We are primarily concerned with implementing these. We are deepening our understanding of these shortages and the factors that lead up to them. By studying specific countries, we are seeing how different nations respond to their own situations. WHO is working with regions and countries to collect better information to understand their challenges and identify meaningful approaches to deal with them. Related to the shortages are the imbalances and maldistribution of health workers within a country and between countries. We aim, of course, to provide best practice recommendations for dealing with these and other HRH problems based on a good understanding of the issues. Knowing how complex these issues are, this is easier said than done. Through various mechanisms we have also initiated a global dialogue with stakeholders on issues such as the migration of health workers which has become a hot topic. Some of these discussions take place within fora organised by the Global Health Workforce Alliance, WHO and other international agencies.
	ICHRN: The World Health Report in 2006 focused on HRH, and highlighted the contribution of nurses. What do you view as priority issues for the nursing workforce worldwide? Can you provide some examples of how these priorities are being addressed by WHO both at headquarters and in the regions?
Dr Dayrit: Unemployed nurses in countries where there are health workforce shortages is one concern. Inability for health systems to retain experienced nurses is another. Ensuring the quality of the education of nurses and midwives is a third. The nursing profession has an elaborate network of schools and WHO collaborating centers which communicate well with each other. The HRH Department has an Office of Nursing and Midwifery which attends to nursing and midwifery issues and we provide as much support as needed to this office. There are also nursing and midwifery focal points in the WHO Regions and they are quite active.
	ICHRN: In many health facilities, health personnel are faced with the challenge of providing safe care in work environments that present health hazards for the staff. How is WHO strengthening the infrastructure of the health systems and providing positive practice environments to health care workers?
Dr Dayrit: Lots more can be done in this area. The World Health Assembly this year passed a resolution on workers' health. One of the objectives in the Global Plan of Action for Workers' Health 2008-2017 is to protect and promote health in the workplace. The WHA resolution actually urges member states to devise, in collaboration with workers, employers and their organisations, national policies and plans for implementation of the global plan of action on workers' health and to establish appropriate mechanisms for their execution, monitoring and evaluation.*
	ICHRN: WHO's Department of Human Resources for Health is working closely with the Global Health Workforce Alliance Task Force on scaling up. We see that much of the emphasis so far has been on the short-term training of community health workers (CHWs). Who is expected to train and supervise these workers? Do you think that producing more CHWs will be sufficient to meet the HRH requirements to deliver sufficient and safe care? What else is required?
Dr Dayrit: Because of the pressure to address critical shortages urgently, training of new cadres of health workers who can take on the work conventionally performed by health professionals has been an attractive policy option. For countries which go down this road, there are many things to consider, for example, the type of worker to be developed; the structure of the training programme; the competencies to be trained for; assessing the quality of care provided by this new cadre of health worker; the mechanisms for accrediting training; the systems for regulating and licensing them; the levels of compensation; etc. Systematic reviews of the performance of CHWs show that they do well with discrete, well-circumscribed tasks for which training programmes can be adequately designed. But to say that producing more CHWs will be sufficient to meet HRH requirements is too sweeping a claim not supported by evidence. Countries will need to consider the appropriate numbers and types of health workers over short and long terms, with specific needs and goals in mind.
	ICHRN: The international migration of health professionals has been the focus of a number of WHA resolutions in recent years. Can you briefly describe for our readers what WHO's current policies and activities are in this area?
Dr Dayrit: WHO recognizes the right of persons to migrate. We know that migration is governed by the proverbial "push" and "pull" factors, but the dynamics of labour markets (domestic and international), immigration policies of countries and the influx of development aid (eg. Malawi) have significant influences on the balance of the migration-retention equation. WHO is working with other agencies like the International Organization for Migration, International Labour Organization and the Organisation for Economic Co-operation and Development to understand these dynamics better. Also, we have started a process of exploring whether a code of practice for the recruitment of international health workers is a useful tool for countries.
	ICHRN: Natural disasters have cruelly demonstrated to the world that no country is immune from the threat of such a calamity. A nation's capacity to respond to a natural disaster and reduce suffering depends to a large extent on the preparedness of its health care providers and nurses in particular. The World Health Report in 2006 highlighted HRH preparedness as one major area for action.
Dr Dayrit: There is a lot going on in this area. To learn more about the types of activities WHO is currently supporting, please visit the WHO Health Action in Crises website.
	ICHRN: WHA Resolutions have been passed that aim to strengthen nursing and midwifery in health systems worldwide. What actions are being taken by WHO to strengthen nursing's voice in WHO policymaking and programmes?
Dr Dayrit: Nurses already have such a strong voice in WHO.** No other profession has an equivalent office as the Nursing and Midwifery Office. The network of WHO Collaborating Centers on nursing and midwifery is an outstanding model of an effective professional network. Regarding programmes, Jean Yan leads the Global Health Workforce Alliance/WHO technical working group on issues of health workforce migration. This group is headed by Mary Robinson. Mwansa Nkowane, the Technical Officer, plays a major role in linking the HRH Department with nursing focal points in the regions as well as priority programmes like Health Action in Crisis, Child and Adolescent Health, Reproductive Health and Mental Health. The Global Advisory Group on Nursing and Midwifery (GAGNM) advises the Director General on Nursing and Midwifery issues and recently Daisy Mafubelu, a nurse-midwife, was appointed as Assistant Director-General of Family and Community Health.
	ICHRN: Is there anything else you wish to share with our readers?
Dr Dayrit: We look forward to even more effective collaboration in the future. Lastly, I wish to encourage readers to visit the WHO Nursing and Midwifery and WHO Department of Human Resources for Health websites.
Editor's Note: * This year the health professions (International Confederation of Midwives, International Council of Nurses, International Pharmaceutical Federation, World Confederation for Physical Therapy, World Dental Federation and World Medical Association), together with the Global Health Workforce Alliance and the International Hospital Federation, will launch a positive practice environments campaign. This multiyear, multi-stakeholder campaign will promote safe and healthy workplaces, thereby strengthening health systems and improving patient safety. The World Health Organization has been invited to join this initiative. ** The presence of nurses and midwives at all levels of WHO continues to decline. Nurses and midwives represented 2.1% of professional staff in the category: "Dental, nutrition, medical, nursing and veterinary specialists" in 2005 and 1.8% in 2006. Analysis of this year's World Health Assembly Report on Human Resources shows that only 1.3% of the professional staff are nurses and midwives, compared to medical specialists who make up 91.6 % and dieticians and nutritionists who make up 1.8 %.