Strengthening health systems is fundamental to achieving universal health coverage and developing the resilience of societies to withstand, respond and adapt effectively to health threats and shocks. Doing so requires considering all of the WHO building blocks for health systems (workforce, commodities, information systems, service delivery, financing and governance) to support delivery of the suite of interventions listed in Annexes 2 and 3 of the Global Strategy. It also requires attention to the links between these building blocks – and between health systems and other sectors. Issues relating to financing and governance are addressed in the corresponding sections of this Operational Framework. In addition, government needs to put in place appropriate policies and legal frameworks to enable access to services and steward the range of providers in public, private and civil society sectors. Considerations on the other four building blocks are outlined below.
5.1 A strong health workforce
In adapting the global strategy to their context, countries should consider the health system and workforce implications of its targets. Specifically, national commitments, plans, investment decisions and related accountability efforts that are developed should contribute to sustainable and long term strengthening of common service delivery platforms.
A strong health workforce that effectively addresses RMNCAH is one that emphasizes delivery at the primary care level, emphasizing prevention as well as treatment. The health RMNCAH workforce should include well-trained, supervised, equipped and incentivized health workers from the community to the referral level. District health managers should be equipped with or trained to develop technical, fiscal management and administrative capabilities.
Pre-service training for providers should be based on international norms, and deployment strategies should be based on identified needs to redress pre-existing inequities. Mechanisms to ensure supportive supervision of providers should also be in place.
To design and implement an enhanced workforce agenda responsive to RMNCAH needs, national institutions need to develop the capacities to collect, collate and analyse workforce data and labour economics; lead short and long term health workforce planning and development; advocate for better employment and working conditions for health workers; design, develop and deliver enhanced pre-service and in-service education and training for health workers; support health professional associations; facilitate collaboration with, and regulation of, private sector educational institutions and health providers; oversee the design of fair and effective performance management; and monitor and evaluate human resources for health interventions.