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<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Recife, 12 November 2013,
during the 3rd Global Forum<br>
on Human Resources for Health
</span></p>
<p><span style="font-size:14pt;font-family:'ArialMT';color:rgb(15,36,62)">No Progress towards Universal Health without Health Workers:
A Civil Society Commitment
</span></p>
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">The health workforce crisis remains a core barrier to achieving the Millennium Development Goals
(MDGs) for health with only 31% and 12% respectively of 75 Countdown countries likely to attain
MDGs 4 and 5. Despite donor and country commitments at the 1st and 2nd Global Forums on Human
Resources for Health, the global health workers’ shortage persists. Of the 57 countries identified as
falling below the WHO target only 19 have seen an improvement in their aggregate health worker
density. Earlier commitments to increase domestic resources or external aid, as well as
implementationof the WHO Global Code of Practice on the International Recruitment of Health
Personnel, remain largely unfulfilled.
</span></p>
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">National and international funds have been channelled to strengthen health workforce programs, like
task shifting and the scaling-up of community health worker’s programmes. However, too little
investment has been targeted at the recurrent costs of health workforce development, for instance on
salaries, education and social protection measures for health workers. The inequitable distribution of
health workers through increased mobility and migration within and between countries adversely
affects access to health.
</span></p>
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Health workers and a robust health system are essential for universal health coverage (UHC), and
realizing the right to health through universal health systems.
</span></p>
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Therefore at the 3rd Global Forum on Human Resources for Health in Recife, Brazil, we, the
undersigned representatives of civil society organizations hereby commit to:
</span></p>
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">We will:
</span></p>
<ul style="list-style-type:disc"><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Help amplify the voices of health workers, especially those at the lower levels of care and
support their work to influence national and global health policies and plans.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Assist local civil society organizations to ensure their voices are heard in global and national
health workforce policy discussions.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Assist in strengthening the capacity of patient groups to advocate for equitable and quality
services staffed by sufficient, competent and equipped health workers at all levels of care.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Recognise the gender dimensions of the health workforce and champion the rights of women
health workers.
</span></p>
<p><span style="font-size:12pt;font-family:'ArialMT';color:rgb(15,36,62);background-color:rgb(219,229,241)">Catalyse a strong movement for health workers
</span></p>
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">We will:
</span></p>
</li></ul>
<ul style="list-style-type:disc"><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Advocate for governments at all levels to institute plans and allocate adequate resources for
human resources for health (HRH) to ensure that every person has access to a trained,
supported and equipped health worker.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Press bilateral and multilateral organizations and civil society actors to increase health
workforce development efforts and financing, including of national training institutions, in
alignment with government plans.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Work with training institutions, professional and regulatory bodies to achieve quality in health
worker education, including on the social determinants, so that every health worker is
competent to provide quality care and accountable to the populations they serve.
</span></p>
</li></ul>
</div>
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<p><span style="font-size:12pt;font-family:'ArialMT';color:rgb(15,36,62)">Strengthen the advocacy of health workers and civil society for improved
infrastructure, support and working conditions
</span></p>
</div>
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<ul style="list-style-type:disc"><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Support the development of a strong, motivated, public workforce to counter some of the ill-
effects of an increasingly globalised, inequitable and unstable economy and rapidly changing
health and demographic patterns.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Commit our own resources and expertise to assist in converting HRH policy and plans into
action.
</span></p>
<p><span style="font-size:12pt;font-family:'ArialMT';color:rgb(15,36,62);background-color:rgb(219,229,241)">Ensure accountable HRH systems at national and global levels
</span></p>
</li></ul>
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">We will:
</span></p>
<ul style="list-style-type:disc"><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Work with governments, the Global Health Workforce Alliance, the World Health Organization,
and other stakeholders to develop mechanisms to measure progress towards improved and
equitable access to competent health workers
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Monitor and report on progress of public HRH commitments made by global actors and
governments.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Assist citizens and health workers in developing strategies to enhance accountability of
national and global actors and challenge inequitable policies that impact on HRH
development.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Increase transparency of our programmatic and technical contributions to national HRH
strategies and attempt to reduce onerous reporting requirements placed on countries. We will
commit ourselves to supporting a strong public sector for health workforce development and
be accountable in our own funding and technical programs to mitigate the ‘internal brain drain’
from the public to the private sector.
</span></p>
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">We will hold donors, government and multilateral actors accountable to:
</span></p>
</li></ul>
<ul style="list-style-type:disc"><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Ensure that economic governance arrangements and fiscal space enables the development of
a strong national health workforce as a long-term investment in the wellbeing of the people
and the economy of a country. The return on investment to employ a health worker is many
times higher than to bail out a bank.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Provide the leadership, resources and stewardship needed to fulfil commitments made to
urgently and effectively address the health workforce crisis and ensure improved and
equitable access for every person to competent health services.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">By 2015, develop, finance, and implement HRH action plans, including strengthening national
training institutions, with concrete targets and integrate them into national health plans.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Ensure that health workers and civil society organizations are active partners in the health
workforce policies, planning and development.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Promote equitable access to health care by investing especially in health workers at primary
and community levels and in community structures to facilitate citizens’ voices.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Improve investment in health workforce development, including salaries and social protection,
and in national training institutions in order to rapidly increase numbers of HRH.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Assist in development of robust HRH information systems to facilitate improved planning and
management.
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Respect and implement the Global Code of Practice on the International Recruitment of
Health Personnel including additional enforceable legislation and redistribution mechanisms to
compensate for the international ‘brain drain’ that exacerbates global health inequalities.
</span></p>
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">SIGNATURES:
</span></p>
</li></ul>
<ul style="list-style-type:disc"><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Equinet
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">European Public Health Alliance EPHA
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Health Poverty Action
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Health Workers for All and All for Health Workers
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Latin-America Association of Social Medicine ALAMES
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Medicus Mundi International Network MMI
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">People’s Health Movement PHM
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Public Services International PSI
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT'">The Centre for Health Sciences Training, Research and Development CHESTRAD
</span></p>
</li><li style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">
<p><span style="font-size:10pt;font-family:'ArialMT';color:rgb(15,36,62)">Wemos
</span></p>
</li></ul>
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