Human Resources for Health

It is people, not just vaccines and medicines, who prevent disease and deliver curative health services.
Dr. Shigeru Omi, Director, Western Pacific Regional Office, WHO

For those of us involved in health workforce development in the Pacific, the 2006 WHO World Health Report entitled Working Together for Health and its companion monograph, Regional Strategy on Human Resources for Health, 2006-2015, published by the WHO Western Pacific Regional Office (WPRO), are sentinel documents--clear clarion calls that not only are we all part of the world's health workforce ("a mother caring for her child, a son escorting his parents to a hospital, or a healer drawing on ancient wisdom to offer care and solace") but we, who consider ourselves health professionals, face many challenges. In Working Together for Health, Dr. Lee Jong-wook, the then Director-General of WHO, defined the global Human Resources for Health (HRH) crisis:

"There is a chronic shortage of well-trained health workers. The shortage is global, but most acutely felt in the countries that need them the most. For a variety of reasons, such as migration, illness or death of health workers, countries are unable to educate and sustain the health workforce that would improve people's chances of survival and their well-being."

Closer to home in the Pacific, Dr. Shigeru Omi, Director of the WHO's WPRO adds in Regional Strategy on Human Resources for Health, 2006-2015 that despite the importance of health workers,

"the sad truth is that decades of cost cutting, poor salaries and under investment in education and training have led to critical shortages of health workers in many countries, a situation that has displaced financial issues as the most common serious obstacle to implementing treatment plans. Other workforce issues include imbalances in the skill mix and distribution of health workers, worsened by unplanned migration from rural to urban areas and overseas, poor work environments and remuneration, and the weak knowledge base of the health workforce..."

In the U.S. Affiliated Pacific Islands (USAPI) we share many of these HRH problems. In our Pacific neighborhood we are challenged with the twin disparities of absolute shortages of well-trained health workers combined with the reality that many of our current workforce need more training (Dr. Omi's the weak knowledge base). Besides worrying about the right numbers and quality of our health workforce, there remain the difficult questions: What is right mix, balance, and distribution of the USAPI health workers needed to effectively address the epidemic of Non Communicable Disease (NCD: cardiovascular disease, cancer,...) and Emerging and Re-emerging Infectious Diseases (multiple drug resistant tuberculosis, HIV-AIDS, leprosy, dengue, leptospirosis, etc.) for our Pacific Island populations scattered across five time zones of USAPI expanse--from American Samoa to Palau.

For the USAPI Flag Territories--American Samoa, Commonwealth of the Northern Marianas (CNMI), and Guam, many of our health care workers migrate to the U.S. Mainland to work in pursuit of higher salaries and other benefits. Of the many Territory high school and community college / college students who go on to study health careers in the U.S., many do not return to their home Territories preferring to stay and seek continued employment in the U.S. As for the Freely Associated States--the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau--many students come from schools systems that are weak in science, mathematics, and study skills and have difficulty qualifying for or surviving in U.S., regional, and Pacific Rim health careers training programs. In the FAS countries the K-12 school systems face the same challenges as the health sector: there are absolute shortages of qualified teachers--especially in the STEM disciplines (Science, Technology, Engineering, and Mathematics)--and many of these teachers need more training (read certification). This lethal brew--the health and education sector shortages of qualified personnel and weak knowledge base of both sectors - is a discouraging barrier to developing the strong educational pipeline needed produce new teachers and health workers. Sending students away to matriculate in America, who generally do not return, has not been the answer.

Historically and now into the present, there have been many vigorous and imaginative responses within the regional health sector to address local manpower challenges. This website will identify regional efforts and in-country solutions that are slowly working to resolve not only our health worker shortages but also increasing efforts to strengthen the educational pipeline. PIHOA and its many partners are now additionally focusing on HRH development through the lens of addressing our NCD epidemic, which for some island nations is becoming an economic and security threat.

The road to strengthening our HRH process and systems will not be easy. Dr. LEE warns us that "the solution is not straight forward, and there is no consensus on how to proceed". PIHOA, for its part, followed WHO's lead and met in August 2006 and developed a preliminary roadmap--the Nahlap HRH Action Plan--which, we think so far, has served us well. Since then, and with the help of its many partners, PIHOA has been developing a bottom-up approach to strengthen HRH systems among its member jurisdictions which vary in rich cultural, ethnic and linguistic diversity, per capita incomes, general economic development, contrasting education and health services systems and infrastructure, and geographic and population distribution. The PIHOA strategy has been to develop local then national consensus plans and then develop a regional plan which is more than just the lowest common denominator of its member jurisdictions--but inclusive next-steps which still capture regional diversity. PIHOA's 2011 Progress Report on its regional HRH efforts is the product of such a process. (See Executive Summary 2011 Progress Report on the PIHOA Nahlap Resolution and Action Plan for Human Resources for Health, dated August 2006, The Pacific Island Health Officers Association, March 2011, pages 6-12).

Some of PIHOA's ongoing HRH-related activities with its many partners include:

  • Human resources management training;
  • Developing bridging programs and facilitating basic training in medicine, public health, health services management, oral health, nursing, and allied health;
  • Strengthening regional Professional Associations for physicians, dentists, nurses, pharmacists and soon the public health workforce;
  • Strengthening professional licensure and continuing professional development;
  • Supporting training activities in quality assurance, quality Improvement, performance management, and health information services; and
  • Working with the Education Sector and Regional Area Health Educations Centers to strengthen the health careers pipeline and develop a Health Careers Readiness Program;

To help navigate and get a better sense of both this symmetric and asymmetric process towards finding practical solutions to our HRH problems, we include excerpts from the select global and regional HRH reports, a list of PIHOA HRH initiatives and supporting documents, and a bibliography on both peer-reviewed and gray literature focusing on HRH strengthening efforts in the region.

Over the centuries, we have progressed remarkably in our understanding and knowledge of health and disease and how to prevent, mitigate, and treat disease conditions and promote heath. Of course, there is much more to be done. The outcomes of such efforts generally have relieved human suffering and advanced wellbeing. However, to translate this understanding and knowledge into good health practice needs a vital link. Dr. Lee reminds us, "People are the vital ingredient in the strengthening of health systems." Dr. Omi underscores this point by stating despite our HRH challenges, "health gains made by many countries are due in part to dedicated health workers who demonstrated commitments far beyond the call of duty. It is people, not just vaccines and medicines, who prevent disease and deliver curative health services."

It is to the many dedicated health workers in our Pacific region who have demonstrated commitments far beyond the call of duty that this section of the website is dedicated. PIHOA thanks its many partners--Health Resources Services Administration, Centers for Disease Control and Prevention, U.S. Department of Interior, WHO, Secretariat for the Pacific Community (SPC), and PIHOA's many Affiliate Members for their valuable assistance in supporting PIHOA in our efforts to strengthen regional HRH systems and support our valuable health workforce.


  1. Message from WHO Director General Dr. LEE Johg-wook / From WHO World Report (2006): Working Together for Health, page xiii.
  2. WHO's Regional HRH Plan for the Pacific / From Regional Strategy on Human Resources for Health, 2006-2015, pages 6-11.
  3. Executive Summary / 2011 Progress Report on the PIHOA Nahlap Resolution and Action Plan for Human Resources for Health, dated August 2006, The Pacific Island Health Officers Association, March 2011, pages 6-12.

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