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This chapter reviews the human resources for health crises plaguing numerous countries around the globe and their effects on advancing the right to health. It focuses on: framing health worker engagement on the right to health as defined by human rights instruments and the work of various right to health advocates; addressing the human resources for health crises plaguing numerous countries and their impact on advancing the right to health; protecting health workers in their work environments, including conflict zones, and empowering them to fulfil their life-saving and life-enhancing work; and holding health workers accountable for human rights abuses and violations.

This chapter analyzes the growing demands of HIV/AIDS care on existing human resources for health (HRH). The pressures on these resources have multiplied and steered many national health systems into ever deeper troubled waters as a result of dire and aggravating human resource shortages and deficits. This is especially the case in those countries hardest hit by the epidemic, and with the recent scale-up of antiretroviral therapy (ART). The crux of the crisis is related to growing mismatches between demand and supply of human resources.

The health workforce is the component of the health sector that determines the efficiency with which all others function. Conceived broadly to include all those who are ‘primarily engaged in actions with the primary intent of enhancing health’, the health workforce includes those who directly deliver health services, and those who determine what should be delivered, what can be delivered given available resources, and what will be delivered in reality; those who identify health information requirements, make plans, implement plans, and collect data; those who identify what medical products, vaccines, and technologies are purchased, stored, and distributed, and the standards applied at all stages; those who identify financing strategies and put them into practice at all levels; and those who establish leadership and governance systems, lead, and govern. This chapter outlines the current state of play concerning human resources in health, and the role of migration and the response of high- and middle/low-income countries. It then focuses on two case studies of Kenya and Ghana, before concluding with policy implications.

In the sex-worker population, the priority of harm minimisation has been to minimise disease transmission through educating the workers on safe-sex practices. This harm-minimisation approach assumes that by educating the sex workers on HIV/AIDS and informing them of their responsibility in preventing transmission, they would make rational choices to protect themselves and others. However, the assumption that sex workers are vectors of diseases marginalises and blames them without considering the implications of poverty, gender, public fear, and law. For a more effective health approach in the sex industry, it is hence vital to consider structural and political issues such as poverty and law. Within this context, public-health workers have been challenged to take a more holistic approach to health promotion for sex workers. In addition to taking into consideration the health of the workers, their human rights and the need to create a safer working environment were also considered in the risk-management and harm-minimisation assessment of the sex industry. Within the broad context of harm minimisation commenced the advocacy for the decriminalisation of the sex industry. It was envisaged that by repealing the laws which criminalised sex-work activities, the autonomy of the sex workers and their capability to protect themselves would increase. It was theorised that under a decriminalised system, human rights and set standards for working environments would improve the health and safety of the workers. This chapter examines whether there have been gains for sex-worker health and safety in a decriminalised environment. It examines the main threats to health and safety identified by the participants: risks to sexual health, risks of violence and exploitation, and risks to emotional health.

The protection of health care workers should be an integral part of the health and safety programme of all health care facilities. Health care facilities have a legal obligation to ensure that all their employees are appropriately trained and proficient in the procedures necessary for working safely. In addition, it is the responsibility of every employee to be aware of their own role in infection prevention and control, and incorporate good practices into their daily activity to ensure that they do not jeopardize the health and safety of themselves or any other person. This chapter discusses the role of occupational health departments, pre-employment assessment, health status of health care workers, measures to protect health care workers, management of sharps injuries, protection against tuberculosis, and pregnant health care workers.

This chapter gives an overview of the history of lay health workers and the diversity of current practice. It examines how the concept of community health workers originated in the 1970s as part of a holistic approach to primary health care. International case studies are used to illustrate the traditions that have since emerged in both the global South and North America. Lessons learnt from programme implementation highlight the importance of community ownership and supportive health systems. In the UK an increasing emphasis on self care and health prevention has led to several major initiatives, including the Expert Patient Programme, health trainers and community health champions. The chapter also considers independent social action on health and how this relates to more professionally directed programmes.

This chapter looks at experiences providing health care to rural women in India. It shares thoughts about the quality of health care offered to women. The chapter also describes the establishment of the Well Woman Clinics, aimed at providing empathic reproductive health care, including information, counseling, and clinical services to women. Community health workers (CHWs) were trained to take a comprehensive, broadly defined health history and provide pre-examination counseling to help women assess what kind of clinical consultation they required and become acquainted with routine examinations.

This chapter compares the marginal, but intersecting, groups of health support workers and practitioners of complementary and alternative medicine in the UK, with particular reference to changing national policy and workforce dynamics. It considers the background to each of these areas, as well as recent policies impacting upon them in more detail alongside the mainstream political, social and economic drivers of reform. This enables a number of comparisons to be drawn. In both cases the associated workforce dynamics have impacted on the healthcare division of labour, with differential moves towards professionalisation, which bring potential regulatory benefits as well as costs for the health workers concerned and the wider public.

However it is measured, the success of an immunisation programme depends ultimately on what happens at the interface between the national health system and a local community. In many countries this interface is manifested as routine immunisation days and outreach clinics. Drawing on detailed ethnographic research in India and Malawi, this chapter discusses the activities taking place at these sites. Success depends on numerousfactors, including the trust the health workers enjoy in the community as well as the trust people have in the health services, on the other services they provide, on an adequate and reliable supply of vaccines, and on health workers’ own motivations and incentives. The chapter examines how local health workers in different settings to reconcile,the demands of ensuring that targets are met and developing a relationship of trust with the community. It also discusses how responses to immunisation are sustained, negotiated, and/or reinterpreted in local communities.

The aim of the book is to provide a comprehensive overview of major themes for policy and practice relating to lay engagement in public health activities. This chapter introduces the structure and scope of the book. It argues that active citizenship is a key issue for public health in the 21^st century, both in the UK and internationally, and can been seen as part of a wider movement for greater patient and public involvement in health governance. Community participation is defined with reference to different interpretations and conceptual debates. The notion of lay health workers is introduced and examples of active roles in health improvement are given. The chapter describes the origins of the book and the evidence gathered through the ‘People in Public Health’ study.

This chapter presents an account of the establishment of primary health care in Gonoshasthaya Kendrai, Bangladesh. It describes experiences in a medical team that arrived in Bangladesh to provide medical care to wounded freedom fighters and refugees, and their eventual training of girls to become paramedics. The paramedics at GK provided various services from basic health care to family planning to surgical operations. Since most of them were from the community, they knew the local language, dialects, and pronunciations. They also understood how the community mind works. As a result, they were often more effective in the field than doctors.

Community Health Workers (CHW) are an important cadre of health care personnel, particularly in impoverished countries. CHW program began with China’s “Barefoot Doctor” campaign. The Barefoot Doctors were lay people educated to provide basic medical education and care in rural China in the 1950s–1970s. CHWs have evolved over the years and now perform a variety of functions in many countries, from education to prevention, case finding to treatment, and referral to follow-up. This cadre is often used to fill the gap in human resources. There are a number of challenges in scaling up and sustaining CHW programs, including the adequate training, compensation, and supervision of CHWs within the health system. This chapter will begin with a historical look at the roots of CHW programs, explore their current status, and address some of the challenges inherent in fully utilizing the potential of this group of health workers.

Health systems rely upon two groups of people: health workers and patients. In recent decades both groups have been on the move globally, with the creation of internationalized labour market opportunities (the hunt for skilled labour in the case of health workers) and private investments in high-end health care on lower-cost developing countries (one of the key incentives for patients seeking care outside of their own country, for uninsured or under-insured services). Both flows raise a number of health equity concerns. Health worker migration can pose undue hardships on low-resource, high-disease burden countries who lose their workers to richer nations, creating a ‘perverse subsidy’ of poor to rich. With medical tourism, private, fee-paying foreign patients in poorer countries could ‘crowd out’ access to care for domestic patients in those countries, while potentially returning with drug resistant infections or complications burdening their home country’s health systems.

Palliative care requires attention to the wide range of symptoms affecting patients with progressive diseases, emotional and cultural issues that accompany advanced illness and the needs of family members, including bereavement. There are enormous needs and many opportunities for palliative care education in South America. Most ambitious medical graduates are attracted to curative procedures while nurses often lack the status to advocate for their patients with effect. It is not easy to identify outcomes for these education initiatives, as most of them lack proper audit measures. There is insufficient collaboration and coordination among different programmes. Despite these limitations, it is highly probable that most of the positive changes observed at clinical practice and policies have their origins in the educational effort of a few health workers who deserve strong encouragement and much practical support.

Impoverished countries face what has been termed a human resource crisis. Decades of under-resourced training programs, low public sector wages, and poor working conditions have led to shortages of health workers and the underperformance of staff where the burden of disease is the highest. In this chapter, the causes of the human resource crisis are explained and the gaps in training and retention of personnel are described. The chapter outlines new programs, such as the Medical Education Partnership Initiative (MEPI), Nursing Education Partnership Initiative (NEPI), and the Rwanda government’s national Human Resources for Health program. All of these programs are working with governments to increase the numbers of health professionals trained and improve their clinical capacity through long-term training and mentorship.

This chapter looks towards Japan and discusses death and suicide resulting from the stress of overwork, offering a stark picture of the ‘dark side’ of the once highly touted ‘Japanese miracle’. It shows how laws designed to prevent overwork and compensate for industrial injuries were undermined in Japan by judicial decisions and cultural practices, but concludes that the pressures of the ‘new’ economy may soon bring similar problems to workplaces everywhere.