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Contents Page number vii Preface x Abbreviations 1 Executive Summary 13 Chapter 1 The Power of the Health Worker 14 Today's health crisis 16 Fresh opportunities 18 Health workforce crisis 21 Why health workers are so important 26 Workers as a global health trust 29 Five clusters of countries 41 Chapter 2 Communities at the Frontllnes 42 Workers at the frontlines 49 Workers in community systems 53 Mobilizing health workers 65 Chapter 3 Country Leadership 66 Engaging leaders and stakeholders 68 Planning human investments 70 Managing for performance 84 Developing enabling policies 88 Learning for improvement 101 Chapter 4 Global Responsibilities 102 Migration: Fatal flows 112 Knowledge: An under-tapped resource 117 Financing: Investing wisely 133 Chapter 5 Putting Workers First 134 Strengthening sustainable health systems 137 Mobilizing to combat health emergencies 138 Building the knowledge base 139 Completing an unfinished agenda: Action and learning 143 Appendix 1 Glossary 149 Appendix 2 Quantitative Information 181 Appendix 3 Joint Learning Initiative Page number Boxes 19 1.1 HIV/AIDS: Triple threat to health workers 33 1.2 Norms or standards?' 34 1.3 "Shortages"- giving a sense of scale 44 2.1 The invisible workforce 51 2.2 Recruiting locally is the most important first step 53 2.3 SEWA's community financing 54 2.4 Smallpox eradication in India, Tensions and harmony with the health system 55 2.5 Ethiopia's military-mobilizing against HIV/AIDS 56 2.6 Mobilizing workers to eradicate polio 58 2.7 Primary health care workers in Costa Rica 69 3.1 Workers on strike 76 3.2 Ghosts and absentee workers 82 3.3 Networks for learning and health 83 3.4 Professional associations as partners 86 3.5 Iran's revolution in health 88 3.6 Human resources in transitional economies 107 4.1 Codes of practice on international recruitment 108 4.2 The Global Commission on International Migration 110 4.3 Cuba's international health workforce 111 4.4 Health worker migration: A global phenomenon 115 4.5 Toolkits for appraising health workforces 116 4.6 The PAHO Observatory of Human Resources in Health 120 4.7 Tanzanian health workforce: Impact of stabilization, adjustment, and reform 121 4.8 Ghana: Initiatives in human resources for health 123 4.9 Worker-friendly donor policies 135 5.1 Key recommendations 137 5.2 High stakes, high leverage 140 5.3 Action & Learning Initiative Figures 3 1 Human resources and health clusters 5 2 Managing for performance 7 3 Investing in national capacity for strategic planning and management 10 4 Decade for human resources for health 15 1.1 Life expectancy-advancing and slipping 22 1.2 The glue of the health system 24 1.3 Health service coverage and worker density 25 1.4 Higher income-more health workers 26 1.5 More health workers-fewer deaths Page number 27 1.6 Stocks and flows 29 1.7 Worker density by region 30 1.8 Human resources and health clusters 32 1.9 Five clusters 42 2.1 Human resource functions for health 43 2.2 Family workers at the base of the pyramid-professionals at the top 48 2.3 Sample survey of national workforce patterns 50 2.4 Achieving balance in accountability 66 3.1 Key dimensions of country strategies 71 3.2 Managing for performance 78 3.3 Workers want more than money 80 3.4 Huge regional disparities in medical schools and graduates 81 3.5 Investment pipeline of learning 102 4.1 Foreign-trained doctors can make up a third of the total number of doctors 103 4.2 New registrants from sub-Saharan Africa on the UK nursing register 104 4.3 South Africa: Main channels for out and in-migration 119 4.4 Investing in national capacity for strategic planning and management 183 A3.1 JLI working groups 197 A3.2 JLI meetings and consultations Tables 46 2.1 Community health workers in Asia 118 4.1 Recent trends in development assistance for health 157 A2.1 Global distribution of health personnel 163 A2.2 Global distribution of medical schools and nursing schools 169 A2.3 Selected health indicators 174 A2.4 Health workforce financing