Facing the challenges in human resources for humanitarian health.

The human resources crisis in humanitarian health care parallels that seen in the broader area of health care. This crisis is exacerbated by the lack of resources in areas in which humanitarian action is needed--difficult environments that often are remote and insecure--and the requirement of specific skill sets is not routinely gained during traditional medical training. While there is ample data to suggest that health outcomes improve when worker density is increased, this remains an area of critical under-investment in humanitarian health care. In addition to under-investment, other factors limit the availability of human resources for health (HRH) in humanitarian work including: (1) over-reliance on degrees as surrogates for specific competencies; (2) under-development and under-utilization of national staff and beneficiaries as humanitarian health workers; (3) lack of standardized training modules to ensure adequate preparation for work in complex emergencies; (4) and the draining of limited available HRH from countries with low prevalence and high need to wealthier, developed nations also facing HRH shortages. A working group of humanitarian health experts from implementing agencies, United Nations agencies, private and governmental financiers, and members of academia gathered at Hanover, New Hampshire for a conference to discuss elements of the HRH problem in humanitarian health care and how to solve them. Several key elements of successful solutions were highlighted, including: (1) the need to develop a set of standards of what would constitute "adequate training" for humanitarian health work; (2) increasing the utilization and professional development of national staff; (3) "training with a purpose" specific to humanitarian health work (not simply relying on professional degrees as surrogates); (4) and developing specific health task-based competencies thereby increasing the pool of potential workers. Such steps would accomplish several key goals, such as: (1) more confidently ensuring that individuals hired for a given post would have the capacity to function at a commonly understood level of training; (2) greatly increasing the potential number and types of workers available for humanitarian work; (3) increasing the efficiency of human resources utilization in humanitarian projects; and (4) recognition that humanitarian work is a multi-disciplinary endeavor: these goals will contribute to ensuring that humanitarian health workers have a minimum training in broader humanitarian action, making them more effective team members in the field. Efforts were made to highlight some promising pilot programs for human resource development in humanitarian work, to identify a future vision for humanitarian health as a profession, and to develop a human resources strategy for achieving that vision.