Bonaventure Ahaisibwe on the White House Health Workforce Initiative
As the White House develops a new initiative to strengthen the global health workforce around the world, we spoke with Bonaventure Ahaisibwe, Regional director for innovation and strategy at Seed Global Health. We talked about what he thinks the Biden Administration needs to consider in order to help build a strong and sustainable health workforce in Africa.
What policies or approaches do you recommend that the White House prioritize for this initiative?
First we have to recognize that there are operational pieces and realities on the ground that can end up being bottlenecks. We have heard everyone say we need to work with governments. But the reality is that it is not just about capacity, it is also about the culture of accountability and getting governments to deliver. This can be a sensitive issue.
I suggest creating a transparently managed human resources for health fund, to which government and other donors contribute. We could set up a coordinating mechanism that creates a place for non-state actors and helps hold government accountable. This could be a middle ground between approaches typically used by the global fund and US government that could be inclusive.
Health workforce evolves rapidly. So, we need a mechanism that can be dynamic.
Are there any problem areas in US approaches or limitations to current US funding mechanisms that you hope the Administration will change or fix? Are there specific flexibilities you would recommend?
The biggest issue is lack of interagency collaboration. US agencies don’t always speak to each other, and they don’t always speak the same language. They focus on opportunities to move their own agendas. There are some USG agencies that have a grants office within the ministry of health, and that gives them a little more leverage.
An initiative has to be sensitive to in-country coordination dynamics and address systemic challenges. Usually, decisions around workforce are made across government, not just in one ministry. For instance, if they are setting a pay scale it isn’t specific to the ministry of health. If we want to make changes to the pay scale in health in that case, we would have to trigger a change across government which makes things difficult, so that has to be considered. Investing in assessing and addressing these systemic bottlenecks would position the health sector for success in the long term.
How best should the US help address shortages of health workers? How should the US address remuneration?
Lots of credit should be given to training by PEPFAR and leveraging in US government investment. But now I think there is an opportunity for USG to be more deliberate by setting targets, holding governments accountable and creating structure.
Everyone is hesitant about funding health workers; donors say it is the responsibility of governments and governments prioritise non recurrent investments. But we need an open dialogue on this and conversations need to happen up front and address long term planning. If we can map out the needs, an initiative could frontload a long to mid term investment in health workers with a phased structure to gradually move new workers each year into the government system rather than suddenly looking to government to absorb contracted health workers at the end of the funding cycle.
What we need is an investment case for the workforce in each country, not just looking at health but contextualizing in the broader context. With an investment case we can move to a shared assessment of needs and opportunities and better position health investments as drivers of economic prosperity rather than a consumptive sector.
Do you think any particular agency should lead the initiative? PEPFAR? USAID? CDC?
My inclination is that PEPFAR should be in the lead because they have had to navigate US interagency dynamics for some time now. And in the case of Uganda, PEPFAR is one of the two largest programs. It has been successful and, in many ways, has been set up as an HRH trans-governmental agency.
Do you think your country or others in the region are ready to invest more in the workforce? Could a US initiative help encourage that?
Yes, but I say that with reservation. The culture around aid is difficult. Governments don’t want to say no to aid. In Uganda, the president met with doctors and promised an increase pay, 4 months later nothing has happened. I have not seen long term commitments in investments in health although commitment to funding health workforce has been serially voiced at the highest level.
Considering multilateral efforts like Gavi, Global Fund, and the GFF, how should the US influence these so they could have a bigger impact on the workforce?
I have seen successful efforts with the global health security agenda. In Uganda we also saw good coordination between DFID and Global Fund, including metric sharing. There is a precedent in that.
When it comes to final implementation, collaboration isn’t clear when you are sitting in the ministry. The mechanisms are different, reporting is different.
I recommend an upfront round table, with agreed upon funding, as a better approach. Global fund has done this well and amassed a lot of experience, I wonder if the USG would trust the Global Fund to implement something like this.
What would be the best indicator for the US to use to measure progress of the initiative?
It would be bad to have universal metrics across countries. Different countries have different needs. Creating flexibly at the country level and metric setting could be helpful.
Bonaventure Ahaisibwe provides regional and global representation for Seed Global Health and key guidance on innovation and strategy.
Driven by a deep belief that every life should be lived with dignity, Bonaventure has served in different capacities in the humanitarian and development contexts. He holds over a dozen years of progressive experience in public health and education project management. Prior to joining Seed, Bonaventure worked with the US mission in Uganda where he helped set a firm foundation for the Global Health Service Partnership as the inaugural program manager.
Bonaventure has led teams through various stages of the entire project cycle including scoping, feasibility assessment, project design, fundraising, implementation, evaluation, and closure of multi-stakeholder donor-funded health system strengthening programs in Africa. He has worked at the United Nations High Commissioner for Refugees/German Technical Cooperation partnership, University Research Co. LLC, the US Peace Corps, the Government of Uganda, and Kampala International University.
He serves on a number of nonprofit boards and technical working groups in Uganda including the project advisory committee for the US Peace Corps, the virtual mentorship pilot committee at the University of Manchester, and the case management pillar of the Uganda National COVID19 Task Force. Bonaventure is a trained physician, public health specialist, and public administrator having graduated from Makerere University, University of Manchester, and Uganda Management Institute respectively.