Everyone is an optimist and a pessimist.
The pessimist in me knows that, out of the 75 countries that account for the vast majority of maternal and child deaths globally, fewer than half will achieve Millennium Development Goal (MDG) 4 (reducing child mortality by two thirds), and very few will achieve MDG 5 (reducing maternal mortality by three quarters).
But the optimist in me knows that the current rates of maternal, newborn and child mortality are the lowest the world has ever seen, thanks to the tremendous progress made particularly in the last decade, and aided by unprecedented international attention and support. Knowing that our work makes a difference, and eventually will leave a full glass to the next generation, is what gets me out of bed every morning.
Tackling maternal mortality may seem like a daunting challenge: a complex interplay of socio-economic, cultural and health system factors conspire to determine life-threatening delays in seeking and accessing quality care. But we have now better evidence than ever before on how to fix these problems: for instance, several different analyses of the last few years converge on identifying health workers (not just their numbers, but also their skills, motivation and performance) as the critical pathway to achieve universal health coverage and reduce maternal and child mortality.
Recent analyses conducted by the World Bank show that having the right incentives in place for health workers might be even more important than the financial dimension alone: only when there are health workers in sufficient numbers and with the requisite skills, with adequate pay and incentives to ensure their equitable distribution and bolster their motivation, and with the required system support and tools to do their job, can the health system offer life-saving services across the different phases of life and in different places of caregiving.
But I want to challenge the myth that improving maternal and newborn health is a highly complex and expensive endeavor. On the contrary; life-saving maternal and newborn care does not need to be costly, hi-tech, and in-hospital. Most interventions to save women's and newborn lives can be offered at the primary care level in facilities equipped to deliver basic emergency obstetric care.
The State of the World's Midwifery 2014 (a ground-breaking recent analysis led by UNFPA and conducted with the support of and in collaboration with a number of partners, including WHO, the development agencies of France, Canada, Norway, Sweden, USA, the International Confederation of Midwives, ICS Integrare, Johnson & Johnson, and The Bill and Melinda Gates Foundation, amongst others) found that midwives who are educated and regulated to international standards can provide most of the essential care needed . Investing in midwifery education, with deployment to community-based services, can yield a 16-fold return on investment, and is one of the "best buys" in primary health care.
And yet such opportunities are often missed through neglect or under-investment in the health workforce. There is no silver bullet or easy shortcut: the design and implementation of effective education, regulation, accreditation, management and financing policies require adequate capacities in governments to understand national health labour market dynamics, translating this intelligence into sound plans, and the political willingness to fund them adequately.
And here I want to de-bunk a second myth, i.e. that health workforce development is a technical issue for health specialists. Health is political, and nowhere more so than in the area of health workforce, which sits at the intersection between the education, labor, employment, gender, finance and (of course) health agendas. To ensure availability of health workers to the whole population, long-term, sustained, and high-level political commitment is required to guarantee collaboration by different sectors and constituencies in society, spanning from health to finance, education and labour, and including professional associations, training institutions, labour unions, and the private sector. Ensuring that more and more countries follow the path of placing health workforce development at the centre of their health and broader development efforts through effective inter-sectoral collaboration is what we do at the Global Health Workforce Alliance.
The scale of the challenge is huge: health systems already face a shortfall of millions of health workers, which will rise if we consider the implications of the "0 targets" of ending preventable newborn and child deaths that the international community is currently considering. Meeting these future requirements will entail matching massive new investments in the training and deployment of health workers with significant improvements in their productivity and quality.
It is not a choice between increasing numbers of health workers or improving their performance: both will be necessary.
Dr Margaret Chan, Director General of WHO, once said she wanted "to be judged by the impact we have on the health of the people of Africa, and the health of women." There is probably no single better measure of success of international development efforts at large; political leaders across the world should be held to account by their citizens -- and hold themselves accountable -- on the same basis. Ensuring conducive policies and adequate investments for the health workforce represents an indispensable step in ensuring that the ambition of eliminating preventable maternal and child deaths becomes a reality.