Lessons from the evolution of human resources for health in Ethiopia: 1941-2010 Yayehyirad Kitaw 1 , Gebre-Emmanuel Teka 1 , Hailu Meche 1 Abstract Human resources for health (HRH) policy and planning is highly challenging in any setting but the more so in underdeveloped countries. Ethiopia has relatively vast and distinctive experience in accelerated training, use of substitute categories/task-shifting… from which important lessons could be drawn. Based on thorough analysis of documents (official, unofficial, government and others) and 1 st hand experience of the authors, the paper explores the major issues in HRH development between 1941 – end of the Italian Occupation - and 2010 – end of the Health Sector Development Program (HSDP) III. The socio-cultural and economic context; development in education, higher education in particular and the general human resources development policy, strategy and plans in the successive periods are assessed briefly. Major developments of • Reconstruction and Basic Health Services Period (1941-1974): the successive five-year plans; the training of orderlies/dressers, the 1 st nursing schools, training abroad…; the Gondar Public Health College and the Gondar Team; the beginnings of medical education … • Primary Health Care Period (1974-1991) the Ten Years Perspective Health Plan; the training of Community Health Workers - Community Health Agents and Trained Traditional Birth Attendants -, nurse practitioners, health assistants; discontinuation of the health officers (HO) training, the initiation of Jimma College of Health Sciences and of post-graduate training in medicine at the Faculty of Medicine Addis Ababa University… • Sector-Wide Approach Period (1991-2010) the Health Sector Development Programs I-III, the reintroduction of Health Officers training, the accelerated training/‘Flooding Strategy’, Health Extension Workers, retention/‘Brain-Drain’ of health workers… are explored in some depth and lessons drawn for future HRH development in the country. The conclusions underscore the laudable efforts in all periods but difficulties of learning from the past; the continued very low workforce density and the highly skewed distribution; the recurring challenges of sustained human resources development – quality, motivation, retention… - of the task-shifting and accelerated training attempts and the need to develop specific HRH policy and strategy. [Ethiop. J. Health Dev. 2013;27 Special Issue 1:6-28] I. Introduction More than ever before, health is recognized as important for development (1, 2) and “The key barrier to scaling up in health is staff…” (3, emphasis ours). Human resources for health (HRH) are recognized as critical, ‘the human equation’, “the glue of the health system”, in achieving these goals (1.2,4). Ethiopia has embarked on major development efforts based on its current policies and strategies (Agricultural Development Led Industrialization, Health Policy …) and its international commitments (Plan for Accelerated and Sustainable Development to End Poverty, MDGs …). It has launched ambitious and accelerated development programs in health (Health Services Extension Program, Accelerated Expansion of Health Officers Training …). However, as in many parts of the world, there are concerns that development may be hampered by the HRH crisis in Ethiopia which has several aspects and raises complex issues as evidenced by studies from a number of countries (4,5). The current health workforce density (HWD) of 0.2 per 1000 in Ethiopia, compared to the minimum of 2.3 required to achieve MDGS in Africa (1), clearly indicates the challenges ahead (5). The frenetic acceleration is, in this context, laudable as an effort to ‘catch up on the years lost’. However, history shows that a lot of programs foundered because they started with the erroneous but appealing frontal and vertical attack neglecting, among others, the human resources development (HRD) aspects. This HRD neglect was also buffeted by emerging and re-emerging diseases including the HIV/AIDS crisis implying increased workload and skill requirement; reduction of the workforce; and psychological stress. There was also the additional challenge of emigration to richer countries (1,2,4). Human resources for health (HRH) policy and planning is highly challenging in any setting but the more so in underdeveloped countries (3, 6). As a large and diverse country, Ethiopia presents even more daunting challenges to HRD. Big by any standards - 1.2million km², 28.7 million people, 90% rural in 1976; 1million km², 80 million people, 84% rural in 2010 – it harbors over 80 ethnic groups and highly diverse climatic zones. Highly complex socio-political conditions, “constants of Ethiopian history” - difficult transitions, internal conflicts (liberation movements…), complex disasters… - have rendered sustainable development difficult (see 5). On the other hand, Ethiopia has relatively vast and distinctive experience in HRD from which important 1 All Independent consultants in public health; Address correspondence to yayehyiradk@yahoo.com