Working together for health

There is a crisis in human resources for health care, with a chronic and global shortage of well-trained health workers, most acutely felt in those countries where they are most needed, says Dr Lee Jong-Wook, the World Health Organization (WHO) Secretary General, in his foreword to the 2006 World Health Report (WHO, 2006). People, he says, are the vital ingredient in strengthening health care systems, but the solution is not straightforward; nor is there a consensus about how to proceed. Health care workers around the world, says the report, are experiencing increasing stress and insecurity, exacerbated by concentrations of population in urban areas and migration from the poorest to the richest countries, compounded where the skills of limited yet expensive professionals are ill-matched to the profile of local health care needs. That crisis has the potential to deepen in coming years as demand for services escalates in countries facing lower fertility and ageing populations. It has been recognized for some time that the shift from acute tertiary hospital care to patient-centred, home-based and team-driven care will require new skills and collaboration between workers and with patients. In particular a team approach is required to respond to the needs of individuals with chronic conditions and to address challenges in public health. Therefore health care employers and managers need to pay attention to building teams if they are to meet the challenges and targets of the future. Care for patients with chronic conditions must be organized and coordinated over time among providers and across settings, sharing power with patients and working with community groups. Outcomes will then improve, asserts the WHO in a related report (WHO, 2005). It argues that health care providers must work interdependently, demonstrating mutual respect, trust, support and appreciation of each discipline’s unique contribution. They must reconcile abstract notions of ‘‘public health’’ while responding to patients’ pressing needs and concerns. The report enunciates core competencies required for working with patients with chronic conditions: patient-centred care; partnering; quality improvement; information and communication technology; and a public health perspective. To dismiss these reports as merely re-treading familiar ground would be to miss their point. The force of their argument lies in the broad consensus of informed opinion that they represent, endorsed by the evidence that they muster. The case for concerted action is compelling and the challenge for readers of this Journal plain: to demonstrate how interprofessional education and practice development can and does help to deliver the required outcomes, as another WHO report argued so persuasively almost 20 years ago (WHO, 1988). We have learned much during the intervening years about means to ends in interprofessional education, which may well help to realize the WHO goals. But our credibility, and our capacity to respond to the needs where they are greatest, depends crucially upon our readiness, coming as we do overwhelmingly from developed countries, Journal of Interprofessional Care, January 2007; 21(1): 1 – 2