A cosmopolitan outlook on health workforce development Citation for published version (APA): van de Pas, R. A. M. (2020). A cosmopolitan outlook on health workforce development. Global Academic Press. https://doi.org/10.26481/dis.20200914rp Document status and date: Published: 01/01/2020 DOI: 10.26481/dis.20200914rp Document Version: Publisher's PDF, also known as Version of record Please check the document version of this publication: • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. 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If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license above, please follow below link for the End User Agreement: www.umlib.nl/taverne-license Take down policy If you believe that this document breaches copyright please contact us at: [email protected] providing details and we will investigate your claim. Download date: 26 Sep. 2021 A cosmopolitan outlook on health workforce development health outlook on workforce A cosmopolitan Over the last few decades, the global health workforce gap has increased. This gap concerns the skilled workforce required A cosmopolitan outlook for providing essential health care services across the world in A Cosmopolitan outlook an equitable manner. Due to demographic growth in different on health workforce development on health workforce development regions of the world, an aging workforce and an epidemiological transition to chronic diseases worldwide, there is a need for, and impetus required, to invest in health workers and Remco van de Pas their decent employment. Remco van de Pas Remco van de Pas A cosmopolitan outlook on health workforce development Remco van de Pas COLOFON A cosmopolitan outlook on health workforce development Dissertation Remco van de Pas Cover and layout: Lize Jansen (lizejansen.nl) Printing: ProefschriftMaken Edit: Ritwik Dahake Author info: [email protected] Van de Pas R. A cosmopolitan outlook on health workforce development. 2020. 353 p. Global Academic Press. ISBN: 978-94-6380-922-1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval database or published in any form or by any means, electronic, mechanical or photocopying, recording or otherwise, without the prior written permission of the author or, when appropriate, the publishers of the papers. The research presented in this thesis was conducted at CAPHRI Care and Public Health Research Institute, Department of Health, Ethics and Society of Maastricht University. CAPHRI participates in the Netherlands School of Public Health and Care Research CaRe. The research presented in this thesis was also conducted at, and financed by, the Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. A cosmopolitan outlook on health workforce development DISSERTATION to obtain the degree of Doctor at the Maastricht University, on the authority of the Rector Magnificus Prof.dr. Rianne M. Letschert in accordance with the decision of the Board of Deans, to be defended in public on Monday, the 14th of September 2020 at 16.00 hrs. By Remco Adrianus Maria van de Pas SUPERVISORS: Prof. dr. D.M.R. Townend, Maastricht University Prof. dr. J.S.M. Krumeich, Maastricht University CO-SUPERVISOR: Prof. dr. W. Van Damme, Institute of Tropical Medicine, Antwerp, Belgium ASSESSMENT COMMITTEE: Prof. dr. K. Horstman (chair) Dr. T. Krafft Prof. dr. R. Labonté, University of Ottawa, Canada Prof. dr. D. Lesage, Ghent University, Belgium Dr. P. Schröder-Bäck to my daughter Ika van de Pas Table of contents Preface 11 Chapter 1: Introduction and Problem Outline 15 1.1 The global health workforce challenge 16 1.2 Cosmopolitanism 18 1.2.1 A cosmopolitan outlook 20 1.2.2 A cosmopolitan outlook on health workforce migration 21 1.3 Global health policy frames 23 1.4 Health equity in a globalizing era of deep economic integration 24 1.4.1 The health labor market 25 1.5 Global health security and the securitization of health 26 1.6 Global health governance 28 1.6.1 Globalization paradox 30 1.6.2 Global health workforce governance complexity 33 1.6.3 Gridlock in global cooperation for health 35 1.7 Research questions 37 1.8 Conceptualizing global health workforce governance and its paradox 38 1.9 Outline 43 Chapter 2: Methodology 47 2.1 Methodological approaches studying global health 48 2.2 Differentiating methodologies in studying globalization and health 49 2.3 Methodological cosmopolitanism 50 2.4 Health workforce development and its governance 51 2.5 Pluriform methodologies 53 2.6 Methodological limitations and challenges 56 Chapter 3: Governance of the global health workforce 59 3.1 Health workforce development and retention in Guinea: a policy analysis post-Ebola 61 3.2 Tracing the policy implementation of commitments made by national governments and other entities at the Third Global Forum on Human Resources for Health 81 Chapter 4: Global health workforce governance 101 4.1 Democratizing the World Health Organization 103 4.2 The Code of Practice and its enduring relevance in Europe and Eastern and Southern Africa 117 Chapter 5: Global governance of the health workforce 133 5.1 The securitization of health and humanitarian space: Health workers under attack? 135 5.2 Ebola, the epidemic that should never have happened 159 5.3 Interrogating resilience in health systems development 167 6 Table of contents Chapter 6: Global health policy and the cosmopolitan outlook 175 6.1 Global health governance in the sustainable development goals: Is it grounded in the right to health? 177 6.2 Global Health in the Anthropocene: Moving Beyond Resilience and Capitalism 199 6.3 Framing the Health Workforce Agenda Beyond Economic Growth 209 Chapter 7: Discussion 221 7.1 Domestic policy space to expand and reform the health workforce 223 7.1.1 International finance 224 7.1.2 Economic reforms and fiscal space limitations 225 7.2 Democratic legitimacy 229 7.2.1 The democratic legitimacy of the World Health Organization 229 7.2.2 The governance of international health workforce migration 231 7.3 International policy trends outside the global health domain 233 7.3.1 The securitization of health and its impact on the health workforce 234 7.3.2 The legitimacy of the health care workers 236 7.3.3 Structural adjustment policies 237 7.3.4 Trade agreements and their impact 240 7.4 Limited cosmopolitan space for global health workforce development 241 7.4.1 Global health governance grounded in the Right to Health 242 7.4.2 Synergies and tensions between UHC and global health security 244 7.4.3 Complex adaptive systems 246 7.4.4 Exerting power in global health governance 247 7.5 The political trilemma and global health workforce governance 250 7.6 Reflections on conceptual framework and methodology 257 7.6.1 Boundary spanning, multi-perspectivism and epistemic limitations 261 7.7 A cosmopolitan outlook on health workforce development 266 References 277 Annex 1: Valorization Addendum 319 Annex 2: Summary 327 Annex 3: Curriculum Vitae 331 Annex 4: Acknowledgements 343 Annex 5: Abbreviations 349 Tables Table 3.1: Numbers of interviews conducted per groups of participants 66 Table 3.2: Health workforce profiles and distribution in Forecariah and Yomou districts 69 Table 5.1: Overview of four roles in four dimensions of health work in violent conflicts 142 7 Table of contents Figures Figure 1.1: Global Health Governance along three political spaces 29 Figure 1.2: The Political trilemma of the World Economy 30 Figure 1.3: The Political Trilemma and Global Health Workforce Governance 39 Figure 3.1: Evolution of HRH policy in Guinea Post-Ebola 65 Figure 3.2: Geographic distribution of health training institutions in Guinea, April 2017 73 Figure 3.3: Distribution of graduates from 2010 to 2015 by staff category 73 Figure 3.4: Distribution of graduates from 2010 to 2015 by type of institution (private or public) 74 Figure 7.1: The Political Trilemma in relation to Global Health Workforce Governance 251 Figure 7.2: Shortfalls and overshoots in the Doughnut 268 Boxes Box 3.1: Reforms by the Guinean government in HW policy and management functions 64 Box 3.2: Results of the implementation of Human Resources for Health actions 86 Box 3.3: Results of the initiated policy and governance mechanisms 89 Box 3.4: Examples of actions according to the Availability, Accessibility, Acceptability and Quality dimensions and policy pathways 90 Box 3.5: Examples of monitoring mechanisms being initiated 91 Box 3.6: Examples of Human resources for Health governance mechanisms being initiated 92 Box 3.7: Examples of the Human resources for Health political momentum 93 Box 3.8: Examples of Human resources for Health actions by other entities 94 8 Table of contents 9 PREFACE “I advance two steps, it goes two steps backward.