PRESENTATION

Human resources in mental health, alcohol and other drugs: global guidelines and for the American Continent^*

Carla Aparecida Arena Ventura

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil

Corresponding Author

In recent decades, imbalances and reductions in the workforce in health have been observed and, in this perspective, the training, availability and qualification of human resources make up the priorities of the global, regional and national health agendas.

The 2006 World Health Report, "Working together for Health"⁽¹⁾, prepared by the World Health Organization (WHO), analyzed the global crisis regarding human resources in health and innovated by presenting proposals to deal with problems related to the workforce in health in ten years. Among the initiatives resulting from this movement, the Global Strategy on Human Resources for Health: Workforce 2030, adopted by the 67^th WHO General Assembly⁽²⁾, stands out as a result of the Recife Political Declaration on Human Resources for Health.

As its vision, the Global Strategy determined to accelerate the organization of programs for universal health coverage and the achievement of the Sustainable Development Goals (SDGs), ensuring equitable access to health workers, through the strengthening of the health systems. It established the following principles: promoting the right to the best possible health standard; promoting integrated and people-centered services; promoting engaged and autonomous communities; strengthening the rights of all health workers, including decent work environments and freedom from all types of discrimination, coercion and violence; in addition to promoting international collaboration and solidarity, in line with the national priorities; ensuring ethical recruitment practices and guaranteeing the countries' political commitment to meet these goals.

Countries with different levels of economic development face difficulties in the training, organization, retention and performance of the workforce in health. Considering that the health professionals' work is essential for the operation of health systems, the advancement of the health services' coverage and the achievement of the right to health will only be possible through their availability, accessibility, acceptability and quality of the service offered. Furthermore, greater availability of health professionals is not enough by itself. It is fundamental that health professionals are distributed equitably and in an accessible manner to the population, develop the necessary skills, and are motivated to offer quality care that is adequate to the sociocultural expectations of the population.

The workforce in health plays a vital role in building resilience in the communities and health systems, so that they may respond to the global and local challenges. However, investments in the workforce in health are still scarce, reducing the sustainability of the health systems and workforce. In this way, the Global Strategy established important policy options for the WHO Member States, aiming to foster progress towards achieving the SDGs, building human capacities to implement this agenda.

In the American Continent, during the 29^th Pan American Sanitary Conference in 2017, the member countries of the Pan American Health Organization (PAHO) reasserted their commitment towards universal access to health and universal health coverage, based on the 2007-2015 Regional Objectives for Human Resource Development⁽³⁾, which reasserted the need for a correlation between the health professionals' competence profiles and the WHO and PAHO strategies for human resource development

They acknowledge that, despite the progress made towards social and economic development and the strengthening of the health systems, there are still many inequalities and much exclusion in access to appropriate and quality services, especially for vulnerable groups. The situation in the region is characterized by low retention rates of professionals in rural areas, high mobility and migration, precarious working conditions, and low productivity and performance. However, even when human resources are available, they may not have the appropriate profile and skills, an intercultural perspective or be in the right place to improve the health of the populations they serve. In summary, human resources for health in the region are not always aligned with the needs of the local health systems; therefore, innovative solutions are needed to deal with the region's challenges.

The regional strategy is based on the principles of the right to health, equality and solidarity, and on the assumption that human resources in health play a central role in progressively dealing with organizational, ethnic and gender barriers so that the communities may have better access to adequate and quality health services.

In this context, the mental health area faces the challenges exposed by the aforementioned documents and strategies, as well as problems in the planning and training of personnel. The vast majority of the countries have few qualified human resources to work in the area. In this sense, mental health should be a priority in the countries' public health agenda.

Over the past fifty years, mental health care has undergone changes, with a focus on the community and greater integration of mental health with general health care, with the purpose of dealing with stigma and discrimination, through multidisciplinary approaches and collaboration with non-State actors. It is fundamental that the countries develop appropriate policies for human resources, adopt management strategies, with a focus on leadership, staff motivation, increased retention, and inclusion of mental health as a component of the health professionals' curriculum, that is, that they work towards the construction of a new paradigm for mental health⁽⁴⁾.

This special issue of the SMAD journal presents relevant contributions to this discussion, corroborating the importance of studies that focus on the strengthening of human resources in the area of mental health/alcohol and other drugs.

This edition was organized as a requirement of the work plan of the PAHO/WHO Collaborating Center for the Development of Nursing Research (activity 2.2. of Reference Term 2), based at Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, aiming to present and integrate diverse evidence on the development of human resources in the area of mental health, alcohol and other drugs. We therefore hope that the articles further inspire our readers to develop innovative research and studies on the subject matter. Enjoy your reading, everyone!

References

1. Organização Mundial da Saúde. Relatório mundial de saúde, 2006: trabalhando juntos pela saúde. Brasília: Ministério da Saúde, OMS; 2007.         [ Links ]

2. Organização Mundial de Saúde. Health Workforce 2030: towards a global strategy on human resources for health. Geneva: OMS; 2015.         [ Links ]

3. Pan American Health Organization. 27th Pan American Sanitary Conference 59th Session of the Regional Committee. Regional Goals for Human Resources for Health 2007-2015. In: Final Report. CSP27/FR (Eng.) 5 December 2007. Washington, D.C., USA, 1-5 October 2007 [cited 2016 Jun 10]. Available from: http://www1.paho.org/english/gov/csp/csp27-fr-e.pdf?ua=1        [ Links ]

4. World Health Organization. Mental Health - Action Plan 2013-2020 [Internet]. Geneva (SW); World Health Organization; 2013 [cited 2016 Jun 10]. Available from: http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf?ua=1        [ Links ]

Corresponding author:
Carla Aparecida Arena Ventura
E-mail: caaventu@eerp.usp.br

* The publication of this article in the Thematic Series "Human Resources in Health and Nursing" is part of Activity 2.2 of Reference Term 2 of the PAHO/WHO Collaborating Centre for Nursing Research Development, Brazil.