L’Initiative: Investing in Human Resources to Strengthen Health Systems

Health professionals are the cornerstone of health systems. Yet, in many countries, shortages in personnel, their unequal distribution across regions, and limited training capacities continue to hamper access to care.

L’Initiative is a mechanism that acts as a complement to the Global Fund to Fight AIDS, Tuberculosis and Malaria. It supports partner countries in strengthening their health systems so that the prevention, diagnosis, and management of these three pandemics can be improved. Developing health human resources is a key driver for ensuring sustainable access to quality care and to strengthening health system resilience.

Through its funding and technical assistance, L’Initiative supports national strategies for health personnel training, deployment, management, and retention. In Rwanda, Chad, and Madagascar, three key projects are mobilising more than €17 million to build national capacities, plan for needs better, and improve the availability of professionals throughout the countries.

In Rwanda, L’Initiative supports the “4×4” national reform, launched in 2023. Its ambitious goal is to quadruple, in four years, the number of health professionals trained. With €5 million over the 2025-2028 period, the project primarily targets nurses, midwives, and other primary healthcare professionals. It is implemented along with the Ministry of Health, the University of Rwanda, and several national institutions.

The challenge is to rapidly increase training capacities while maintaining a high level of quality. The project provides support for revising teaching programmes, strengthening teaching skills, and implementing simulation equipment. Scholarships are also provided to support students, and the development of mentoring and continuing education should help to sustainably strengthen the professionals’ skills.

In addition to training, L’Initiative helps modernise human resource management tools and strengthen regulatory mechanisms for health professions. In this way, the project supports the structural transformation of the Rwandan health system.

In Chad, the main challenge is the lack of health professionals and the fact that they are spread unevenly across the country. Health personnel remain highly concentrated in the capital, with many provinces continuing to face an insufficient care offer. This situation is made worse because training capacities are limited and human resource management tools remain poorly developed.

To address these challenges, L’Initiative is funding a €7 million project, implemented between 2025 and 2029. The goal of the project is to boost knowledge among the workforce and improve their management by creating a national health personnel file and strengthening dedicated information systems. It also provides guidance in developing planning tools and in improving recruitment and assignment processes.

The project also provides support to several medical and paramedical training institutions to improve learning conditions and develop new specialised training. In the long term, the project aims for professionals to be more evenly distributed throughout the country and for improved access to health care over the long term. At the same time, it promotes gender equality in the health sector.

One of the main challenges in Madagascar lies in the links among health system needs, training and recruitment capacities, and the deployment of professionals in the country. Despite the investments made in recent years, many trained personnel are still struggling to join the public sector over the long term. Recruitment of general practitioners by the State remains limited in particular, while some rural areas continue to face a chronic shortage of health professionals.

With €5.2 million in funding, the L’Initiative-supported project supports institutions responsible for planning and developing health human resources. In particular, it supports the implementation of the future national plan for health human resources development and capacity building for training facilities.

The action also focuses on developing continuing training, supporting the general medicine sector, and backing professionals working in rural areas. By strengthening the links between training, recruitment, and personnel deployment, the project is helping to bring health care closer to the people and to build a more coherent and equitable health system.