1. HRH Key resource of health care systems and especially for primary care Human relationship in care is a part of treatment (curative and preventive)

2. Trends –FTE MD decrease (papy doctors boomers, regulation, trade off bteween working and private life and feminization) –Demand increase ? (papy boomers) –Mal distribution deprived rural and urban areas more than global shortage –Brain drain (more than 25 % are foreign doctors inUK and US...) –Immigration of poor health workers and emigration of rich elderlies

3. Issues for primary care More organized/coordinated/integrated system : solo practice...group practice/home care model... team work...networks Skill mix –Changing roles (New roles of professionals or new professionals ) and/or changing interfaces ? –Systemic changes : scopes of practice, training and incentives and remunerations Competition in health sector but competition with other sectors : how to attract and maintain skilled workers

4. HRH crisis : threat or opportunity ? (1) Increase of geographic/social inequalities Less quality staff (selection and training) and risk of cheap primary care again and not attractive for population (eg Task shifting initiative, Mali) Power of professionals (income) Effects in low income countries (multilateral agreement, self sufficiency)

5. HRH crisis : threat or opportunity ? (2) Surfing on HRH crisis to restructure health care organisation –Willingness of medical profession to change (practice, incentives, education, training…) –Less concurrence between doctors in ambulatory care is more convenient to transfer tasks Need for arguments, data, evidence, research, training and.. clear goals