Human Resources

The world health report 2006 - working together for health
World Health Organization – April 2006

The World Health Report 2006 - Working together for health contains an expert assessment of the current crisis in the global health workforce and ambitious proposals to tackle it over the next ten years, starting immediately. The report reveals an estimated shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide. The shortage is most severe in the poorest countries, especially in sub-Saharan Africa, where health workers are most needed. Focusing on all stages of the health workers' career lifespan from entry to health training, to job recruitment through to retirement, the report lays out a ten-year action plan in which countries can build their health workforces, with the support of global partners.

Further details: /newsletter/id/31419
The Zambian HIV/AIDS workforce study

Anticipating significant scale-up of its current HIV/AIDS services, the Zambian Central Board of Health commissioned this study of the human resource implications. The study collected data at 16 government, NGO, and private for-profit sites across Zambia that currently provide VCT, P-MTCT, and ART services. It analyses the time taken to carry out the prescribed tasks involved in each of the services, describes the present workforce involved in providing these services and the extent to which services are currently following national service delivery standards, and projects the human resource requirements and costs associated with scaling up services to planned levels.

The ‘Skills Drain’ of health professionals from the developing world
Medact paper

"This paper examines policy towards health professionals' migration from economic and governance perspectives. Our aims are conceptual and agenda-setting. In essence, we argue that current policy responses to migration of health professionals from low income developing countries underestimate the pressures and mis-identify the reasons for rising migration, overestimate the impact of recruitment policies on migration flows while ignoring unintended side effects, and mis-specify the ethical dilemmas involved."

Thousands quit SA health service jobs

The provincial health department [Western Cape] has lost nearly 4 000 staff in the past six years - and there are no plans to replace them. But the department does not intend to let the numbers drop further. In his budget speech in the provincial legislature, Health MEC Pierre Uys said the department was losing staff at the rate of 1 000 a year.

Time savings – realized and potential – and fair compensation for community health workers in Kenyan health facilities: a mixed-methods approach
Sander LD, Holtzman D, Pauly M, Cohn J: Human Resources for Health 2015, 13:6

Sub-Saharan Africa faces a severe health worker shortage, which community health workers (CHWs) may fill. This study describes tasks shifted from clinicians to CHWs in Kenya, places monetary valuations on CHWs’ efforts, and models effects of further task shifting on time demands of clinicians and CHWs. Interviews were conducted with 28 CHWs and 19 clinicians in 17 health facilities throughout Kenya. Twenty CHWs completed task diaries over a 14-day period to examine current CHW tasks and the amount of time spent performing them. A modelling exercise was conducted examining a current task-shifting example and another scenario in which additional task shifting to CHWs has occurred. CHWs worked an average of 5.3 hours per day and spent 36% of their time performing tasks shifted from clinicians. The authors estimated a monthly valuation of US$ 117 per CHW. The modelling exercise demonstrated that further task shifting would reduce the number of clinicians needed while maintaining clinic productivity by significantly increasing the number of CHWs. The authors’ argue that this costing of CHW contributions raises evidence for discussion, research and planning regarding CHW compensation and programmes.

Too Poor to Leave, Too Rich to Stay: Developmental and Global Health Correlates of Physician Migration to the United States, Canada, Australia, and the United Kingdom
Arah OA, Ogbu UC, Okeke CE: American Journal of Public Health, 22 October 2007

This paper analyses the relationship between physician migration from developing source countries to more developed host countries (brain drain) and the developmental and global health profiles of source countries. Source countries with better human resources for health, more economic and developmental progress, and better health status appear to lose proportionately more physicians than the more disadvantaged countries. Higher physician migration density is associated with higher current physician and public health workforce densities and more medical schools. Policymakers should realize that physician migration is positively related to better health systems and development in source countries. In view of the "train, retain, and sustain" perspective of public health workforce policies, physician retention should become even more important to countries growing richer, whereas poorer countries must invest more in training policies.

Toward Interventions in Human Resources for Health in Ghana
Appiah-Denkyira E, Herbst CH, Soucat A, Lemiere C and Saleh K (Eds): World Bank, 2013

This book was produced to support the policy dialogue on Human Resources for Health (HRH) in Ghana. Despite some recent successes, further improvements in health outcomes are in part hampered by the lack of skilled service providers, or human resources for health (HRH), particularly in rural areas, that prevent critical health services from being accessed and adequately delivered to those that need them most. To address the lack of information to guide the development of policies and programmes on HRH, the book aims to paint a comprehensive picture on HRH, consolidating new and existing evidence on some of the underlying determinants impacting stock, distribution and performance of health workers in Ghana, including health worker production and attrition, management and accountability structures, the capacity of health training institutions, and health worker compensation. As is made clear, any potential policies to improve the situation on HRH need to be well targeted, and take into account some of the fiscal and political challenges that are specific to the health labour market in Ghana. The book is intended to provide a basis for Ghanaian decision makers and external partners to dialogue on HRH and related policies, resulting in concrete HRH actions. More broadly, it will be of interest to all those working to improve HRH in Africa and beyond.

Towards a global health workforce strategy
A new book on human resources for health issues

The papers presented in the book cover the main dimensions of HRD in health: planning and managing the workforce, education and training, incentives and working conditions, managing the performance of personnel and policies needed to ensure that investments in human resources produce the benefits to which the investing populations are entitled. Authors write from diverse professional, regional and cultural perspectives, and yet there is a high degree of consistency in their diagnosis of problems and proposals for strategies to address them. They all agree on the multidimensionality of problems and on the need for solutions that take into account all dimensions. They also agree that if problems tend to be similar in nature, they take forms that are time and context-determined.

Towards better stewardship:
concepts and critical issues

Phyllida Travis, Dominique Egger, Philip Davies, Abdelhay Mechbal. Evidence and Information for Policy, World Health Organization, 2002.
The paper proposes that stewards should have access to reliable, up-to-date information on: Current and future trends in health and health system performance? For example, on levels, trends and inequalities in key areas such as national health expenditures; human resources; health system outcomes; health risk factors; vulnerable groups; coverage; provider performance; organisational / institutional challenges in provision, financing, resource generation, stewardship Important contextual factors and actors the political, economic and institutional context; the roles and motivation of different actors; user / consumer preferences; opportunities and constraints for change. Events / reforms in other sectors with implications for the health sector Possible policy options, based on national and international evidence and experience? For example, intelligence on different policy tools and instruments for similar problems; on their effects in different settings, and on managing change. It includes information on relatively specific things such as cost-effective interventions; and on possible institutional arrangements for different functions.

Further details: /newsletter/id/29173
Tracking and monitoring the health workforce: A new human resources information system (HRIS) in Uganda
Spero JC, McQuide PA, Matte R: Human Resources for Health 9(6), 17 February 2011

The purpose of this article is twofold. First, the authors describe Uganda's transition from a paper filing system to an electronic Human Resource Information System (HRIS) capable of providing information about country-specific health workforce questions. They examine the ongoing five-step process to strengthen the HRIS to track health worker data at the Uganda Nurses and Midwives Council (UNMC). Second, they describe how HRIS data can be used to address workforce planning questions via an initial analysis of the UNMC training, licensure and registration records from 1970 through May 2009. The data indicated that, for the 25,482 nurses and midwives who entered training before 2006, 72% graduated, 66% obtained a council registration, and 28% obtained a licence to practice. Of the 17,405 nurses and midwives who obtained a council registration as of May 2009, 96% are of Ugandan nationality and just 3% received their training outside of the country. Thirteen percent obtained a registration for more than one type of training. Most (34%) trainings with a council registration are for the enrolled nurse training, followed by enrolled midwife (25%), registered (more advanced) nurse (21%), registered midwife (11%), and more specialised trainings (9%). The authors found the UNMC database was valuable in monitoring and reviewing information about nurses and midwives. However, they add that information obtained from this system is also important in improving strategic planning for the wider health care system in Uganda.

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