Confronting challenges in health personnel A Ntuli HST EQUINET theme co-ordinator ant@hst.org.za The biggest and most important component of any health system is its human resources (HR). The effective, equitable and appropriate production, training and deployment of health workers has been associated with periods of high health gain in southern Africa. Despite this, many health systems in southern Africa now face a variety of HR problems and personnel scarcities have become a critical limiting factor in health interventions. Health worker migration is further compounding inequities and stresses. Responding to economic and social triggers, personnel flow from rural to urban areas, from public to private sectors, from lower to higher income countries within southern Africa and from African countries to industrialized countries, exacerbating inequities and providing a reverse (poor to rich) subsidy. However a new policy momentum exists in relation to human resources for health. This draws from a number of political, economic, trade and labour rights trends, but also from the extent to which personnel scarcities have become a critical limiting factor in health interventions. Policy initiatives are being taken at regional, international and global level by government, private and health professional actors. This paper highlights constraints to designing policies that neither punish workers nor leave poor communities unfairly underserved. These include the availability of timely and accurate information on health personnel distribution and movements, and the paper presents a conceptual framework for approaching and further developing a wider mapping of determinants of health personnel distribution and flows. It also argues that while a host of factors influencing personnel flows are identified, there is inadequate specific assessment of the relative impact of these factors in different settings with different mixes of personnel; and of how different policy measures have impacted on them, objectively and from the view of stakeholders relevant to the issue. Available literature signals but does not adequately elaborate the role of institutional and governance factors in policy development on human resource issues, but provides sufficient evidence that it is an area where stakeholder perceptions and interests cannot be ignored. Promising policy options and plans that may contribute to a more equitable distribution of personnel being developed by the HR network (a consortium of Southern based institutions with partners in Australia, the UK and Canada), will be presented with particular emphasis upon potential advocacy and policy responses.