Human resources for health

Health workers are all the people who are engaged in actions whose primary intent is to protect and improve health. This includes health service providers and health management and support workers in the private and public sector. An appropriately trained, well performing health workforce is essential to achieving the best health outcomes possible given the available resources and circumstances. An ideal workforce has sufficient staff, and these are competent, fairly distributed, responsive and productive.

In many fragile states a large proportion of the health workforce has left the country or migrated to the cities, resulting in overall shortages and imbalances in the distribution of remaining workers. Additionally, the deteriorating skills and capacity of accredited training institutions has often led to the development of different cadres of staff whose competence for safe practice is not easily demonstrable. In the rush to scale up health services delivery during the reconstruction phase, the limitations in the health workforce are often overlooked. There is a tendency to treat the training of a new workforce as an emergency in order to address the urgent short-term needs, while structural support towards the development and implementation of national workforce policies and investment plans are often not prioritised by governments or donors alike.

Fragile states have a considerable amount of catching up to do in terms of human resources planning and training, the development of norms and standards, and the establishment of human resources databases. Smith and Kolehmainen-Aitken suggest a number of key steps in health workforce reconstruction in a post-conflict setting: (1) identifying available staff; (2) developing Human Resource management structures, systems, and capacity; (3) clarifying Human Resource roles and responsibilities; (4) establishing health worker equivalencies and upgrading skills; (5) supporting civil service reconstruction; and (6) widely communicating the rationale behind Human Resource management decisions.