• Achieving change

Achieving change

The quality of health services depends on the performance of health service workers, but little attention has been paid to improving how human resources are managed in the health sector. A document by the Pan American Health Organization (PAHO) looks at the situation in the Pan-American region, and outlines actions for improving the institutions which manage health sector workers. It argues that human resource management needs to be reconceptualised as central to health service systems, and that national- and regional-level actions can be taken to improve how health sector staff are managed. Improving how health service workers are managed is key to improving the health services they deliver, and therefore central to health sector reform.

Efforts to reform health services in the Pan-American region have tended to neglect the issue of human resource management. In some cases, the incentives of health sector workers to perform have even declined as a result of the reforms. But it is increasingly recognised that the quality and quantity of health services delivered depends ultimately on health sector workers at all levels. There have been few efforts to reform the incentives of health sector workers to perform more effectively, and the management of health workers is usually delegated to a personnel office rather than treated as central to the sector as a whole. This review by the PAHO highlights three concerns about the institutions which currently manage health sector human resources:

• Institutions need to take into account and address how health sector reforms (including decentralisation, deregulation, increasing flexibility, lack of resources, and organisational change) themselves affect the performance of health workers.
• Human resource management needs to shift from the old management model of protected, stable, public sector careers, towards the new flexibility required of employees and the institutions that manage them.
• The old management model did not generate enough information about human resources.

The document identifies key actions that need to be taken to improve the institutions that manage health sector workers:

• Human resource management needs rethinking, to develop new concepts and visions of how health sector workers can contribute to better services.
• The management of human resources needs to become integral to health sector policy, and based on the decisions of health system managers, rather than relegated to personnel offices.
• National level strategies could include promoting new and tested management practices and styles; improving information systems, including on good practice, and simplifying regulation.

Recognising the need for these actions, PAHO has developed the Observatory of Human Resources in Health Sector reform, an organisation which studies and shares information about best practice regionally.

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