Civil service reform

Human resource development is gradually being recognised as crucial to future reforms and the formulation of health policy. New information systems at local and regional level will be needed to collect data on human resources. New employment arrangements, strengthening organisational culture, training and continuing education will also be needed.

The introduction of market mechanisms often involves the formation of an internal market within the health sector and market testing of different functions with the private sector. This has immediate implications for the employment of health workers in the public sector, because the public sector may reduce its workforce if services are purchased from other sectors or may introduce more short-term and temporary employment contracts.

Decentralisation of budgets and administrative functions can affect the health sector, often negatively, by reducing available resources and confusing lines of accountability for health workers. Governance and regulation of health care, when delivered by both public and private providers, require new systems of regulation. The increase in private sector provision has led to many health workers moving to the private sector. For those remaining in the public sector, there are often worsening working conditions, a lack of employment security and dismantling of collective bargaining agreements. Public sector reform and demand for human resources for health considers some of the effects of health sector reform on HRH in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector.

The authors of Human resources: the Cinderella of health sector reform in Latin America, describe how World Bank-led reforms, meant to increase equity, efficiency and quality of care in Latin American health systems did not address HRH problems, despite having been identified in multiple health sector assessments. The authors describe how the two most important reform policies, decentralisation and privatisation, impacted negatively on employment conditions and prompted organised opposition on the part of health care workers. Consequently, the workforce became the most important obstacle to successful reform. The authors suggest that solutions determined from within the system are more likely to succeed than those imported from outside.

Emphasising the potentially overlooked importance of managing and administrating human resources (HR) in the health sector in Administrative and civil service reform – health sector issues, James Buchan acknowledges that managing HR in health care is a complex challenge and one that has often been underestimated when reform and restructuring has been planned. Overall he suggests that the key to achieving effective HR is to recognise that it has to be an integral element of overall planning and management of the delivery of health services.