Civil service reform
Public sector reform and demand for human resources for health
Better conditions for public sector health care workers need to accompany fiscal reforms
Authors:
J. Lethbridge
Publisher:
Human Resources for Health, 2004
This article, from Human Resources for Health, considers the effect of fiscal reform and the introduction of decentralisation and market mechanisms on human resources in the health sector. Findings show that these reforms often result in ‘corporatised’ institutions, with reductions in the workforce as health services are contracted out, or increased short-term and temporary employment contracts. Increased private sector provision leads health workers to move to the private sector. This often leaves worsening working conditions, lack of employment security and dismantling of collective bargaining agreements for those who remain in the public sector.
The author makes a number of recommendations to help strengthen skills, expertise and retention of health workers and to strengthen the integration of human resource issues into health policymaking and into relevant agencies. These include: increased coordination of facility and human resources planning at national and local levels; better understanding of organisational culture and public sector ethos in health worker motivation; improved working conditions through flexible working arrangements; establishing a living wage, which is competitive with the private sector; and continued access to professional development, including skills for performance management, management of contracts and other new ways of operating in reformed systems. [adapted from author]
