Civil service reform
Human resources: the Cinderella of health sector reform in Latin America
World Bank reforms have negative impact on health workforce
Authors:
N. Homedes; A. Ugalde
Publisher:
Human Resources for Health, 2005
This article, in the journal Human Resources for Health, argues that the two most important World Bank health reform policies in Latin America – decentralisation and privatisation – have had a negative impact on workers’ conditions of employment, and have prompted opposition from organised professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. The article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region.
The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that solutions coming from within a country are more likely to succeed than those imported from the outside. [adapted from authors]
