Institutional and system considerations
The lack of a common approach has been one of the obstructive factors to tackling the Human Resources for Health (HRH) crisis. HRH policy and decision makers are often lost in an overwhelming number of complex problems in this area. The WHR 2006 suggests a technical framework that is intended to guide planning and strategy development at the country level and to raise awareness among donors and multisector organisations outside ministries of health.
The framework outlines areas of technical competence necessary to establish a strategy for human resources. It will also help to: prevent simplistic approaches to complex issues; avoid duplication by harmonising the HRH agenda; and promote sharing among stakeholders. At country level the framework will help decision makers see a broad picture of the health workforce and avoid fragmentation. In particular, the framework can support governments in establishing a comprehensive strategic agenda and invite donors to define their agendas accordingly.
Many HRH experts see the lack of focus on human resource issues in the wider context of sector reform as the single most important reason for human resource problems faced by developing countries, and cite it as the reason for the failure to successfully implement reform. The public health system needs to be seen as both part of the wider public system and also part of the overall health system.
Because those managing the public health system do not usually have total authority over the human resources working within the system, then HR can only be satisfactorily addressed if actions are considered not only within the public health system but also within the public service and within the health system generally.
Therefore, if health workforce management is to be fully and effectively addressed in the public health system then issues related to good governance, civil service reform, and education need to be addressed. This requires a wider embracing of health sector reform within government and an acceptance that reform beyond the health sector is needed as well, if the aims of health sector reform are to be fully realised.
Equally, policy change in the public health system may be affected or indeed thwarted by change in the private or not-for-profit sector. Policy implementation needs to address the human resource implications across the health sector as a whole. Regulation of the private health sector is one route for addressing the issues.
This analysis applies equally well to other sectors, for example education, as it does to health. The importance of the human resource issue is therefore cross-sectoral, and linked closely to global initiatives and approaches. This includes not only disease specific issues, such as the Global Fund to Fight HIV/AIDS, TB and Malaria (GFATM), but also cross-cutting initiatives such as PRSPs and HIPC.
Ownership: an effective HR strategy must be owned by key stakeholders, including ministry officials, trade unions and staff. The use of widely agreed mission statements and corporate values, and clear messages about the goals of HR strategy can help foster ownership.
External fit: HR strategy should be in line with the external health policy environment if it is to be effective. Crucially, HR strategy should be developed as part of the organisation’s overall policies and agendas, rather than as a separate means of quantifying the numbers of staff needed at different levels.
Internal fit: personnel policies need to be internally consistent if they are to be effective. Competency frameworks can help ensure ‘internal fit‘, by linking HR needs to the attitudes and behaviour of staff.
Financial crises have triggered reforms which affected health systems in different ways. Narrow approaches to these problems, which underestimate the importance of the health workforce as part of the solution, have led to health systems failing to achieve their established health goals. Decentralising decision-making without first increasing the capacity of health managers at peripheral level and reducing health workforce size driven exclusively by financial criteria rather than health needs are two examples of this.
The combination of failing health systems and donor pressure has led to an increased vertical or disease specific health programmes. This has resulted in a loss of health workers in primary care and contributed to the overall depletion of human resources across health systems. Apart from these systemic problems, individual health workers have to accept low pay, an inadequate work environment and a lack of supervision and support.
Insufficient HRH supply for a growing demand is at the root of the existing crisis. On one hand, demand is increased due to factors such as the ageing of the population, increasing in chronic ailments requiring longer term assistance, new and re-emerging diseases that require long term care, and advanced technology whose operation requires skilled professionals. On the other hand, supply is being reduced by migration and brain drain, decrease in number of new professionals due to low capacity of the educational system, and increasing turnover among health professionals.
The paper Health human resources demand and management: strategies to confront the crisis proposes eight recommendations for policy, management and migration. At policy level the report recommends increased political commitment with increased financial support to HRH, increasing the capacity at peripheral level, and defining the role of the private sector and its contribution. At managerial level the report advises improved strategic HRH planning and proposes the establishment of a global HRH intelligence body. To manage the problems posed by migration, the authors recommend improving the production and retention of resources in destination countries and establish a global crises response strategy to help source countries to overcome the effect of the crises.
The framework outlines areas of technical competence necessary to establish a strategy for human resources. It will also help to: prevent simplistic approaches to complex issues; avoid duplication by harmonising the HRH agenda; and promote sharing among stakeholders. At country level the framework will help decision makers see a broad picture of the health workforce and avoid fragmentation. In particular, the framework can support governments in establishing a comprehensive strategic agenda and invite donors to define their agendas accordingly.
Many HRH experts see the lack of focus on human resource issues in the wider context of sector reform as the single most important reason for human resource problems faced by developing countries, and cite it as the reason for the failure to successfully implement reform. The public health system needs to be seen as both part of the wider public system and also part of the overall health system.
Because those managing the public health system do not usually have total authority over the human resources working within the system, then HR can only be satisfactorily addressed if actions are considered not only within the public health system but also within the public service and within the health system generally.
Therefore, if health workforce management is to be fully and effectively addressed in the public health system then issues related to good governance, civil service reform, and education need to be addressed. This requires a wider embracing of health sector reform within government and an acceptance that reform beyond the health sector is needed as well, if the aims of health sector reform are to be fully realised.
Equally, policy change in the public health system may be affected or indeed thwarted by change in the private or not-for-profit sector. Policy implementation needs to address the human resource implications across the health sector as a whole. Regulation of the private health sector is one route for addressing the issues.
This analysis applies equally well to other sectors, for example education, as it does to health. The importance of the human resource issue is therefore cross-sectoral, and linked closely to global initiatives and approaches. This includes not only disease specific issues, such as the Global Fund to Fight HIV/AIDS, TB and Malaria (GFATM), but also cross-cutting initiatives such as PRSPs and HIPC.
Principles
Arriving at clear, universal principles to guide workforce management in all health sectors can be difficult: health systems vary widely, and models of HR practice tend to focus on individual firms rather than complex national systems like health provision. However, three general principles can be arrived at to guide the development of effective HR strategy:Ownership: an effective HR strategy must be owned by key stakeholders, including ministry officials, trade unions and staff. The use of widely agreed mission statements and corporate values, and clear messages about the goals of HR strategy can help foster ownership.
External fit: HR strategy should be in line with the external health policy environment if it is to be effective. Crucially, HR strategy should be developed as part of the organisation’s overall policies and agendas, rather than as a separate means of quantifying the numbers of staff needed at different levels.
Internal fit: personnel policies need to be internally consistent if they are to be effective. Competency frameworks can help ensure ‘internal fit‘, by linking HR needs to the attitudes and behaviour of staff.
Financial crises have triggered reforms which affected health systems in different ways. Narrow approaches to these problems, which underestimate the importance of the health workforce as part of the solution, have led to health systems failing to achieve their established health goals. Decentralising decision-making without first increasing the capacity of health managers at peripheral level and reducing health workforce size driven exclusively by financial criteria rather than health needs are two examples of this.
The combination of failing health systems and donor pressure has led to an increased vertical or disease specific health programmes. This has resulted in a loss of health workers in primary care and contributed to the overall depletion of human resources across health systems. Apart from these systemic problems, individual health workers have to accept low pay, an inadequate work environment and a lack of supervision and support.
Insufficient HRH supply for a growing demand is at the root of the existing crisis. On one hand, demand is increased due to factors such as the ageing of the population, increasing in chronic ailments requiring longer term assistance, new and re-emerging diseases that require long term care, and advanced technology whose operation requires skilled professionals. On the other hand, supply is being reduced by migration and brain drain, decrease in number of new professionals due to low capacity of the educational system, and increasing turnover among health professionals.
The paper Health human resources demand and management: strategies to confront the crisis proposes eight recommendations for policy, management and migration. At policy level the report recommends increased political commitment with increased financial support to HRH, increasing the capacity at peripheral level, and defining the role of the private sector and its contribution. At managerial level the report advises improved strategic HRH planning and proposes the establishment of a global HRH intelligence body. To manage the problems posed by migration, the authors recommend improving the production and retention of resources in destination countries and establish a global crises response strategy to help source countries to overcome the effect of the crises.
- Health human resources demand and management: strategies to confront crisis
- ( V. Hicks / Global Health Trust , 2004)
- This report, by the Joint Learning Initiative’s Working Group on Demand, considers health needs and current initiatives to improve health. The working group finds that labour markets for human resourc...
