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If poverty cannot be eradicated without a sound macroeconomic context, neither can health care improve without stronger focus on human resources (HR). This is the central thesis of this issues paper produced for the Department for International Development (DFID) by the DFID Health Systems Resource Centre (HSRC). Aimed primarily at DFID advisers and health sector analysts, the paper attempts to map out selected issues relating to the planning and management of HR by combining an international perspective with issues and trends emerging from individual countries.

Human resource issues are grouped into four broad objectives or challenges that, it is proposed, poor countries, donors and advisers will need to address. The major issues and possible responses accompanying each objective are discussed. The following challenges and issues are raised:

• Increasing coverage and staff retention is needed to ensure adequate and equitable delivery of priority health services. This is complicated by the level of pay need to attract health professionals, the distribution and retention of those that are available, and the significant losses currently being experienced through international migration and HIV/AIDS.
• There is a need to ensure availability of key competencies and skills in the health workforce. This is complicated by entry qualifications for posts and training outputs not matching job descriptions, job descriptions being unclear or vague, and training needs of health personnel not being updated and acted upon.
• Increasing staff performance against objectives is needed. The failure of existing performance management systems, the use of incentives in managing performance, and the opportunities created by organisational changes are important issues to be addressed.
• Capacity for planning and managing HR in the health sector will need to be strengthened. The large number of stakeholder involved in the process of policy and decision-making impair the responsiveness of the system. Furthermore, the capacity for HR planning and management within the health sector is weak.

Recommendations for action to improve the planning and management of HR in developing countries are proposed, including the following:

• Salary issues need to be addressed by donors, and donors need to keep in sight the wider public sector and recognise that changes in terms of salary or incentives in one part of the public system have implications for the system as a whole.
• The HR component of health sector appraisals needs substantial improvement in terms of separating shorter and longer-term HR policy issues. Failure to articulate HR strategies will limit the potential impact of initiatives, in the same way as it has limited the impact of aid for health care, public sector and civil service reforms.
• In the health sector, managers with HR functions (for example, chair of an HR taskforce, chief executive of a professional association, HR director within the ministry of health) need to map out all the important stakeholders and identify their different agendas.
• Donors must face the challenge that recipient countries are facing of dealing with complex human resource scenarios through the provision of training and technical assistance, and through maintaining a longer term attention and consistency in their approaches.

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