A comprehensive framework for human resources for health system development in fragile and post-conflict states

Responding to the global human resource crisis requires systems thinking if a more comprehensive approach to human resource management and development is to be achieved. We present a comprehensive and visible framework for human resource system development. This has been derived from the lessons learned in supporting human resource system development in three fragile and post-conflict health systems in Afghanistan, the Democratic Republic of Congo, and Cambodia. The efforts of development partners and the government typically concentrate on the “production” and training of health personnel, but this approach neglects other elements and often the necessary linkages between them.

While there is potential value in focused forms of support, they will be much less effective, with negative effects on both systems and population health, when they are unbalanced, incomplete, or miss the necessary linkages between them. While the “house model” contains elements similar to the World Health Organization HRH Action Framework, some functions are extracted in order to draw more attention to them. Issues such as the legal and regulatory framework, coordination, and monitoring are often neglected. We also place particular emphasis on the linkages among elements by highlighting some core functions of human resource management (production-deployment-retention), or by separating the foundation components (policy and planning, finances, legal) as primarily the responsibility of the government.