Decentralising health workforce management in China and South Africa

Decentralising health workforce management may help local services to coordinate and plan their human resources more effectively to meet health care needs.

Health sector decentralisation in China and South Africa is complex, with different forms being implemented within differenttimescales and for different purposes. In China decentralisation has takenplace alongside the transition to a market economy, whilst post-apartheid SouthAfrica is attempting to establish a new district healthsystem.

In the Xinlou and Lianchengcounties of China's Fujian Province human resourceplanning, recruitment and selection, staff performance management and trainingare all decentralised, though in some cases control has been regained by higherlevels of governance. Human resource planning is influenced by the need forhealth institutions to generate income, and in some cases this may bedetrimental to wider health service objectives.

In the Alfred Nzo District of South Africa's Eastern Province, the performance management and training functionsare partially decentralised. However, local decision-making regarding humanresource planning has been overtaken by higher level staffing initiatives.

In both countries decentralisation allows managers to manage theirworkforce better, though in some cases – particularly in China – this is tomeet organisational objectives as opposed to broader health service objectives.In some cases managers are frustrated as authority is either not fullydecentralised or sometimes withdrawn. 

The complexity of several forms of decentralisation happeningsimultaneously means managers, particularly in China, are not prepared orsupported in their new roles. There is a need for better planning, capacity development,and monitoring of the process of decentralising human resource management andthe impact of decisions made by newly empowered managers. Recommendations include:

• Putting humanresources management clearly on the agenda of decentralisation reforms at anearly stage.
• Developing clearstrategies for decentralising human resources management, including decidingwhat, how and when functions should be decentralised.
• Developing asystem to monitor both processes of decentralisation - to ensure that adequatepreparation and support is provided - as well as the impact on both humanresources and the achievement of wider health system objectives.