Abstract
Hospitals in Sub-Saharan Africa (SSA) face major workforce challenges while having to deal with extraordinary high burdens of disease. The effectiveness of human resource management (HRM) is therefore of particular interest for these SSA hospitals. While, in general, the relationship between HRM and hospital performance is extensively investigated, most of the underlying empirical evidence is from western countries and may have limited validity in SSA. Evidence on this relationship for SSA hospitals is scarce and scattered. We present a systematic review of empirical studies investigating the relationship between HRM and performance in SSA hospitals.Following the PRISMA protocol, searching in seven databases (i.e., Embase, MEDLINE, Web of Science, Cochrane, PubMed, CINAHL, Google Scholar) yielded 2252 hits and a total of 111 included studies that represent 19 out of 48 SSA countries.From a HRM perspective, most studies researched HRM bundles that combined practices from motivation-enhancing, skills-enhancing, and empowerment-enhancing domains. Motivation-enhancing practices were most frequently researched, followed by skills-enhancing practices and empowerment-enhancing practices. Few studies focused on single HRM practices (instead of bundles). Training and education were the most researched single practices, followed by task shifting.From a performance perspective, our review reveals that employee outcomes and organizational outcomes are frequently researched, whereas team outcomes and patient outcomes are significantly less researched. Most studies report HRM interventions to have positively impacted performance in one way or another. As researchers have studied a wide variety of (bundled) interventions and outcomes, our analysis does not allow to present a structured set of effective one-to-one relationships between specific HRM interventions and performance measures. Instead, we find that specific outcome improvements can be accomplished by different HRM interventions and conversely that similar HRM interventions are reported to affect different outcome measures.In view of the high burden of disease, our review identified remarkable little evidence on the relationship between HRM and patient outcomes. Moreover, the presented evidence often fails to provide contextual characteristics which are likely to induce variety in the performance effects of HRM interventions. Coordinated research efforts to advance the evidence base are called for.
Highlights
While Sub-Saharan Africa (SSA) is home to 12% of the global population [1], it employs 3.5% of the global health workforce to service a disproportionate 27% of the global burden of disease [2]
16 studies mention hospitals without specifying the type of hospital, in contrast to the others that specified whether it regarded public, national, private, missionary, teaching, district, secondary care, rural, and/or primary care hospitals
For the first time, an overview of studies that researched the link between human resource management (HRM) and performance in SSA hospitals is presented
Summary
While Sub-Saharan Africa (SSA) is home to 12% of the global population [1], it employs 3.5% of the global health workforce to service a disproportionate 27% of the global burden of disease [2]. A majority of countries across the globe for which the health workforce shortage is classified as critical (36 out of 57) lie in SSA [3, 4]. Most SSA countries are not able to attain an average health workforce density of 2.5 per 1000 population as recommended by the World Health Organization (WHO) [5, 6] and half of the SSA countries have fewer than ten physicians per 100,000 people (while Western countries commonly have 250 per 100,000 or more) [5, 7–9]. The low workforce density and high workload in SSA especially impacts hospital [6, 7]. The shortage of supply to match demand further increases because of low retention rates among skilled health workers [8–12]. Implementation of human resource management (HRM) practices is needed to improve the situation for a depleted and overstretched health workforce, and patient outcomes [10, 13–18]
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