Abstract
As a fundamental human right, the right to health (RTH) can influence state actors' behaviour towards health inequities. Human rights advocates have invoked the RTH in a collective demand for improved access to essential medicines in low- and middle-income countries (LMICs). Similarly, scholars have used the RTH as a framework for analysing health problems. However, its utility for addressing skilled health worker (SHW) shortages in LMICs has been understudied. Realising that SHW shortages occur due to existing push-and-pull factors within and between LMICs and high-income countries (HICs), we sought to answer the question: "how, why, and under what circumstance does the RTH offer utility for addressing SHW shortages in LMICs?" We conducted a realist synthesis of evidence identified through a systematic search of peer-reviewed articles in Embase, Global Health, Medline (Ovid), ProQuest - Health & Medical databases, Scopus (Elsevier), Web of Science (Clarivate), CINAHL (EBSCO), APAIS-Health, Health Systems Evidence and PDQ-EVIDENCE; as well as grey literature from Google Scholar. We found that the RTH offers utility for addressing SHW shortages in LMICs through HIC state actors' concerns for their countries' reputational risk, recognition of their obligation to support health workforce strengthening in LMICs, and concerns for the cost implication. State actors in LMICs will respond to adopt programs inspired by the RTH when they are convinced that it offers tangible national benefits and are not overly burdened with ensuring its success. The socio-economic and institutional factors that constrain state actors' response include financial cost and sustainability of rights'-based options. State and non-state actors can use the RTH as a resource for promoting collective action towards addressing SHW shortages in LMICs. It can also inform negotiations between state actors in LMICs and their HIC counterparts.
Highlights
The right to health (RTH) is a fundamental human right
We found that the RTH influenced the response of high-income countries (HICs) state actors to skilled health worker (SHW) shortages in low- and middle-income country (LMIC) through two mechanisms
We found that in the absence of the RTH as a conceptual resource, state actors in LMICs still responded to SHW shortages because they wished to avoid/address labour crises in the health system or were influenced by an existing commitment to public service in their countries
Summary
The right to health (RTH) is a fundamental human right. It captures the entitlement of everyone to enjoy the highest attainable standard of physical and mental health. These include adequate remuneration, sustainable national financing for an essential public health system, international assistance and cooperation, and measures to prevent violation of populations’ RTH
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