Health Workforce Policy Research Articles

A critical review of the development of advanced practice competency frameworks and their contribution to autonomous practice

A critical review of the development of advanced practice competency frameworks and their contribution to autonomous practice

The specialised health workforce matters: how to adapt the WHO National Health Workforce Accounts

Abstract Background The importance of a sustainable health workforce is increasingly recognised. However, the specialised heath workforce remains marginal in health workforce planning, policy and research. This paper aims to improve the integration of small specialised professional groups in health workforce governance and to critically assess existing tools, using Germany and rheumatology physicians as a case study. Methods A qualitative explorative approach was applied, which draws on a scoping review of the literature, public statistics and expert information. The National Health Workforce Accounts (NHWA) and the WHO 'AAAQ' framework served as guidance to assess workforce development in rheumatology in Germany. Results On average physician density is high in Germany, yet access to specialised care may be seriously delayed and services may not be accessible to all patients; e.g. currently only half of the patients with spondyloarthritis are treated by a rheumatologist which impacts quality of care. An estimated 850 to 1000 additional rheumatologists are needed to ensure early diagnoses and treatment and prevent long-term health damage. However, shortage will even reinforce in future: annual inflow of newly registered rheumatologists over recent years did not exceed 30 to 50 physicians and young rheumatologists more often prefer part-time work. Conclusions Specialised health professions with small numbers and long duration of training face specific challenges to create a sustainable workforce. This calls for (1) greater investment in education and training, (2) greater attention to qualitative indicators, such as assess and prevention measurements like early diagnosis, and (3) a dynamic health workforce approach to respond to both new technologies/ treatments and changing preferences of the health professionals, like part-time work. Key messages Integrating the specialised health workforce in health workforce governance is important to improve prevention, quality and access to care. NHWA may be aligned to qualitative indicators and prevention policies to respond more effectively to future population needs.

Our climate and health emergency - Future role for global public health

Abstract Prof Laetitia Rispel is Immediate past President of the WFPHA, and Professor of Public Health at the University of the Witwatersrand: Johannesburg. She has a strong research background and publication record on public health governance, health workforce education, ethics, policy and practice. Following talks on the relationship between climate change and food and water insecurity presenting a public health emergency, and case examples of recent disasters, Professor Rispel will outline the WFPHA vision for the public health sector's role in the coming decades. The expanding need for well resourced, and well-trained public health sector at national and regional levels will be outlined. As the world careers ever closer to existential threats from unabated climate change, a key theme covered will be the imperative for multilateral climate negotiations to include public health experts Following this presentation, the panel will invite questions and discussion from the floor to share experience and develop solutions-based model for expanded role of public health, and how we transition to that new world.

A public health approach to health workforce policy development in Europe.

A public health approach to health workforce policy development in Europe.

Health workers on the move: the need for global policy

Abstract Issue WHO's Global Code of Practice on the International Recruitment of Health Personnel was adopted in 2010 by WHO Member States to 1: monitor and address unethical international recruitment practices; 2: to strengthen national health workforces. Unethical recruitment and lack of investments in resilient health workforces was leading to increased health inequalities worldwide. The WHO Code provided non-binding behavioral principles to address these. Description The WHO Code came with a monitoring and review mechanism. Member States were to report on Code implementation every three years and every five years the Code's relevance and effectiveness is reviewed. In the 2018/19 reporting round, non-state actors, too, submitted reports to WHO. Wemos carried out a qualitative analysis of these (14) reports and presented the findings to the Expert Advisory Group (EAG) tasked to review the Code in 2019/20. Results Non-state actor reports provide important additional information to Member States' reports on Code implementation. The 14 submissions included cases of unfair treatment of migrant health workers and indicated some improvement in health workforce planning and forecasting. Moreover, they pointed to a lack of efforts (or results thereof) by governments to invest in more resilient health workforces, fueling health worker mobility globally. Lessons These findings are consistent with observations from civil society, trade unions, health professional associations and employers' organizations, as evidenced during the roundtable discussions with the EAG in June 2019. They noted that increased global mobility, not just by health workers, is a given and actually further accelerated by a growing number of inter-country migration agreements, undermining equitable access to a health worker across the globe. They urged for supra-national policies and practices in order to achieve Universal Health Coverage for all by 2030. Key messages With increased global mobility of individuals, an equitable distribution of health workers worldwide surpasses the policy scope of national governments and requires supra-national measures. The involvement of civil society in the monitoring of mobility trends and equity effects of health workforce policies is essential for shared prosperity as envisioned in the SDG Agenda.

2.G. Workshop: The health labour market and the human face of the health workforce: analysis, advocacy and action

Abstract Background Health workforce research and data have significantly improved over recent years. Many countries have stepped up efforts to establish more complex health workforce monitoring and planning systems, to increase the stock of care workers, and to introduce new education and training programs. There is now also greater attention to skill-mix and task-shifting models. However, major policy problems and knowledge gaps remain. Health systems across countries have largely failed to respond adequately to the globalisation of health labour markets and the growing mobility. Furthermore, research on needs and demands of the health workforce is still poorly developed. Health policy largely ignores the 'human being' behind every single healthcare worker. Objectives This workshop connects health labour market data (macro-level) with the 'human face' of the health workforce (micro-level) and brings a global approach (transnational level) to the analysis, with a focus on Europe. It aims to identify gaps in health workforce policies and to highlight a need for a public health approach, which moves beyond nationally-defined health workforce policy of 'faceless numbers' of health professionals and carers. The workshop relates to ethical, cultural and social aspects of the health labour market. It also builds on the research that has revealed the connections between working conditions, staff turn-over, job satisfaction and quality of care. It acknowledges that we have a European labour market for health workers, but very little common policies developing the European health workforce. The workshop introduces novel results drawn from major international data sources (WHO, OECD, EUROSTAT), from a European primary care survey, cross-country comparative research and in-depths country case studies. Next to the nursing, medical and primary care workforce, specific attention is paid the long-term care and geriatric sectors. A particular area of concern are the threats of labour market migration to the individual professional and the sending countries. Two major policy recommendations are emerging from the research: (1) to move beyond national health labour market policy and develop a transnational regulatory framework to reduce growing inequality in Europe and globally caused by health workforce shortage and labour market migration; (2) to bring the 'human face' of the health workforce into data analysis and policymaking. The workshop will stimulate critical debate and improve knowledge exchange across countries and between researchers and international data holders. It will strengthen public health advocacy and action for future health workforce governance with a 'human face' to create a sustainable workforce and support the implementation of the SDGs. Key messages Analysis must connect health labour markets with the ‘human face’ of the health workforce. Action is needed to develop a global regulatory framework for effective and ethically responsibile health workforce governance.

I Want to Become a Registered Nurse as a Non-Traditional, Returning, Evening, and Adult Student in a Community College: A Study of Career-Changing Nursing Students.

The current significant human resource and workforce shortages of registered nurses (RNs) are impacting urban, suburban, and rural hospitals and healthcare facilities all over the globe, regardless of the entities’ economic and financial backgrounds. The purpose of this research study is to understand why non-traditional, returning, evening, and adult (NTREA) students decided to enrol at the Associate Degree in Nursing programme during their mid-adulthood? 40 s-career nursing students who are pursuing their nursing programme were invited to individual interview sessions and focus group activities on sharing and expressing the motivations in the New England region in the United States. Based on the theoretical framework of Social Cognitive Career Theory, the researcher concluded that family consideration and higher social status were two of the major themes. The study provided a blueprint for human resource professionals, health and social caring leaders, government agencies, policymakers, and researchers to reform their current nursing curriculum and health workforce policy to attract potential second-career nursing joining the nursing profession.

Thực trạng nhân lực Y tế và một số kết quả của chính sách nhân lực y tế đến tình hình sức khỏe của đồng bào dân tộc thiểu số

A descriptive study was employed by using desk-studyapproach, focused on the reports and policies of the human resources for health in Vietnam, especially for the ethnic minority group. This study aimed to describe the status of the healthcare workforce in Vietnam and some outcomes of implementating the health workforce policies on the healthcare indicators among the ethnic minority group. The results of this study based on the data of health indicators for the period of 2013-2018. The main findings showed that the quantity and quality of the health workforce had increased gradually and also the health status and healthcare services utilization in the ethnic people had improved. However, the health workforce still had an imbalance in both quantitative and qualitative dimensions. While comparing to the general population, the inequity in healthcare services utilization and health indicators of ethnic minorities group still remained. Therefore, the Government and Ministry of Health need to review and develop the specific policies of the healthcare workforce to attract and maintain the health workers in the remote areas for ethnic minorities group. At the local health level, it is necessary to take the initiative in advising on develop the policies of the healthcare workforce; Strengthen the collaboration with all the stakeholders in the policy implementation; Monitoring and evaluation of the policy implementation to suggest the appropriate recommendations and solutions in the upcoming period. Keywords: Health workforce, human resources for health, ethnic minorities, health policy, health care, healthcare service utilization,…

Rethinking workforce planning for integrated care: using scenario analysis to facilitate policy development

BackgroundA goal of health workforce planning is to have the most appropriate workforce available to meet prevailing needs. However, this is a difficult task when considering integrated care, as future workforces may require different numbers, roles and skill mixes than those at present. With this uncertainty and large variations in what constitutes integrated care, current health workforce policy and planning processes are poorly placed to respond. In order to address this issue, we present a scenario-based workforce planning approach.MethodsWe propose a novel mixed methods design, incorporating content analysis, scenario methods and scenario analysis through the use of a policy Delphi. The design prescribes that data be gathered from workforce documents and studies that are used to develop scenarios, which are then assessed by a panel of suitably qualified people. Assessment consists of evaluating scenario desirability, feasibility and validity and includes a process for indicating policy development opportunities.ResultsWe confirmed our method using data from New Zealand’s Older Persons Health sector and its workforce. Three scenarios resulted, one that reflects a normative direction and two alternatives that reflect key sector workforce drivers and trends. One of these, based on alternative assumptions, was found to be more desirable by the policy Delphi panel. The panel also found a number of favourable policy proposals.ConclusionsThe method shows that through applying techniques that have been developed to accommodate uncertainty, health workforce planning can benefit when confronting issues associated with integrated care. The method contributes to overcoming significant weaknesses of present health workforce planning approaches by identifying a wider range of plausible futures and thematic kernels for policy development. The use of scenarios provides a means to contemplate future situations and provides opportunities for policy rehearsal and reflection.

The 11th Australian Rural and Remote Mental Health Symposium Communiqué.

The 11th Australian Rural and Remote Mental Health Symposium Communiqué.

Sociology with Health: Health Workforce Governance Problems, Priorities and Policy Recommendations

Sociology with Health: Health Workforce Governance Problems, Priorities and Policy Recommendations

Developing the health workforce for universal health coverage.

Optimizing the management of the health workforce is necessary for the progressive realization of universal health coverage. Here we discuss the six main action fields in health workforce management as identified by the Human Resources for Health Action Framework: leadership; finance; policy; education; partnership; and human resources management systems. We also identify and describe examples of effective practices in the development of the health workforce, highlighting the breadth of issues that policy-makers and planners should consider. Achieving success in these action fields is not possible by pursuing them in isolation. Rather, they are interlinked functions that depend on a strong capacity for effective stewardship of health workforce policy. This stewardship capacity can be best understood as a pyramid of tools and factors that encompass the individual, organizational, institutional and health system levels, with each level depending on capacity at the level below and enabling actions at the level above. We focus on action fields covered by the organizational or system-wide levels that relate to health workforce development. We consider that an analysis of the policy and governance environment and of mechanisms for health workforce policy development and implementation is required, and should guide the identification of the most relevant and appropriate levels and interventions to strengthen the capacity of health workforce stewardship and leadership. Although these action fields are relevant in all countries, there are no best practices that can simply be replicated across countries and each country must design its own responses to the challenges raised by these fields.

Researching the health workforce: a framework for action

Abstract Background The importance of a sustainable health workforce is increasingly recognised. However, the building of a future health workforce that is responsive to diverse population needs and demographic and economic change remains challenging. There is a need to improve research and education to address these questions effectively and build capacity for public health approaches in health workforce policy. This paper introduces an agenda for health workforce research. Methods The research agenda has been developed through bringing together expertise and knowledge from a wide range of authors and leading organisations involved in health workforce research and policy. It takes a health system approach and focuses on Europe. Results Six major objectives for health workforce policy were identified: (1) to develop frameworks that align health systems/governance and health workforce policy/planning, (2) to explore the effects of changing skill mixes and competencies across sectors and occupational groups, (3) to map how education and health workforce governance can be better integrated, (4) to analyse the impact of health workforce mobility on health systems, (5) to optimise the use of international/EU, national and regional health workforce data and monitoring and (6) to build capacity for policy implementation. The research highlights critical knowledge gaps that currently hamper the opportunities of effectively responding to these challenges and advising policymakers in different health systems. Closing these knowledge gaps is therefore an important step towards future health workforce governance and policy implementation. Conclusions There is an urgent need for building health workforce research as an independent, interdisciplinary and multi-professional field. Action has to be taken to establish new training courses and Master programmes to create competences for leadership in health workforce research.

Skills building seminar: Building skills and capacity for a future health workforce

Abstract Background It is increasingly recognised that there is ‘no health without a workforce’ and that action has to be taken to develop an integrated and sustainable future health workforce. However, training and education opportunities are lacking for all those engaged in health workforce development. There is an urgent need for health systems and policy to foster skills building and institutional capacity for health workforce development to respond effectively to changing healthcare needs of the population and to the labour market shortages in many countries. Objectives This seminar will address these issues and help reducing the knowledge gaps. The seminar is arranged around for major topics: the WHO framework for action to guide health workforce planning and governance, the competences framework to strengthen the education and professionalisation of public health developed by the WHO Coalition of Partners and ASPHER, the internationalisation of health professional education using medical education in Romania as a case study, and finally a framework for strengthening health workforce research. The seminar aims to help PhD students and early career researchers to develop skills in the field of health workforce research and development. It also provides knowledge and tools for policymakers and practitioners who are responsible for health workforce education and governance. This seminar will promote the development of training programmes for health workforce research and thereby contribute to public health leadership in health workforce development. There will be ample time for discussion and teaching material will be made available for the participants. Key messages Building skills and institutional capacity is key to improve health workforce research and policy. People-centred care and universal healthcare coverage call for new skills and education programmes.

Workshop: Care4Care: the migrant care workforce in Europe

Abstract Background Foreign trained health workers increasingly fill the care gaps caused by labour market shortage and governance failures. As doctors, nurses and carers they make a crucial contribution to health system performance and the health of the population. These contributions are likely to increase in future, especially in high-income countries, where demographic change and NCDs reinforce the gap between demand for care and labour market supply. However, health system demands for migrant carers do not sit easily with the new wave of nationalism and populist movements in Europe and globally; they may also reinforce the ‘care drain’ in less well-resourced sending countries. There is an urgent need for more inclusive health workforce governance in order to take ‘care’ for the migrant health workforce both nationally and globally and ensure ‘health for all’. Objectives This workshop addresses these questions and fosters critical debate. It has three major aims: to make the migrant carers visible as important part of the health workforce and health system performance, to unmask the threats of growing nationalism and populist movements to healthcare systems and universal healthcare coverage, and finally to critically discuss how to govern the migrant care workforce in ways that improve both integration in the host country and solidarity across Europe and globally. The workshop brings together knowledge and expertise from the areas of health workforce, health services, and health policies and systems. It is organised as round table discussion, facilitated by an overview of migrant care workforce patterns and policies in selected European Union (EU) high-income countries and two in-depth country cases, namely Italy and Austria, both known for growing populism and nationalism and strong anti-migrant policies in the EU. The three panelists will discuss the role of migrant care workers and explore, from different perspectives, how to build capacity for new forms of health workforce governance that move beyond narrowly defined national/regional interests of health systems. The workshop will foster a wider debate on migrant careers and health workforce needs, and how public health can contribute to better take ‘care’ for the human resources for health. Key messages Migrant carers form an important part of the health workforce in European countries. Health systems must take care of the migrant health workforce and counteract growing nationalism.

A strife of interests: A qualitative study on the challenges facing oral health workforce policy and planning

Oral health workforce policy has often lacked systematic connections with broader health policy, and system-based reforms that would enable more effective responses to future needs of the population. The aim of the study was to better understand challenges facing oral health workforce policy and planning and identify potential solutions. In-depth interviews of 23 senior oral health leaders and/or health policy experts from 15 countries were conducted in 2016-17. Grounded theory principles using the Straussian school of thought guided the qualitative analysis. The findings identified: (i) narrow approach towards dental education, (ii) imbalances in skills, jobs and competencies, and (iii) geographic maldistribution as major challenges. An overarching theme -“strife of interests” - shed light on the tension between the profession's interest, and the needs of the population. A key aspect was the clash for power, dominance and authority within the oral health workforce and across health professions. This study argues that appreciating the history of health professions and recognising the centrality of the strife of interests is necessary in developing policies that both address professional sensitivities and are in line with the needs of the population. Integration and closer collaboration of oral health professionals with the mainstream medical and health professions has emerged as the key issue, but the solutions will be diverse and dependent on country- or context-specific scenarios.

The evolution of New Zealand\u2019s health workforce policy and planning system: a study of workforce governance and health reform

IntroductionWhile considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand’s health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives.Case descriptionNew Zealand’s health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations.Discussion and evaluationThe case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand’s more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care.ConclusionThe case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.

Older people's mental health in rural areas: Converting policy into service development, service access and a sustainable workforce.

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15-year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks. A sustained focus on policy and implementation which explicitly supports rural older people's mental health service enhancement, and development of evidence-based models of care, has significantly improved access to specialist mental health care for older people in rural areas. It has delivered 23 new rural older people's mental health community teams and a 440% increase in the number of people accessing these teams. It has also doubled the number of acute inpatient units and established new specialistmental health-residential aged care partnership services in rural New South Wales. It has resulted in increased access to services for the "older old," while not diminishing older people's rates of access to general adult mental health services. It has also supported innovative, sustainable rural service models such as "hub and spoke" models and step-up step-down inpatient services that build on existing health and hospital infrastructure and link geographically dispersed specialist clinicians and services together in rural service delivery.

Analysing public sector institutional capacity for health workforce governance in the South-East Asia region of WHO

BackgroundIn order to analyse the institutional capacity for health workforce policy development and implementation in countries in the South-East Asia region, the WHO facilitated a cross-sectional analysis of functions performed, structure, personnel, management and information systems of human resources for health (HRH) units in Ministries of Health.Case presentationA self-assessment survey on the characteristics and roles of HRH units was administered to relevant Government officials; the responses were validated through face-to-face workshops and by the WHO staff. Findings were tabulated to produce frequency distributions of the variables examined, and qualitative elements categorized according to a framework for capacity building in the health sector.Ten countries out of the 11 in the region responded to the survey. Seven out of 10 reported having an HRH unit, though their scope, roles, capacity and size displayed considerable variability. Some functions (such as planning and health workforce data management) were reportedly carried out in all countries, while others (inter-sectoral coordination, research, labour relations) were only performed in few.Discussion and conclusionsThe strengthening of the HRH governance capacity in countries should follow a logical hierarchy, identifying first and foremost the essential functions that the public sector is expected to perform to optimize HRH governance. The definition of expected roles and functions will in turn allow identifying the upstream system-wide factors and the downstream capacity requirements for the strengthening of the HRH units. The focus should ultimately be on ensuring that all the key strategic functions are performed to quality standards, irrespective of institutional arrangements.

Accelerating reforms of primary health care towards universal health coverage in Sri Lanka.

Since the late 1920s, the Sri Lankan health system has been based on a firm foundation of primary health care, and it has been recognized internationally as a highly successful low-cost model. However, rethinking the future health-care model has been essential, owing to the country having one of the fastest ageing populations in the world, coupled with a high premature mortality from noncommunicable diseases. To sustain past gains and meet new challenges, several models centred on an expanded primary health-care system have been trialled and refined in the past decade. Primary health care was identified as a key priority in the National Health Strategic Master Plan 2016-2025, and in 2018 the Cabinet approved the Policy on healthcare delivery for universal health coverage. This policy introduces the "shared care cluster" system, whereby an apex specialist institution serves the local primary care referral institutions. The catchment population is divided into populations of approximately 5000, for which one family doctor is responsible. Strengthening and retaining human resources at these primary-level curative institutions will be essential, especially in rural locations. Also critical will be initiatives to orient the population's health-seeking behaviours. Sustained political commitment, an effective communication strategy, a tailored health workforce policy, performance monitoring and evaluation, coordination mechanisms, and changes in administrative and financial regulations are some of the future factors that will be critical to realizing the full potential of primary health care and accelerating universal health coverage in Sri Lanka.