Human Resources For Health Challenges Research Articles

Challenges faced by human resources for health in Morocco: A scoping review.

Human resources for health (HRH) play a pivotal role in effective health system operation, yet various impediments challenge sustainable development. This scoping review aimed to explore these challenges and potential solutions in aligning the health workforce to meet the evolving healthcare needs of the Moroccan population. We conducted a scoping review searching PubMed, Science Direct, Cairn and Google Scholar for relevant articles published between 2014 and 2023. Additionally, non-peer-reviewed literature sourced from Ministry of Health consultations and allied websites was included. Among the nineteen studies meeting our inclusion criteria, the majority were cross-sectional and predominantly focused on challenges faced by nurses. While some papers delineated multiple HRH challenges (5/19), the rest addressed specific challenges. The identified challenges span organizational and personal levels. Organizationally, the focus was on training, lifelong learning, continuing education, health coverage and shortages, and job satisfaction. At a personal level, HRH in the public health sector encountered challenges such as burnout, stress, and broader occupational health concerns. The reviewed publications underscored a spectrum of challenges necessitating robust policy interventions. Despite promising developments in the Moroccan healthcare system, addressing the unequal urban-rural HRH distribution, augmenting funding, and enhancing HRH quality of life stand as pivotal imperatives.

Reviewing academic coordination on the rural distributed training platform in South Africa.

Distributed training of students from a variety of health professions is increasing in South Africa because of the type of learning it offers and that it caters for the increasing number of students being accepted into health sciences programs. Challenges and facilitators to distributed training are well documented in the literature, and include increased distance from the academic home, human resources for health challenges, student access to support systems, and identifying learning environments to match learning outcomes. In the case of the Rural Clinical School in the Western Cape, South Africa, 'academic coordinators' were employed on site to fulfil the role of coordinating and supervising student learning and community engagement. This article explores their experiences. A large-scale qualitative study was conducted in 2017 exploring the history and development of the Ukwanda Centre for Rural Health and the Rural Clinical School. Part of this study included semi-structured individual and focus group interviews with consenting academic coordinators exploring their experiences of developing and working on a rural distributed training platform in South Africa. Data were inductively analysed. Ethical approval and institutional permission were obtained for this study, and all participants provided consent. In addition to previously published challenges that clinical supervisors who are employed by the health system face, the academic coordinators reported facing challenges related to professional isolation, boundary blurring between providing student support versus acting as clinical educator, juggling multiple line managers and administrative responsibilities, navigating the new field of academia, and not having the potential for career progression. Reflecting on the needs of academic coordinators expressed in this article, we identified four conditions that may promote sustained and continuous academic coordination at rural or remote distributed training sites. These conditions are (1) living and working local; (2) having a dual role in academia and the health system; (3) having access to academic support; and (4) regular engagement with the academic home, the value of which is detailed in this article. These recommendations can be adopted to optimise and sustain academic engagement on the distributed training platform, especially in light of the current expansion of health professions training and subsequent need to attract and retain clinician-academics in remote locations.

Perspectives of policymakers and health care managers on the retention of health workers in rural and remote settings in Nigeria.

Health workers are indispensable to service delivery especially in rural and remote communities where the burden of disease is high. Nigeria faces numerous human resources for health challenges, health workers are reluctant to take up rural postings, and the government is struggling to implement planned interventions due to staff shortages. This study explored the perspectives of policymakers and primary health care (PHC) managers on factors that hinder health workers from staying in rural and remote areas and strategies for improving retention. We interviewed purposively selected 10 policymakers and 20 PHC managers in Bauchi and Cross River States, Nigeria. Respondents identified a lack of basic social amenities, the poor state of infrastructure, poor working conditions, remuneration and the barrier to career advancement as factors that impede health workers from taking up rural postings. Strategies for improving retention include enforcing bonding; paying salaries promptly, increase in rural allowances and prioritizing health workers in rural and remote areas for capacity building. The results of the study indicate the importance of applying context-specific strategies aimed at ensuring the availability of social amenities such as roads, water, electricity, telecommunication, security, the status of infrastructure, working conditions and remunerations.

Human Resources for Health-Related Challenges to Ensuring Quality Newborn Care in Low- and Middle-Income Countries: A Scoping Review.

A critical shortage of health workers with needed maternal and newborn competencies remains a major challenge for the provision of quality care for mothers and newborns, particularly in low- and middle-income countries. Supply-side challenges related to human resources for health (HRH) worsen shortages and can negatively affect health worker performance and quality of care. This review scoped country-focused sources to identify and map evidence on HRH-related challenges to quality facility-based newborn care provision by nurses and midwives. Evidence for this review was collected iteratively, beginning with pertinent World Health Organization documents and extending to articles identified via database and manual reference searches and country reports. Evidence from country-focused sources from 2000 onward was extracted using a data extraction tool that was designed iteratively; thematic analysis was used to map the 10 categories of HRH challenges. A total of 332 peer-reviewed articles were screened, of which 22 met inclusion criteria. Fourteen additional sources were added from manual reference search and gray literature sources. Evidence has been mapped into 10 categories of HRH-related challenges: (1) lack of health worker data and monitoring; (2) poor health worker preservice education; (3) lack of HW access to evidence-based practice guidelines, continuing education, and continuing professional development; (4) insufficient and inequitable distribution of health workers and heavy workload; (5) poor retention, absenteeism, and rotation of experienced staff; (6) poor work environment, including low salary; (7) limited and poor supervision; (8) low morale, motivation, and attitude, and job dissatisfaction; (9) weaknesses of policy, regulations, management, leadership, governance, and funding; and (10) structural and contextual barriers. The mapping provides needed insight that informed new World Health Organization strategies and supporting efforts to address the challenges identified and strengthen human resources for neonatal care, with the ultimate goal of improving newborn care and outcomes.

Confronting power in low places: historical analysis of medical dominance and role-boundary negotiation between health professions in Nigeria

IntroductionInterprofessional interaction is intrinsic to health service delivery and forms the basis of task-shifting and task-sharing policies to address human resources for health challenges. But while interprofessional interaction can be...

Global Fund financing and human resources for health investments in the Eastern Mediterranean Region

BackgroundDespite the large investments in donor-related health activities in areas of the globe prone to tension and conflict, few studies have examined in detail the role of these donor investments in human resources for health (HRH).MethodsWe used a mixed-methods research methodology comprising both quantitative and qualitative analyses to analyze the Enhanced Financial Reporting System of the Global Fund to Fight AIDS, Tuberculosis and Malaria budget and expenditure data from 2003 to 2017 for 13 countries in the Eastern Mediterranean Region (EMR). We analyzed additional detailed budgetary data over the period 2015–2017 for a sub-set of these countries. Two country-case studies were conducted in Afghanistan and Sudan for a more in-depth understanding of the HRH-related activities that occurred as a result of Global Fund grants.ResultsThe results show that US$2.2 billion Global Fund dollars had been budgeted and US$1.6 billion were expended over the period 2003–2017 in 13 Eastern Mediterranean countries. The average expenditures for human resources for health (training and human resources) as a percentage of total expenditure are 28%. Additional detailed budgetary data analysis shows a more conservative investment in HRH with 13% of total budgets allocated to “direct” HRH activities such as salaries, training costs, and technical assistance. HRH-related activities supported by the Global Fund in Afghanistan and Sudan were similar, including pre-service and in-services training, hiring of program coordinators and staff, and top-ups for clinical staff.ConclusionsHRH remains a key issue in strengthening the health systems of low- and middle-income countries. While this study suggests that Global Fund’s HRH investments in the EMR are not lagging behind the global average, there appears to be a need to further scale up these investments considering this region’s unique HRH challenges.

Coordinating health workforce management in a devolved context: lessons from Kenya

IntroductionIn 2013, Kenya fully and rapidly devolved health services to 47 county governments under its new constitution. It soon became evident that the coordination mechanism to manage the health workforce at a county level was inadequate. This case study describes how Kenya created an inter-county, multi-stakeholder human resources for health (HRH) coordination framework that promotes consensus, commitment, and cooperation in devolved HR management.Case presentationThrough USAID funding, IntraHealth International built the health workforce management capacity of county governments by strengthening coordination mechanisms at the national and county levels. Informed by stakeholder mapping, Kenya’s 47 counties were grouped into nine clusters with similar geographic contexts and HRH challenges. Inter-county cluster HRH stakeholder coordination forums are hosted by a rotating county-led secretariat and meet quarterly to address gaps, share successes and challenges, and track implementation of action plans. They link to the national level for capacity building, policy formulation, HRH regulation, and provision of standards. Counties have assumed ownership of the forums and contributed about US$85000 to date toward expenses.ConclusionsAs a mechanism for transforming Kenya’s national HRH agenda into action at the county level, the HRH coordination framework has been instrumental in (1) expediting development, customization, and dissemination of policies, (2) enabling national HRH officers to mentor their county counterparts, and (3) providing collaborative platforms for multiple stakeholders to resolve HRH challenges and harmonize HR practices nationwide. Successes catalyzed through the inter-county forums include hiring over 20 000 health workers to address shortages; expanding the national HR information system to all 47 counties; developing guidelines for sharing specialist providers; and establishing professionalized HRH units in all 47 counties.Kenya has made great strides in strengthening its health system through the HRH coordination framework, which supports standardization of county health operations with national goals while enabling national policy to address HRH gaps in the counties. Transitioning to fully local funding of inter-county forums is important for sustaining progress.

Workshop: Bridging the health divide across the Mediterranean: an agenda for public health research and polic

Abstract Objectives Develop 3-4 areas for intensified collaboration The Mediterranean region has a rich history and is home to some of the earliest civilisations. Today, the Mediterranean is often in the news as a result of tragic events and unrest including conflict and loss of lives at sea. Political meetings such as the South EU summit of Southern European leaders and the 5 + 5 EuroMed are useful events to highlight the priority policy issues of this region. Yet, health has rarely been at the forefront of the political agenda for the Mediterranean. The migrant crisis comes as a timely reminder that there exists a full continent on the other side of this sea and border countries from Africa, themselves in active processes of reform and change, should be seen as neighbours with whom the European public health community needs to collaborate. The purpose of this workshop is to shine a light on the health divide across the Mediterranean, to highlight key epidemiological, health systems and global health governance issues of priority to the region. It aims to stimulate an initial discussion for a public health research and policy focus on the Mediterranean region which could eventually lead to a call for action and a programme of activities at international level. Our neighbours share with us several public health challenges, from financing of health systems, epidemiological transition toward NCD diseases, environment and life style risks, human resources for health challenges and migrant issues from other parts of the continent. Marseille, as the conference location, provides a unique opportunity to debate and exchange with the three Maghreb countries facing the southern border of Europe. Key messages Maghreb health systems are in transition, all three rather different, but rather close to some European and EU health systems regarding financing, priorities, social and regional inequalities in access to health services, aging and NCD growth pressure. How can they become a part and contribute to the very active European Public Health analysis and benchmarks on optimizing health systems performance? Part of the health crisis regarding migrants in Europe is also an issue for health care systems in Maghreb countries. Are there ways to collaborate, to implement real collaborative and joint actions? Maghreb countries face a very specific crisis because of European policies of attracting health professionals: the brain drain is a significant issue, endangering the capacity of the Maghreb health systems. Do we foresee solutions to it? Maghreb countries face the same transition as Europe toward chronic diseases’ increased burden due to global changes in lifestyles and exposure to globalized health risks, But also thanks to improved health care and longer life expectancies. Fighting an increase in some risk factors can only be global or regional, with joint actions in need of forgetting the presence of the sea. Chronic disease is also an issue for international organizations: for example, such discussion could bring the three WHO regional officers involved around the Mediterranean Sea closer.

Human Resources for Health challenges during health emergencies—low number of workers in El Salvador

Abstract El Salvador is one of the 57 countries considered to be in Human Resources for Health (HRH) crisis according to the World Health Organization (WHO). El Salvador’s healthcare worker density is 1.95 health professionals per 1,000 population, with even lower numbers in certain departments of the country. There have been improvements in the distribution of healthcare workers since 2010; however, on average it has remained “in crisis” based on the 2006 World Report definition. The increase in vector borne diseases in the region, has resulted in an overwhelmed vector control system and public health sector in many Central American countries. This study aims to analyze whether the healthcare workers identify the numbers of HRH as a factor that affects the health system response during health emergencies. Through an extensive review of scientific literature, country reports, 16 meetings and 34 in depth semi-structured interviews with key stakeholders; this paper explores the challenges healthcare workers faced and how they were influenced by the numbers of available HRH during recent arboviral epidemics in El Salvador, using the recent Zika epidemic as a point of comparison. The study findings suggest that some of the barriers that the health workforce identified during health emergencies include factors related to the low availability of HRH such as feelings of tiredness, being overwhelmed, as well as a need to rely on doctors in their social year in some areas of the country. Despite this, they also recognize that the recent intersectoral work done by the government and the Ministry of Health, has helped to overcome the obstacles of a low healthcare workforce by involving other sectors of society into the emergency response. Therefore, there is not a clear consensus on how the low number of HRH affect the health emergency response. Key messages The study findings suggest that some of the barriers that the health workforce identified during health emergencies include factors related to the low availability of HRH. They also recognize that the recent intersectoral work done by the government and the Ministry of Health, has helped to overcome the obstacles of a low healthcare workforce.

Towards a regional strategy for resolving the human resources for health challenges in Africa.

### Summary box The decline in child mortality by as much as 75% between 2000 and 2013 in Cape Verde, Equatorial Guinea, Eritrea and Rwanda,1 in the Africa region that is famous for its depressing health outcomes, is worthy of celebration. However, before we bring out the drums and dancers, let us deliberate over the sustainability of the gains, scale-up and expansion to the rest of sub-Saharan Africa (SSA) for implementing the Universal Health Coverage (UHC) agenda or for meeting the Sustainable Development Goal number three (SDG3). We did, but had no other choice than to suspend the euphoria. Until SSA countries crack the nut that keeps the region behind others in the prevention and containment of the issues which pose a major threat to UHC attainment in the region, all other ancillary efforts will continue to function at suboptimum level. The production, distribution and retention of the human resource for health (HRH) are at the heart of the region’s health system performance, which if addressed alongside the other health system elements such as infrastructure, medicines and financing will place the region on the right path towards UHC and SDG 3. The shortage of skilled health workforce (HWF) and inequitable distribution of the available ones which is well acknowledged as the crux of the health inequity and the health outcomes in the region are major sources of apprehension.2–4 The pervasively inadequate human resource …

Understanding HRH recruitment in post-conflict settings: an analysis of central-level policies and processes in Timor-Leste (1999\u20132018)

BackgroundAlthough human resources for health (HRH) represent a critical element for health systems, many countries still face acute HRH challenges. These challenges are compounded in conflict-affected settings where health needs are exacerbated and the health workforce is often decimated. A body of research has explored the issues of recruitment of health workers, but the literature is still scarce, in particular with reference to conflict-affected states. This study adds to that literature by exploring, from a central-level perspective, how the HRH recruitment policies changed in Timor-Leste (1999–2018), the drivers of change and their contribution to rebuilding an appropriate health workforce after conflict.MethodsThis research adopts a retrospective, qualitative case study design based on 76 documents and 20 key informant interviews, covering a period of almost 20 years. Policy analysis, with elements of political economy analysis was conducted to explore the influence of actors and structural elements.ResultsOur findings describe the main phases of HRH policy-making during the post-conflict period and explore how the main drivers of this trajectory shaped policy-making processes and outcomes. While initially the influence of international actors was prominent, the number and relevance of national actors, and resulting influence, later increased as aid dependency diminished. However, this created a fragmented institutional landscape with diverging agendas and lack of inter-sectoral coordination, to the detriment of the long-term strategic development of the health workforce and the health sector.ConclusionsThe study provides critical insights to improve understanding of HRH policy development and effective practices in a post-conflict setting but also looking at the longer term evolution. An issue that emerges across the HRH policy-making phases is the difficulty of reconciling the technocratic with the social, cultural and political concerns. Additionally, while this study illuminates processes and dynamics at central level, further research is needed from the decentralised perspective on aspects, such as deployment, motivation and career paths, which are under-regulated at central level.

Human Resources for Health Challenges in Nigeria and Nurse Migration.

The emigration of sub-Saharan African health professionals to developed Western nations is an aspect of increasing global mobility. This article focuses on the human resources for health challenges in Nigeria and the emigration of nurses from Nigeria as the country faces mounting human resources for health challenges. Human resources for health issues in Nigeria contribute to poor population health in the country, alongside threats from terrorism, infectious disease outbreaks, and political corruption. Health inequities within Nigeria mirror the geographical disparities in human resources for health distribution and are worsened by the emigration of Nigerian nurses to developed countries such as the United States and the United Kingdom. Nigerian nurses are motivated to emigrate to work in healthier work environments, improve their economic prospects, and advance their careers. Like other migrant African nurses, they experience barriers to integration, including racism and discrimination, in receiving countries. We explore the factors and processes that shape this migration. Given the forces of globalization, source countries and destination countries must implement policies to more responsibly manage migration of nurses. This can be done by implementing measures to retain nurses, promote the return migration of expatriate nurses, and ensure the integration of migrant nurses upon arrival in destination countries.

Investigating the remuneration of health workers in the DR Congo: implications for the health workforce and the health system in a fragile setting.

The financial remuneration of health workers (HWs) is a key concern to address human resources for health challenges. In low-income settings, the exploration of the sources of income available to HWs, their determinants and the livelihoods strategies that those remunerations entail are essential to gain a better understanding of the motivation of the workers and the effects on their performance and on service provision. This is even more relevant in a setting such as the DR Congo, characterized by the inability of the state to provide public services via a well-supported and financed public workforce. Based on a quantitative survey of 1771 HWs in four provinces of the DR Congo, this article looks at the level and the relative importance of each revenue. It finds that Congolese HWs earn their living from a variety of sources and enact different strategies for their financial survival. The main income is represented by the share of user fees for those employed in facilities, and per diems and top-ups from external agencies for those in Health Zone Management Teams (in both cases, with the exception of doctors), while governmental allowances are less relevant. The determinants at individual and facility level of the total income are also modelled, revealing that the distribution of most revenues systematically favours those working in already favourable conditions (urban facilities, administrative positions and positions of authority within facilities). This may impact negatively on the motivation and performance of HWs and on their distribution patters. Finally, our analysis highlights that, as health financing and health workforce reforms modify the livelihood opportunities of HWs, their design and implementation go beyond technical aspects and are unavoidably political. A better consideration of these issues is necessary to propose contextually grounded and politically savvy approaches to reform in the DR Congo.

Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study

The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi-structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision-makers and planners are urged to identify HRH as the most important input for the success of PHC programmes and interventions, especially in the growing fields of mental health and geriatric care.

A scoping review of training and deployment policies for human resources for health for maternal, newborn, and child health in rural Africa.

BackgroundMost African countries are facing a human resources for health (HRH) crisis, lacking the required workforce to deliver basic health care, including care for mothers and children. This is especially acute in rural areas and has limited countries’ abilities to meet maternal, newborn, and child health (MNCH) targets outlined by Millennium Development Goals 4 and 5. To address the HRH challenges, evidence-based deployment and training policies are required. However, the resources available to country-level policy makers to create such policies are limited. To inform future HRH planning, a scoping review was conducted to identify the type, extent, and quality of evidence that exists on HRH policies for rural MNCH in Africa.MethodsFourteen electronic health and health education databases were searched for peer-reviewed papers specific to training and deployment policies for doctors, nurses, and midwives for rural MNCH in African countries with English, Portuguese, or French as official languages. Non-peer reviewed literature and policy documents were also identified through systematic searches of selected international organizations and government websites. Documents were included based on pre-determined criteria.ResultsThere was an overall paucity of information on training and deployment policies for HRH for MNCH in rural Africa; 37 articles met the inclusion criteria. Of these, the majority of primary research studies employed a variety of qualitative and quantitative methods. Doctors, nurses, and midwives were equally represented in the selected policy literature. Policies focusing exclusively on training or deployment were limited; most documents focused on both training and deployment or were broader with embedded implications for the management of HRH or MNCH. Relevant government websites varied in functionality and in the availability of policy documents.ConclusionsThe lack of available documentation and an apparent bias towards HRH research in developed areas suggest a need for strengthened capacity for HRH policy research in Africa. This will result in enhanced potential for evidence uptake into policy. Enhanced alignment between policy-makers’ information needs and the independent research agenda could further assist knowledge development and uptake. The results of this scoping review informed an in-depth analysis of relevant policies in a sub-set of African countries.

Strengthening human resources for health through multisectoral approaches and leadership: the case of Cameroon

Cameroon has a severe shortage of human resources for health (HRH) and those that are available are concentrated in urban areas. As the result of a national emergency plan for the years 2006-2008, innovative strategies and a multisectoral partnership - led by the Ministry of Public Health and supported by diverse national and international organizations - were developed to address the shortages and maldistribution of HRH in Cameroon. At the time that the emergency plan was developed, Cameroon had health services of poor quality, an imbalance between HRH training and employment, a maldistribution of HRH between urban and rural areas and a poor allocation of financial resources for HRH. It also lacked an accreditation system for use in the training of health workers. Between 2007 and 2009, the number of active health workers in Cameroon increased by 36%, several new institutions for higher education in health care and training schools for paramedical staff and midwives were opened, and a national strategy for universal health coverage was developed. In the improvement of HRH, strong leadership is needed to ensure effective coordination and communication between the many different stakeholders. A national process of coordination and facilitation can produce a consensus-based view of the main HRH challenges. Once these challenges have been identified, the stakeholders can plan appropriate interventions that are coordinated, evidence-based and coherent.

Differences in preferences for rural job postings between nursing students and practicing nurses: evidence from a discrete choice experiment in Lao People’s Democratic Republic

BackgroundA discrete choice experiment was conducted to investigate preferences for job characteristics among nursing students and practicing nurses to determine how these groups vary in their respective preferences and to understand whether differing policies may be appropriate for each group.MethodsParticipating students and workers were administered a discrete choice experiment that elicited preferences for attributes of potential job postings. Job attributes included salary, duration of service until promotion to permanent staff, duration of service until qualified for further study and scholarship, housing provision, transportation provision, and performance-based financial rewards. Mixed logit models were fit to the data to estimate stated preferences and willingness to pay for attributes. Finally, an interaction model was fit to formally investigate differences in preferences between nursing students and practicing nurses.ResultsData were collected from 256 nursing students and 249 practicing nurses. For both groups, choice of job posting was strongly influenced by salary and direct promotion to permanent staff. As compared to nursing students, practicing nurses had significantly lower preference for housing allowance and housing provision as well as lower preference for provision of transportation for work and personal use.ConclusionsIn the Lao People’s Democratic Republic, nursing students and practicing nurses demonstrated important differences in their respective preferences for rural job posting attributes. This finding suggests that it may be important to differentiate between recruitment and retention policies when addressing human resources for health challenges in developing countries, such as Laos.

Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities.

BackgroundGlobal Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined.MethodsA multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context.ResultsIn all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs.ConclusionSustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.

Implementing the Agenda for Global Action on human resources for health: analysis from an international tracking survey

Objective:A survey was conducted to analyse the governance and policy environment for human resources for health (HRH) development in 57 priority countries, with the objective of understanding the linkages between policy and context factors.Methods:Responses to a questionnaire tracking proxy indicators were received from 51 (89%) countries. Findings are presented by frequency; correlations were investigated through cross tabulations and multiple regression analysis.Results:The results indicate uneven performance among countries and across different domains of health workforce development. The only indicator showing a significant correlation with other areas of performance was implementing an HRH plan. No significant correlation with contextual factors was found.Discussion:Progress in addressing HRH challenges appears to be independent of contextual factors, suggesting that countries can improve their performance through concerted action by stakeholders. Having and implementing an HRH plan appears to be a key factor in galvanising that action.

HIV/AIDS Workforce Development in Sub-Saharan Africa: Leveraging Opportunity for Long-Term Human Development

Three decades into the global HIV pandemic, hindsight has become a bittersweet ally. Hindsight has shown that it is ultimately futile to address HIV/AIDS without simultaneously mounting a campaign to embolden human rights; it has taught us that the war against disease must include a battle against persistent poverty, national debt, and other structural barriers to human development; and it has demonstrated that HIV/AIDS efforts cannot and must not be developed in isolation from other health care– and health systems–related challenges, particularly in the case of resource-limited countries. Indeed, our three-decade long response to HIV/AIDS has yielded this paramount lesson: the energy, global attention, and resources that are being amassed to combat HIV/AIDS must be effectively leveraged to achieve broader progress in the areas of human rights, socioeconomic development, and public infrastructure, including ‘‘human infrastructure.’’ Too often, however, and despite our best intentions, this lesson is not effectively heeded. As a result, our programmatic response often falls into silos and/or fails to address systemic and root issues at the heart of the HIV pandemic. As a result, key opportunities are missed. There is a danger that this may again become the case with our efforts to dramatically expand the health workforce as a response to HIV/AIDS, tuberculosis, and malaria in sub-Saharan Africa and other resource-poor regions. If we wish to make a sustainable difference, without causing undue harm, we must guard vigilantly against this possibility. The challenge of scarce health human resources in subSaharan Africa is not new. This challenge predates HIV/AIDS and has preoccupied health planners, health system administrators, government leaders, academics, and other key stakeholders throughout the African continent for many decades. Scarcity of health care providers and the interconnected social, economic, and political variables that are root causes of this problem are all, themselves, epidemic in nature. From the structural adjustment policies that have forced African nations to scale back social spending, to the global poaching of developing nation physicians, nurses, and other health care providers, and now the deepening loss of health care providers to endemic diseases, African nations are all too familiar with the human resources for health challenges at hand. What is new, however, is the unprecedented global resolve—and the resources—that are currently being amassed to address this challenge as a pillar of the global HIV/AIDS response. Perhaps, the single greatest indication of this new opportunity is captured in the United States’ push to increase by 140 000 the production of health workers—physicians, nurses, and paraprofessionals—by 2013, as part of the reauthorized President’s Emergency Plan for AIDS Relief (PEPFAR). While the late stage at which this shared resolve has emerged is a testament to our continued reliance on hindsight, it nevertheless provides us a critical opportunity to improve health and human development throughout the globe. For us to realize the potential of this opportunity, however, we require innovative and carefully considered approaches and a willingness to forge new partnerships and pool resources across agencies and donor countries. We also require bold and frank discussion regarding the current capacity of academic training institutions throughout the African continent to adequately prepare physicians, nurses, and public health specialists for the health care and health management challenges posed by the HIV pandemic, in combination with other, local endemic epidemics, not to mention the delivery of primary health care. This is not to question the ability or commitment of either existing health and health care professionals or those who were charged with their training but the extent to which academic training institutions will be able to produce adequate cadres and numbers of health and health care professionals, with the appropriate skills mix necessary to address societal needs, unless there is collective resolve from the donor and technical assistance communities to help these institutions overcome