Human Resources For Health Management Research Articles

Assessment of quality indicators of nursing care and clients’ satisfaction at federal medical centre Jigawa state, Nigeria

Background:The challenges in Human Resources for Health Management and Development are global. It is particularly worst in sub Saharan Africa which has been strewn with crisis. Investments in the training of the much needed professionals do not seem to match requirement and therefore does not make the expected impact. A number of other factors have also been assigned to the low level of health worker concentration in areas where their services are needed in Africa. The quality of care that nurses provide is influenced by individual nurse characteristics such as knowledge and experience, as well as human factors such as fatigue. Aims: The study aim was to Assess Quality indicators of Nursing care and clients’ satisfaction at Federal Medical Centre Jigawa State, Nigeria. Methodology: A Descriptive cross sectional design with quantitative and qualitative data collection approach was implemented in this study to Assess Quality indicators of Nursing care and clients’ satisfaction at Federal Medical Centre Jigawa State, Nigeria. The population of the study comprises nurse managers and in-patients of Federal medical Centre, Birnin kudu, Jigawa State. Probability (stratified) sampling was used for quantitative aspect and census sampling for qualitative aspect. Four main tools were used for data collection. SPSS version 24 was used for data analysis. Results: The results revealed that: In the result to assess the nursing care quality, 34% of the respondents were very comfortable of the helpfulness of nurses. 26.7% reported to be good as well as excellent by 23.3%.Significant percentages of the respondents (38.4%) were very comfortable on how nursing staffs respond to their calls, and only 5.8% reported to be poorly comfortable. Skills and competence of nursing were determined, and results show that 33.7% of the patients happen to be very good with how nurses are administering medicines and handling I.Vs. As high as 24.4% of the patients agreed that the coordination of care by the nurses as very good, while 23.3 reported to be excellent Conclusion: There is uneven distribution of nurses. Hospital infection rates and mortality rates are important indicators of quality. There are so many strategies to improve quality of care. Clients are satisfied with quality of care they receive; however, a lot improvement can be made.

Impacts of performance-based financing on health system performance: evidence from the Democratic Republic of Congo

BackgroundHealth systems’ weakness remains one of the primary obstacles towards achieving universal access to quality healthcare in low-income settings. Performance-based financing (PBF) programs have been increasingly used to increase access to quality care in LMICs. However, evidence on the impacts of these programs remains fragmented and inconclusive. We analyze the health system impacts of the PBF program in the Democratic Republic of the Congo (DRC), one of the largest such programs introduced in LMICs to date.MethodsWe used a health systems perspective to analyze the benefits of PBF relative to unconditional financing of health facilities. Fifty-eight health zones in six provinces were randomly assigned to either a control group (28 zones) in which facilities received unconditional transfers or to a PBF program (30 zones) that started at the end of 2016. Follow-up data collection took place in 2021–2022 and included health facility assessments, health worker interviews, direct observations of consultations and deliveries, patient exit interviews, and household surveys. Using multivariate regression models, we estimated the impact of the program on 55 outcomes in seven health system domains: structural quality, technical process quality, non-technical process quality, service fees, facility management, providers’ satisfaction, and service coverage. We used random-effects meta-analysis to generate pooled average estimates within each domain.ResultsThe PBF program improved the structural quality of health facilities by 4 percentage points (ppts) (95% CI 0.01–0.08), technical process quality by 5 ppts (0.03–0.07), and non-technical process by 2 ppts (0–0.04). PBF also increased coverage of priority health services by 3 ppts (0.02–0.04). Improvements were also observed for facility management (9 ppts, 0.04–0.15), service fee policies, and users’ satisfaction with service affordability (14 ppts, 0.07–0.20). Service fees and health workers’ satisfaction were not affected by the program.ConclusionsThe results suggest that well-designed PBF programs can lead to improvements in most health systems domains relative to comparable unconditional financing. However, the large persisting gaps suggest that additional changes, such as allocating more resources to the health system and reforming the human resources for health management, will be necessary in DRC to achieve the ambitious global universal health coverage and mortality goals.Trial registrationAmerican Economics Association Trial registry AEARCTR-0002880.

Understanding the factors influencing health workers’ choice of workplace locations: a qualitative description of primary healthcare workers’ perspectives in Nigeria

Background Universal access to a qualified, skilled, motivated and equitably distributed health workforce is pertinent for the delivery of quality health services needed to achieve national health sector goals and sustainable development goals. However, there remains a shortage of health workers attributed to health workers’ choices of not taking up postings due to the characteristics of workplace locations, amongst other factors. This study sought to understand the factors influencing primary healthcare workers’ choice of workplace locations in Nigeria. Methods This study applied a qualitative research design. We interviewed 41 primary healthcare workers, including nurses, midwives, and community health practitioners, in Bauchi and Cross River States in Nigeria. The interviews elicited responses on the important issues that health workers consider when thinking of taking up or staying in a work location. Results We found that the working conditions, living environment and human resources for health (HRH) management practices influence the choice of work location amongst health workers. For working conditions, the quality of facilities, workload concerns, the scope of practice and community support were suggested as important factors. The living environment, specifically the availability of quality housing or an allowance to pay for quality accommodation, availability of transport facilities, and quality schools for children’s education were suggested as important factors. Lastly, the HRH management practices linked to supportive management, remunerations, career advancement and continuing education were highlighted as central factors. Conclusions Our study highlights the importance of work location to health workers. In practice, there is a need for policymakers and health planners to gain and apply contextual evidence on factors influencing health workers’ choice of workplace locations in health and HRH planning and management. This is pertinent in designing and implementing tailored interventions for ensuring the equitable distribution of health workers.

COVID-19 and human resources for health: analysis of planning, policy responses and actions in Latin American and Caribbean countries

BackgroundThe COVID-19 pandemic led to worldwide health service disruptions, due mainly to insufficient staff availability. To gain insight into policy responses and engage with policy-makers, the World Health Organization (WHO) developed a global approach to assess and measure the impact of COVID-19 on the health workforce. As part of this, WHO, together with the Pan American Health Organization (PAHO), supported an impact analysis of COVID-19 on health workers and policy responses, through country case studies in Latin America and the Caribbean (LAC).MethodsWe sought to identify lessons learned from policies on human resources for health (HRH) during health emergencies, to improve HRH readiness. First, we performed a rapid literature review for information-gathering. Second, we used the WHO interim guidance and impact measurement framework for COVID-19 and HRH to systematically organize that information. Finally, we used the Health Labour Market Framework to guide the content analysis on COVID-19 response in eight LAC countries and identify lessons learned to improve HRH readiness.ResultsPlanning and implementing the COVID-19 response required strengthening HRH governance and HRH data and information systems. The results suggest two main aspects for HRH governance crucial to enabling an agile response: (1) aligning objectives among ministries to define and produce regulation and policy actions; and (2) agreeing on the strategy for HRH management between the public and private sectors, and between central and local governments. We identified three areas for improvement: (a) HRH information systems; (b) methodologies to estimate HRH needs; and (c) teams to analyse information for decision-making. Three key actions were identified during countries monitored, reviewed, and updated their response stages: (i) strengthening response through primary health care; (ii); planning HRH needs to implement the vaccination plan; and (iii) securing long-term HRH availability.ConclusionCountries coordinated and articulated with different stakeholders to align objectives, allocate resources, and agree on policy actions to implement the COVID-19 response. Data and information for HRH preparedness and implementation were key in enabling an agile COVID-19 response and are key areas to explore for improved pandemic preparedness.

Implementation of the plan of action for human resources for health and the COVID-19 pandemic responseImplementação do plano de ação sobre recursos humanos para a saúde e a resposta à pandemia de COVID-19

RESUMENObjetivos.Sistematizar y analizar las acciones de respuesta relacionadas con los recursos humanos en salud durante la pandemia reportadas por 20 países de la Región de las Américas en la evaluación de medio término del Plan de acción sobre recursos humanos para el acceso universal a la salud y la cobertura universal de salud 2018-2023 (Organización Panamericana de la Salud, 2018), y valorar la trascendencia de las políticas y la gestión de los recursos humanos expresadas en la Estrategia y el Plan de recursos humanos durante emergencias sanitarias y en tiempos normales.Métodos.Se seleccionaron y sistematizaron reportes sobre las acciones contra la COVID-19 y los recursos humanos en salud de 20 países de la Región. Se clasificaron las acciones en acciones inmediatas de contingencia, acciones relacionadas con capacidades instaladas y acciones emergentes.Resultados.Las capacidades de planificar y gestionar los recursos humanos en salud en los países dependen de las estructuras y competencias instaladas y funcionales. La pandemia visibilizó la necesidad de disponer de nuevos perfiles laborales, mejorar las condiciones laborales y contractuales precarias, visibilizar la perspectiva de género y solucionar brechas numéricas en determinadas áreas y niveles de atención.Conclusiones.La vinculación de acciones contra la COVID-19 con el monitoreo del Plan demostró la importancia de la gobernanza, la gestión y las capacidades instaladas en recursos humanos de salud para dar respuestas en emergencias sanitarias y en tiempos normales. El análisis invita a la revisión de las políticas públicas existentes, los modelos de atención necesarios para orientar las necesidades actuales y futuras de recursos humanos de salud, los perfiles requeridos, las condiciones laborales y la cobertura de brechas numéricas existentes, entre otros temas. La pandemia permitió innovaciones en los países para responder a la demanda. La Estrategia y el Plan siguen vigentes para orientar y fortalecer el desempeño de los recursos humanos en salud.

Implementing a digital human resources management tool in the government health sector in Bangladesh: a policy content analysis

IntroductionIn Bangladesh, to address the challenges of ensuring adequate human resources for health (HRH), the government began implementing a digital tool for HRH management in 2017. However, evidence suggests institutionalizing such tools in low-and-middle-income countries is impeded by policy aspects like implementation strategy and poor regulatory framework. Therefore, we aimed to explore factors in the current policy landscape that might facilitate and challenge the implementation of the tool in Bangladesh.MethodsWe conducted a review of policies related to ICT implementation and human resources management in the health sector in Bangladesh using qualitative content analysis method. Ten policies have been identified, and extensive reading was done to ascertain common themes and patterns. A document analysis matrix was developed to synthesize and help interpret the findings.ResultsRegarding facilitators, strong upstream level commitments were reflected in the content of policies in terms of setting out specific objectives, targets, timelines, and budget allocation. However, the lack of explicit monitoring strategy and extent of stakeholders’ engagement was not well-defined, ultimately creating chances for impeding downstream implementation. In addition, effective coordination among stakeholders and different HRH and ICT policies could be strengthened.DiscussionFindings support the current discourse that national commitment plays a vital role in the integration of ICTs in health services. However, well-defined monitoring strategy and inter-ministry and intra-ministry policy coordination are crucial.

Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in Kenya

BackgroundHealth sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH.MethodsWe used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county.ResultsWe found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county.ConclusionDevolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country’s efforts for promoting service delivery equity as a key goal – both for the devolution and the country’s quest towards Universal Health Coverage (UHC).

Health sector decentralisation in Tanzania: Analysis of decision space in human resources for health management.

While decentralisation of health systems has dominated the political arena in the low- and middle-income countries since the 1970s, many studies on decentralisation have focused on understanding who is given more decision-making authority, but less attention is paid to understanding what that authority involves. This paper assesses the range of decision-making authority transferred from the central government to subnational levels in the area of human resources for health management in Tanzania. This analysis was guided by the decision space framework and relied on interviews, focused group discussions, and analysis of documents. Data were analysed using thematic approach. While districts had narrow decision space on recruitment and promotion of health service providers, they had wide decision space on distributing health providers within districts and providing incentives. Centrally managed recruitments resulted in frequent delays, thereby intensifying shortages of skilled health service providers. This analysis concludes that decentralisation of human resources for health planning and deployment role to lower levels of the administrative hierarchy in Tanzania is limited. This suggests the need for the central government to increase decision space to districts in the area of recruitment. In order for the Ministry of Health to perform its functions better in the area of human resources for health management, there is a need to strengthen the capacity of the department dealing with recruitment of skilled health staff at the Ministry of Health.

Exploring the Implications of District Splitting on the Constitution and Functionality of District Service Commissions in Uganda: A Case Study of 8 Districts in Uganda

In Uganda district splitting occurs when new districts are created out of old districts using existing boundaries which usually constitute a health sub district or county boundary. The Ugandan system of local governance is based on the district as a functional unit under which there are lower local governments and administrative units that follow the devolution system of decentralisation. The aim of this study was therefore to assess issues affecting constitution, functionality and operationalization (establishment and appointment) of District Service Commission (DSCs). This was an exploratory cross-sectional study that used qualitative methods about the implications of the phenomenon of district splitting (creation) in relation to constitution and functionality of the district service commissions and human resources for health management. We purposively collected data from 16 key informants based on their roles and responsibilities on the DSCs. Out of the eight districts in the study, only one district constituted a fully functional DSC while the remaining seven districts managed to constitute DSCs in a period between 6 and 12 months. This study shows that splitting negatively affected both the parent and child (new) districts in sense that they could not constitute a complete committee within the stipulated time of three months. Generally, all the districts have had challenges in constituting the DSCs of 5-7 commission committee members. Only one in the eight districts had managed to constitute a full committee within three months of post-splitting. After districts are split, majority of the DSCs especially in the child districts took over almost a year to be constituted and fully functional due to mainly lack of qualified members for example retired senior civil servants in these districts. All the eight districts had a challenge of political interference during the process of appointing the technical team, which delayed constitution of quorum of DSCs in the districts. Lack of resources to carry out most of the DSC functions was also mentioned in all districts as a major hindrance to the district councils which were responsible for appointing DSC members. The DSCs should be allowed to operate with no political interference and this can be enacted as a law by parliament.

The current situation of human resources for health in the province of Cabinda in Angola: is it a limitation to provide universal access to healthcare?

BackgroundAngola is among sub-Saharan African countries dealing with a crisis of Human Resources for Health (HRH). The province of Cabinda, besides the efforts, still suffers from both HRH shortage and a badly distributed health workforce. In Cabinda, one can find urban concentration and rural shortages of healthcare professionals, many rural areas’ healthcare facilities often secured only by basic or medium level HRH; and difficulties in developing HRH retention strategies in rural areas where most services are covered by foreign HRH. This study aims at analysing the situation of HRH in the province of Cabinda. It considers organizational issues, policies and practices resulting from the HRH strategy followed in the recent years, moreover the creation of a medical school. The context that affects the distribution of the health workforce is analysed to contribute to the development of evidence-based policies that promote a better HRH allocation in the poorest and distant villages in the province.MethodsA mixed-methods study was developed, combining a quantitative and qualitative approach to analyse HRH situation in the province of Cabinda. Data was collected from key informants, selected by intentional sampling from public and private health organizations, to respond to a questionnaire and a semi-structured interview. Quantitative and qualitative data was analysed with descriptive and inferential statistics and content analysis respectively. The study was complemented by a comprehensive desk review.ResultsResults show a clear change in HRH data from 2011 to 2015 with significant fluctuations due to variations in retirement, migration and lack of regular public HRH recruitment tenders. HRH density is apparently better in rural when compared with urban areas. However, one should bear in mind that often HRH allocated to rural areas do not stay there, which leads to real geographical imbalances. Factors like lack of proper incentives for HRH retention and social support goes against significant HRH management efforts contributing to this result. Whereas HRH are financed by the State General Budget, the majority of health facilities are still dependent on the Provincial Health Secretariat budget.ConclusionThe study provides a broader view of the current HRH situation in Cabinda Province. Geographical imbalances and other issues with impact in delivering universal access to healthcare are highlighted.

Retention of qualified healthcare workers in rural Senegal: lessons learned from a qualitative study

Deployment and retention of a sufficient number of skilled and motivated human resources for health (HRH) at the right place and at the right time are critical to ensure people's right to access a universal quality of health care. Vision Tokyo 2010 Network, an international network of HRH managers at the ministry of health (MoH) level in nine Francophone African countries, identified maldistribution of a limited number of healthcare personnel and their retention in rural areas as overarching problems in the member countries. The network conducted this study in Senegal to identify the determining factors for the retention of qualified HRH in rural areas, and to explore an effective and feasible policy that the MoH could implement in the member countries. Doctors, nurses, midwives and superior technicians in anesthesiology who were currently working (1) in a rural area and had been for more than 2 years, (2) in Dakar with experience of working in a rural area or (3) in Dakar without any prior experience working in a rural area were interviewed about their willingness and reasons for accepting work or continuing to work in a rural area and their suggested policies for deployment and retention of healthcare workers in rural areas. In-depth interviews were conducted with policy makers in MoH, asking for their perceptions on human resource management in health and about their suggested policies for deployment and retention. A total of 176 healthcare workers and eight policy makers were interviewed. The willingness to face challenges in a new place was one of the main reasons for accepting work in rural areas. The identified factors to motivate or demotivate healthcare workers in rural areas were related to pre-service and in-service education, regulatory systems, financial and non-financial incentive schemes and environmental support. Factors not included in WHO's global recommendation but highly valued in this study were (1) the fairness, transparency and predictability of human resource management by the MoH and (2) employment status, ie permanent government staff versus contract staff. Financial incentive schemes were less commonly suggested. Family bonding and religious-related non-financial incentive schemes were found to be specific factors in Senegal, but would also be applicable in countries where family and religion play important roles in the values of healthcare workers. Improved HRH management, eg the transparency of human resource management by the MoH, was identified as a pre-condition of any policy implementation related to HRH. This factor can be considered in other countries struggling to retain healthcare workers in rural areas. The Vision Tokyo 2010 Network or HRH managers' network in Francophone Africa, Senegal MoH and the research team plan to conduct a quantitative survey to confirm the generalizability of the results of this qualitative survey, and to identify the most effective combination of policies to improve the retention of qualified healthcare workers and seek their implementation in other countries in the region as network activities.

Devolution and its effects on health workforce and commodities management \u2013 early implementation experiences in Kilifi County, Kenya

BackgroundDecentralisation is argued to promote community participation, accountability, technical efficiency, and equity in the management of resources, and has been a recurring theme in health system reforms for several decades. In 2010, Kenya passed a new constitution that introduced 47 semi-autonomous county governments, with substantial transfer of responsibility for health service delivery from the central government to these counties. Focusing on two key elements of the health system, Human Resources for Health (HRH) and Essential Medicines and Medical Supplies (EMMS) management, we analysed the early implementation experiences of this major governance reform at county level.MethodsWe employed a qualitative case study design, focusing on Kilifi County, and adapted the decision space framework developed by Bossert et al., to guide our inquiry and analysis. Data were collected through document reviews, key informant interviews, and participant and non-participant observations between December 2012 and December 2014.ResultsAs with other county level functions, HRH and EMMS management functions were rapidly transferred to counties before appropriate county-level structures and adequate capacity to undertake these functions were in place. For HRH, this led to major disruptions in staff salary payments, political interference with HRH management functions and confusion over HRH management roles. There was also lack of clarity over specific roles and responsibilities at county and national government, and of key players at each level. Subsequently health worker strikes and mass resignations were witnessed. With EMMS, significant delays in procurement led to long stock-outs of essential drugs in health facilities. However, when the county finally managed to procure drugs, health facilities reported a better order fill-rate compared to the period prior to devolution.ConclusionThe devolved government system in Kenya has significantly increased county level decision-space for HRH and EMMS management functions. However, harnessing the full potential benefits of this increased autonomy requires targeted interventions to clarify the roles and responsibilities of different actors at all levels of the new system, and to build capacity of the counties to undertake certain specific HRH and EMMS management tasks. Capacity considerations should always be central when designing health sector decentralisation policies.

District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study.

BackgroundIn sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs).MethodsThis study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews.ResultsThe eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs.ConclusionsThe incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

The Role of a Network of Human Resources for Health Managers in Supporting Leadership for Health Systems Strengthening in Francophone African Countries

This article presents the Vision Tokyo 2010 Network, a unique model of peer learning and information sharing among human resources for health (HRH) managers in Francophone African countries. It describes the network's origins, achievements, and factors underlying its success.The network's origins lie in an overseas training program in Tokyo between 2010 and 2014. Participants included directors and heads of HRH management departments at federal and provincial levels across nine Francophone African countries: Benin, Burkina Faso, Burundi, the Democratic Republic of Congo, Côte d'Ivoire, Niger, Mali, Senegal, and Togo. The network itself was established in 2012 based on the common strategic vision (Vision Tokyo 2010) developed during the training program, with an objective of tackling major problems to improve the performance of human resource development systems in the health systems of participants' countries. Some of the main outcomes of the network, demonstrated during the Ebola outbreak include: improved use of human resource information systems in Senegal established as a result of peer learning within the network and technical cooperation between the Democratic Republic of Congo and Côte d'Ivoire to develop standard operational procedures and to train health workers in the management of Ebola.Having a common strategic vision and contextualized framework—African house of solidarity—as a symbol for HRH system development, strong ownership by core members, participatory processes, a positive peer learning environment, and coaching-style support by partners were key elements of success in this initiative. The biggest challenge for this network thus far has been financial sustainability. However, steps are being taken to demonstrate the cost-effectiveness of networks such as these in order to garner further support from partners to invest in networked approaches rather than siloed, country-specific programs.

Mapping the governance of human resources for health in Serbia

This article maps the current governance of human resources for health (HRH) in relation to universal health coverage in Serbia since the health sector reforms in 2003.The study adapts the Global Health Workforce Alliance/World Health Organization four-dimensional framework of HRH in the context of governance for universal health coverage. A set of proxies was established for the availability, accessibility, acceptability and quality of HRH. Analysis of official HRH documentation from relevant institutions and reports were used to construct a governance profile of HRH for Serbia from the introduction of the reform in 2003 up to 2013. The results show that all Serbian districts (except Sremski) surpass the availability threshold of 59.4 skilled midwives, nurses and physicians per 10,000 inhabitants. District accessibility of health workforce greatly differed from the national average with variances from +26% to −34%. Analysis of national averages and patient load of general practitioners showed variances among districts by ±21%, whilst hospital discharges per 100 inhabitants deviated between +52% and −45%. Pre-service and in-service education of health workforce is regulated and accredited. However, through its efforts to respond to population health needs Serbia lacks a single coordinating entity to take overall responsibility for effective and coordinated HRH planning, management and development within the broader landscape of health strategy development.

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.

Turnover Intention and Associated Factors Among Health Professionals in University of Gondar Referral Hospital, Northwest Ethiopia

Background: Health workers turnover is an increasing problem that threatens the functioning of the health care sector worldwide, especially in developing countries. There are very few studies on turnover intention in low-income countries, especially in Ethiopia. This study aimed to assess turnover intention of health workers and its determinants in University of Gondar Referral Hospital, Ethiopia. Methods: Institutional based cross sectional study was conducted from March to April, 2014 at University of Gondar Referral Hospital on 394 health professionals using stratified random sampling techniques. The data were cleaned, coded, entered into EPI INFO version 3.5.3, and transferred and analyzed using SPSS version 20. Bi-variable and multivariable logistic regression analyses were carried out to identify factors associated with turnover intention. Results: overall, 52.5% of the health professionals reported to have turnover intentions. Respondents who have degree and above academic rank [AOR=2.717(95%CI:1.192,6.190)]; nursing profession [AOR= 7.668(95%CI: 2.913,20.188)], laboratory profession[AOR 9.153,(95% CI: 2.925,28.636)], work experience of 2.1 to 5 years [AOR=1.937,(95% CI: 1.142,3.288)] and income level of 2100 to 2259 [AOR =0.431(95% CI: 0.213,0.871)] were significantly associated with turnover intention of the health professionals. Conclusions: In this study, turn over intention of health professionals was found to be high. Educational level, profession, work experience, income are significantly associated with intent to turnover. Hence, it is worth strengthening human resources for health management at hospital level through implementing retention strategies.

Role of Civil Society in Human Resources for Health Management in Nepal

Role of Civil Society in Human Resources for Health Management in Nepal

Human resources for health and decentralization policy in the Brazilian health system

BackgroundThe Brazilian health reform process, following the establishment of the Unified Health System (SUS), has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH), through the Secretary of Labour Management and Health Education, is responsible for establishing national policy guidelines for health labour management, and also for implementing strategies for the decentralization of management of labour and education in the federal states. This paper assesses whether the process of decentralizing human resources for health (HRH) management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level.MethodsThe research methods used comprise a survey of HRH managers of states and major municipalities (including capitals) and focus groups with these HRH managers - all by geographic region. The results were obtained by combining survey and focus group data, and also through triangulation with the results of previous research.ResultsThe results of this evaluation showed the evolution policy, previously restricted to the field of 'personnel administration', now expanded to a conceptual model for health labour management and education-- identifying progress, setbacks, critical issues and challenges for the consolidation of the decentralized model for HRH management. The results showed that 76.3% of the health departments have an HRH unit. It was observed that 63.2% have an HRH information system. However, in most health departments, the HRH unit uses only the payroll and administrative records as data sources. Concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them, specialization courses account for 61.4% and short courses for 56.1%.ConclusionsDue to decentralization, the HRH area has been restructured and policies beyond traditional administrative activities have been developed. However, twenty years on from the establishment of the SUS, there remains a low level of institutionalization in the HRH area, despite recent efforts of the MoH.