The human resource crisis in health care is an important obstacle to attainment of the health-related targets for the Millennium Development Goals. One suggested strategy to alleviate the strain upon government services is to encourage new forms of non-government provision. Detail on implementation and consequences is often lacking, however. This article examines one new element of non-government provision in Tanzania: small-scale independent midwifery practices. A multiple case study analysis over nine districts explored their characteristics, and the drivers and inhibitors acting upon their development since permitted by legislative change.
The growing gap between the supply of health care professionals and the demand for their services are recognized as a key issue for health and development worldwide. Policy-makers, planners and managers continue to seek effective means to recruit and retain staff. One way to achieve this is to develop and implement effective incentive schemes.
The HRH Action Framework is designed to assist governments and health managers to develop and implement strategies to achieve an effective and sustainable health workforce. By using a comprehensive approach, the Framework will help address staff shortages, uneven distribution of staff, gaps in skills and competencies, low retention and poor motivation, among other challenges.
Health systems in most high-income countries aim to provide a comprehensive range of services to the entire population and to ensure that standards of quality, equity and responsiveness are maintained. Although approaches vary widely, responsibility for developing the overall framework for financing and organizing health care usually lies with the central government, while governance of the health system is often shared by central and regional authorities.
This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study to identify the level of satisfaction among current health workers in public and PNFP sectors, determine health workers intent to stay in the Ugandan health sector and to collaborate with the Ugandan Ministry of Health and other stakeholders to develop strategies to improve retention of health workers. The identified factors associated with health worker satisfaction, turnover and out-migration will be used to develop strategies and policies to improve health worker satisfaction and retention.
The first Global Forum on Human Resources for Health was held in Kampala, Uganda from 2-7 March, 2008. It called for immediate and sustained action to resolve the critical shortage of health workers around the world. Attendees at the Forum endorsed the Kampala Declaration and the Agenda for Global Action. This high profile event was attended by nearly 1500 participants, including donors, experts and ministers of health, education and finance. [from conference website]
Countries all around the world have made significant progress in scaling up HIV services. Nevertheless, major barriers must be overcome if universal access is to be achieved. One of the main constraints is a serious shortage of health workersthe people on the front line of the efforts to prevent and treat HIV infection.
Task shifting is the name now given to a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers. By reorganizing the workforce in this way, task shifting can make more efficient use of the human resources currently available. For example, when doctors are in short supply, a qualified nurse could often prescribe and dispense antiretroviral therapy. Further, community workers can potentially deliver a wide range of HIV services, thus freeing the time of qualified nurses.
Throughout the 1980s, the doctor and nurse-to-patient ratio in sub-Saharan Africa was well below that of other developing countries 1:10,800 for doctors and 1:2,100 for nurses. Some twenty-five years later, ten sub-Saharan African countries still have a 1:10,000 doctor-to-patient ratio, as compared to Honduras, India and Bolivia which each have approximately one doctor per 3,000 population. The problem is most acute in nursing and midwifery. In many countries, the education sector has also undergone reforms that have decreased the number of teachers and allocated fewer resources for public sector basic education. As a result, many secondary school graduates complete their education without the requisite academic skill sets needed to enter nursing, midwifery, medical and pharmacy schools.
Well-intentioned reform approaches have focused on reducing the absolute number of health workers with little or no regard for the mix of skills needed to meet client demand or burden of disease. As a result, those workers who remain are over-worked, poorly motivated and under paid, and eventually leave, thereby further accelerating the worker retention problem.
This guideline describes an innovative promising practice in human resources for health (HRH) development that has been evaluated and described by the Capacity Project. This guide is for human resources planners and managers in the health sector and sets out the steps required to extend the health workforce by incorporating lay workers (field officers), especially in the delivery of antiretroviral therapy (ART) to home-based clients.
"The HRH Global Resource Center is the preeminent resource on HR that serves the developing world, and maybe even the developed world, in health," says Tim Martineau, senior lecturer in HR management at the International Health Research Group, Liverpool School of Tropical Medicine.
To foster a global exchange of human resources for health (HRH) evidence, tools and innovation, the Capacity Project created a searchable collection of HRH resources with librarian support. Launched in May 2006, the HRH Global Resource Center now has over 1,500 resources to support HRH in developing countries and help the health community address workforce challenges.
The shortfall of health personnel continues to represent one of the major constraints to the development of health services and access to basic health care in Sierra Leone. This is against a background of increased demands for health care from various stakeholders, a shrinking budget against high expectations from the public for quality health care. Sierra Leone has implemented health human resource policies and plans to chart the course for a coherent resolution of major human resources problems and puts in place a framework to facilitate decision making in the human resources arena.
To achieve the health-related Millennium Development Goals, many low-income countries need to significantly scale up coverage of priority health services. This will generally require additional national and international resources, but better leadership and management are key to using these resources effectively to achieve measurable results. Good leadership and management are about providing direction and gaining commitment from partners and staff, facilitating change and achieving better health services through efficient, creative and responsible deployment of people and other resources. While leaders set the strategic vision and mobilize the efforts towards its realization, good managers ensure effective organization and utilization of resources to achieve results and meet the aims.
One of the challenges facing HRH development is having evidenced based information as a base for policy, planning and implementation. Having fact sheets on human resources for health is therefore a real achievement. The data presented here in 46 country fact sheets for all countries in the African Region was collected in a comprehensive HRH data collection exercise in 2005. The development of the questionnaires for this survey was coordinated in the African Regional Office in collaboration with counterparts in headquarters in Geneva. Data collection was routed through the WHO country offices. In most countries, the Ministry of Health was the main source for data. However many other partners such as statistical offices, professional registries and associations contributed to this survey and make it the most comprehensive data collection of health workforce data in Africa to date. These fact sheets provide general information such as total numbers and densities of the health workforce and distribution by cadre.
The GRC is a user-driven site that depends on input from our visitors to make decisions about the types of resources to include, needed technological improvements and features, and the future direction of the site. In order to better solicit this valuable information, the HRH Global Resource Center has launched a public user survey to get feedback about the usefulness of the site and suggestions about how we can improve the GRC. The survey will only take a few minutes, and visitors are welcome to answer anonymously. We encourage you to take the survey and share your experiences and ideas with the HRH Global Resource Center team.
Although the [critical shortage of health care workers] is not new, recent international efforts to vaccinate children and to fight HIV/AIDS, malaria, tuberculosis, and other diseases have brought it into sharper focus. Donors are increasingly realizing that without enough trained workers to deliver drugs, vaccines, and care, pumping money into projects will not have the desired effects. The worker shortage derives from a combination of underproduction, internal maldistribution, and emigration of trained workers ("brain drain"). Fortunately, many African countries have begun attacking the problem by implementing innovative programs that may serve as models for other countries. Once effective pilot programs have been identified, scaling up will be the next hurdle: programs that are found to work on a small scale or in a particular environment may not be easy to expand or replicate.
This presentation was given as part of the Christian Health Associations Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It provides an excellent overview of the challenges of Malaria and HIV/AIDS; discusses the human resource needs in light of these challenges; and how to build and maintain capacity. The author presents information on effective malaria interventions and details the Joint Uganda Malaria Training Programme. This model of malaria training influences both the management and control of malaria and is designed to improve quality of care for patients with malaria through building the capacity of health workers in the diagnosis, treatment and prevention of malaria.
Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms through which health sector reforms either promote or discourage health worker performance. How do reforms affect the health workforce and create responses that are likely to encourage the success or failure of reform objectives? How does context influence the routes through which reforms affect provider incentive environments and eventually motivation and performance? To address these questions, this paper seeks to trace these mechanisms of effect and examines health workers' responses to the changes in their working environments by taking a realistic evaluation approach.
Health workers are among the most valuable resources of any health system. Developing a strong workforce requires training health workers to perform their jobs, updating their skills and knowledge to match evolving health needs and helping health workers advance along appropriate and satisfying career paths. Learning interventions are critical components of offering good quality health care services, ensuring that health workers perform to standard and addressing the human resources for health crisis facing many countries.
Many developing countries face daunting obstacles to meeting the health care needs of their people. To ensure that the right health care provider is in the right place with the right skills, these countries require current, accurate data on human resources for health (HRH). A strong human resources information system (HRIS) enables health care leaders to quickly answer the key policy and management questions affecting health care service delivery.
The Capacity Project is developing free, Open Source HRIS solutions to supply health sector leaders and managers with the information they need to assess HR problems, plan effective interventions and evaluate those interventions. The project provides a program of technical assistance and expertise to ensure that the technology is transferred effectively and serves the ability of decision makers to use data to lead and manage. The participatory approach results in systems that are appropriate for the context in which they are used and sustainable.
The study of the health workforce has gained in prominence in recent years, as the dynamic interconnections between human resource issues and health system effectiveness have come into sharper focus. This paper reviews lessons relating to strategic management challenges emerging from the growing literature in this area. Workforce issues are strategic: they affect overall system performance as well as the feasibility and sustainability of health reforms. Viewing workforce issues strategically forces health authorities to confront the yawning gaps between policy and implementation in many developing countries.
As the international community rallies funds to support the expansion of HIV/AIDS services in the developing world, the human resources for health crisis presents a significant challenge to achieving HIV/AIDS service delivery goals. This is especially true of countries in sub-Saharan Africa where, in the last 30 years, the health workforce has declined relative to population growth, and the HIV/AIDS epidemic has intensified health service needs.
A key approach to address the global shortage of health care providers is to improve the productivity of existing workers, thereby improving the quality and coverage of services. Workplace environment improvements and task shifting of health functions to different cadres of providers are two promising interventions that are being used for this purpose. This presentation describes innovative solutions to enhance the capacity and productivity of the current workforce and to build coherence into the management of human resources for stronger health systems. Adapted from publishers description.
This pre-tested and peer-reviewed curriculum focuses on the knowledge and skills necessary for providing holistic Community Home-Based Care (CHBC) for people living with HIV/AIDS, transferring knowledge and skills to caregivers and CHBC clients and mobilizing communities around HIV/AIDS prevention, care, treatment and support. The trainers guide includes comprehensive units that cover topics such as: HIV basics; communication skills; nursing care; nutrition; positive living; family planning; HIV prevention; antiretroviral treatment; and community mobilization. The accompanying illustrated handbook provides community health workers with a practical user-friendly tool that can be used as reference material and to aid in transferring skills to clients and caregivers. [publishers description]
Health services depend on having the right people, with the right skills, in the right place. Yet, the world is experiencing a chronic shortage of well-trained health workers, a crisis felt most acutely in those countries that are experiencing the greatest public health threats. The World Health Organization (WHO) estimates that over four million health workers are needed to fill the gap and the global deficit of doctors, nurses and midwives in particular is no less than 2.4 million.
Health workers are an essential input to service provision. Decisions governing human resources are thus crucially important for rebuilding a health system. In many post-conflict countries, however, little attention is given to identifying the effects of prolonged conflict upon the composition, skills and deployment of the health workforce that is expected to provide services in a rebuilt health system. This paper seeks to elucidate HRH issues in the critical start-up period of reconstruction in countries that have experienced relatively prolonged and major conflict. The examples are drawn mostly from Afghanistan and Cambodia, two countries that experienced more than twenty years of conflict.
Credentialing of health care providers, facilities and educational institutions is an integral component in building and sustaining robust human resources for health (HRH) systems. The credentialing mechanismslicensure/registration, certification and accreditationare among the most frequently used quality assurance tools in health care and serve as valuable instruments in the broader function of health care regulation. This technical brief examines the characteristics and potential advantages of these mechanisms and common challenges faced in implementing them in low-resource settings. Authors description
With the aim of bringing together the countries of the Americas in a coordinated effort, the Pan American Health Organization, Health Canada, and the Minister of Health of Ontario organized a regional meeting in October 2005 to define strategic orientations that will enable the region to confront critical challenges in HRH. To this end, each participating country was invited to develop a national analysis, with the collaboration of relevant stakeholders, to identify the long term objectives for development and management of human resources as well as immediate objectives for addressing the most critical problems and needs.
The HRH Global Resource Center has recently begun including presentations on HRH topics in the collection. This presentation, "Health Worker Flight from Sub-Saharan Africa: Patterns, Implications & Mitigating Strategies," was given at the 2006 Association of American Medical Colleges' Physician Workforce Research Conference, "2020 Vision: Focusing on the Future." It discusses out-migration and brain drain from sub-Saharan Africa and gives an overview of the issues related to this problem. The presentation offers statistics on the number of health workers, charts representing the deployment of health workers worldwide and pictures of the project to create registries of licensed health personnel in Uganda.
Many developing countries are facing daunting obstacles to meet the health care needs of their people. A critical challenge to training, deploying and retaining the health workforce is the lack of current, accurate data about health professionals working in the country. Even when data is collected, usually in paper form, that data often cannot be used effectively. A mature and complete human resources information system (HRIS) links all human resources data from the time health professionals enter pre-service training to when they leave the health workforce. Using the system, decision makers can quickly find the answers they need to assess HRH problems, plan effective interventions and evaluate those interventions.
Welcome to the HRH Global Resource Center Newsletter. This newsletter provides information on the latest resources, improvements and news from the Resource Center, a digital library devoted to human resources for health (HRH). Please contact us with your questions and suggested resources.
News
Resources
One Million More presents some of the interventions, debates, discussions and conclusions of a conference held in London from 2122 March 2006. The conference was organized to create a stimulating and interactive forum to discuss the crisis in human resources for health in an effort to influence national, regional and international policies for the promotion of sustainable skills capacity in Africa and to engage the African Diaspora in innovative, practical steps to move the agenda forward.

Many nations create country-level HRH strategic plans in order to ensure that they can produce the required number and types of key health workers, utilize them effectively and retain and motivate existing health workers. Several countries have human resource policies and plans as part of national health policies and strategies or as stand-alone documents that would be useful for those involved in the process of HRH strategic planning.
Faith-based organizations (FBOs) have a long history of providing health services to people and communities most in need. Faith-based organizations often deliver 25% to 50% of all health care services for entire countries, often in the most inaccessible and impoverished areas. The WHOs 2004 World Health Report estimates that FBOs make up 20% of all organizations combating HIV/AIDS.