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All decentralization initiatives require making changes in the structure of the agency or organization, which means making changes in how the work gets done. It means developing new management systems, training staff in the skills that they will need to perform in their new roles, designing or modifying service delivery systems, and developing strategies for enhancing the long-term sustainability of the program.

This study reviews the experience of decentralization in four developing countries: Ghana, Uganda, Zambia and the Philippines. It uses two analytical frameworks to describe and compare the types and degrees of decentralization in each country. The first framework specifies three types of decentralziation: deconcentration, delegation and devolution. The second framework uses a principle agent approach and innovative maps of decision space to define the range of choice for different functions that is transferred from the centre to the periphery of the system. [from abstract]

Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization — the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization.

Both the advocates and the detractors of decentralization are probably wrong. A thoughtfully designed process of decentralization is not likely to radically improve a health system, nor is it likely to severely disrupt the system. We have evidence that a well-designed decentralization can improve equity of allocations and may have other positive effects such as increased funding of promotion and prevention. Its influence over efficiency and quality is not as clear. These guidelines suggest some mechanisms which can be effective in the design and implementation of decentralization.

This comparative study evaluates the implementation of decentralization of health systems in three Latin American countries: Chile, Bolivia, and Colombia. In terms of the relationship between decentralization and system performance in general, the findings support the conclusion that both the die-hard detractors and the fervent advocates for decentralization are wrong. Decentralization appears to be improving some indicators of equity, such as a tendency toward similar per capita expenditures for wealthier and poorer municipalities, and to be associated with increased and more equitable per capita spending on promotion and prevention.

This document offers some help in addressing decentralization for health sector actors interested in designing decentralization policies and strategies, implementing them, and/or operating within decentralized health systems. [author’s description]

The objective was to examine whether decentralization has improved health system performance in the State of Ceara, north-east Brazil. Decentralization was associated with improved performance, but only for 5 of our 22 performance indicators. Moreover, in the multiple regression, decentralization explained the variance in only one performance indicator; indicators for informal management and political culture appeared to be more important influences. However, some indicators for informal management were themselves associated with decentralization but not any of the political culture indicators.

The general argument for decentralizing health care is the potential for improved service quality and coverage. This note raises the issues to consider if decentralization is to bring about beneficial results. A table summarizes a general framework for assigning responsibilities to central and local levels, while the rest of the note outlines a series of issues to consider. [From author]

In issuing this statement, WHO, ICM and FIGO are advocating for skilled care during pregnancy, childbirth and the immediate postnatal period. This statement is especially aimed at countries in which the coverage of skilled attendance at birth is below 85%. The statement defines clearly who is a skilled attendant, what skills she/he should have and how she/he should be trained and supported. Thus a skilled attendant is an accredited health professional

Current safer motherhood and newborn care programmes emphasize interventions that do not reach the poorest households. Community based interventions have been neglected and undervalued. In this article, we argue that large scale community effectiveness trials are both necessary and feasible if we are to make further progress with reducing maternal and child mortality. [author’s description]

This docuemnt presents nationally representative data of births attended by skilled health workers available up to 2005 together with global, regional and subregional estimates. [author’s description]

Decentralization of political and administrative power, combined with a civil service reform, are increasingly prevalent components of health sector reform. The wider implications of decentralization for human resources development are, however, poorly researched and inadequately understood. This paper analyzes these implications from the experience of the author, her colleagues and published literature. [from abstract]

This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. It draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. [from abstract]

Specific programs for selected diseases are an important component of the national and international health agenda. But in many developing countries, such programs fail to reach their full potential because of either insufficient implementation capacity or the lack of an integrated approach. For disease control programs to work, attention must be paid to human resources management.

This paper explores human resources constraints with regards to specific disease control programs, and provides an inventory of strategies to overcome these constraints. The paper is an edited version of the report on the meeting of the working group “Priority Diseases,” one of the seven working groups of the Joint Learning Initiative. The Joint Learning Initiative was set up to explore strategies to improve health services delivery through human resources management. [Publisher’s description]

The number of health workers employed is an indicator of a country’s ability to meet the health care needs of its people, especially the poorest and most vulnerable. Resource-constrained countries committed to the Millennium Development Goals are facing up to the reality that shortages and uneven distribution of health workers threaten their capacity to tackle the HIV/AIDS pandemic, as well as the resurgence of tuberculosis and malaria. Worker shortages are linked to three factors: 1) decreasing student enrollment in health training institutions, 2) delays or freezes in the hiring of qualified professionals and 3) high turnover among those already employed.

As a key contribution toward increasing human capacity in national health systems, the Capacity Project is hosting a series of Human Resources for Health (HRH) Action Workshops. The initial workshop—held in Johannesburg in partnership with the United Nations Development Programme/Southern Africa Capacity Initiative (UNDP/SACI)—facilitated the exchange of knowledge and best practices in planning, developing and supporting the health workforce. The three and one-half day workshop brought together 38 HRH leaders from 11 countries (Kenya, Lesotho, Malawi, Namibia, Rwanda, Sudan, South Africa, Swaziland, Tanzania, Uganda and Zambia). Almost all of the participants are senior HRH directors or practitioners working at the operational level within the Ministry of Health in their respective countries. Two representatives from faith-based organizations also attended.

The International Labour Office (ILO), the International Council of Nurses (ICN), the World Health Organization (WHO) and Public Services International (PSI) launched in 2000 a joint programme in order to develop sound policies and practical approaches for the prevention and elimination of violence in the health sector. When the programme was first established and information gaps were identified, it was decided to launch a number of country studies as well as cross-cutting theme studies and to conclude by drafting guidelines to address workplace violence in the health sector.

The Human Resource Management (HRM) Assessment Tool offers a method for assessing what an organization’s Human Resource Management system consists of and how well it functions. The HRM Assessment Tool helps users to develop strategies to improve the human resource system and make it as effective as possible. It can also serve as a basis for focusing discussions, brainstorming, and strategic planning. It is designed to be used in public and private-sector health organizations.

This paper distills lessons from recent efforts to improve the supervision of family planning and health programs in developing countries and identifies approaches that may be more effective and sustainable. It describes supportive supervision, an approach to supervision that emphasizes joint problem-solving, mentoring, and two-way communication between supervisors and those being supervised.

This study provides an overview of existing information on the migration of health workers, with an emphasis on related social and labour issues. It considers trends in migration, the working conditions of migrants, migration policies and recruitment practices, and the impact of international standards and trade agreements on conditions of migrant health workers. The study also outlines policies and practices associated with more socially acceptable forms of managed migration. It focuses on nurses and doctors, who have been in the forefront of current debate about health worker migration. [author’s description]

This paper reviews recent innovations in education for human resources for health (HRH). The paper outlines the rationale for HRH education, identifies shortcomings in HRH education, and addresses the global contents of educational programs and trends. Recent changes in didactic approaches used in HRH educational programs are analyzed. The paper concludes with an evaluation of innovations and a set of recommendations. [adapted from author]

Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. This study presents a unique exploration of how the factors affect the performance of primary reproductive health providers (nurse-midwives) in two regions of Armenia. [from abstract]

This paper reviews lessons learned regarding getting decision-makers to recognise the nexus between workforce planning, overall health service development and operational policy; data collection and collation; moving beyond a simple personnel to population ratio approach; and adjusting the model to suit local circumstances. The project has identified some emerging and worrying trends in health workforce development. The need for consistent, sustained technical assistance which reflects long and wide experience in health service development and management is underlined. [abstract]

For decades, discussions on human resources in health have ended with a ritual call for more and better manpower planning. But this traditional wisdom has been discredited by unrealistic or vague targets, based all too often on information that was inaccurate, outdated and unrelated to the policy agenda… Policy-makers and donors concerned with human resources problems may want to request those proposing a major new project or policy to make a systematic and formal human resource impact assessment during its preparation. Such assessments would examine the likely effects of the proposed project or policy on the health workforce.

To inform the design and implementation of improved workforce planning systems, a review of healthcare systems and interaction between systems of service delivery and approaches to planning human resources was done in five countries: Australia, France, Germany, Sweden and the United Kingdom. These represent different welfare state regimes, and a range of health systems dominated by national taxation, local taxation and social insurance. [from executive summary]