Policy

The purpose of this policy and guidelines is to ensure that in all violent incidents, appropriate action is consistently taken to protect health service staff, patients and visitors, and health service property from the effects of such behaviour. The guidelines are provided as a reference tool and should be used to develop local policies and procedures that reflect the intent of this document, and that are specifically targeted at and adapted to local workplace cultures, situations and needs. [from introduction]

West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes and consequences of the migration. We conducted interviews and focus groups with faculty, administrators (deans and provosts), students and post-graduate residents in six medical schools in Ghana and Nigeria. In addition to the migration push and pull factors documented in previous literature, we learned that there is now a well-developed culture of medical migration.

This tool seeks to assist HRH workers and policy makers in a country think through, diagnose, and stimulate dialogue about their HRH challenges by responding to questions and reflecting on the policy implications of their answers.

The shortage of health workers with the right expertise and experience has reached crisis levels in many developing countries. The ability of health services to deliver care depends on the knowledge, skills and motivation of health workers. Without enough skilled staff in the right place at the right time health systems cannot function effectively and populations are left without the treatment and support they need. [author’s description]

As part of the High-Level Forum on the Health Millennium Development Goals, this issue paper discusses improving health workforce performance as a key factor in meeting MDGs. The required scaling up of interventions towards the MDGs depends on effective health services delivery systems (HSDS). The availability, the skills, the attitudes, motivation, and behaviors of health workers are key to well-functioning HSDS. [adapted from author]

This report is the result of the meeting of the 47th Directing Council and 58th session of the Regional Committee in Washington DC. It is a summary of actions and proposals for a plan of action on human resources for health in the Americas submitted for the consideration of the Directing Council. This document summarizes the activities carried out to date in the countries and in the Governing Bodies. It provides an overview of the situation and the predominant trends in the Region, as well as a vision of the technical proposals and agreements for activities that are being developed.

The consequences of health professional mobility have become a prominent public policy concern. This paper considers trends in mobility amongst doctors and nurses and the consequences for health systems. Policy responses are shifting from a reactive agenda that focuses on stemming migration towards a more active agenda of managed migration that benefits source and destination countries. Improved working conditions and effective human resource practice are required to encourage retention of health professionals in both source and destination countries. [abstract]

This report focuses primarily on the policy implications of the international migration of nurses, and highlights recent trends. International recruitment and migration of nurses has been a growing feature of the global health agenda since the late 1990s. Nurses have always taken the opportunity to move across national borders in pursuit of new opportunities and better career prospects, but in the last few years nurse migration appears to have grown significantly, with the potential to undermine attempts to achieve health system improvement in some developing countries.

Against the backdrop of growing concern about shortages of health personnel, the report focuses on one of the most critical components of the workforce

This report describes global progress on the “3 by 5” (Treating 3 million by 2005: making it happen) project in scaling up access to [HIV/AIDS] antiretroviral therapy and outlines the areas in which important progress has been made and lessons learned. It also outlines the remaining challenges and roadblocks to treatment access. [author’s description]

Chapter 2 (Strengthening Health Systems) provides an overview of HRH related approaches and progress.

The tools and guidelines collected in this book will assist health program managers, policymakers, and leaders to assess the impact of HIV/AIDS on the health workforce and its capacity to deliver and scale up HIV/AIDS services. The book provides materials to help decision-makers develop a strategy to mitigate the impact of HIV/AIDS, for both a short-term emergency response and a longer-term plan to strengthen HRM systems. This compilation also includes a tool developed by the World Health Organization to help HIV/AIDS programs to achieve a more sustainable workforce appropriately trained to provide ART.

The loss of skilled personnel to rich countries is a major concern for many developing countries today. However, large numbers of people from developing countries are also being trained overseas and, of those trained at home, many cannot be absorbed productively into their economies of origin. At the same time, the association between the presence or absence of health personnel and the health status of a population is seen as simplistic and a range of other factors are addressed. This Briefing examines the case for a two-tiered health training system, one for global markets and the other for local markets.

The relationship between poor conditions of employment and work of nursing personnel and shortages is complex. Consequences may include: increased patient morbidity and mortality; greater levels of violence in the workplace; reduced occupational safety and health for remaining personnel; high levels of job dissatisfaction with intention to quit; and unsustainable patterns of health worker migration from developing countries.The Nursing Personnel Convention articulates the kinds of provisions needed to address many of the identified problems. It must be implemented in the greatest number of countries in order to set decent standards of work, boost the professional and political profile of nursing personnel, and provide incentive for nursing personnel to remain in their jobs.

In the face of rising demand for medical services due to ageing populations, physician migration flows are increasingly affecting the supply of physicians in Organisation for Economic Co-operation and Development (OECD) countries. This paper offers an integrated perspective on the impact of physician migration on home and host countries and discusses international regulation and policy approaches governing physician migration. [from abstract]

The synthesis report addresses the issues of the impact of high skilled emigration on developing countries, and the policy mixes and options available to both receiving and sending countries to harness its benefits. The study argues that the feedback or indirect effects of skilled migration can often outweigh any initial negative impacts on developing countries. The challenge is to maximize these benefits through appropriate policies relating to encouraging return migration, retention of manpower, tapping diaspora networks, and productive utilization of remittances.

This document presents a framework for analyzing factors affecting the development and implementation of HRH policies and strategies.

Triple-drug combination antiretroviral (ARV) therapy has yielded remarkable results in affluent countries and some middle-income countries such as Brazil. Lessons can be learned from these examples, but this publication reviews the experiences of ARV programmes already underway in countries with very severe HIV epidemics but severely constrained resources, as in most of Africa and part of the Caribbean. The publication aims to show how some of the key policy issues for scaling up HIV/AIDS treatment have been dealt with and to identify common elements that should be considered by everyone seeking to provide HIV/AIDS care on a significant scale.

This paper is intended to be the basis for the development of policy options with countries for countries. As such, it has multiple objectives: to provide a guide for the analysis of human resources for health (HRH) as part of health systems performance assessment; to highlight HRH policy questions - derived from analyses and other input from countries — with which policy-makers are often struggling; to integrate HRH policy issues with indicators to assess and monitor HRH performance. [author’s description]

The aim of the code of practice is to promote high standards of practice in the international recruitment and employment of healthcare professionals. [author’s description]

This report presents findings from a nationwide Expenditure Tracking and Service Delivery Survey implemented in Mozambique between August and October 2002. The study focuses on the primary health care system, which is frequently the only source of health care for most Mozambicans. The report covers a broad set of issues, including institutional context, budget management, cost recovery, allocation and distribution of drugs, human resources, infrastructure and equipment, and service outputs. [from abstract]

This article considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. [adapted from abstract]

This article discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. [from abstract]

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]

In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources.

In this paper, we focus on those policy instruments with monetary incentives that are used to contain public health expenditure in high-income countries.

Some 60 participants from ministries of health, multilateral and bilateral international agencies, foundations, nongovernmental organizations (NGOs) and professional organizations discussed and debated a range of issues in order to contribute to the objectives of this workshop, which were to: further the development of an HRH framework for policies; identify policy questions and agree upon an agenda for development of policy options; identify gaps in evidence and priorities for obtaining evidence on which to base policy; build capacity and partnership for action at country level. [author’s des

Many countries are using the strategy of international recruitment to make up for shortages of health professionals. This is often to the detriment of health systems in the poorest parts of the world. Codes of practice on ethical international recruitment or similar instruments are beginning to be introduced at both national and international levels to protect the health systems of vulnerable countries. This study was designed to review the potential impact of existing instruments. [from executive summary]

This booklet has been prepared to assist policy makers in international organizations, governments and civil society. The authors hope that it will help design, introduce and implement public service and health sector reforms in the most effective and sustainable way, taking into account human resource policies. At the heart of the booklet are a set of critical questions which aim to help policy makers, including all social partners, to construct an effective path through the complex process of reform and restructuring. [author’s description]

This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce.

This is the fourth of a series of policy briefs produced by the Community Health Department of the Aga Khan Health Service in Kenya. It focuses on a number of issues related to the management of health facilities: the rational for decentralisation of health services, the role of the community in the management of health facilities, the membership of local management committees, selection criteria and, finally, the involvement of local politicians.

These briefs are primarily intended for directors and managers of community-based health care programmes — whether working within ministries of health, international donor agencies or non-government organisations.