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Planning for the efficient and effective delivery of health care services to meet the health needs of the populations is a significant challenge. Globally policy makers, educators, health service researchers, leaders of unions and professional associations, and other key stakeholders struggle with the best way to plan for a workforce to fulfill the health needs of populations.

This review of experience in accreditation and external quality assessment systems was produced at the request of the UK Department for International Development in India. The purpose of this review is to describe where External Quality Assessment fits in the broader set of levers that exist for engaging with health care providers and organisations in developing countries in order to improve quality and affordability of care.

This paper reviews some experiences of social agencies contracting with the private sector to provide health care services. It focuses on the capacity of this mechanism to improve access to services by the poor. The term private sector is used to cover both for-profit and not-for-profit providers of health services. The paper draws on these experiences to suggest some lessons and basic guidelines for contracting. [author’s description]

This case study provides details of a partnership that emerged in Georgia following the initiation of health sector reforms in 1995. It mainly focuses on describing the details of how and why the public purchaser contracted a non-governmental provider to deliver a set of health services in Georgia. The case study is discussed with proper attention to the context within which this arrangement developed. The nature of the services provided was paediatric cardio-surgery, which can hardly be considered a basic essential health service.

This literature review provides a short summary on some specified features of the training systems which are in place in developing countries (mainly low income Africa and Asia) which supply key workers into the health and education sectors. [author’s description]

The recent UN Millennium Project (UNMP) report recommended as a ‘quick win’ a massive training of community-based workers. This review examines the evidence to support or reject the hypothesis that investment in community workers can only impact on health outcomes with parallel investments in trained health workers and health systems. [author’s description]

This review paper…looks at strategies that have been undertaken to increase the productivity of health workers. It examines the evidence to support or reject the hypothesis that short term training, incentives, better equipment, supplies and conditions and other things can be employed that improve outputs and health outcomes without increasing the numbers of health workers. The review provides an overview of key aspects and options for improving productivity, with country illustrative examples. [author’s description]

It is becoming increasing important that policymakers be aware of health worker motivation and it’s impact on health sector performance. Health care delivery is highly labor-intensive, and service quality, efficiency, and equity are all directly mediated by workers’ willingness to apply themselves to their tasks. While resource availability and worker competencies are essential, decision makers should know that they are not sufficient in themselves to ensure desired worker performance. Worker performance is also dependent on workers’ level of motivation stimulating them to come to work regularly, work diligently, and be flexible and willing to carry out the necessary tasks.

The long-term objective of this paper is to galvanize action to ensure that all current and future health managers are well prepared to lead and manage to achieve results. With good preparation, they will be able to develop and manage the kind of health services that achieve health goals, reduce illness, and save lives. [author’s description]

This study analyzed and compared the knowledge base of trained community health workers with that of doctors and nurses in Afghanistan to determine the differences in their abilities to provide healthcare and health information to patients.

The NGO Service Delivery Program (NSDP) developed a system ensuring better access of the health services to the poorest segment of the population, along with raising revenue by providing fee-for services to the better off population. The former strategy highlights a safety net policy for the poorest segment, who are identified by participatory rapid appraisal technique and handed out a health benefit card. The latter strategy helps the NGOs to revise their service charges according to local demand and other factors. This report analyzes this pilot effort and its drawbacks and makes recommendations based on lessons learned. [adapted from author]

This paper examines the potential roles and responsibilities of professional obstetrical and midwifery associations in addressing the tragedy of maternal deaths. We examine the successes and challenges of obstetrical and midwifery associations and encourage the growth and development of active associations to address maternal mortality within their own borders. [abstract]

This study aimed to document nursing staff dynamics in maternal health services, and to explore the factors associated with these dynamics. We have used the term nursing staffing dynamics to encompass a range of human resource processes including staff turnover, absenteeism, average length of stay in a facility, vacancy rates and workload. The study was carried out in Limpopo, KwaZulu-Natal and Mpumalanga provinces in South Africa. [author’s description]

This paper aims to provide an overview of the current evidence and opinion of the workforce implications of regulation, competency development and role definition. These three elements are inextricably linked to each other and are fundamental to the practice of nursing in today’s environment. [from introduction]

The Population Council and The Pubcomm Group, Inc. have developed simple, inexpensive, user-friendly computerized job aids to assist supervisors in improving the quality of family planning, maternity care, and postabortion care services. The software is free to download. [publisher’s description]

Tools to assist primary providers and their managers in assessing, monitoring and improving the gender sensitivity of family planning and reproductive health services on an ongoing basis. [publisher’s description]

The HRH Framework provides a pathway for governments and health managers to develop a comprehensive plan for addressing the critical shortage of health staff in HIV/AIDS and health services in general. [author’s description]

This issue of The Manager discusses the role of local resources in strengthening health services. It will help health managers at the local level to identify types of local resources that may be available to them, decide on strategies for mobilizing these resources, and assess the value of such resources to their organization or program. [author’s description]

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

Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada? [author’s description]

The Workload Indicators for Staffing Levels was created to provide a rational method of setting the correct staffing levels in health facilities, taking into account the the wide local variations which are found within every country, such as the different levels and patterns of morbidity in different locations, the ease of access to different facilities, the patient attitudes in different parts of the country to the services provided, and the local economic circumstances. This Manual sets out all the activities which are necessary in order to design and implement the WISN Method in a country.

This study demonstrates how Workload Indicators of Staffing Need (WISN) can be used as a human resources planning and management tool for improving decisions at all levels of health services about the provision, allocation and deployment of staff. [from abstract]

This report presents a comprehensive analysis of the human resources for health (HRH) currently available and required to reach the targets set by the President’s Emergency Plan for AIDS Relief and the Millennium Development Goals (MDGs) in both the public sector and the faith-based organizations (FBOs) in Kenya. A stratified convenience sample of health facilities at all levels of care (primary, secondary, tertiary) in each of the eight provinces was selected for the assessment. Detailed information on human resources and provision of services related to HIV/AIDS, tuberculosis (TB), malaria, maternal health, and child health was collected.

As the private sector plays an increasingly critical role in the delivery of reproductive health/family planning (RH/FP) services, donors and public health ministries are turning their attention to business arrangements that offer the potential to increase access to high-quality priority health services. Private provider networks hold the promise of cost effectively expanding the scale of private practice, and are increasingly being considered as a way to achieve national public health objectives.

This study provides evidence on the cost of providing HAART to health care workers and suggests that this strategy could reduce absenteeism and alleviate future staff shortages at moderate cost to hospitals. This is crucial, given the impending human resources crisis in health care in South Africa and the growing burden of HIV/AIDS. These cost estimates should be good indicators of the costs of extending antiretroviral therapy to health care workers in public-sector hospitals in KwaZulu-Natal. [author’s description]

There is a growing conviction among policy-makers that the availability of adequate numbers of well-trained and motivated human resources is a key determinant of health system’s capacity to achieve their health, responsiveness and fairness-improving goals. The objective of this study was to estimate the cost, effectiveness and incremental cost effectiveness ratios of various distance-education strategies for the health sector in Swaziland; and recommend the most cost-effective option. [abstract]

This chapter of the World Health Report provides a framework for developing a national HRH strategic plan including: building trust and managing expectations; fair and cooperative governing; leadership; strategic intelligence; and workforce institutions.

Intended to complement Working Together for Health: The World Health Report 2006, these policy briefs are intended to assist those who make and carry out health policy worldwide. The briefs address the following, Strengthening information and research on the health workforce: strategies for action; Investing in education for expanded capacity and lifelong learning; Making the most of the existing health workforce; Addressing the complex challenges of health worker migration; Bridging between health workers in separate public health programs; and Financing health workforce development. After describing an issue, the briefs propose ways to address it, many of which have been drawn from experience in countries. [author’s description]

This report has been prepared by the International Labour Office as the basis for discussions at the Joint Meeting on Terms of Employment and Working Conditions in Health Sector Reforms. It reviews the impact of health sector reforms on health workers and the implications of changes in employment and pay, labour relations, working conditions and terms of employment on the general performance of health systems in the light of the links between health policy, human health and the economy. [preface]