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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.

Using incentives and disincentives to direct individuals’ energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas.

Functioning health services are key to making the community of New Orleans livable again. Conversely, a livable community is key to attracting a stable healthcare workforce to New Orleans. Hurricane Katrina forced the entire healthcare workforce to evacuate the City of New Orleans and a large majority of these workers have since found jobs elsewhere, such as in neighboring parishes and Texas. This brief summarizes policy options to create and maintain a healthcare workforce, as well as options to bridge the transition from the current situation to the point at which the interventions will show an effect.

This paper examines why building HR capacity is important to effective health care reform, assesses the existing evidence on HR capability in the health sector, and draws out lessons from existing practice. Developing HR capability requires investing in the training and development of both HR specialists and line managers/professionals with staff management responsibilities. It is vital that any investment in specialist HR capacity evaluates the different ways to deliver the HR function. To be effective the HR function must develop both an operational and a strategic HR capacity. [author’s sum

This guide describes the step-by-step process used to create a positive environment on the national level for strengthening medical, nursing, and preservice education, and the steps on the institutional level to improve the existing curriculum and its implementation. Adapted from the World Health Organization’s 2001 document Integrated Management of Childhood Illness (IMCI): Planning, Implementing and Evaluating Pre-Service Education.

African public health care systems suffer from significant brain drain of its health care professionals and knowledge as health workers migrate to wealthier countries. In this paper, the brain drain is defined as both a loss of health workers (hard brain drain) and unavailability of research results to users in Africa (soft brain drain).

This issue of the Bulletin of the World Health Organization addresses the issue of the migration of health professionals. It includes articles about the genteral topic, specific measurements and evaluations of the problem and strategies to address the brain drain.

The Health Sector Policy is the basis of national health planning and the first point of reference for all actors working in the health sector. It sets the health policy objectives, identifies the priority health interventions for meeting these objectives, outlines the role of each level in the health system, and provides guidelines for improved planning and evaluation of activities in the health sector. One of the priority interventions elaborated is Human Resources. [adapted from introduction]

Four articles by separate authors on institutional responses and policies for managing HIV/AIDS in Africa, with specific emphasis on the role of tertiary institutions, such as schools and colleges. The articles are not specific to health training institutions, but are relevant to this context.

This paper aims to summarize strategies to solve inequitable distribution of human resources for health (HRH) between urban and rural areas, by using four decades of experience in Thailand as a case study for analysis. [from abstract]

Health sector workers respond to inadequate salaries and working conditions by developing various individual coping strategies; some, but not all, of which are of a predatory nature. The paper reviews what is known about these practices and their potential consequences (competition for time, brain drain and conflicts of interest).

This paper seeks to provide a compelling evidence base to reveal the factors that lead to high turnover and to promote tested responses to retain health workers. The literature researched is presented to support country-level action. [abstract]

Donor funds may be inadequate to support the growing demand for services provided by community-based distribution (CBD) programs. One solution may be to reduce the remuneration of CBD agents, but this approach may lower their productivity. Programs also need to consider reducing other costs, including those for supervision and training. The cost per agent visit—including costs associated with payments to agents and to supervisors and the costs of training—was calculated for three CBD programs in Tanzania. The output measure was visits in which contraceptives were provided or referrals made for family planning services.

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.

The purpose of this strategy is to guide the planning, management and development of human resources for health in Eritrea for the period 2006 - 2014. Whilst much progress has been made with the staffing of the health services in the health sector, there is still more work to be done. There is a general shortage of health professionals, particularly amongst more highly skilled groups. Although geographic distribution is relatively good compared to many countries in Africa, there are still health stations and health centres that are under-staffed. There is a major shortage of midwives, exacerbating the high rate of maternal mortality. [from author]

This issue presents a system for funding programs that is tied to program performance to help providers improve their services and the impact of those services in the client population. This issue explains how different payment mechanisms encourage different types of organizational behavior, and why performance-based payment schemes are more likely to help achieve the desired goals than traditional payment schemes. [editors’ description]

For a health district to function, referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. [from abstract]

Ghana is undergoing health sector reforms aimed at achieving greater equity of access to services, improved efficiencies in resource utilization, development of wider linkages with communities and other partners, as well as improved quality of health services. These reforms have strong influences on issues of human resources development, deployment and motivation. [from abstract]

In 2003 the Network published a discussion paper reviewing available literature and identifying key issues in need of further work, which this paper summarizes. In Southern Africa there are inadequate ratios of personnel to population for key skilled health personnel. There are a variety of push and pull factors that impact on the movement of healthcare workers. A more rigorous policy analysis is needed to stimulate innovation and to avoid measures and incentives counteracting each other. It is important to provide clearer policy analysis on production of health workers, on availability and distribution, and on movement and migration.

The purpose of this book is to provide information about what works—specifically, the cost-effectiveness of health interventions in a variety of settings. Such information should influence the redesign of programs and the reallocation of resources, thereby helping to achieve the ultimate goal of reducing morbidity and mortality. [from foreword]

Of particular interest are Chapter 3 “Strengthening Health Systems” and Chapter 71 “Health Workers: Building and Motivating the Workforce.”

Human resources (HR) constraints have been reported as one of the main barriers to achieving the 2005 global tuberculosis (TB) control targets in 18 of the 22 TB high-burden countries (HBCs); consequently we try to assess the current HR available for TB control in HBCs. A standard questionnaire designed to collect information on staff numbers, skills, training activities and current staff shortages at different health service levels was sent to national TB control programme managers in all HBCs. [From abstract]

This issue introduces Training Impact Evaluation (TIE), a process designed to help managers identify and strengthen the links between training and staff performance. The issue describes the benefits of conducting a Training Impact Evaluation using a team approach and takes you step-by-step through the TIE process. The issue also offers practical suggestions for collecting, analyzing, and interpreting data on trainee performance in the workplace. It concludes with suggestions for ways that managers can use the information to make recommendations to decision makers, to improve training courses, or to seek management solutions to performance problems.

This WHO strategy aims to set out in clear detail how life-long antiretroviral treatment can be provided to 3 million people living with HIV/AIDS in poor countries by the end of 2005. Core principles include urgency, equity and sustainability. HIV/AIDS has devastated the populations and health services of many developing countries. We must act now. Further, since this magnitude of scaling up HIV/AIDS treatment has never been attempted before, we must learn by doing. [summary from author]

The objective of this paper is to contribute to a better understanding of the issues related to imbalance through a critical review of its definition, nature and measurement techniques, as well as the development of an analytical framework. [author’s description]

Using Thailand as a case study, this paper aims to explore the potential implications of integrated health system intervention. Within the Thai context, it is argued in this paper that autonomy of a network of public providers, rather than autonomy of individual hospitals, should be encouraged if management of health manpower is to be optimized. [from abstract]

Results of a study of human resources and antiretroviral therapy (ART) at 41 sites in 11 countries, presented in three sections: an overview of service delivery models for ART, a more in-depth account of the systems studied and a report of an international workshop on HRH and ART delivery.

Nurses are expected to empower their clients, but they cannot do so if they themselves feel powerless. They must become empowered before they can empower others. This paper is an attempt to clarify the concept of power in nursing. It also presents a model describing the factors affecting nurse empowerment. [from abstract]

This report examines whether Zambia’s hospital accreditation program improved health outcomes and other indicators. Performed after an accreditation program had been launched in about 40 hospitals, the evaluation examined eight indicators of healthcare quality at hospitals that had and had not been exposed to the accreditation program.

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]

This pilot study focused on self-identified factors of nursing students who expressed an interest in rural practice post-graduation. The sample included students from the USA and Canada, who were enrolled in graduate and undergraduate programs of nursing, and were attending an international rural nursing conference. [From abstract]