Human Resources Management

This issue of The Manager offers financial and program managers—from headquarters to the service delivery level - reasons to assess their financial management systems and a method for performing this assessment. It introduces FIMAT, the Financial Management Assessment Tool, a step-by-step process and instrument for rapidly assessing budgeting, accounting, purchasing and other financial systems. It describes how managers can use their assessment results to develop detailed action plans that can be incorporated into their organization’s annual operation plans. [from author]

This issue shows how managing and leading can be practiced at the same time by managers at all levels. It discusses effective leadership values and practices that exist around the world. It explains how managers can, individually and together, undertake leadership development. [editors’ description]

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.

Despite the limited, but growing, evidence base on the impact of HRM on organisational performance in other sectors, there have been relatively few attempts to assess the implications of this evidence for the health sector. This paper examines this broader evidence base on HRM in other sectors and examines some of the underlying issues related to “good” HRM in the health sector. [from abstract]

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 toolkit includes a collection of HRM resources and links assembled for the Global Health 2005 conference. Most of the resources are in Microsoft Word format and provide guidance on how to develop a variety of HRM documents or processes. Topics covered include supervision, hiring and recruitment, HR policies, and HIV Workplace Programs and training. [publisher’s description]

This issue outlines the connections between work climate, employee motivation, and performance. It describes how managers can assess the climate in their work group and shows how they can use the results to make changes in leadership and management practices that will motivate their group to do the best work possible and improve results. [editor’s description]

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

The Chinese government has found it impossible to maintain uniform pay levels, particularly in the face of a radical devolution of its own financial management. Health workers have increasingly resorted to informal methods of earning an income. The government considers this to be unprofessional behavior and has used a combination of moral pressure and loss of professional privileges to discourage it.

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]

The difficulty of ensuring an adequate and appropriate distribution of health services, together with increasing financial pressures in the public sector, are forcing many countries to consider using more rigorous methods for determining staffing levels in the health facilities. The Workload Indicators of Staffing Need (WISN) method is one such method. It uses a form of activity analysis (activity standards), together with measures of utilisation and workload to determine staffing requirements. The method provides a vehicle for assessing localised staffing needs that is believable and which at the same time is sharply different to historic methods.

This issue discusses human resource development, its components, and its critical role in improving organizational performance. The accompanying supplement, the Human Resource Development Assessment Tool, is designed to help a public or private-sector organization identify problem areas in the organization’s HRD system and develop an action plan to address them. [editors’ description]

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 organizations. This brief takes up a number of likely questions about the management functions of the nurses in charge of small, local health facilities:

• How prepared are “nurses in charge” for carrying out administrative and management functions?
• How should they relate to the new management committees?
• What additional training do they need?
• What are the lessons from the Kwale project—lessons about the training of nurses—that can be applied elsewhere?
  

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.

The HRM-HIV Tool provides organizations with a participatory, rapid assessment tool for identifying an organization’s human resource management status and making concrete plans for improvements within HIV/AIDS environments. It has been used with both public and private organizations in Ghana, Kenya, Nigeria, and Tanzania. The tool conforms to principles of participation and self-determination that guide all of MSH’s training and technical assistance activities. [author’s description]

As many countries initiate health sector reform-led cost containment and quality improvement measures, there is an increasing need for health care organisations to identify the most appropriate mix of staff. This paper examines why achieving the right mix is so important, critiques the main approaches used in determining personnel mix in health care, and discusses the main lessons from research in this area.

Several countries are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals. This trend has led to concerns that in many of the source countries—especially within Africa—the outflow of health care professionals is adversely affecting the health care system. This paper examines the role of wages in the migration decision and discusses the likely effect of wage increases in source countries in slowing migration flows. [from abstract]

This paper reviews the strategies for polio eradication, summarizes the skills and number of people required for their implementation, outlines the approach used to mobilize and manage these human resources, and discusses the impact of this approach. [from introduction]

This paper, aimed primarily at DFID advisers and health sector analysts, will attempt to map out selected issues relating to the planning and management of human resources by combining an international perspective with issues and trends emerging from individual countries. HR issues and challenges have been grouped into four broad objectives that poor countries, donors and advisers will need to address simultaneously over the next decade and beyond.

The 10th edition of the South African Health Review has the major theme of Human Resources for Health (HRH). South Africa has made significant progress in producing policies supportive of a good quality of health for all residents. However, there are challenges and gaps in translating these policies into action. Probably the most important of these challenges is the lack of adequate human resources. [Publisher’s description]

This resource guide assists program managers in planning and implementing supervision systems in healthcare settings. Emphasis is placed on clear job expectations, leadership, and communication.

This document summarizes the human resources management situation in the region, its determinants, and the projects for its development. To promote improvements in the human resources management function as part of the sectoral changes under way at the national and regional level, the Pan American Health Organization is proposing a series of strategies, actions, and operational tools through the Observatory of Human Resources in Health Sector Reform initiative. [adapted from author]

The paper summarizes the rapidly accumulating evidence and growing recognition of the HRH crisis, especially in sub-Saharan Africa. The nature of the crisis is briefly outlined, drawing attention to escalating activities, demand and momentum emerging from Africa and other countries calling for appropriate and effective global and regional support. There are clear needs for quality technical work, stronger regional cooperation, harmonization of health systems and global initiatives, and for sound fiscal and migration policies.

This issue of The Manager provides a comprehensive framework for addressing human capacity development. It presents steps for developing a strategy that will help managers sustain a supply of adequately trained health staff. It examines four components of planning and managing the workforce: policy and financial requirements, human resource management, partnerships, and leadership. The issue also suggests actions managers and policymakers can take to address issues in these areas so that appropriately trained staff are available in the right places at the right time. [editors’ description]

With a population of more than 8 million, Chad has around 3,600 health workers: 50 percent of these are unskilled, and 35 percent are nurses and midwives. Chad also faces geographical imbalances in the distribution of health professionals, with approximately half working in the capital N’Djamena. This article provides an overview of the issues related to the health workforce in Chad. [adapted from author]

Though reforms in the health sector have recently been common around the world, their success has, for a variety of reasons, been mixed. The paper aims to examine and explain the importance of human resources (HR) to the success or failure of health reforms using case studies from Russia, Zambia and the United Kingdom. [from abstract]

Over the last two decades, health sector reform in many countries has been characterized by spirited efforts to bring down costs and reduce gaps in coverage. Various approaches to decentralization and public-private partnerships have been introduced, but there has been hardly any attempt to understand or address the human resources (HR) aspects and implications of such structural changes. This technical brief synthesizes findings from recent publications to help promote general understanding among the various HRM actors, especially advocates and practitioners in developing countries. [from aut