Policy

These training modules and handouts provide the materials to conduct a two day workshop designed to help participants define gender and related concepts; understand the continuum of gender as it relates to integration in projects; understand the six domains of gender and related questions; apply a process for gender analysis to HRH contexts; understand where and how gender can be integrated in HRH country strategies. [adapted from author]

This document aims to facilitate the development of quality-oriented health sector reforms by providing a clear conceptual framework that can serve as a roadmap for policymakers and senior managers. By taking advantage of opportunities to integrate quality assurance activities into health sector reforms, healthcare leaders can maximize the effectiveness of reform and move toward optimizing health outcomes for the citizens of Latin America and the Caribbean. [author’s description]

Human resources become increasingly relevant in this context. Health human resource (HHR) is currently experiencing a three-fold problem, which encompasses old issues, together with the effects of reform, and the consequences of globalisation. This includes the workforce crisis in nursing which, facing all kinds of difficulties, requires complex in-depth analysis, synergies and alliances in order to ensure quality nursing services.

The safety of heath care workers (HCWs) who take care of people with HIV/AIDS and other infectious diseases is of paramount importance. Occupational transmission of blood borne infections is not regarded as a common problem in developed country settings, but this is not the case in resource poor countries where the incidence and impact of such exposures is under-reported and is now becoming appreciated as an important risk factor for HCWs.

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 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]

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.

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.

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]

The paper outlines a conceptual framework that integrates the key strategies that must be addressed and linked if policy-makers are to create the kinds of health care system to which the citizens of [central and eastern Europe and Eurasia] are entitled. It examines how financing, coordinated service delivery and quality measures matter independently, and it highlights the need to interweave them effectively with citizen and community participation mechanisms and a far-reaching concern for public health. It also reviews the complex issues that hinder or help the implementation of reforms and suggests how an understanding of context, stakeholders and capacity will be critical to delivering change.

The broad objective of this paper is to contribute to the retention of health workers in Malawi by providing an enhanced understanding of health workers’ coping strategies, together with the identification of possible strategies that could impact on their retention. [from author]

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.

This document contains a country analysis on HRH covering situations, trends, and priority problems including issues in undifferentiated strategies of health sector development for remote areas and the shortage and maldistribution of well trained nurses and community nurses. It also includes a discussion on HRH development, strategies and policies in Lao PDR. [adapted from author]

The nurse program for foreign countries in Indonesia has been carried out since 1996. In the beginning, this program attempted to solve the false ‘surplus’ problem of nurses in Indonesia. Recently, however, the MOH has developed serious concerns with this program. There have been several efforts to promote the nurse program for foreign countries starting with the improvement of education, recruitment and other mechanisms related to nurses for foreign countries. Some achievements, strengths, weaknesses, potentials and threats are discussed in this paper.

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.

With globalisation trends, the emigration of highly skilled persons from developing countries has significantly increased. The implication of this movement of skilled labour (termed as “the brain drain”) has emerged as an important issue of international debate in recent years. The objective of the paper is to look at different possible policy responses which can minimize its adverse effects, and which can promote the sharing of gains between source and host countries. The paper focuses on three policy approaches: retention, return and circulation of skills. It argues that the best strategy to deal with the problem of loss of skilled labour is one based on the concept of circulation of skills, which yields mutual benefits for both sending and host countries.

This publication provides an overview of some of the key challenges for policy-makers in addressing the linkages between migration, health and human rights.The first section explains why we are addressing the issue of migration and health and what is meant by doing this through a human rights framework. It then explores some of the terminology used. The second section links the reasons why people migrate with the health and human rights implications of moving on the populations left behind. The third section considers the health implications for those on the move both in the context of public health as well as in relation to the health of the individual.

This paper should be read in association with its companion paper on migration and human rights (Bueno de Mesquita and Gordon 2005). Our aims are conceptual and agenda-setting. In essence, we argue that current policy responses to migration of health professionals from low income developing countries underestimate the pressures and misidentify the reasons for rising migration, overestimate the impact of recruitment policies on migration flows while ignoring unintended side effects, and mis specify the ethical dilemmas involved.

The main aim of these guidelines is to support countries in the Human Resource Development and management process of assessing the human resource for health situation, policy and plan development with the view of achieving some level of comprehensiveness and consistency country level. The guidelines will discuss HRH processes, situation analysis, policy and plan development with reference to the overall context of national health policies and strategies. These guidelines describe how to formulate, develop, review HRH situations, policies and plans with the flexibility necessary for each country context.

An honest and critical examination of the role of Health Care Professionals (HCPs) during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. [summary]

Australia is experiencing workforce shortages across a number of health professions despite a significant and growing reliance on overseas trained health workers. The shortages are even more acute in rural and remote areas. It is critical to increase the efficiency and effectiveness of the available health workforce, and to improve its distribution. This report describes the Australian government’s objectives of developing a more sustainable and responsive health workforce while maintaining a commitment to high quality and safe health outcomes. A set of national workforce objectives are also proposed.

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]