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A number of ART projects are trying to tackle the HRH problematic by delegating certain tasks from medical doctors to other cadres. While this task-shifting is certainly an important step, we contend that it will not be enough for scaling up ART in the high HIV-prevalence countries with the most severe HRH shortages. In the present report we argue that an altogether different approach to HIV/AIDS care and treatment might be required for overcoming the HRH bottleneck. [from summary]

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]

There have been reported shortages in both the regulated and unregulated workforce in New Zealand, in particular of medical practitioners, nurses in primary care, mental health professionals, allied and primary health professionals, Māori and Pacific practitioners, and support workers. There is also an ongoing issue of a maldistribution of workers between rural and urban locations. In the future, the constraints on labour supply in New Zealand will necessitate a much greater focus on growing the health workforce and improving the performance and productivity of the available workforce.

Credentialing of health care providers, facilities and educational institutions is an integral component in building and sustaining robust HRH systems. This technical brief examines the characteristics and potential advantages of credentialing mechanisms and common challenges faced in implementing them in low-resource settings. [from author]

A Village Development Committee Orientation organized to allow representatives of different organizations to discuss and identify causes of low coverage and high drop-out in their community. Special emphasis was placed on monitoring the immunization drop-out rate of each health facility. Indicators for VDCs have improved in 2003, and Parsa District is now regarded as one of the highest performing districts in the region.

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.

Zambian nurses have been greatly affected by the rise in the morbidity and mortality of nurses with TB. This article explains the impact of TB on the Zambian nursing workforce. Review of Zambian government programmes designed to address this health crisis and targeted interventions to reduce TB among nurses are offered. [abstract]

Shortages of skilled health workers occur in most countries in the world, and most significantly in countries where education levels are relatively high. Migration has tended to be at some cost to relatively poor countries where the costs of production are considerable and losses are not compensated. The costs of global mobility are thus unevenly borne by the poorer source countries and the benefits are concentrated in the recipient countries. Since migration cannot be ended, and source countries have only limited scope for substantial policy change that will improve the number and status of health workers in the home countries, the onus has increasingly shifted towards the role of recipient countries in ensuring that, if migration is to continue, then it be more equitable and that there be adequate compensation for losses incurred in source countries.

The appealing, modern websites of the private agencies specializing in the recruitment of health care professionals for Western markets invite the loggers-on to explore a myriad of opportunities. So fierce is the competition to secure scarce health care professionals that private recruitment agencies stage promotional events and aggressive recruitment campaigns in supplying countries, tripping over each other to attract suitable candidates. How did the shortages of health care professionals become so acute, and how did international migration come to be viewed as one of the solutions to the problem?

To explore the extent, characteristics, incentives, effects and possible regulation of private medical practice in public facilities this study undertook a cross sectional quantitative

There are four types of health providers at present in China. These are defined in terms of differences in ownership. Private practice in the health sector was reintroduced from 1980, when China began its economic reform from a planned economy to a market economy. Dual practice (DP) is quite common and a major concern from the point of view of health policy-making as little is known about it. The aim of this study was to describe policies and regulations of DP, the current situation, its impact on access to services and physician behaviour, and to provide evidence for future policy decisions.

This paper evaluates structural quality of hospital care in the context of an evaluation of contracting out district hospital services in South Africa. Three contractor hospitals, run by a private company and paid by public purchasers to provide district hospital care to a rural catchment population, were matched with three adjacent public hospitals and three private hospitals serving largely insured patients. A structured instrument was used to provide a quantitative measure of structural quality. Private hospitals scored highest overall, followed by public and then contractor hospitals.

All decentralization initiatives require making changes in the structure of the agency or organization, which means making changes in how the work gets done. It means developing new management systems, training staff in the skills that they will need to perform in their new roles, designing or modifying service delivery systems, and developing strategies for enhancing the long-term sustainability of the program.

This study reviews the experience of decentralization in four developing countries: Ghana, Uganda, Zambia and the Philippines. It uses two analytical frameworks to describe and compare the types and degrees of decentralization in each country. The first framework specifies three types of decentralziation: deconcentration, delegation and devolution. The second framework uses a principle agent approach and innovative maps of decision space to define the range of choice for different functions that is transferred from the centre to the periphery of the system. [from abstract]

Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization — the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization.

Both the advocates and the detractors of decentralization are probably wrong. A thoughtfully designed process of decentralization is not likely to radically improve a health system, nor is it likely to severely disrupt the system. We have evidence that a well-designed decentralization can improve equity of allocations and may have other positive effects such as increased funding of promotion and prevention. Its influence over efficiency and quality is not as clear. These guidelines suggest some mechanisms which can be effective in the design and implementation of decentralization.

This comparative study evaluates the implementation of decentralization of health systems in three Latin American countries: Chile, Bolivia, and Colombia. In terms of the relationship between decentralization and system performance in general, the findings support the conclusion that both the die-hard detractors and the fervent advocates for decentralization are wrong. Decentralization appears to be improving some indicators of equity, such as a tendency toward similar per capita expenditures for wealthier and poorer municipalities, and to be associated with increased and more equitable per capita spending on promotion and prevention.

This document offers some help in addressing decentralization for health sector actors interested in designing decentralization policies and strategies, implementing them, and/or operating within decentralized health systems. [author’s description]

The objective was to examine whether decentralization has improved health system performance in the State of Ceara, north-east Brazil. Decentralization was associated with improved performance, but only for 5 of our 22 performance indicators. Moreover, in the multiple regression, decentralization explained the variance in only one performance indicator; indicators for informal management and political culture appeared to be more important influences. However, some indicators for informal management were themselves associated with decentralization but not any of the political culture indicators.

The general argument for decentralizing health care is the potential for improved service quality and coverage. This note raises the issues to consider if decentralization is to bring about beneficial results. A table summarizes a general framework for assigning responsibilities to central and local levels, while the rest of the note outlines a series of issues to consider. [From author]

In issuing this statement, WHO, ICM and FIGO are advocating for skilled care during pregnancy, childbirth and the immediate postnatal period. This statement is especially aimed at countries in which the coverage of skilled attendance at birth is below 85%. The statement defines clearly who is a skilled attendant, what skills she/he should have and how she/he should be trained and supported. Thus a skilled attendant is an accredited health professional

Current safer motherhood and newborn care programmes emphasize interventions that do not reach the poorest households. Community based interventions have been neglected and undervalued. In this article, we argue that large scale community effectiveness trials are both necessary and feasible if we are to make further progress with reducing maternal and child mortality. [author’s description]

This docuemnt presents nationally representative data of births attended by skilled health workers available up to 2005 together with global, regional and subregional estimates. [author’s description]

Decentralization of political and administrative power, combined with a civil service reform, are increasingly prevalent components of health sector reform. The wider implications of decentralization for human resources development are, however, poorly researched and inadequately understood. This paper analyzes these implications from the experience of the author, her colleagues and published literature. [from abstract]

This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. It draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. [from abstract]

Specific programs for selected diseases are an important component of the national and international health agenda. But in many developing countries, such programs fail to reach their full potential because of either insufficient implementation capacity or the lack of an integrated approach. For disease control programs to work, attention must be paid to human resources management.

This paper explores human resources constraints with regards to specific disease control programs, and provides an inventory of strategies to overcome these constraints. The paper is an edited version of the report on the meeting of the working group “Priority Diseases,” one of the seven working groups of the Joint Learning Initiative. The Joint Learning Initiative was set up to explore strategies to improve health services delivery through human resources management. [Publisher’s description]

The number of health workers employed is an indicator of a country’s ability to meet the health care needs of its people, especially the poorest and most vulnerable. Resource-constrained countries committed to the Millennium Development Goals are facing up to the reality that shortages and uneven distribution of health workers threaten their capacity to tackle the HIV/AIDS pandemic, as well as the resurgence of tuberculosis and malaria. Worker shortages are linked to three factors: 1) decreasing student enrollment in health training institutions, 2) delays or freezes in the hiring of qualified professionals and 3) high turnover among those already employed.

As a key contribution toward increasing human capacity in national health systems, the Capacity Project is hosting a series of Human Resources for Health (HRH) Action Workshops. The initial workshop—held in Johannesburg in partnership with the United Nations Development Programme/Southern Africa Capacity Initiative (UNDP/SACI)—facilitated the exchange of knowledge and best practices in planning, developing and supporting the health workforce. The three and one-half day workshop brought together 38 HRH leaders from 11 countries (Kenya, Lesotho, Malawi, Namibia, Rwanda, Sudan, South Africa, Swaziland, Tanzania, Uganda and Zambia). Almost all of the participants are senior HRH directors or practitioners working at the operational level within the Ministry of Health in their respective countries. Two representatives from faith-based organizations also attended.

The International Labour Office (ILO), the International Council of Nurses (ICN), the World Health Organization (WHO) and Public Services International (PSI) launched in 2000 a joint programme in order to develop sound policies and practical approaches for the prevention and elimination of violence in the health sector. When the programme was first established and information gaps were identified, it was decided to launch a number of country studies as well as cross-cutting theme studies and to conclude by drafting guidelines to address workplace violence in the health sector.

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]