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For any wide-ranging effort to scale up health-related priority interventions, human resources for health (HRH) are likely to be a key to success. This study explores constraints related to human resources in the health sector for achieving the Millennium Development Goals (MDGs) in low-income countries. [adapted from author]

The papers presented here cover the main dimensions of HRD (Human Resource Development) in health: planning and managing the workforce, education and training, incentives and working conditions, managing the performance of personnel and policies needed to ensure that investments in human resources produce the benefits to which the investing populations are entitled.

In low and middle income countries, health workers are essential for the delivery of health interventions. However, inadequate health-worker performance is a very widespread problem. We present an overview of issues and evidence about the determinants of performance and strategies for improving it. [authors’ description]

International recognition that the growing shortage of health workers poses a major threat to fighting diseases such as HIV/AIDS and tuberculosis has prompted a flurry of measures to stem the exodus of health professionals from developing countries. The initiatives — such as ethical recruitment codes to try to limit damage inflicted by the brain drain, and exchange and training programmes and projects to tap the resources of what has become known as the diaspora of migrant health workers — remain fragmented but at least mark a start in the search for solutions to the crisis. [autho

Despite their high level of training and medical knowledge, health professionals remain a population that is vulnerable to HIV/AIDS. AIDS-related mortality has been recognized as a significant factor in the loss of trained health staff in high prevalence countries, but little empirical research has been done to quantify the damage. In this study, we applied a case/comparison methodology to estimate the costs of HIV infection in the professional workforce at three Zambian healthcare institutions: Lusaka District Health Management Team, University Teaching Hospital (the national tertiary care hospital) and Kasama District Hospital and Health Management Team. Deaths or medical retirements among professional staff were analyzed wherever the complete personnel records were available, with the exclusion of cases resulting from violence, accident or disease of sudden onset. 108 cases were identified over a three-year period ending in October 2003. Each case was matched with two comparisons of similar age, sex and professional training. Data were collected for both cases and comparisons on absenteeism, compensation and medical care and reimbursement. Data were also collected on death and retirement benefits paid, or owed, to the cases. [author’s description]

Considered an introduction to the Performance Improvement Approach in low resource settings. Stages, Steps and Tools presents an easy-to-use guide for finding the root causes of performance problems and then selecting and implementing interventions to fix those deficits. A set of tools can be used independently or in conjunction with other interventions to improve the quality and accessibility of health care services. [

The causes of brain drain are complex and interrelated, involving social, political, and economic factors. The necessary responses will therefore be varied and cover an array of areas. Drawing on growing interest and scholarship, Physicians for Human Rights (PHR) proposes this plan of action for addressing brain drain and the unequal distribution of health personnel within countries, recommending actions by high-income countries, African governments, WHO, international financial institutions, private businesses, and others. [author’s description]

What effect does the increased number of Malawians living with HIV/AIDS have on the public health sector? To address this question, the Commonwealth Regional Health Community Secretariat (CRHCS) and Malawian researchers from the Ministry of Health and Population (MoHP), with support from the U.S. Agency for International Development, Bureau for Africa, undertook an assessment to explore the effects of HIV/AIDS on the health workforce. [author’s description]

Most statistics on the migration of health-care workers are neither complete nor fully comparable, and they are often underused, limited, because they often give only a broad description of the phenomena, and are not as timely as required. This paper presents information on the uses of statistics and those who use them, the strengths and limitations of the main data sources, and other challenges that need to be met to obtain good evidence on the migration of health workers. This paper also proposes methods to improve the collection, analysis, sharing, and use of statistics on the migration of health workers.

The human resource (HR) problem in the health sector in sub-Saharan Africa has worsened to an extent that it has reached crisis proportions in some countries. Although the gravity of the problem varies across the continent, the situation in some of the countries is so grave that urgent action is needed. A complex set of factors has contributed to this problem, some exogenous, such as the austere fiscal measures introduced by structural adjustment, often resulting in cutbacks in the number of health workers.

This report, written for the World Summit on Sustainable Development, Johannesburg 2002, discusses the impact of HIV on the workforce and calls for governments to live up to the benchmark of action agreed to in the 2001 Declaration of Commitment to HIV/AIDS.

This policy brief from the World Health Report 2005 argues that it will not be possible to effectively scale up Maternal, Newborn and Child Health (MNCH) care without confronting the global health workforce crisis. It highlights how lack of managerial autonomy, gender discrimination and violence in the workplace, dwindling salaries, poor working conditions and some donor interventions have all contributed to a lack of productivity, as well as the rural to urban, public to private and poor to rich country brain drain and migration. The brief argues the need to plan the expansion of the workforce while implementing corrective measures to rehabilitate productivity and morale.

Billions of dollars have been invested in efforts to prevent the spread of HIV and other diseases in the world’s poorest countries. Yet at the same time, qualified health workers are leaving the same areas to work in the world’s richest countries. This article provides a brief overview of this issue. [author’s description]

This document describes USAID’s strategy for combating Tuberculosis. The strategy focuses on four main areas: a) expand and strengthen DOTS, b) increase and strengthen human resource capacity, c) develop and disseminate new tools and strategies, and d) adapt DOTS to address special challenges.

This Praxis Note describes the author’s response to the challenge of documenting and evaluating a capacity building process that had taken place in the Tangababwe Red Cross Society (TRCS). The hope is that it will stimulate ideas and show that even quick and dirty evaluations can prove useful, and are certainly better than nothing. [publisher’s description]

This article takes up the relatively neglected issue of gender in human resources policy and planning (HRPP), with particular reference to the health sector in developing countries.

Contracting with non-state entities, including non-governmental organisations, has been proposed as a means for improving health care delivery, and the global experience with such contracts is reviewed here. The ten investigated examples indicate that contracting for the delivery of primary care can be very effective and that improvements can be rapid. [from author]

Building health research expertise in developing countries often requires personnel to receive training beyond national borders. For research funding agencies that sponsor this type of training, a major goal is to ensure that trainees return to their country of origin: attaining this objective requires the use of proactive strategies. This paper describes the strategies employed to discourage brain drain by the principle investigators of five of the longest-funded AIDS International Training and Research Program. [from abstract]

This paper summarizes the key issues confronting human resources (HR) in the health sector in sub-Saharan Africa and the role that HIV/AIDS has played in exacerbating this crisis. Section I reviews the causes and consequences of this crisis. Section II focuses on the effects of the HIV/AIDS epidemic on the crisis. Section III analyzes the constraints faced by recent health initiatives in addressing HR issues. Finally, Section IV provides recommendations on how donors and other partners can address HR issues in a more intensive, sustained, and concerted manner. [summary]

Over the past few years, the human resources situation in the Zambia public sector has reached a point of severe crisis and inability to provide basic health services, primarily due to three interrelated factors. First, the country is losing substantial numbers of health workers to countries that offer better conditions of service, or are changing professions to ones that offer more attractive opportunities. Second, Zambia’s medical and professional schools have a limited capacity to train additional staff.

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]

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]

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]

There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration, less developed countries lose important health capabilities as a result of the loss of physicians. With the use of World Health Organization data, this article presents an emigration factor for the countries of origin of the immigrant physicians to provide a relative measure of the number of physicians lost by emigration. [from abstract]

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]

Physicians for Human Rights testimony before the U.S. House International Relations Committee, April 13, 2005 calling for a second Presidential initiative for health in Africa to accelerate the recruitment, retention, training, and rational deployment of skilled health workers while simultaneously continuing to scale up prevention, care, and treatment of HIV/AIDS.

Designed to assist in re-establishing health services in a context of political and economical instability, this guide provides practical information and tools for rebuilding a health workforce, as well as examples from post-conflict countries. [publisher’s description]

Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised. The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration. [from abstract]

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 paper discusses the implications for health personnel of the HIV epidemic, and health sector responses to it, in southern Africa, using Malawi as a case study. Published and grey literature has been consulted to assess the situation and its implications for equity. [author’s description]