Documents & Reports

Several high-profile meetings have focused global attention on critical human resources for health (HRH) issues, providing much needed high-level support and calls for action to address the HRH crisis. The Capacity Project’s HRH Action Workshop series was intended to extend this work by focusing on specific HRH actions and experiences, what is being done in countries, what is working and what is not.

The HIV pandemic does not spare health workers. In many countries, HIV prevalence among health care providers is equal to or higher than national averages, and in some areas, morbidity and mortality account for over 60% of health worker vacancies, compared to the 23% accounted for by the more commonly acknowledged impact of out-migration. The resulting attrition of health workers has a severe impact on the health resource capacity of developing nations and leaves critical efforts such as the rollout of antiretroviral therapy largely insurmountable. [from introduction]

The theme of this edition is primary health care in South Africa. It includes national and international perpescitves on primary health care and focuses on areas such as policy and legislation, infectious diseases, maternal and child health and human resources. Chapter 11 discusses strengthening human resources for primary care. [adapted from summary]

This background report for the World Health Report 2006 details the costs of eliminating critical HRH shortages based on data from the 2006 World Health Organization World Health Report. This was used to determine the minimum number of health workers required to supply sufficient health care to the populations of developing countries, as well as calculating the necessary costs of bridging the gap between current health worker availability and the projected requirements for 2015. [adapted from introduction]

This document discusses the in-country ownership of health initiatives from the Health Sector Strategic Plan focusing on critical areas such as retention, recruitment and occupational safety.

The United States has the largest professional nurse workforce in the world but does not produce enough nurses to meet its growing demand. The U.S. is now the world’s major importer of nurses, but the shortage is too large to be solved by recruitment abroad without depleting world nursing resources. The national shortage could be largely addressed by investments in expanding nursing school capacity. [adapted from summary]

Most healthcare in the UK is delivered through the National Health Service (NHS). Shortages of skilled staff led to policy changes including international recruitment of health professionals. Subsequent changes in the UK migration policy have impacted international recruitment, leading to a significant reduction in the inflow of international clinicians to the NHS. [adapted from summary]

Italy’s aging population is placing a strain on the public health system. Care for the aged has increasingly been delegated to informal immigrant workers. However, international migration will not be sufficient to solve Italy’s health care professional needs. [adapted from summary]

This OECD report examines the role played by immigrant health workers in the Canadian health workforce, as well as the interactions between migration policies and education and health workforce management policies. [adapted from introduction]

This paper investigates the impact of the framework and strategies to retain critical health professionals (CHPs) that the Zimbabwean government has put in place, particularly regarding non-financial incentives, in the face of continuing high out-migration. [from summary]

This document summarizes a project to design, implement and compare two models of integrating CT for HIV within FP services in 23 health facilities in Kenya in terms of their feasibility, acceptability, cost and effect on the voluntary use of CT, as well as the quality of FP services. [adapted from summary]

Tanzania’s government has developed various policies and guidelines to address the HIV/AIDS pandemic, including a five-year commitment to provide anti-retroviral therapy to 500,000 Tanzanians. This program faces many HRH-related challenges and constraints. This report discusses the implementation of a home-based care model to support older caregivers for Tanzanians living with HIV/AIDS. [adapted from report]

This report looks at how the landscape of human resources for health (HRH) has evolved and current key challenges. It looks at the complexities of HRH planning and management in the current environment and how various jurisdictions are finding innovative ways to collect and use HHR information. It also talk abouts education and training, workplace environment, distribution and migration, and provides updated data and information on supply-side trends for health professions. [adapted from author]


There is also a reference guide that provides aggregate, supply-based trend information.

This issue offers an overview of the core factors contributing to the success of family planning programs. Family planning professionals around the world helped to identify these 10 crucial program elements. This report highlights program experiences, best practices, and evidence-based guidance derived from nearly six decades of experience in international family planning. [adapted from author]

Sections of the report that address HRH include “High-Performing Staff” (p. 16).

The 2008 World Health Report revisits the vision of primary health care as a set of values and principles for guiding the development of health systems. It represents an opportunity to identify major avenues for health systems reform in the areas of universal coverage, service delivery, public policy and leadership. [adapted from publisher]

This version of Voices discusses the Capacity Project’s work with the Ministry of Health in Southern Sudan to strengthen its ability to plan for and manage the health workforce. [adapted from author]

JHPIEGO has been focused on improving the quality and availability of reproductive health and family planning services for slum residents, both by targeting the facility-based health care providers and the community members who access these services. This document outlines several lessons that have been learned from this experience. [adapted from author]

In developing countries, postabortion care (PAC) programs are frequently available only in urban or regional health facilities, placing rural women at greater risk for mortality and morbidity from complications because they lack access to services. This technical brief evaluates efforts to decentralize PAC activities in Senegal and Tanzania that show PAC can be safely and successfully decentralized with services capably provided by mid-level personnel in health centers, dispensaries, and some health posts when providers are trained and supervised and equipment and supplies are available.

This paper presents some of the basic governance issues related to decentralization and some examples of how projects and donor policies have contributed to more effective decentralization processes. [from author]

This Voices discusses the experiences of nurse hired through the Emergency Hiring Plan in Kenya in providing family planning services, and the importance of confidentiality in the successful provision of these services.

The report aims to document the present health workforce in the country in order to find out their strengths and weaknesses and put forward recommendations for improvement. It lays special emphasis on the profile and density of healthcare providers, quality of services provided by selected groups of providers, training, and production and future challenges for healthcare providers. [adapted from author]

Most children undergoing surgery in Kenya are anaesthetised by clinical officers or anaesthetists with minimal training in paediatric anaesthesia. This article details the statistics of how this personnel shortage impacts anaesthesia delivery. [from introduction]

The researchers conclude that given the HRH crisis, ART delivery models requiring much less doctor time need to be developed. Overall, there is a need to shift tasks from medical doctors to nurses and from nurses to community health workers. In particular, the patients themselves need to play an important role in the delivery of ART. The outcomes of the various scenarios are predicted. [from author]

There is a gross shortage of nurses, yet there is a need to provide quality care and defend patient care. Widening scope of practice is not new to all categories of nurses and given the Occupational Specific Dispensation for nurses there is a need to critically engage with these issues.

This brief considers the policy implications in Europe of the international migration of health workers and addresses the question of how the migration of health service professionals can be managed in ways that reduce any negative effects on supply. [from executive summary]

In what areas do the HIV/AIDS donor programs interact with key operational parts of health systems? To answer it, and to better inform the ongoing discussion of AIDS and health systems, the report investigates and compares the donors’ interactions in three countries (Mozambique, Uganda, and Zambia) with three components of health systems: the health information system, the supply chain system for essential medicines, and human resources for health. [from summary] Chapter 4 is dedicated to the HRH aspects of this issue.

Leaders of the University of Belize’s Faculty of Nursing and Allied Health had a vision. Their country has the third highest HIV prevalence in the region, after Haiti and Guyana, yet it lacked an effective system for training providers in counseling and testing. As faculty members, they dreamed of establishing a national training center that would provide the latest resources and trainings for both students and providers. [from author]

This report details the findings of the Forum on Engaging the Private Sector in Child Health held in Uganda in 2005. It discusses the potential of private providers and the private sector as a resource for improving community health outcomes. [from executive summary]

With external assistance, developing countries in sub-Saharan Africa are beginning to establish better human resources information systems (HRIS) as part of a comprehensive and integrated response to some of the fundamental challenges posed by the health crisis. While this is a positive development, it is equally important to begin thinking about simple, practical approaches for supporting HR planners and senior decision-makers to be effective leaders and managers of HR data. [from author]

Health workforce planning is necessary in order to ensure that trained and knowledgeable health workers are available to deliver health care services when and where they are needed. The aim of this technical brief is to provide a rapid review of different health workforce projection approaches. [from author]