Documents & Reports

As part of the High-Level Forum on the Health Millennium Development Goals, this issue paper discusses improving health workforce performance as a key factor in meeting MDGs. The required scaling up of interventions towards the MDGs depends on effective health services delivery systems (HSDS). The availability, the skills, the attitudes, motivation, and behaviors of health workers are key to well-functioning HSDS. [adapted from author]

Various constraints are being experienced in the health delivery systems, namely weak health infrastructure, limited tools, inadequate human resource capacity, limited public financing to the health sector as a whole (and not only to disease specific programs), poor management and planning and lack of integrated health systems and misapplication of human, technical and financial resources. In order to improve health in Africa, inequalities to health service access between and within countries should be addressed within the health system. [author’s description]

The document aims to analyse the health system in Sudan, to identify the new challenges brought about by the new context, and on this basis to present a post-conflict strategic framework for the health sector. Chapter 3 presents an overview of the health sector. Available data on infrastructures and human resources indicate wide inequality across states in resource availability.

This publication is a companion document to the Workforce Trends of Regulated Nurses in Canada series of publications. The Workforce Trends series organizes and presents data by nursing profession, with separate publications for each of the licensed practical nurse (LPN), registered nurse (RN) and registered psychiatric nurse (RPN) workforces. This publication, in contrast, organizes and presents data by province or territory.

The main objectives of this paper are to report on the country and demographic profile, motivations, experiences and career plans of recently recruited international nurses working in London, and to give a detailed insight into why they have come to the UK, and what are their future intentions. In order to put these findings in context, the paper also outlines the overall trends in numbers of nurses coming to the UK, and examines the policy context in which international recruitment activity has been conducted. [from introduction]

This report documents the efforts of the Institute for Reproductive Health (IRH) to integrate natural family planning methods into the health delivery system in the Phillipines. It discusses the venues used for implementation such as government and NGO partnerships as well as IRH’s training resources and activities for nurses and midwives on family planning. Finally, the report details best practices and lessons learned from the multi-year project.

HIV/AIDS mainstreaming has traditionally been equated with adjusting programs to be more relevant to beneficiaries affected by HIV/AIDS. Bitter experience is demonstrating, however, that civil society organizations (CSOs) are not immune to the impacts of AIDS within their own organizations. Few local CSOs are responding adequately to this threat, partly because they simply do not know the extent of these costs. This paper suggests how CSOs in sub-Saharan Africa can build organizational resilience in order to survive the loss of valuable staff, time and money that HIV/AIDS will cause. It also concludes with practical recommendations for their donors in how they can move beyond being concerned bystanders. [publisher’s description]

The Gender Policy Guidelines have been established in order to support the Department of Health in meeting not only its constitutional commitment to promoting gender equity and equality, but also its own commitments to equity, meeting the needs of those who have been previously marginalized and improving its productivity and quality of care within the health services.

This resolution, enacted by the Department of Health in South Africa, details the management and conditions of an allowance designed to attract and retain health workers in rural areas.

Accurate, detailed and up-to-date manpower data is a prerequisite for human resource management. This technical brief describes how the Ministry of Health conducted a human resource mapping exercise of all public health staff in Kenya, and discusses the implications of the findings. The aim is to demonstrate the many practical uses of human resource data. [adapted from author]

To tackle problems of staff shortage and maldistribution, in 2003 the Government of the Republic of Zambia in partnership with the Royal Netherlands Government embarked on a Pilot Zambian Health Workers Retention Scheme (ZHWRS) for health professionals. The scheme had as first objective to replace the Dutch doctors, working under the bilateral agreement between Zambia and the Netherlands. A regular review process was included as part of the scheme. This report is from the Midterm review that took place in January 2005. [from introduction]

This Kenya assessment is part of a multicountry initiative to provide data and options to policymakers and donors amidst for building the capacity of health care systems in low resource countries through recruitment, training, and deployment of public and private health workers. The assessments look at how human resource (HR) policy and workload planning can address personnel shortages, specifically, gross imbalances across urban and rural areas and among personnel categories, including doctors, nurses, pharmacists, and lab technicians. [adapted from author]

Performance lmprovement (PI), a process pioneered in industry, is now helping to strengthen reproductive health organizations. PI focuses on meeting the needs of service providers and other staff members. When programs enable and inspire staff to do their best, the quality of care improves. [author’s description]


This Population Report covers how to: define desire performance, describe actual performance, measurs/describe performance gaps, find the root causes, select and implement interventions, monitor and evaluate performance and manage change.

The purpose of the Regional Strategy is to provide Member States with a range of policy options and strategic actions from which to choose. The strategy’s framework for action is comprised of five interrelated strategic objectives organized around three key result areas, with suggested national actions to achieve them and WHO enabling responses. The key result areas are:a health workforce that is responsive to population health needs, or demand; effective and efficient workforce development, deployment and retention, or supply; and workforce governance and management.

The Health Management Information System (HMIS) in Kwale District, Coast Province is Kenya’s first computerised district-level HMIS. A joint effort of the Ministry of Health and the Community Health Department of the Aga Khan Health Service, Kenya, the system uses simple, user-friendly software developed by Data Dynamics Limited to collect and analyse data from local health facilities.

Pathfinder has provided community-based family planning and reproductive health services to women and men throughout the developing world for over 50 years. Partnerships with local governments and Nongovernmental Organizations (NGOs) allow Pathfinder access into communities to provide information and services. These local organizations provide a solid, established network through which Pathfinder reaches people. Faith-Based Organizations (FBOs) are a vital extension of this network. [author’s description]

Government and donor funds fail to meet growing demands for reproductive health care in the public sector. Strategies to support uch services include: convince governments to invest more in family planning; use market segmentation to direct subsidies to the poor and to direct clients who can afford to pay to the private sector; encourage public-private partnerships to increase use of the private sector; increase the efficiency of service provision in the public sector; plan for the phase-out of donor-provided contraceptives. [author’s description]

Maldistribution of human resources for health is a worldwide phenomenon and may appear in different dimensions. The first and greatest concern is the inequitable distribution, particularly of high level professionals like doctors, both among countries in the world and within each country. [author’s description]

This report is the result of the meeting of the 47th Directing Council and 58th session of the Regional Committee in Washington DC. It is a summary of actions and proposals for a plan of action on human resources for health in the Americas submitted for the consideration of the Directing Council. This document summarizes the activities carried out to date in the countries and in the Governing Bodies. It provides an overview of the situation and the predominant trends in the Region, as well as a vision of the technical proposals and agreements for activities that are being developed.

To support good performance, health care workers need clear job expectations, up-to-date knowledge and skills, adequate equipment and supplies, constructive feedback and a caring supervisor (Luoma and Crigler, 2002). Workers also need motivation, especially when some of the other factors that support good performance are lacking. Indeed, highly motivated individuals can often overcome obstacles such as poor working conditions, personal safety concerns and inadequate equipment. Given the current challenges related to human resources for health (HRH) in most developing countries (Joint Learning Initiative, 2004), helping workers to be as productive as possible in the face of such obstacles can be an important outcome of increased motivation.

This paper discusses human capital outflow from Africa from a developmental perspective. The focus is on the high skill content of African emigration to industrial countries, its impact on development in the region, and the challenges faced by institutions of higher learning to help the region deal with this problem. This paper further takes up the issue of African brain drain in the context of relevant changes taking place globally: globalization, movement towards a knowledge-based economy, and global demographic trends. [adapted from author]

Workers tend to go where the working conditions are best. Income is an important motivation for migration, but not the only one. Other reasons include better working conditions, more job satisfaction, career opportunities and the quality of management and governance. Political instability, war, and the threat of violence in the workplace also are strong drivers in many countries. [author’s description]

The involvement of district-level workers in local-level practical approaches to mainstreaming gender is central to facilitating change and informing health strategies. There are very few practical examples of mainstreaming gender in health, especially at the lower levels of the health sector. One approach is to build the capacity of staff to conduct and respond to gender analysis. [author’s description]

This report presents estimates of the total cost of providing comprehensive antiretroviral (ARV) treatment in the public sector in Nigeria, using the AIDSTREATCOST model to estimate the cost of providing Highly Active Antiretroviral Therapy (HAART), Voluntary Counseling and Testing (VDT), and Opportunistic Infection (OI) treatment, and other resource requirements for implementing the national antiretroviral (ARV) treatment program

This policy brief discusses the efforts of the South African government to create legislation for the country’s traditional medicine, and provides a synopsis of national initiatives that are transforming the field of traditional knowledge. It also examines what these changes mean for the users of traditional medicines. [author’s description]

The Christian Health Association of Ghana (CHAG) is a large faith-based NGO which currently serves an estimated 35 percent of the Ghanaian population, mainly in remote rural areas. CHAG’s financial sustainability is threatened due to declining donations from missionary groups and donor agencies, uncertain support from government, and low cost recovery in member facilities. Although knowledge of costs is essential to program management, CHAG members had no information on the costs of the services they provided. Thus, CHAG had no economic benchmarks for evaluating efforts to control costs, no denominator for calculating cost recovery for different services, and no empirical data on service costs that could be used to approach donors and the Ghanaian government with requests for funding.

A comparison showed that two models for teaching maternal care skills to providers resulted in similarly modest improvements in knowledge and performance. However, maternal care skills remained weak overall. Training should incorporate the best elements of the two approaches while seeking improvements in basic knowledge of maternal care. [author’s description]

The human resources for health strategy in the context of ongoing reforms, including HRH planning, development and management was one of the major components that was undertaken as part of the 2002 review of the health sector. The main objective was to propose strategies and approaches for developing a new and implementable long term plan which should address current health sector and local government reform needs and requirements. [author’s description]

The consequences of health professional mobility have become a prominent public policy concern. This paper considers trends in mobility amongst doctors and nurses and the consequences for health systems. Policy responses are shifting from a reactive agenda that focuses on stemming migration towards a more active agenda of managed migration that benefits source and destination countries. Improved working conditions and effective human resource practice are required to encourage retention of health professionals in both source and destination countries. [abstract]

The 2004 Egypt Service Provision Assessment (ESPA 2004) survey was designed to collect informationon the provision of reproductive health and child health services in Egypt in order to complement the information obtained through the 2003 Egypt Interim Demographic and Health Survey. The ESPA 2004 collected information on the preparedness of health facilities in Egypt to provide high quality care to clients seeking services for family planning, maternal health, child health, and sexually transmitted infections. A representative sample of 659 clinics of all types of facilities, in both government and nongovernmental organization facilities, was assessed. The survey included, in addition to the resources of the facilities, interviews with service providers, observations of consultations between the providers and clients, and interviews with clients after they were served. The information included in this report is important for identifying areas of intervention that will help improve the quality of family planning, maternal health, and child health services provided to clients. [preface]