Health Sector Reform

This technical brief focuses on the relationship between human resource management and health sector reform in Latin America and Caribbean countries. [adapted from introduction]

This paper advocates multiple strategies for the United States to further assist with solving the global health workforce crisis.

This report describes three health system developments introduced by the Rwandan government that are improving these barriers to care

The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia. [from abstract]

This document review the Observatory of Human Resources in Health in the Health Sector Reform Processes in Latin America and Caribbean, which is a cooperative initiative among the countries of the Americas aimed at producing information and knowledge in order to improve human resource policy decisions as well as contributing to human resoures development within the health sector on the basis of sharing experiences among countries. [adapted from author]

This issue focuses on the health workforce and contains the articles: Could health worker migration bring benefits to Malawi?; Removal of childbirth delivery fees: the impact on health workers in Ghana; Regulation of dual job-holding public sector doctors in Peru; Health worker responses to health sector reforms; and Motivating Tanzanian primary health care workers. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It reviews a study of how Rwanda, faced with constrained fiscal conditions, has implemented innovative reforms to create fiscal space for human resources and to make these resources more responsive to needs through an analysis of budget documents and policy and regulation changes and key informant interviews. [adapted from author]

This article presents the results of a 2002 social audit of the health sector of three Baltic States. Comparisons were made of perceptions, attitudes and experience regarding unofficial payments in the health services of Estonia, Latvia and Lithuania. The findings can serve as a baseline for interventions and to compare each country’s approach to health service reform in relation to unofficial payments. [adapted from abstract]

Rural health care is changing. Following restructuring in the 1990s some small hospitals remained independent, while others reorganized as amalgamations and alliances. In 2004, Ontario was divided into 14 Local Health Integration Networks (LHINs) to create accessible, quality health care at a local level. Th is study was designed to gain an understanding of the impact on nursing work and the workforce. [from executive summary]

This resulted in a collection of papers with very different viewpoints and formats, reflecting the different professional and geographical backgrounds of the participants. We have grouped them under three headings. First a set of papers describes the performance of health personnel in a number of countries and attempts to improve it. A second part looks more closely at the various coping strategies health care workers, medical and paramedical, clinical and managerial, actually apply to deal with difficult working and living conditions.

Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers responses to the changes in their working environments by taking a realistic evaluation approach. [abstract]

Ensuring high performance of health care delivery systems is a challenge facing all governments. Dealing with the incentive problems underlying public health care delivery to improve productivity, quality, and performance is a common theme of health sector reforms in many countries. However, the impact of these reforms is often hard to establish. This book presents a series of case studies of health systems innovations by the Central American republics in the 1990s. The cases have a common theme of efforts to improve specific aspects of health system performance through the introduction of innovative and alternative financial, organizational, or delivery models…The case studies in this book report on the results of these experiences, encompassing a range of issues from the expansion of primary care to the use of public-private partnerships and the establishment of a social security-financed delivery system.

This paper describes the specific policy measures that the Zimbabwean government has recently implemented to try to improve health sector performance, and promote higher levels of motivation amongst public sector health care workers. The overall reform package is to include financial reforms (user fees and social insurance), strengthening of health management, liberalization and regulation of the private health sector, decentralization, and contracting out. Unfortunately, the process of reform implementation in Zimbabwe and the government’s poor communication with workers, combined with a conflict between local cultures and the measures being implemented, has undermined the potentially positive effect of reforms on health worker motivation.

This paper reports the experiences of primary care reform in the Zhezkazgan region of Kazakhstan. After the collapse of the Soviet regime, Kazakhstan undertook a radical program of reform to restructure the health sector, making primary care the centerpiece of their health reform agenda. The reforms included the creation of independent family group practices financed on a capitation basis directly from the Ministry of Health, allowing free choice of primary care providers through open enrollment, and creating a non-governmental primary care physician association. This program has had remarkable success in improving motivation among primary health care workers.

This paper offers a conceptual framework for considering the many layers of influences upon health worker motivation. It suggests that worker motivation is influenced not only by specific incentive schemes targeted at workers, but also by the whole range of health sector reforms which potentially affect organizational culture, reporting structures, channels of accountability, etc.

This publication is an effort to respond to the different needs for capacity building in management and implementation of health programmes and delivery of essential services. It reflects the thinking acquired from experience working with health sector reforms being implemented in the African Region. The District Health Management Training modules cover the principles that are applicable across the Region and are meant to guide and strengthen the management capacity of district health management teams. [author’s description]

The article analyzes the practice of physicians and nurses working on the Family Health Program (Programa de Sa

The authors argue that health for all is not achievable in most countries without health sector reform that incorporates a process of coordinated health and human resources development. They examine the situation in countries in the Eastern Mediterranean Region of the World Health Organization.

This study provides initial information about current nursing issues that have arisen as a result of health care reform initiatives. Regardless of differences in service models or phases of health sector reform implementation, in all the countries the participating nurses identified many common themes, trends, and changes in nursing practice. The driving forces for change and their intensity have been different in the five countries. Nurses maintain their core values despite increased work stress and greater patient care needs in all the countries as well as economic crises in the Latin American countries.

Few countries in Latin America have experienced in such a short period the shift from a socialist government and centrally planned economy to a liberal market economy as Nicaragua. The impact of such a change in the health field has been supported by the quest for reform of the health system and the involvement of external financial agencies aimed at leading the process. However, this change has not been reflected in the planning of human resources for health.

The human resources for health (HEH) 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 joint MoH/Partners review of the health sector as a follow up of the 2001 joint review. The main objective of the terms for the human resources review 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]

Costa Rica has taken the search for improvement of quality health care seriously, and has initiated several activities in that area. The Quality Assurance Project… has provided technical assistance to introduce continuous quality improvement methodology in seven hospitals and clinics in the South Central Health Region. This intervention was expected to result in concrete improvements for specific problems in each of these health facilities, and to serve as a model to be duplicated in health facilities elsewhere in the country. [author’s description]

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]

It is becoming increasing important that policymakers be aware of health worker motivation and it’s impact on health sector performance. Health care delivery is highly labor-intensive, and service quality, efficiency, and equity are all directly mediated by workers’ willingness to apply themselves to their tasks. While resource availability and worker competencies are essential, decision makers should know that they are not sufficient in themselves to ensure desired worker performance. Worker performance is also dependent on workers’ level of motivation stimulating them to come to work regularly, work diligently, and be flexible and willing to carry out the necessary tasks.

This paper is presented as a contribution to a new approach to human resource management that will take account of developments in public sector reform in the 1980s and 1990s. The intent is to show that those reforms, especially in their opening stages, underemphasized the importance of human resource management for two essential reasons. First, because of the reformers’ strong emphasis on the need to reduce the size of the government apparatus, and second because they made war on bureaucracy one of the principal objectives of the new style of public administration they advocated. Hence, their approach to human resource management was essentially a negative one and paid no attention to the legal framework that was essential to it, or to its political complexity.

Developing countries that have to cope with pressures to reform their bureaucracies have to contend with increasing health worker benefits and salaries that are often intended to retain these health workers in government service. In the Philippines, national and local efforts in health have been forced to focus on guaranteeing some of these benefits, and local governments are feeling the financial limitations of their local funds. [from abstract]

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]

This booklet has been prepared to assist policy makers in international organizations, governments and civil society. The authors hope that it will help design, introduce and implement public service and health sector reforms in the most effective and sustainable way, taking into account human resource policies. At the heart of the booklet are a set of critical questions which aim to help policy makers, including all social partners, to construct an effective path through the complex process of reform and restructuring. [author’s description]

This paper examines why building HR capacity is important to effective health care reform, assesses the existing evidence on HR capability in the health sector, and draws out lessons from existing practice. Developing HR capability requires investing in the training and development of both HR specialists and line managers/professionals with staff management responsibilities. It is vital that any investment in specialist HR capacity evaluates the different ways to deliver the HR function. To be effective the HR function must develop both an operational and a strategic HR capacity. [author’s sum

Ghana is undergoing health sector reforms aimed at achieving greater equity of access to services, improved efficiencies in resource utilization, development of wider linkages with communities and other partners, as well as improved quality of health services. These reforms have strong influences on issues of human resources development, deployment and motivation. [from abstract]