Skill Mix Imbalance

The township health system in Myanmar is regarded as means to achieve the end of an equitable, efficient and effective health system based on the principles of primary health care approach. A township hospital caters medical care at the second referral level. Under the leadership and management of a Township Medical Officer in each township, para-professionals deployed at Rural Health Centers (RHCs) and Sub-centers under each RHC’s jurisdiction play key roles for providing primary health care services for rural population. There had been an expansion of township hospital beds, RHCs and Sub-centers during the past 15 years.

As many countries initiate health sector reform-led cost containment and quality improvement measures, there is an increasing need for health care organisations to identify the most appropriate mix of staff. This paper examines why achieving the right mix is so important, critiques the main approaches used in determining personnel mix in health care, and discusses the main lessons from research in this area.

This paper provides practical guidelines for managers and health professionals looking to skill mix as a potential solution to health service delivery problems. These guidelines emphasise the need to evaluate the problem, and examine the context, before deciding if skill mix is the answer. The guidelines are provided in the knowledge that skill mix is rarely examined in a pure theoretical sense by organisations. They have to adopt a pragmatic approach which takes account of the day-to-day realities of their priorities and resources. [abstract]

Uganda Catholic Medical Bureau (UCMB) affiliated hospitals, like many other health institutions, are stressed by limited resources and increasing costs. This calls for a need to finance the increasing costs through efficiency gains on fixed inputs. Determining optimal staffing levels and skill mix would ensure efficiency gains on personnel whose costs account for 31-65% of UCMB’s total recurrent expenditure. It would also match the staffing to the workload. A descriptive cross sectional study was carried out in four UCMB hospitals with the main objective of setting standard workloads for each staff category.

In 2003 the Network published a discussion paper reviewing available literature and identifying key issues in need of further work, which this paper summarizes. In Southern Africa there are inadequate ratios of personnel to population for key skilled health personnel. There are a variety of push and pull factors that impact on the movement of healthcare workers. A more rigorous policy analysis is needed to stimulate innovation and to avoid measures and incentives counteracting each other. It is important to provide clearer policy analysis on production of health workers, on availability and distribution, and on movement and migration.

This document report on the trends of HRH during past fifty years including the issues of unqualified doctors in rural areas, geographical differences in HRH, and the increase in medical school graduates. It also forecasts HRH needs for fifteen years from 2000 to 2015.

Against the backdrop of growing concern about shortages of health personnel, the report focuses on one of the most critical components of the workforce – nurses. Nurses are the “front line” staff in most health systems, and their contribution is recognised as essential to meeting these development goals and delivering safe and effective care. In presenting a global overview, the paper reports on key trends, main challenges and potential solutions. The emphasis is on breadth of coverage, but specific nursing workforce issues in different countries are highlighted to illustrate the main challenges facing those responsible for developing and implementing policies on the nursing workforce. The report presents a snapshot of a dynamic and challenging situation worldwide. [from executive summary]

Ghana, a low income developing country, 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, and are influenced by, issues of human resources development, deployment and motivation. Some of the human resources issues debated under the reforms include issues of distribution of personnel, reprofiling of staff types and skill mixes including delegation of some essential skills.

This paper, aimed primarily at DFID advisers and health sector analysts, will attempt to map out selected issues relating to the planning and management of human resources by combining an international perspective with issues and trends emerging from individual countries. HR issues and challenges have been grouped into four broad objectives that poor countries, donors and advisers will need to address simultaneously over the next decade and beyond. The objectives are: Increasing coverage and staff retention to ensure adequate and equitable delivery of priority health services; Ensuring availability of key competencies and skills in the health workforce; Increasing staff performance against objectives; Strengthening capacity for planning and managing HR in the health sector.

Imbalance in the health workforce is a major concern in both developed and developing countries. It is a complex issue that encompasses a wide range of possible situations. This paper aims to contribute not only to a better understanding of the issues related to imbalance through a critical review of its definition and nature, but also to the development of an analytical framework. [from abstract]

The objective of this paper is to contribute to a better understanding of the issues related to imbalance through a critical review of its definition, nature and measurement techniques, as well as the development of an analytical framework. [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]

Health service managers in the Western Cape requested a skills audit of medical officers in district hospitals to identify a possible gap in competencies that may impact on service delivery. The aim of this study was thus to identify the knowledge and skills of medical practitioners delivering these services in the Western Cape and to compare them with service needs in order to make recommendations for education and training. This article reports on the results of the knowledge and skills gap analysis, while the results of the district hospital performance data and in-depth interviews are reported elsewhere.

The purpose of these Guidelines is to assist Member Countries in strengthening the management of their nursing and midwifery workforce and, through this, to assist in strengthening health care delivery and strategies for improving health. In particular, they aim to assist Member Countries by assisting them to effectively manage nursing and midwifery issues, including the problems of continuing shortage and maldistribution of nursing and midwifery personnel along with an inappropriate skill mix. [from introduction]

This paper aims to provide an overview of the current evidence and opinion of the workforce implications of regulation, competency development and role definition. These three elements are inextricably linked to each other and are fundamental to the practice of nursing in today’s environment. [from introduction]

This paper discusses the reasons for skill mix among health workers being important for health systems. It examines the evidence base, identifies its limitations, summarizes the main findings from a literature review, and highlights the evidence on skill mix that is available to inform health system.

Based on a review of the literature and country examples, the brief describes why task shifting is important and highlights some key steps in planning for, developing and supporting cadres involved in task shifting. [author’s description]