Evaluations & Reviews

Human Resources and Health Outcomes: Cross-Country Econometric Study

Only a few studies have investigated the link between human resources for health and health outcomes, and they arrive at different conclusions. The authors tested the strength and significance of density of human resources for health with improved methods and a new WHO dataset on maternal mortality rate, infant mortality rate, and under-five mortality rate. [from summary]

Gender and Equity in Health Sector Reform Programmes: a Review

This paper reviews current literature and debates about health sector reform in developing countries in the context of its possible implications for women's health and for gender equity. It points out that gender is a significant marker of social and economic vulnerability which is manifest in inequalities of access to health care and in women's and men's different positioning as users and producers of health care. [from abstract]

How Can Self-Assessment Improve the Quality of Healthcare

This paper examines the issues relating to self-assessment, such as the different types of self-assessment, its uses, and its validity. It also reviews the literature (largely from developed countries) that informs our knowledge of self-assessment. The paper makes recommendations for future research and concludes that while much remains to be done to assure that self-assessment has the impact it promises, it may also be less costly and easier to implement than alternatives. [from author]

Retention: Health Workforce Issues and Response Actions in Low-resource Settings

This paper seeks to provide a compelling evidence base to reveal the factors that lead to high turnover and to promote tested responses to retain health workers. The literature researched is presented to support country-level action. [abstract]

Multiple Public-Private Jobholding of Health Care Providers in Developing Countries: An Exploration of Theory and Evidence

This review examines the systemic and individual causes of multiple job holding (MJH) and evidence on its prevalence. MJH should be seen as resulting initially from underlying system-related causes. These include overly ambitious efforts by governments to develop and staff extensive delivery systems with insufficient resources. Governments have tried to use a combination of low wages, incentives, exhortations to public service, and regulation to develop these systems.

Selecting and Applying Methods for Estimating the Size and Mix of Nursing Teams: A Systematic Review of the Literature Commissioned by the Department of Health

The aims of this summary and the main report are to help make sense of the complex and uncertain world of nursing workforce planning and to make better decisions about cost-effective numbers and mixes of nurses. Consequently, five commonly used workforce planning methods are reviewed and described: 1. Professional judgement approach, 2. Nurses per occupied bed method, 3. Acuity-quality method, 4. Timed-task/activity approaches, and 5. Regression-based systems. [From introduction]

Licensure, Accreditation, and Certification: Approaches to Health Services Quality

This monograph provides a brief overview of several aspects of quality assurance, including its cost-effectiveness and its feasibility in less developed countries. The monograph describes the dimensions of quality, the four principles of quality assurance, the QA process, and key activities in the development of a QA program.

Skill Mix in the Health Care Workforce: Reviewing the Evidence

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.

Planning Human Resources in Health Care: Towards an Economic Approach, An International Comparative Review

To inform the design and implementation of improved workforce planning systems, a review of healthcare systems and interaction between systems of service delivery and approaches to planning human resources was done in five countries: Australia, France, Germany, Sweden and the United Kingdom. These represent different welfare state regimes, and a range of health systems dominated by national taxation, local taxation and social insurance. [from executive summary]

Health Systems Strengthening and HIV/AIDS: Annotated Bibliography and Resources

Over the past few years, a united battle against HIV/AIDS has gained momentum worldwide. Non-governmental and community-based programs, national and international organizations—all are confronting the myriad of challenges posed by the HIV/AIDS pandemic. In an effort to provide policymakers, technical personnel, and other stakeholders comprehensive information on the costs of interventions and the impact of HIV/AIDS on health systems, PHRplus has prepared this annotated bibliography. The documents described focus on those aspects of the pandemic most related to the work of the project issues of economic impact, financing and resource allocation, costing, health system strengthening, scaling up antiretroviral therapy, surveillance systems, and program monitoring and evaluation.

Equity in the Distribution of Health Personnel: Draft Discussion Paper

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.

Helping Healthcare Providers Perform According to Standards

This paper reviews several theoretical perspectives to increase understanding of the key determinants of health worker performance, including theories of behavior change, diffusion of innovation, health education, and social influence. The main types of interventions that have been used to encourage health workers to perform in accordance with standards are described, and evidence from empirical research for their effectiveness is summarized. [author’s description]

Uses of Population Census Data for Monitoring Geographical Imbalance in the Health Workforce: Snapshots from Three Developing Countries

This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options. [from abstract]

Integrated Strategies to Tackle the Inequitable Distribution of Doctors in Thailand: Four Decades of Experience

This paper aims to summarize strategies to solve inequitable distribution of human resources for health (HRH) between urban and rural areas, by using four decades of experience in Thailand as a case study for analysis. [from abstract]

Ghana Community-Based Health Planning and Services Initiative for Scaling Up Service Delivery Innovation

The Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care. This paper reviews the development of the CHPS initiative, describes the processes of implementation and relates the initiative to the principles of scaling up organizational change which it embraces.

Zambia Accreditation Program Evaluation: Operations Research Results

This report examines whether Zambia’s hospital accreditation program improved health outcomes and other indicators. Performed after an accreditation program had been launched in about 40 hospitals, the evaluation examined eight indicators of healthcare quality at hospitals that had and had not been exposed to the accreditation program.

Quality and Accreditation in Health Care Services: A Global Review

A global review resulted from a study conducted by the International Society for Quality in Health Care (ISQua) under contract to the World Health Organization. The first of this report’s three parts describes structures and activities at national and international levels around the world to promote quality in health care. The second part catalogues quality concepts and tools in local use in various countries. The third part outlines initiatives in health service accreditation and analyses the operation of functioning national programmes around the world. The appendices include recommendations of major international bodies and meetings on quality assurance.

Fixing Health Systems

A cautiously optimistic appraisal of the Tanzania Health Interventions Project (TEHIP) in Tanzania, which was designed to test the proposition that mortality and morbidy rates in developing countries could be significantly reduced even with modest resources if health care funding was allocated to cost-effective health interventions more in line with the prevailing local burden of disease. [from preface]

Impact of HIV/AIDS on the Health Sector in Sub-Saharan Africa: The Issue of Human Resources

This paper reviews data, studies, and other information on HIV/AIDS impacts on human resources in sub-Saharan Africa. The purpose is to guide the development of an instrument to conduct HIV/AIDS human resource assessments in the health sector. Until now, inadequate attention has been devoted to this critical step in responding to the epidemic. Such assessments can assist policy makers and advocacy groups to shape and accelerate the implementation of national HIV/AIDS policies and programs throughout the continent. [Description from author]

Human Resources in the Health Sector: An International Perspective

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.

Human Resources and the Success of Health Sector Reform

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]

How Can We Achieve and Maintain High-Quality Performance of Health Workers in Low-Resource Settings?

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]

Using Mid-level Cadres as Substitutes for Internationally Mobile Health Professionals in Africa: A Desk Review

Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. This desk review was conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization.

HIV/AIDS, Equity and Health Sector Personnel in Southern Africa

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]

Equity, Equal Opportunities, Gender and Organization Performance

This review highlighted the fact that employment equity debates and policies largely refer to high-income countries. Even in these countries, there is more rhetorical commitment than hard evidence of successful outcomes. Evaluations have been mainly post hoc and many initiatives have not been evaluated at all. There is a continuing debate about what is the appropriate kind of intervention, a number of competing models being advocated. The most noticeable trend seems to be away from reliance on targeting by numbers (particularly for recruitment) and towards more comprehensive approaches across a range of inter- and intra-organizational interventions and over the whole career of the employee.

Migration of Health Professionals in Six Countries: A Synthesis Report

This report presents findings of a study on the migration of health professionals in Cameroon, Ghana, Senegal, South Africa, Uganda and Zimbabwe. The report provides detailed information about migration patterns and numbers, reasons for migration, effects on the quality of health care and the policies being undertaken in the respective countries to reduce outward migration. [from executive summary]

Skill-Mix and Policy Change in the Health Workforce: Nurses in Advanced Roles.

This report was commissioned by OECD to examine the evidence on role change and delegation from physicians to advanced practice nurses (APN), nurse practitioners and nurses in other advanced roles in the hospital setting and primary care. The report has three components: a literature review, an assessment of country responses to an OECD questionnaire, and two more detailed country case studies, on England and the US. [author’s description]