Planning

A roundtable discussion of the following questions: 1) Why attempt HRH planning? 2) What should be the objectives for HRH planning? 3) Why has HRH planning had limited success in the past? 4) Will these reasons for limited success continue in the future? 5) Even if HRH planning might be useful, why wouldn’t market forces be a better guide to policy? 6) If both HRH planning and market forces have their use, when should we choose one and when the other? [From author]

Australia is experiencing workforce shortages across a number of health professions despite a significant and growing reliance on overseas trained health workers. The shortages are even more acute in rural and remote areas. It is critical to increase the efficiency and effectiveness of the available health workforce, and to improve its distribution. This report describes the Australian government’s objectives of developing a more sustainable and responsive health workforce while maintaining a commitment to high quality and safe health outcomes. A set of national workforce objectives are also proposed.

As a key contribution toward increasing human capacity in national health systems, the Capacity Project is hosting a series of Human Resources for Health (HRH) Action Workshops. The initial workshop—held in Johannesburg in partnership with the United Nations Development Programme/Southern Africa Capacity Initiative (UNDP/SACI)—facilitated the exchange of knowledge and best practices in planning, developing and supporting the health workforce. The three and one-half day workshop brought together 38 HRH leaders from 11 countries (Kenya, Lesotho, Malawi, Namibia, Rwanda, Sudan, South Africa, Swaziland, Tanzania, Uganda and Zambia). Almost all of the participants are senior HRH directors or practitioners working at the operational level within the Ministry of Health in their respective countries. Two representatives from faith-based organizations also attended.

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]

This document outlines five key areas requiring intervention: human resources planning and capacity building, management of personnel, evidence-based practice, education, and stewardship. It provides a tangible response to resolution WHA54.12, which was adopted by the World Health Assembly in May 2001, and facilitates the achievement of WHO’s four strategic directions as well as the United Nations Millennium Development Goals. The document consists of two sections. Part I introduces the Strategic Directions, Key Result Areas and Objectives with the Expected Results to achieve them.

This issue discusses human resource development, its components, and its critical role in improving organizational performance. The accompanying supplement, the Human Resource Development Assessment Tool, is designed to help a public or private-sector organization identify problem areas in the organization’s HRD system and develop an action plan to address them. [editors’ description]

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]

This paper reviews lessons learned regarding getting decision-makers to recognise the nexus between workforce planning, overall health service development and operational policy; data collection and collation; moving beyond a simple personnel to population ratio approach; and adjusting the model to suit local circumstances. The project has identified some emerging and worrying trends in health workforce development. The need for consistent, sustained technical assistance which reflects long and wide experience in health service development and management is underlined. [abstract]

The core objective of the plan is national, comprehensive treatment and care for HIV/AIDS with equal access to services, long-term commitment, improvement of Rwanda’s general health services infrastructure beyond HIV/AIDS, and financial transparency. The approach for implementation will involve service integration with existing health system infrastructure, community mobilization, linkage between treatment and care and prevention, multi-country procurement economies of scale, and rapid scale-up and iterative learning based on a collaboratives model.

A technical consultation on imbalances in the health workforce was held in Ottawa, Ontario, Canada, from 10 to 12 March 2002. The discussions focused on the following main themes: the rationale for WHO’s work on imbalances in the health workforce; developing a conceptual framework for defining imbalances in the health workforce; identifying sources of data required for optimal monitoring of imbalances; and identifying areas for further research. [author’s description]

TEHIP (Tanzania Essential Human Interventions Project) was designed to test how and to what extent evidence can guide decentralized planning of the health sector at District level. From the outset, the evidence set included burden of disease, cost effectiveness, health system capacity, and community voice. The Burden of Disease Tool and the Community Voice Tool have been developed as planned. The Cost-Effectiveness Tool has been designed but left on the shelf due to the need to introduce some new precursor tools that had not been foreseen. These include the District Cost Information Tool, the District Health Expenditure Mapping Tool (both of which have been developed and applied) and a District Intervention Coverage Tool that is under development. Also, for the health system capacity, a number of innovations and new tools have evolved including the District Integrated Management Tool, the District Health Mapping Tool, The Community Ownership Strategy, and Strengthening Health Management and Administration. All together, these tools and strategies can be seen as major “interventions” into the capacities of the TEHIP supported districts and must be understood in that sense when comparing the performance of such districts with those with conventional approaches to planning and resource allocation.

This paper analyses in detail the changing international health paradigms and the situations that challenge international mechanisms existing globally and in Thailand. Human resources development on international health and negotiation skills constitute the core responses. The initial success of the recent development in Thailand is also reviewed. Finally, the conceptual framework, possible strategies and priority activities are proposed to be carried out for future international health development. [from abstract]

This document describes two microcomputer spreadsheet models for developing 10 to 30+ year projection scenarios for the supply of and requirements for human resources for health, and for studying the interactions between personnel policies, health sector costs and productivity. The models are designed for use at the national or subnational level, and users may define their projection period in the requirements model according to their needs. [from introduction]

This paper provides an analysis of how labour market indicators can be integrated into service planning, discusses whether planning is sufficiently responsive and flexible to retain relevance and validity in rapidly changing health systems, describes different models and approaches to linking and integrating workforce planning and service planning, discusses methodological approaches to integrating planning, and examines effective approaches to the use of computer based scenario modeling to support assessment of current and future planning options. [from abstract]

For decades, discussions on human resources in health have ended with a ritual call for more and better manpower planning. But this traditional wisdom has been discredited by unrealistic or vague targets, based all too often on information that was inaccurate, outdated and unrelated to the policy agenda… Policy-makers and donors concerned with human resources problems may want to request those proposing a major new project or policy to make a systematic and formal human resource impact assessment during its preparation. Such assessments would examine the likely effects of the proposed project or policy on the health workforce.

This study assessed the impact of management training in the performance of managers from agencies in Bangladesh delivering primary healthcare services. [from abstract]

This paper looks at the successes and failures of today’s health care workforce. Hargadon and Plsek argue that our current solutions to the problems in the health workforce are insufficient. To overcome these insufficiencies, they believe that we need to better understand the complexities of the workforce. However, this is not an easy feat, because these problems challenge our traditional mental models of how things should work. [abstract]

An annual review done against the priorities set in the South Africa Health Sector Strategic Framework, 1999 to 2004, and in the Strategic Plan of the National Department for 2003/04 to 2005/06. Section 2 is devoted to Human Resource Management Data.

Chapter 1 of this document describes the environment that affects the health workforce. Chapter 2 presents an overview of what lessons can be learned from priority programmes that have already struggled with the consequences of HRH limitations. Chapter 3 discusses possible strategies that can help to overcome HRH constraints. The last chapter proposes an agenda for action. [Adapted from authors]

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]

This guide is designed for managers, supervisors, educators, planners, and evaluators. Its purpose is to discuss ways to improve decisions that affect how human resources are used to provide health services. Improved decisions require up-to-date and detailed information about three components of human resources for health: (1) the workforce, (2) the work performed and (3) the work settings. This guide discusses how to establish an information system that links these three components to form a unified model of human resources planning, training, and utilization. [from overview]

The overall aim of the workshop was to identify and agree on priorities for coordinated action in improving human resources for health (HRH) policy and practice, based on a timetable for strategic work involving the agreed participation of different stakeholders. Specific objectives were to improve the performance of health workers/health workforce by: improving understanding of the determinants of successful approaches to workforce development and HRH; developing strategies and the evidence base in relation to the first point; and achieving consensus among stakeholders on a strategy for research, development of knowledge tools, and implementation mechanisms for HRH.

As a key contribution toward increasing human capacity in national health systems, the Capacity Project is hosting a series of Human Resources for Health (HRH) Action Workshops. The initial workshop—held in Johannesburg in partnership with the United Nations Development Programme/Southern Africa Capacity Initiative (UNDP/SACI)—facilitated the exchange of knowledge and best practices in planning, developing and supporting the health workforce.

The three and one-half day workshop brought together 38 HRH leaders from 11 countries (Kenya, Lesotho, Malawi, Namibia, Rwanda, Sudan, South Africa, Swaziland, Tanzania, Uganda and Zambia).

The human capacity-building plan proposes a set of products and services supporting countries in their efforts to plan for, train and sustain the human capacity to achieve 3 by 5.

This article proposes a conceptual framework for the analysis of human resources for health interventions according to their degree of technical complexity; this complements the notion of institutional capacity in considering the feasibility of implementing an intervention.

In much of the developing world, private health care providers and pharmacies are the most important sources of medicine and medical care and yet these providers are frequently not considered in planning for public health. This paper presents the available evidence, by socioeconomic status, on which strata of society benefit from publicly provided care and which strata use private health care. [from abstract]

This issue of The Manager provides a comprehensive framework for addressing human capacity development. It presents steps for developing a strategy that will help managers sustain a supply of adequately trained health staff. It examines four components of planning and managing the workforce: policy and financial requirements, human resource management, partnerships, and leadership. The issue also suggests actions managers and policymakers can take to address issues in these areas so that appropriately trained staff are available in the right places at the right time. [editors’ description]

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]

This policy brief from the World Health Report 2005 argues that it will not be possible to effectively scale up Maternal, Newborn and Child Health (MNCH) care without confronting the global health workforce crisis. It highlights how lack of managerial autonomy, gender discrimination and violence in the workplace, dwindling salaries, poor working conditions and some donor interventions have all contributed to a lack of productivity, as well as the rural to urban, public to private and poor to rich country brain drain and migration. The brief argues the need to plan the expansion of the workforce while implementing corrective measures to rehabilitate productivity and morale.

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.