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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 examines evidence from published literature on decentralization’s impact on the demand side of the human resource equation, as well as the factors that have contributed to the impact. The elements that make such an impact analysis exceptionally complex are identified. They include the mode of decentralization that a country is implementing, the level of responsibility for the salary budget and pay determination, and the civil service status of transferred health workers. The main body of the paper is devoted to examining decentralization’s impact on human resource issues from three different perspectives: that of local health managers, health workers themselves, and national health leaders.

OECD countries face a number of challenges in matching the supply to the demand for the services of physicians. These include making the right decisions on the numbers and training of new entrants, on the retention and retirement of the existing stock of physicians, and on migration policies for physicians. It also requires policies to ensure that there is the right specialty mix and geographical distribution of physicians. It will require appropriate decisions on terms and conditions of service and on methods of remuneration — not only to ensure that the right number of individuals is attracted to work in medicine but also to ensure that those who are attracted are motivated to be as productive as possible.

This report is an attempt to systematically document and evaluate the state of the health workforce in Africa. It draws on academic published literature (which is limited), the WHO statistical database (which is incomplete and only sporadically updated), studies of bilateral donors, national documents, and newspaper articles. The report shows clearly that for more than a decade HR issues have received very little attention. [from foreword]

This study aims at analysing the impact of international service trade on the health care system, particularly in terms of human resources for health (HRH), using Thailand as a case study. [from abstract]

Using preliminary research results from 15 case studies conducted the world over we examine the prerequisites for successful introduction of performance management systems which are appropriate for developing country situations. The key message and conclusion is that it is important to measure and value staff performance, but that this requires levels of organisational management and an external policy environment that are seldom in place in a developing context.

Countries in the Europe and Eurasia region are facing a significant and expanding HIV/AIDS epidemic that is largely concentrated among particularly vulnerable populations. A window of opportunity exists to respond effectively to the epidemic and to halt its spread, both within and beyond vulnerable populations. However, available evidence indicates that this opportunity is being missed. One explanation for this is that significant barriers exist within the region’s health systems that prevent rapid scale–up of effective HIV/AIDS programs.

This study seeks to examine these barriers and ways they can be overcome.

This study was carried out in order to determine factors that may facilitate the poor retention of registered nurses in the Malawian public health sector.

This report emanates from the results of a study that examined the impact of HIV/AIDS on the public and private health facilities in South Africa, and outlines the subsystems that are affected. Both public and private sector health facilities have reported an increase in the number of patients seeking clinical care for people living with HIV/AIDS, leading to increased admissions to medical and pediatric wards and increased workloads. This study addresses these issues and makes recommendations for managing the HIV/AIDS case load. [from author]

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.

This study explored the factors that motivate lay volunteers to join tuberculosis (TB) control programmes in high burden but resource-limited settings. [adapted from abstract]

Action is underway to increase access to antiretroviral drugs, especially in countries with high rates of HIV. The role of private providers is largely ignored, although they are an important source of care for stigmatizing diseases in many poor countries. Evidence is emerging that antiretroviral drugs are leaking into formal and informal private markets. Uncontrolled use of drugs in the private sector will lead to rapid development of HIV resistance. Countries require guidance and support from international policy makers and pharmaceutical companies to implement strategies for working with private providers.

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]

This paper describes three examples of human resource development in community-driven HIV/AIDS programmes. The basic proposition is that acknowledgement, inclusion of and support for community based health initiatives is necessary to understand fully where health action is occurring and where potential for expansion lies. The paper calls for an expanded definition of health systems encompassing work being carried out by communities who are at the frontline in responding to the HIV/AIDS epidemic. Health care workers live in communities, and communities are providing health care.

This paper distills lessons from recent efforts to improve the supervision of family planning and health programs in developing countries and identifies approaches that may be more effective and sustainable. It describes supportive supervision, an approach to supervision that emphasizes joint problem-solving, mentoring, and two-way communication between supervisors and those being supervised.

This article describes the validation of an instrument to measure work group climate in public health organizations in developing countries. The instrument, the Work Group Climate Assessment Tool, was applied in Brazil, Mozambique, and Guinea to assess the intermediate outcomes of a program to develop leadership for performance improvement. [from abstract]

This paper reviews recent innovations in education for human resources for health (HRH). The paper outlines the rationale for HRH education, identifies shortcomings in HRH education, and addresses the global contents of educational programs and trends. Recent changes in didactic approaches used in HRH educational programs are analyzed. The paper concludes with an evaluation of innovations and a set of recommendations. [adapted from author]

This paper addresses the problem of wastage of the qualified labor force, which takes place both during the education process and when trained personnel try to find jobs in the local market. Reducing wastage at both the educational and labor levels should improve the capacity of social investment, thereby increasing the capacity of the health system as a whole to provide services, particularly to those populations who are most in need. [from abstract]

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 document presents a framework for analyzing factors affecting the development and implementation of HRH policies and strategies.

No satisfactory strategy for reducing high child mortality from malaria has yet been established in tropical Africa. The authors compared the effect on under-5 mortality of teaching mothers to promptly provide antimalarials to their sick children at home, with the present community health worker approach. The study concludes that a major reduction in under-5 mortality can be achieved in holoendemic malaria areas through training local mother coordinators to teach mothers to give under-5 children antimalarial drugs. [adapted from abstract]

This paper is intended to be the basis for the development of policy options with countries for countries. As such, it has multiple objectives: to provide a guide for the analysis of human resources for health (HRH) as part of health systems performance assessment; to highlight HRH policy questions - derived from analyses and other input from countries — with which policy-makers are often struggling; to integrate HRH policy issues with indicators to assess and monitor HRH performance. [author’s description]

This research sheds light on the nature, design and provision of institutional services for providing training to the premier community health service providers in the public sector in Bangladesh. Virtually no major study exists on the training of the FWVs in the country. The methodology of the research mainly consists of a personal interview and questionnaire survey, covering the concerned trainers and officials of the major public health administration and training institutions of the country, including the National Institute of Population Research and Training, the Family Planning Directorate and the Family Welfare Visitors’ Training Institute.

This document is a combined Human Resources Development Plan and Human Resources Strategic Plan for the health and social welfare sector of Lesotho. The Development Plan is presented in Chapters 2 through 5, and the Strategic Plan is presented in Chapter 6. The essential difference between the two is that the HR Development Plan represents a technical assessment of the total labor supply and training requirements for the sector in the absence of any budget or production constraints. It reflects a technical assessment of what is needed and what should be produced and financed if we faced no constraints.

This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce.

QAP implemented the first randomized control trial to measure the impact of accreditation in a developing country setting and reports its findings in this Operations Research Results report. The central issue to the report addresses the extent to which accreditation, known to favorably impact measurable indicators relating to the quality of care, actually improves patient outcomes. While exploring this issue, the report also sheds light on the importance of careful planning and communication in implementing complex research and would serve as a guide to others in undertaking similar efforts.

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).

We report on income generation and work mix among 100 civil servants who manage public health services in developing countries. Their salary puts these managers among the better-off in their countries. However, 87% of the respondents complement their salaries with other income-generating activities.

This toolkit includes a collection of HRM resources and links assembled for the Global Health 2005 conference. Most of the resources are in Microsoft Word format and provide guidance on how to develop a variety of HRM documents or processes. Topics covered include supervision, hiring and recruitment, HR policies, and HIV Workplace Programs and training. [publisher’s 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]