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Measuring the Competence of Healthcare Providers

This paper provides a framework for understanding the key factors that affect provider competence. Different methods for measuring competence are discussed, as are criteria for selecting measurement methods. Also, evidence from various research studies on measuring the effectiveness of different assessment techniques is presented. [author’s description]

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]

Human Resource Management (HRM) Rapid Assessment Tool for Public- and Private-Sector Health Organizations: A Guide for Strengthening HRM Systems

The Human Resource Management (HRM) Assessment Tool offers a method for assessing what an organization’s Human Resource Management system consists of and how well it functions. The HRM Assessment Tool helps users to develop strategies to improve the human resource system and make it as effective as possible. It can also serve as a basis for focusing discussions, brainstorming, and strategic planning. It is designed to be used in public and private-sector health organizations.

Payment of Lunch Allowance: A Case Study of the Uganda Health Service

This paper presents a case study of an intervention (the lunch allowance scheme) instituted in Uganda to improve retention and motivation of health workers. The study traces the scheme’s evolution, assesses its impact on the brain drain of health professionals (medical doctors and nurses), and identifies difficulties encountered and lessons learned. [abstract]

International Migration of Health Workers: Labour and Social Issues

This study provides an overview of existing information on the migration of health workers, with an emphasis on related social and labour issues. It considers trends in migration, the working conditions of migrants, migration policies and recruitment practices, and the impact of international standards and trade agreements on conditions of migrant health workers. The study also outlines policies and practices associated with more socially acceptable forms of managed migration. It focuses on nurses and doctors, who have been in the forefront of current debate about health worker migration. [author’s description]

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]

Dual Practice in the Health Sector: Review of the Evidence

This paper reports on income generation practices among civil servants in the health sector, with a particular emphasis on dual practice. It first approaches the subject of public-private overlap. Thereafter it focuses on coping strategies in general and then on dual practice in particular. In this paper dual practice is approached from six different perspectives: what is meant by dual practice; typology of dual practices; prevalence; impact on personal income, the health care system and health status; reasons; and possible interventions. [adapted from author]

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.

Improving Health Outcomes for the Poor in Uganda: Current Status and Implications for Health Sector Development

This report attempts to provide a comprehensive assessment of health outcomes and of the health sector performance in targeting the poor. The report is guided by the Poverty Reduction Strategy Framework on health, nutrition and population and poverty. It also uses the frameworks on accountability and service provision from the World Development Report 2004: Making Services Work for Poor People. The report builds upon a vast literature on the health sector in Uganda and uses available data from surveys and the health information system for its analysis. It provides an in depth examination of inequalities in health outcomes, health behavior and practices and of health system performance and financing from the equity perspective.

Iranian Staff Nurses' Views of Their Productivity and Human Resource Factors Improving and Impeding It: A Qualitative Study

Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients. Productivity is a significant indicator of professional development within any professional group, including nurses. The human resource element has been identified as the most important factor affecting productivity. This research aimed to explore nurses’ perceptions and experiences of productivity and human resource factors improving or impeding it. [from abstract]

Ethical International Recruitment of Health Professionals: Will Codes of Practice Protect Developing Country Health Systems?

Many countries are using the strategy of international recruitment to make up for shortages of health professionals. This is often to the detriment of health systems in the poorest parts of the world. Codes of practice on ethical international recruitment or similar instruments are beginning to be introduced at both national and international levels to protect the health systems of vulnerable countries. This study was designed to review the potential impact of existing instruments. [from executive summary]

National Human Resources Plan for Health

The National Human Resource Plan is a national guideline for all stakeholders. It outlines broad issues whilst taking the lead in some areas in order to facilitate the resolution of some of the chronic systemic challenges facing the health system. In implementing this plan, all stakeholders will be required to adapt to the guidelines expressed here. It is envisaged that there will be a measure of variation between the provinces, because each province must take into consideration the prevailing conditions and demands on its human resource capacity to plan objectively.

Public Service Reforms and Their Impact on Health Sector Personnel

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]

Impact, Regulation and Health Policy Implications of Physician Migration in OECD Countries

In the face of rising demand for medical services due to ageing populations, physician migration flows are increasingly affecting the supply of physicians in Organisation for Economic Co-operation and Development (OECD) countries. This paper offers an integrated perspective on the impact of physician migration on home and host countries and discusses international regulation and policy approaches governing physician migration. [from abstract]

Report of the "Public-Private Interactions" Lekgotla, 11-12 July 2002, Kopanong, Gauteng

Public-Private health sector Interactions (PPI) are on the increase in South Africa. However, there are few mechanisms for the two sectors to routinely engage with each other. Such mechanisms are necessary to allow all stakeholders to understand better the motivations of, and the challenges that face, each sector and are a key part of the process of building trust between the sectors. The overall purpose of PPIs, and therefore of engagement between the public and private sectors, is to strengthen the overall health system for the benefit of all South Africans. [author’s description]

Workers for Priorities in Health

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]

Assessing Human Resources for Health: What Can Be Learned From Labour Force Surveys?

Human resources are an essential element of a health system’s inputs, and yet there is a huge disparity among countries in how human resource policies and strategies are developed and implemented. The analysis of the impacts of services on population health and well-being attracts more interest than analysis of the situation of the workforce in this area. This article presents an international comparison of the health workforce in terms of skill mix, sociodemographics and other labour force characteristics, in order to establish an evidence base for monitoring and evaluation of human resources for health.

Ghost Doctors: Absenteeism in Bangladeshi Health Facilities

The authors report on a study in which unannounced visits were made to health clinics in Bangladesh with the intention of discovering what fraction of medical professionals were present at their assigned post. This survey represents the first attempt to quantify the extent of the problem on a nationally representative scale. [from abstract]

Human Resources Impact Assessment

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.

Forming Partnerships to Improve Public Health

This issue defines public-private partnerships, lists potential partners at different administrative levels, reviews the factors behind the growth in partnerships, looks at some of the benefits and challenges of partnerships, and offers thoughts on preparing for and implementing them. It also describes the steps involved in developing a contractual relationship and provides examples of several successful partnerships. [editors’ description]

Wastage in the Health Workforce: Some Perspectives from African Countries

This paper illustrates that the way human resources for health (HRH) are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers.

Integrating Workforce Planning, Human Resources, and Service Planning

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]

Effect of Performance-Related Pay of Hospital Doctors on Hospital Behaviour: A Case Study From Shandong, China

With the recognition that public hospitals are often productively inefficient, reforms have taken place worldwide to increase their administrative autonomy and financial responsibility. Reforms in China have been some of the most radical: the government budget for public hospitals was fixed, and hospitals had to rely on charges to fill their financing gap. Accompanying these changes was the widespread introduction of performance-related pay for hospital doctors, termed the “bonus” system. While the policy objective was to improve productivity and cost recovery, it is likely that the incentive to increase the quantity of care provided would operate regardless of whether the care was medically necessary.

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.

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.

Training of Human Resources for Health in Africa

Traditionally, training institutions have in the main adopted the training programmes of rich countries. Graduates from these programmes have not usually been suitably adapted to the needs of the communities where the vast majority of people live. As such, their practice has not been based on an appropriate consideration of the social determinants of health. Graduates have offered services which have neglected key aspects of people’s living and working circumstances and lifestyles as well as the health implications of economic policies. [from abstract]

Technical Consultation on Imbalances in the Health Workforce: Report of the Consultation

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]

Determining Skill Mix: Practical Guidelines for Managers and Health Professionals

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]

Integrated Management of Adolescent and Adult Illness: Interim Guidelines for First-Level Facility Health Workers

The WHO IMAI guidelines support the rapid expansion of access to ART by supporting the shifts of key tasks to multi-purpose health workers at first-level facilities located in the community (health centres and clinics). By preparing nurses and clinical aids to provide acute care to adults, many opportunistic infections can be treated and the patient stabilized for ARV treatment without referral to district clinic. Management of patients near their home is important for equity and to achieve high levels of ARV adherence. [adapted from publisher’s description]

Public Sector Reform and Demand for Human Resources for Health (HRH)

This article considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. [adapted from abstract]