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Human resources for health policies: a critical component in health policies

Human resources for health policies: a critical component in health policies

The literature presents at least four "prescriptions" to adapt the policy process relating to the health workforce: (1): HRH policies must be comprehensive, i.e. go beyond personnel administration and incorporate all aspects of HRM. [11,18,41,87] HRM should be recognized as a set of trans-sectoral activities, all necessary, acting globally on the HR system so that the workforce is used in ways that effec- tively contribute to meeting the health needs of the popu- lation. HRM will continue to include traditional functions such as recruitment of personnel, but also others, such as negotiations with professional groups and unions, as reforms usually envisage changes in working conditions, allocation of responsibilities or training programmes. Closer relations need to be maintained with various min- istries, such as that of education for training issues, or fi- nance for matters relating to remuneration and to incentive schemes. The policy challenges, therefore, are to involve HR managers in all decisions relating to the work- force and to develop coordinated (across both jurisdic- tions and stakeholders) "policy packages" [88,89]. (2): The development and implementation of HRH poli- cies should reflect the integrated, interdependent and sys- temic nature of the different components of HRM. Acknowledging the systemic nature of HRM calls for a rec- ognition of (1) the contribution of each of its functions and their mutual dependencies; and (2) the links between HR policy, health policy and the environment in which they are to be implemented.
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Human resource technology disruptions and their implications for human resources management in healthcare organizations

Human resource technology disruptions and their implications for human resources management in healthcare organizations

Strengthening Human Resource (HR) practices and adopting HR technologies such as Human Resource Information Systems (HRIS), that can collect, store and report workforce data are often described as a potential solution to this problem. Indeed, examples from other industries show that HRIS can help to launch or manage, as well as provide ongoing insights concerning the whole career cycle of an employee. However, few of the existing studies that discuss technology or its impacts on the future of work have focused on health organizations, and those that do have not received sufficient attention in health literature. Furthermore, such contributions as there have been have either prioritized a particular type of technology or focused mainly on the effect of automation on health professionals ’ work. They have thus overlooked the full range of possible uses of these technologies and, specifically, have neglected the topic of HR for Health (HRH) management in health organizations. The primary aim of this paper is to address this lacuna, with specific reference to the existing categorization of HR technological disruptions. To conclude, health organizations and the health and HR professionals who work within them need to use HRIS responsibly, finding a balance between the drive for innovation, productivity and efficiency and respect for all potential legal, ethical and compliance issues, as well as taking account of the importance of HRH wellbeing and satisfaction.
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The Human Resources for Health Effort Index: a tool to assess and inform Strategic Health Workforce Investments

The Human Resources for Health Effort Index: a tool to assess and inform Strategic Health Workforce Investments

As with other dimensions (Finance, Education, and Training), a few respondents did not complete this di- mension, probably reflecting its more specialized nature or difficulty among the categories. Items that scored lower in this dimension included whether the country has a staffing and employment information system (4.5)—particularly in the DR national application (3.9)—and the degree of interoperability of information systems related to HRH such as between payroll and other health management information systems (4.4), which received the lowest score in Ghana (3.9). Burkina Faso produced a low score on the infrastructure and capacity of the information and communications tech- nology (3.8). A respondent there complained that HR software installed in 2014 had yet to prove effective to improve their HR information system. On the other hand, respondents in Ghana gave an extremely high score to their health worker licensure and registration system (7.6), stating that there is a “well structured” system for doctors, nurses, and midwives, which will be extended to other qualified health personnel. This item
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Public sector reform and demand for human resources for health (HRH)

Public sector reform and demand for human resources for health (HRH)

In Uganda at the time of decentralisation, salaries for staff on the payroll were a central responsibility, although this has now been decentralised through a special conditional grant. In the past, professional staff were put on the national payroll and nursing aides were hired locally for work in rural health centres and health posts and paid for by the Ministry of Local Government. After the decentral- isation reforms, nursing aides were supposed to be paid by local committees, but in practice this often did not happen and they were not paid for long periods [18]. Botswana and Tanzania have had long experience of decentralisation. As a result of health sector reform, health staff were transferred to local government contracts although senior staff remained employed by the Ministry of Health. This has led to confused loyalties and manage- ment responsibilities. In some districts the "personality factor" has meant that individuals working together have managed to overcome some of these problems, in spite of the systems introduced. Senior staff who have subse- quently been transferred to local government complain that that there is "little relationship between promotions/ disciplinary actions and performance". In both countries there is some scope for local decision-making in relation to personnel management, but there is still resistance to distributing staff according to local needs. More incentives and other measures are considered necessary if regional imbalances of staff are to be addressed [17].
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The impact of austerity on the health workforce and the achievement of human resources for health policies in Ireland (2008–2014)

The impact of austerity on the health workforce and the achievement of human resources for health policies in Ireland (2008–2014)

Background: The global economic crisis saw recessionary conditions in most EU countries. Ireland ’ s severe recession produced pro-cyclical health spending cuts. Yet, human resources for health (HRH) are the most critical of inputs into a health system and an important economic driver. The aim of this article is to evaluate how the Irish health system coped with austerity in relation to HRH and whether austerity allowed and/or facilitated the implementation of HRH policy. Methods: The authors employed a quantitative longitudinal trend analysis over the period 2008 to 2014 with Health Service Executive (HSE) staff database as the principal source. For the purpose of this study, heath service employment is defined as directly employed whole-time equivalent public service staffing in the HSE and other government agencies. The authors also examined the heath sector pay bill and sought to establish linkages between the main staff database and pay expenditure, as given in the HSE Annual Accounts and Financial Statements (AFS), and key HRH policies. Results: The actual cut in total whole-time equivalent (WTE) of directly employed health services human resources over the period 2008 to 2014 was 8027 WTE, a reduction of 7.2% but substantially less than government claims. There was a degree of relative protection for frontline staffing decreasing by 2.9% between 2008 and 2014 and far less than the 18.5% reduction in other staff. Staff exempted from the general moratorium also increased by a combined 12.6%. Counter to stated policy, the decline in staffing of non-acute care was over double than in acute care. Further, the reduction in directly employed staff was to a great extent matched by a marked increase in agency spending.
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Iran towards universal health coverage: The role of human resources for health

Iran towards universal health coverage: The role of human resources for health

The training of HRH can be used as a tool to increase the quality of services and their better acceptance by the society. We reviewed the few available studies, interviewed with the policymakers, and found that conducting educational courses (in-service training) has been neglected in Iran. Regarding the classification of occupations in HRH, it seems that the review just focused on the public sector and only explained the duties related to each occupation. However, considering the lack of workforce in certain occupations, it is better to study other options, such as changing the scope of practice and task- shifting. Another problem is lack of an accreditation system in HRH for all the related businesses; there is only an accreditation system for physicians, which is imperfect and inadequate. The other issue affecting the quality is the
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Willingness to work in rural areas and the role of intrinsic versus extrinsic professional motivations - a survey of medical students in Ghana

Willingness to work in rural areas and the role of intrinsic versus extrinsic professional motivations - a survey of medical students in Ghana

While previous research has looked at incentives and working conditions to promote uptake of rural posts, few studies have focused on motivation crowding and its effect on willingness to accept postings to rural area. Motivation crowding [14] is the conflict between exter- nal factors (extrinsic), such as monetary incentives or punishments, and the underlying desire or willingness to work (intrinsic) in areas needed most. Students may have a mix of extrinsic and intrinsic motivations for studying medicine. Extrinsic factors may either under- mine or strengthen intrinsic motivation, led by the belief that medicine has the imperative to help others, as enshrined in the Hippocratic Oath [15-17]. Current monetary incentives, which favour urban practice, may crowd-out the intrinsic desire to give back to society by working in underserved areas [18,19]. This could have debilitating effects on health worker retention in rural areas [20-22]. To tackle the maldistribution of human resources for health (HRH), understanding the factors that crowd-out the intrinsic motivation of medical stu- dents and their willingness to accept postings to rural underserved area is integral. This paper analyzes the effect of extrinsic versus intrinsic motivational factors on stated willingness to accept postings to rural under- served areas in Ghana.
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A political economy analysis of human resources for health (HRH) in Africa

A political economy analysis of human resources for health (HRH) in Africa

Despite a global recognition of the gravity and urgency of health worker shortage in Africa, little progress has been achieved to improve health worker coverage in many of the African HRH crisis countries generally. Powerful political and institutional incentives push stakeholders at the domestic and international levels not to invest in HRH. The status quo of institutional ar- rangements needs to be changed for new policy choices to reach the top of the agenda, and ideas have the power to be the earthquake to disrupt the previous rules of the game. Good governance and some degree of bureau- cratic capacity alone do not ensure a successful HRH plan. We argue that political will, in the form of a long-term commitment to HRH, is essential to mobilize internal and external resources. We also con- tend that this political commitment to HRH was the product of framing—policy entrepreneurs successfully tied more health workers to better health services for more Ethiopians.
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Advancing the science behind human resources for health: highlights from the Health Policy and Systems Research Reader on Human Resources for Health

Advancing the science behind human resources for health: highlights from the Health Policy and Systems Research Reader on Human Resources for Health

Apart from improving the quality of HRH data sources, the Reader also stressed further use and devel- opment of a broad range of research methods. Featured HRH research methods included experiments involving discrete choices [15, 57] or dictatorship games [17], time-use studies [13, 45], Likert scales and other types of scale development for measuring latent concepts such as motivation and job satisfaction [22, 26, 58], and vignettes to measure health worker performance [44]. While includ- ing examples of these known HRH research methods, the Reader highlights the need for improvement in how they are utilised to understand HRH. In addition, the Reader also highlights a range of social science methodologies as central to HRH research, including numerous examples of ethnography [18, 23, 25, 30, 58, 59], case study research [55, 60] and historical analysis [28, 61]. Innovations drawn from HPSR and applied to HRH showcased by the Reader include social network analysis [62], realist evaluation [31], action research [36, 42] and sampling through social media [20].
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Development and validation of a structured observation scale to measure responsiveness of physicians in rural Bangladesh

Development and validation of a structured observation scale to measure responsiveness of physicians in rural Bangladesh

Responsiveness of health care providers is an essential attribute of their performance. The concept of respon- siveness has appeared in the literature on human resources for health (HRH). In 2004, the Joint Learning Initiative on HRH used the term ‘responsiveness’ in the context of HRH, but did not elaborate further [1]. In 2006, Dieleman and Harnmeijer [2] proposed an analyt- ical framework for HRH performance measurement. This framework suggested four domains of HRH per- formance, including responsiveness. The World Health Report of 2006 also used the same framework around the same time [3]. However, none of these reports pro- vided any clear definition of HRH responsiveness. Based on literature on responsiveness, patient satisfaction, ser- vice quality, doctor-patient communication, as well as relevant studies in other fields (e.g., gender sensitivity, cultural competency) [4], in this paper, we adopted the following definition of HRH responsiveness: “social actions by health providers to meet the legitimate expec- tations of service seekers”.
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The ‘Dream Team’ for sexual, reproductive, maternal, newborn and adolescent health: an adjusted service target model to estimate the ideal mix of health care professionals to cover population need

The ‘Dream Team’ for sexual, reproductive, maternal, newborn and adolescent health: an adjusted service target model to estimate the ideal mix of health care professionals to cover population need

The inclusion of the health workforce as a key strategy to achieve Sustainable Development Goal (SDG) 3 on health [1], and the global strategy on human resources for health (HRH) [2] are signs of a greater emphasis on the health workforce as an engine for human development [3]. The 2015 report of the independent Expert Review Group [4] called for the delivery of ‘an expanded and skilled health workforce, especially in Sub-Saharan Africa, which serves women and children with measurable impact’ and its 2014 report clearly identified the lack of health workers (espe- cially midwives) as a major neglected global and national priority [5]. The 2014 State of the World’s Midwifery (SoWMy 2014) report [6] provided new data on the mid- wifery workforce to inform policy and planning with SRMNAH workforce projections for 73 countries based on full-time equivalent (FTE) staff rather than headcounts. The 2014 Lancet Series on Midwifery established a frame- work for quality maternal and newborn care (QMNC), the package of care required and the values and philosophy embodied in this care are key to achieving the post-2015 vi- sion to end preventable maternal and newborn deaths and improve health and wellbeing [7].
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State-building and human resources for health in fragile and conflict-affected states: exploring the linkages

State-building and human resources for health in fragile and conflict-affected states: exploring the linkages

Effective intersectoral coordination Until 2010, there existed a Ministry of HIV/AIDS alongside with the Ministry of Health — and the lack of coordination between the two ministers was notorious. The divide of ministries between political parties and “ ethnic ” groups, with the Ministry of Health not necessarily always falling in the camp of the main political party, also contributed to hampering coordination until around 2010 when the CNDD-FDD established a firmer control over the MoH. Formal mechanisms of coordination remain primarily aid-led. They also suffer from the reluctance of the health sector to collaborate with other sectors that did not move as fast as it did after the war. Indeed, the MoH had a clear advantage over other ministries as (1) it did not face the same challenges of reintegration of part of the workforce as other sectors (see below) and (2) could count on a well-identified workforce whose work was not very different from past regimes. In the recent years, the presidency has established a stronger grip on health issues, but often, decisions are taken without consultation with or agreement of the MoH staff. A very clear example is the introduction of a new insurance scheme in 2013 that many in the MoH viewed as badly designed but was forced by the presidency. The coordination of the different actors, including non-state, involved in HRH management still remains a weakness of the health system [93] and maintains Burundi as an aid-dependant state.
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The Australian Rural Clinical School (RCS) program supports rural medical workforce: evidence from a cross sectional study of 12 RCSs

The Australian Rural Clinical School (RCS) program supports rural medical workforce: evidence from a cross sectional study of 12 RCSs

Methods:  All medical schools funded under the RCS Program were contacted by email about participation in this study. De-identified data were supplied for domestic students about their gender, origin (rural background defined as having lived in an Australian Standard Geographic Classification-Remoteness Area (ASGC-RA) 2–5 area for at least 5 years since beginning primary school) and participation in extended rural clinical placement (attended an RCS for at least 1 year of their clinical training). The postcode of their practice location according to the publicly available Australian Health Practitioner Regulation Agency (AHPRA) register was collected (February to August 2017) and classified into rural and metropolitan areas using the ASGC 2006 and the more recent Modified Monash Model (MMM). The main outcome measure was whether graduates were working in a ‘rural’ area (ASGC categories RA2–5 or MMM categories 3–7) or ‘metropolitan’ area. Pearson’s χ test was used to detect differences in gender, rural background and extended
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Service delivery in Kenyan district hospitals – what can we learn from literature on mid-level managers?

Service delivery in Kenyan district hospitals – what can we learn from literature on mid-level managers?

We encountered challenges in retrieving some publications, largely because of difficulty in accessing print-only articles not available in Kenya that attempts to contact authors dir- ectly did not overcome. Despite this, we feel the literature included was informative. In this review, literature charac- terizing MLM roles was limited by absence of data evaluat- ing roles or identified tasks. Nonetheless, the articles we found provide a useful insight into factors that may indeed increase MLM influence on the quality of care delivered. These findings reveal that important factors, such as decision-making and problem-solving, championing change, communication and information synthesis, are basic roles and tasks for MLMs. Studies included in this re- view were commonly concerned with the roles MLM are expected to play in times of organizational change. These support a major role for MLMs as potential change agents and opinion leaders, who can either facilitate or impede efforts to improve services [22,25,38,45] because of their boundary-spanning position [23,24,46]. Middle-level managers may be better disposed to support change when they understand the proposed initiatives for improvement and their role in it, if it is in line with their own values and fits the context in which they work, and if they feel supported by senior management [23,47,48]. Our findings are broadly consistent with those of Birken et al. [49], who focused on MLMs’ roles as agents of translation of policy into action, condensing these roles into those of diffusion, synthesis, mediation and marketing. Drawing on reports of empirical work, we preferred to maintain a greater level of granularity in our summary of the roles that MLMs who are also clinical or nursing service providers might play in a Kenyan hospital setting. We also highlight that these roles allow influence and information flow to be bidirectional and that at times MLMs may be aligned with and act with either senior managers or front-line workers. Given their apparent pivotal role and the radical changes needed within low-income country health systems, it is perhaps surprising that MLMs have been so ignored in these settings.
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Perceived unfairness in working conditions: The case of public health services in Tanzania

Perceived unfairness in working conditions: The case of public health services in Tanzania

Health workers in the public sector in Tanzania have experienced a considerable salary increase in recent years. In November 2005, junior medical doctors at Muhimbili National Hospital, Dar es Salaam, Tanzania went on strike over salary [34]. The strike was successful as it initiated a process of substantial salary increases for all health workers in Tanzania. Calculations based on government circulars on health worker salaries show a combined salary increase for junior medical doctors of more than 220% in the period from 2005 to 2008 (based on calculations for the Financial Year 2005-2006 and the Financial Year 2008-2009). The salaries of AMOs, COs and nursing staff were increased by 122-178% dur- ing the same period, with the highest salary increase for the lowest categories within each cadre [[32]:177-183, [35,36]]. Annual salary increases have been much higher than annual inflation in Tanzania [[37]:8]. In the Finan- cial Year 2008-2009 the gross monthly starting salary of a Nurse II (the lowest category in the nursing cadre) was TSH 315,750, while the AMO salary started at TSH 435,750. Nursing staff, COs and AMOs are able to attain double the starting salary through long working experience and promotion. For example, a Nurse II could receive a salary increase of at least 28% if pro- moted to the next level of Nurse I [36]. Similar substan- tial salary increases could also apply through promotion for other cadres.
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Needs-based planning for the oral health workforce - development and application of a simulation model

Needs-based planning for the oral health workforce - development and application of a simulation model

at all [37, 38]. In a European context, it is reported that while Greece has the highest dentist to population ratio of EU countries, far above the EU average, oral health- care remains expensive and unavailable to many citizens. Furthermore, the study highlights that simply using a dentist to population ratio as a measure to plan and allo- cate the dental workforce will result in oral health needs remaining unmet [39]. The situation in Greece high- lights the complexities associated with the provision of integrated health services and workforce planning in try- ing to balance publicly and privately provided oral healthcare to ensure the oral health needs of the popula- tion are comprehensively served. A recent synthesis of analyses of workforce requirements in high-income OECD countries highlighted that there is evidence of in- consistent use of key workforce planning terminology, not least in terms of using ‘need’ , ‘demand’ and ‘utilisa- tion’ interchangeably which in turn affected the choice of method and quality of output in some studies [40]. Undoubtedly, there are challenges associated with plan- ning human resources for health with differing schools of thought regarding the best approach to adopt. Efforts to date across the health sector have not demonstrated that they are fit for purpose or achieving the aim of ‘hav- ing the right people in the right place at the right time to treat the right people ’ [1]. This failure to effectively develop and implement workforce planning across the health sector has associated risks which are not insignifi- cant, including lives at risk, increases in morbidity, inef- fective allocation of health service roles and inefficient allocation of public funds.
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What topics should we teach the parents of admitted neonates in the newborn care unit in the resource-limited setting - a Delphi study

What topics should we teach the parents of admitted neonates in the newborn care unit in the resource-limited setting - a Delphi study

CHUK: University Teaching Hospital of Kigali; FICare: Family Integrated Care; HCPs: Health Care Professionals; HRH: Human Resources for Health; KMC: Kangaroo Mother Care; LBW: Low Birthw[r]

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Psychological wellbeing in a resource-limited work environment: examining levels and determinants among health workers in rural Malawi

Psychological wellbeing in a resource-limited work environment: examining levels and determinants among health workers in rural Malawi

Psychological wellbeing of health workers was measured using the WHO-5 Wellbeing Index (abbreviated as “WHO-5” in the following), a short, disease-unspecific, and non-invasive self-rating scale [35, 36] (see Table 2). The WHO-5 has been translated into over 30 languages and used vastly in a wide range of fields of application, although with health workers in a LLMIC only in the study in Zimbabwe mentioned earlier, where it was not validated [22]. Despite this lack of context-specific valid- ation studies, we have no reason for serious doubts in its cross-cultural validity due to the straightforward lan- guage and item wording which does not appear to be particularly sensitive to cultural norms [36]. Both Cron- bach’s α (.72) and factor analysis results (Loevinger H = .380, p = 0.000) support the notion that the WHO-5 items measure a unidimensional wellbeing factor.
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Specialist training aspirations of junior doctors in Sierra Leone: a qualitative follow-up study

Specialist training aspirations of junior doctors in Sierra Leone: a qualitative follow-up study

Female junior participants desired medical over surgery related specialties (as defined by the WAPMC). Comparable results were found in relevant studies from SSA [28, 32] and high-income settings [33, 34]. The anticipated amount of standing involved in surgery was why female doctors in this study were deterred from becoming a surgeon. A similar reason was given by female doctors from Zimbabwe; the na- ture of surgical work was perceived as too demanding [32]. Other than one female doctor considering time with family as reason to pursue a public health focused career and two preferring to stay in Sierra Leone for PGME to be close to their children, no obvious gender differences were found in this study.
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Can we halt health workforce deterioration in failed states? Insights from Guinea-Bissau on the nature, persistence and evolution of its HRH crisis

Can we halt health workforce deterioration in failed states? Insights from Guinea-Bissau on the nature, persistence and evolution of its HRH crisis

International aid in the health field has changed con- siderably in direction and intensity over the years, first inspired by geopolitical motives in the years following independence, and more recently motivated to a large extent by global security and drug smuggling control concerns [19]. The development of the national health workforce has been swayed by the Portuguese former colonial power offering refuge to professionals during the two diaspora waves, as well as by the ideologies and technical expertise of those former communist bloc countries—particularly Cuba—offering opportunities for training abroad first, and then creating capacity for training physicians locally. Far from remaining a do- mestic process, HRH development has been affected by multiple international forces. This crucial aspect, regularly missed by traditional policy and planning approaches, is becoming the norm in an increasingly globalised world, particularly in small countries with open borders [44].
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