Human resources for health
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“Health systems can only function with health workers; improving health service coverage and realizing the right to the enjoyment of the highest attainable standard of health is dependent on their availability, accessibility, acceptability and quality”. i
Many countries face difficulties in the education, deployment, retention, and performance of their health workforce. Health priorities aiming for universal health coverage (UHC) will remain aspirational unless accompanied by strategies aiming to strengthen health workforces. A knowledgeable, skilled and motivated health workforce is critical for reaching national goals. Strengthening human resources is, therefore, a fundamental part of the effort to build resilient and sustainable systems for health.
UNDP works closely with WHO to build national capacity to aim for: sufficient staffing and skill levels; adequate structures, roles and responsibilities; plans for addressing human resource gaps; and effective staff retention and staff development strategies.
- Strengthening capacity for effective policy-making governing human resources.
- Strengthening workforce planning for both the short and long-term, through support to developing retention strategies and human resources for health strategies.
- Increasing the supply and competencies of human resources through education and training in multiple areas such as programme implementation, monitoring and evaluation and finance.
- Improving motivation and retention through monetary or non-monetary incentives, such as staff development programmes, for example enabling staff within national procurement agencies to be certified by the Chartered Institute of Procurement and Supply in both Sudan and Zimbabwe.
- Strengthen communications, leadership, and mentoring, through leadership programmes for ministry of health staff in both Zambia and Zimbabwe.
UNDP in Afghanistan
As part of its capacity development in challenging operating environments, UNDP has supported the participatory development of capacity development plans for both the Ministry of Public Health and civil society groups in Afghanistan.
UNDP has worked with the Afghan Ministry of Public Health and the Global Fund to set up six nursing schools training female nurses. According to WHO, around 40% of health facilities in Afghanistan are without female staff, a significant problem in a country where community norms often mean that women are not allowed to receive care from men unless accompanied by a male family member. To date, this programme has trained more than 200 female nurses.
The civil society groups are small and have difficulties recruiting and retaining staff in a demanding environment. UNDP has supported the groups in developing a human resources manual to begin the process of improving staff development and retention. It will also be working with the Ministry of Public Health in carrying out a functional analysis to review what skills and positions are required to achieve the ambitious health goals in Afghanistan.
UNDP in Sudan and Zimbabwe
UNDP has supported staff within national procurement agencies both in Sudan and Zimbabwe to gain international accredited qualifications to support their personal staff development, and to lead to better procurement practises and systems. The CIPS accreditation is available at different levels, which allows staff to gain higher level qualifications as their careers progress. Staff development programmes like these act as non-financial incentives to reduce staff turnover and increase retention—crucial for building national capacity.
Coverage versus quality
The health sector is not only labour-intensive, but it also depends on a precise application of the knowledge and skills of its workforce to ensure patient security and health. The mere availability of health workers is not sufficient; only when they are evenly distributed and accessible to the population, when they possess the required competencies, are motivated and empowered to deliver quality care, and when they are adequately supported by the health system, does this translate into effective service coverage.
Human resource for health strategies
Many countries have a high turnover of skilled health personnel in the form of migration to more developed countries offering better remuneration, better working conditions, opportunities for postgraduate education and training and better standards of living.
The challenge is to produce the required number of key health workers and ensure that they remain motivated to stay. Ad hoc interventions consistently fail to correct workforce imbalances in health care. It takes years to educate and train health professionals, thus a long-term approach needs to be taken. Human resource decisions have long-lasting effects and are often difficult to reverse. This means that, rather than respond reactively, a strategic approach is needed which supports the development of a more resilient health system.
Countries in, or emerging from, armed conflict or natural or man-made disasters present specific health workforce challenges that should be taken into account.
HRH strategy development
A national human resources for health policy is a guide for action for health personnel. The policy describes the priorities that a country wants to achieve in the area of HRH as it responds to implementation of health priorities. It also identifies the main strategies for attaining those priorities, in the short-term, medium-term and long-term. The goals of the HRH policy should be consistent with the broader national health objectives.
The main objective of an HRH policy is to ensure availability of health workers in sufficient quantity and quality, at all levels, at the right place at the right time, and well-motivated to perform their functions.
An HRH strategic plan tries to elaborate on what the policy will achieve and how it will be implemented. The plan contains information on the situation analysis, the issues, the objectives and the strategies to solve the identified challenges.
The plan specifies and sets targets with expected results and makes proposals for financing the implementation. A good strategic plan also indicates what to observe to assess whether it is being implemented according to plan and provides the flexibility for amendment, review or adjustment. WHO offers guidance and tools to support planning.
Human versus physical resources
The health workforce includes those that provide direct health services such as doctors, nurses, etc. and those that support the health services such as hospital managers, provincial and district managers, accountants reporting on health budgets and others.
Skilled health workers are unable to deliver services effectively without appropriate support personnel (accountants, IT support officers, etc.) as well as physical capital such as adequate facilities, equipment and consumables such as medicines. Thus, health systems and the supporting HRH strategies need to balance these three vital demands—human resources, physical capital and consumables.
Making good use of information and communications technology (ICT) is one way to improve impact in HRH. ICT investments can focus on software and systems to contribute to issues such as workforce planning, professional development and improving the working environment.
ICT can support: the analysis of where health workers are most required; the development of e-learning modules to motivate and improve on-the-job learning; electronic health records improving links between health workers and patients; improving morale, payroll management; and performance management.
The Global Fund recognizes HRH as one of the key elements to creating resilient and sustainable health systems and that it can be a critical bottleneck to the scale-up and delivery of high quality health services.
Most countries supported by the Global Fund face human resources challenges, including shortages and poor distribution, high turnover, inadequate skills, poor working conditions and a lack of appropriate health workforce information. In addition, human resources manage and make decisions about the use of all the other inputs to the health system. HRH are, therefore, a fundamental part of the effort to achieve the health-related sustainable development goals and to build resilient and sustainable systems for health.
The Global Fund prioritizes HRH investments in funding applications if health workforce challenges represent a barrier to the availability, accessibility, acceptability or quality of services, especially in countries with high disease burden and low economic status.
Suggested capacity development indicators
- human resource strategy in place
- staff development plan exists
- % of health staff with appropriate certification levels
- % staff turnover per year
- number of senior staff at primary health care facilities who received in-service training (using nationally approved curriculum) in the past 12 months