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The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9

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Author: search.filters.author.Cometto, G.

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    Implementing the Agenda for Global Action on human resources for health: analysis from an international tracking survey
    (Sciedu Press, 2013-02) Witter, Sophie; Cometto, G.; Zaman, R.; Sheikh, M.; Wibulpolprasert, S.
    Objective: A survey was conducted to analyse the governance and policy environment for human resources for health (HRH) development in 57 priority countries, with the objective of understanding the linkages between policy and context factors. Methods: Responses to a questionnaire tracking proxy indicators were received from 51 (89%) countries. Findings are presented by frequency; correlations were investigated through cross tabulations and multiple regression analysis. Results: The results indicate uneven performance among countries and across different domains of health workforce development. The only indicator showing a significant correlation with other areas of performance was implementing an HRH plan. No significant correlation with contextual factors was found. Discussion: Progress in addressing HRH challenges appears to be independent of contextual factors, suggesting that countries can improve their performance through concerted action by stakeholders. Having and implementing an HRH plan appears to be a key factor in galvanising that action.
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    Removing user fees: Learning from international experience to support the process
    (Oxford University Press, 2011-11) McPake, Barbara; Brikci, N.; Cometto, G.; Schmidt, A.; Araujo, Edson
    Removing user fees could improve service coverage and access, in particular among the poorest socio-economic groups, but quick action without prior preparation could lead to unintended effects, including quality deterioration and excessive demands on health workers. This paper illustrates the process needed to make a realistic forecast of the possible resource implications of a well-implemented user fee removal programme and proposes six steps for a successful policy change: (1) analysis of a country's initial position (including user fee level, effectiveness of exemption systems and impact of fee revenues at facility level); (2) estimation of the impact of user fee removal on service utilization; (3) estimation of the additional requirements for human resources, drugs and other inputs, and corresponding financial requirements; (4) mobilization of additional resources (both domestic and external) and development of locally-tailored strategies to compensate for the revenue gap and costs associated with increased utilization; (5) building political commitment for the policy reform; (6) communicating the policy change to all stakeholders. The authors conclude that countries that intend to remove user fees can maximize benefits and avoid potential pitfalls through the utilization of the approach and tools described.
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    Mid-level health providers: A promising resource
    (Instituto Nacional de Salud, 2011) Brown, A.; Cometto, G.; Cumbi, A.; de Pinho, H.; Kamwendo, F.; Lehmann, U.; McCourt, W.; McPake, Barbara; Pariyo, G.; Sanders, D.
    Mid-level health providers (MLP) are health workers trained at a higher education institution for at least a total of 2-3 years, and authorized and regulated to work autonomously to diagnose, manage and treat illness, disease and impairments, as well as engage in preventive and promotive care. Their role has been progressively expanding and receiving attention, in particular in low- and middle-income countries, as a strategy to overcome health workforce challenges and improve access to essential health services and achieve the health related targets of the Millennium Development Goals. Evidence, although limited and imperfect, shows that, where MLP are adequately trained, supported and integrated coherently in the health system, they have the potential to improve distribution of health workers and enhance equitable access to health services, while retaining quality standards comparable to, if not exceeding, those of services provided by physicians. Significant challenges however exist in terms of the marginalization and more limited management support of MLP in health systems. The expansion of MLP should have priority among the policy options considered by countries facing shortage and maldistribution challenges. Improved education, supervision, management and regulation practices and integration in the health system have the potential to maximize the benefits from the use of these cadres.