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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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Subject: search.filters.subject.Human Resources for Health

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    Understanding HRH recruitment in post-conflict settings: an analysis of central-level policies and processes in Timor-Leste (1999–2018)
    (BioMed Central, 2018-11-29) Bertone, Maria Paola; Martins, Joao S.; Pereira, Sara M.; Martineau, Tim; Alonso-Garbayo, Alvaro
    Background - Although human resources for health (HRH) represent a critical element for health systems, many countries still face acute HRH challenges. These challenges are compounded in conflict-affected settings where health needs are exacerbated and the health workforce is often decimated. A body of research has explored the issues of recruitment of health workers, but the literature is still scarce, in particular with reference to conflict-affected states. This study adds to that literature by exploring, from a central-level perspective, how the HRH recruitment policies changed in Timor-Leste (1999–2018), the drivers of change and their contribution to rebuilding an appropriate health workforce after conflict. Methods - This research adopts a retrospective, qualitative case study design based on 76 documents and 20 key informant interviews, covering a period of almost 20 years. Policy analysis, with elements of political economy analysis was conducted to explore the influence of actors and structural elements. Results - Our findings describe the main phases of HRH policy-making during the post-conflict period and explore how the main drivers of this trajectory shaped policy-making processes and outcomes. While initially the influence of international actors was prominent, the number and relevance of national actors, and resulting influence, later increased as aid dependency diminished. However, this created a fragmented institutional landscape with diverging agendas and lack of inter-sectoral coordination, to the detriment of the long-term strategic development of the health workforce and the health sector. Conclusions - The study provides critical insights to improve understanding of HRH policy development and effective practices in a post-conflict setting but also looking at the longer term evolution. An issue that emerges across the HRH policy-making phases is the difficulty of reconciling the technocratic with the social, cultural and political concerns. Additionally, while this study illuminates processes and dynamics at central level, further research is needed from the decentralised perspective on aspects, such as deployment, motivation and career paths, which are under-regulated at central level.
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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
    (BioMed Central, 2018-08-14) George, A. S.; Campbell, J.; Ghaffar, A.; HPSR HRH reader collaborators
    Health workers are central to people-centred health systems, resilient economies and sustainable development. Given the rising importance of the health workforce, changing human resource for health (HRH) policy and practice and recent health policy and systems research (HPSR) advances, it is critical to reassess and reinvigorate the science behind HRH as part of health systems strengthening and social development more broadly. Building on the recently published Health Policy and Systems Research Reader on Human Resources for Health (the Reader), this commentary reflects on the added value of HPSR underpinning HRH. HPSR does so by strengthening the multi-disciplinary base and rigour of HRH research by (1) valuing diverse research inferences and (2) deepening research enquiry and quality. It also anchors the relevance of HRH research for HRH policy and practice by (3) broadening conceptual boundaries and (4) strengthening policy engagement. Most importantly, HPSR enables us to transform HRH from being faceless numbers or units of health producers to the heart and soul of health systems and vital change agents in our communities and societies. Health workers’ identities and motivation, daily routines and negotiations, and training and working environments are at the centre of successes and failures of health interventions, health system functioning and broader social development. Further, in an increasingly complex globalised economy, the expansion of the health sector as an arena for employment and the liberalisation of labour markets has contributed to the unprecedented movement of health workers, many or most of whom are women, not only between public and private health sectors, but also across borders. Yet, these political, human development and labour market realities are often set aside or elided altogether. Health workers’ lives and livelihoods, their contributions and commitments, and their individual and collective agency are ignored. The science of HRH, offering new discoveries and deeper understanding of how universal health coverage and the Sustainable Development Goals are dependent on millions of health workers globally, has the potential to overcome this outdated and ineffective orthodoxy.
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    Le défi de la fidélisation des personnels de santé dans les zones rurales: analyse des stratégies mises en œuvre dans sept pays d’Afrique francophone = The challenge of health workforce retention in rural areas: an analysis of the strategies implemented in seven countries of francophone Africa.
    (2017-09-25) Bertone, Maria Paola
    Objectifs: De nombreux pays font face à des défis en termes de nombre, de composition, de compétences et de distribution des ressources humaines pour la santé. Cet article décrit les interventions de fidélisation adoptées au cours de la dernière décennie dans sept pays d’Afrique francophone et les compare aux recommandations de l’OMS, en évaluant l’étendue de l’adoption des politiques reflétant ces recommandations. Méthodes: L’étude se base sur la comparaison d’études de cas, et a été articulée en deux phases. Premièrement, sept pays d’études ont été consultés pour faire une cartographie et une analyse préliminaire des interventions. Deuxièmement, une synthèse analytique a été préparée en comparant systématiquement les études de cas. Résultats: Les résultats indiquent que les politiques de fidélisation des ressources humaines envisagent rarement un « éventail » des interventions et que certaines des recommandations de l’OMS sont moins souvent adoptées que d’autres. L’analyse montre aussi l’existence d’efforts pour développer des stratégies (informelles) locales, alors que l’élaboration des politiques officielles demeure souvent un exercice standardisé, sans une véritable réflexion spécifique au contexte. En outre, il y a peu d’information sur la mise en œuvre et sur l’efficacité des politiques en place. Discussion et conclusion: L’étude souligne l’importance de la disponibilité des données, ainsi que des outils de suivi et d’évaluation, de même que de la création d’un environnement politique favorable à l’élaboration de stratégies réalistes et fondées sur l’identification des besoins. En effet, les « bonnes pratiques » sont souvent le résultat d’adaptations locales, plutôt que de l’adoption de lignes directrices standardisées. Pour être efficaces, les recommandations internationales doivent être complétées par des connaissances construites et appropriées localement. Objectives: Many countries face challenges in terms of number, skill mix, quality and distribution of the health workforce. This paper provides an overview of interventions focusing on retention adopted over the last decade in seven countries of francophone Africa. We assessed these interventions with respect to WHO guidelines and evaluated the extent of application of these recommended policies. Methods: This study was conducted according to a comparative multiple case-study design and comprised two phases. First, seven country reports were consulted to provide a mapping and preliminary analysis of the interventions. Secondly, an analytic synthesis was prepared by systematically and deliberately comparing and contrasting country cases in order to draw higher-level conclusions. Results: This comparative analysis indicated that some WHO guidelines are introduced less often than others and HRH retention policies are rarely envisaged within coherent 'bundles' of interventions. This analysis identifies the efforts to develop local (informal) strategies tailored to the context, while official policy-making often remains a standardized exercise, which does not take context-specific features into account. Moreover, little information is available on the implementation and effectiveness of existing policies. Discussion and conclusions: The study stresses the importance of two key issues for the design of effective policies: the availability of sound data, as well as monitoring and evaluation structures, and the creation of a supportive and coherent political environment, focused on country-driven, realistic policy-making based on contextual problem identification and actual needs. This paper also suggests that good practices are often the result of local adaptations, rather than the close adoption of standardized guidelines. Therefore, in order to be effective, international guidelines must be complemented by locally acquired and fully appropriated knowledge.