Top

Published in:

Open Access 01-12-2018 | Commentary

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

Authors: A.S. George, J. Campbell, A. Ghaffar, HPSR HRH reader collaborators

Published in: Human Resources for Health | Issue 1/2018

Abstract

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.

World Health Organization. Working for Health and Growth: Investing in the Health Workforce. High-Level Commission on Health Employment and Economic Growth. Geneva: WHO; 2016.

World Health Organization. Global Strategy on Human Resources for Health Workforce 2030. Draft for the 69th World Health Assembly. Geneva: WHO; 2016.

Joint Learning Initiative. Human Resources for Health: Overcoming the Crisis. Cambridge: Harvard University Press; 2004.

World Health Organization. World Health Report: Working Together for Health. Geneva: WHO; 2006.

George A, Scott K, Govender V, editors. A Health Policy and Systems Research Reader on Human Resources for Health. Geneva: WHO; 2017.

Sheikh K, George AS, Gilson L. People-centred science: strengthening the practice of health policy and systems research. Health Res Policy Syst. 2014;12:19.CrossRefPubMedPubMedCentral

Gilson L, Hanson K, Sheikh K, Agyepong IA, Ssengooba F, Bennett S. Building the field of health policy and systems research: social science matters. PLoS Med. 2011;8:e1001079. https://doi.org/10.1371/journal.pmed.1001079.CrossRefPubMedPubMedCentral

Rao KD, Bhatnagar A, Berman P. So many, yet few: human resources for health in India. Hum Resour Health. 2012;10:19.CrossRefPubMedPubMedCentral

Ahmed SM, Hossain MA, RajaChowdhury AM, Bhuiya AU. The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution. Hum Resour Health. 2011;9:3.CrossRefPubMedPubMedCentral

10.

Arah OA. The metrics and correlates of physician migration from Africa. BMC Public Health. 2007;7:83. https://doi.org/10.1186/1471-2458-7-83.CrossRefPubMedPubMedCentral

11.

Newman CJ, de Vries DH, d’Arc Kanakuze J, Ngendahimana G. Workplace violence and gender discrimination in Rwanda’s health workforce: increasing safety and gender equality. Hum Resour Health. 2011;9:19.CrossRefPubMedPubMedCentral

12.

Maini R, Hotchkiss DR, Borghi J. A cross-sectional study of the income sources of primary care health workers in the Democratic Republic of Congo. Hum Resour Health. 2017;15:17. https://doi.org/10.1186/s12960-017-0185-4.CrossRefPubMedPubMedCentral

13.

Tavrow P, Kim Y, Malianga L. Measuring the quality of supervisor – provider interactions in health care facilities in Zimbabwe. Int J Qual Health Care. 2002;14:57–66.CrossRefPubMed

14.

Rocha FLR, Marziale MHP, De Carvalho MC, Cardeal Id SDF, De Campos MCT. The organizational culture of a Brazilian public hospital. Rev da Esc Enferm. 2014;48:308–14. https://doi.org/10.1590/S0080-623420140000200016.CrossRef

15.

Vujicic M, Shengelia B, Alfano M, Thu HB. Physician shortages in rural Vietnam: using a labor market approach to inform policy. Soc Sci Med. 2011;73:2034–70. https://doi.org/10.1016/j.socscimed.2011.06.010.CrossRef

16.

Bhatnagar A. Health worker motivation: individual, organizational and cultural factors. In: George A, Scott K, Govender V, editors. A Health Policy and Systems Research Reader on Human Resources for Health. Geneva: WHO; 2017.

17.

Smith R, Lagarde M, Blaauw D, Goodman C, English M, Mullei K, et al. Appealing to altruism: an alternative strategy to address the health workforce crisis in developing countries? J Public Health. 2013;35:164–70.CrossRef

18.

Aberese-Ako M, Van Dijk H, Gerrits T, Arhinful DK, Agyepong IA. Your health our concern, our health whose concern?’: Perceptions of injustice in organizational relationships and processes and frontline health worker motivation in Ghana. Health Policy Plan. 2014;29:ii15–28.CrossRefPubMedPubMedCentral

19.

McPake B, Russo G, Tseng FM. How do dual practitioners divide their time? The cases of three African capital cities. Soc Sci Med. 2014;122:113–21. https://doi.org/10.1016/j.socscimed.2014.10.040.CrossRefPubMed

20.

Humphries N, McAleese S, Matthews A, Brugha R. “Emigration is a matter of self-preservation. The working conditions... are killing us slowly”: qualitative insights into health professional emigration from Ireland. Hum Resour Health. 2015;13:35. https://doi.org/10.1186/s12960-015-0022-6.CrossRefPubMedPubMedCentral

21.

Topp SM. Health worker performance, practice and improvement. In: George A, Scott K, Govender V, editors. A Health Policy and Systems Research Reader on Human Resources for Health. Geneva: WHO; 2017.

22.

Gilson L, Palmer N, Schneider H. Trust and health worker performance: exploring a conceptual framework using South African evidence. Soc Sci Med. 2005;61(7):1418–29.CrossRefPubMed

23.

Jewkes R, Abrahams N, Mvo Z. Why do nurses abuse patients? Reflections from south African obstetric services. Soc Sci Med. 1998;47:1781–95.CrossRefPubMed

24.

Kwamie A, Bhatnagar A, Lehmann U. Leadership, management and organizational cultures. In: George A, Scott K, Govender V, editors. A Health Policy and Systems Research Reader on Human Resources for Health. Geneva: WHO; 2017.

25.

Hahonou EK. Juggling with the norms: informal payment and everyday governance in healthcare facilities Niger. In: De Herdt T, Olivier de Sardan J-P, editors. Real Governance and Practical Norms in Sub-Saharan Africathe Game of the Rules. London and New York: Routledge; 2015. p. 123–40.

26.

Choi SL, Goh CF, Adam MBH, Tan OK. Transformational leadership, empowerment, and job satisfaction: the mediating role of employee empowerment. Hum Resour Health. 2016;14:73.CrossRefPubMedPubMedCentral

27.

Huicho L, Molina C, Diez-Canseco F, Lema C, Miranda JJ, Huayanay-Espinoza CA, et al. Factors behind job preferences of Peruvian medical, nursing and midwifery students: a qualitative study focused on rural deployment. Hum Resour Health. 2015;13:90. https://doi.org/10.1186/s12960-015-0091-6.CrossRefPubMedPubMedCentral

28.

Kwamie A, Agyepong IA, van Dijk H. What Governs District manager decision making? A case study of complex leadership in Dangme West District, Ghana. Health Syst Reform. 2015;1:167–77. https://doi.org/10.1080/23288604.2015.1032475.CrossRef

29.

Prashanth N, Roberton T. Building health worker capacity through training and supervision. In: George A, Scott K, Govender V, editors. A Health Policy and Systems Research Reader on Human Resources for Health. Geneva: WHO; 2017.

30.

Gladwin J, Dixon RA, Wilson TD. Rejection of an innovation: health information management training materials in East Africa. Health Policy Plan. 2002;17:354–61. https://doi.org/10.1093/heapol/17.4.354.CrossRefPubMed

31.

Prashanth NS, Marchal B, Devadasan N, Kegels G, Criel B. Advancing the application of systems thinking in health: a realist evaluation of a capacity building programme for district managers in Tumkur, India. Health Res Policy Syst. 2014;12:42. https://doi.org/10.1186/1478-4505-12-42.CrossRefPubMedPubMedCentral

32.

Bradley S, Kamwendo F, Masanja H, de Pinho H, Waxman R, Boostrom C, et al. District health managers’ perceptions of supervision in Malawi and Tanzania. Hum Resour Health. 2013;11:43. https://doi.org/10.1186/1478-4491-11-43.CrossRefPubMedPubMedCentral

33.

Purohit B, Maneskar A, Saxena D. Developing a tool to assess motivation among health service providers working with public health system in India. Hum Resour Health. 2016;14:15. https://doi.org/10.1186/s12960-016-0111-1.CrossRefPubMedPubMedCentral

34.

Witter S, Zulfiqur T, Javeed S, Khan A, Bari A. Paying health workers for performance in Battagram district, Pakistan. Hum Resour Health. 2011;9:1–12.CrossRef

35.

Loewenson R, Laurell AC, Hogstedt C, D’Ambruoso L, Shroff Z. Participatory Action Reserach in Health Systems: A Methods Reader. TARSC, AHPSR, WHO, IDRC Canada. Harare: EQUINET; 2014.

36.

Lehmann U, Gilson L. Action learning for health system governance: the reward and challenge of co-production. Health Policy Plan. 2015;30:957–63. https://doi.org/10.1093/heapol/czu097 CrossRefPubMed

37.

Nyikuri M, Tsofa B, Barasa E, Okoth P, Molyneux S. Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan coast. PLoS One. 2015;10:1–18.CrossRef

38.

Namakula J, Witter S. Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centred health systems. Health Policy Plan. 2014;29:ii6–ii14.CrossRefPubMedPubMedCentral

39.

Hernández AR, Hurtig A-K, Dahlblom K, San Sebastián M. Integrating views on support for mid-level health worker performance: a concept mapping study with regional health system actors in rural Guatemala. Int J Equity Health. 2015;14:91. https://doi.org/10.1186/s12939-015-0225-4.CrossRefPubMedPubMedCentral

40.

Ruck NF, Darwish OA. Motivating health workers through nutrition training: an example from Egypt. Health Policy Plan. 1991;6:130–40.CrossRef

41.

Onyango-Ouma W, Laisser R, Mbilima M, Araoye M, Pittman P, Agyepong I, et al. An evaluation of health workers for Change in seven settings: a useful management and health system development tool. Health Policy Plan. 2001;16(Suppl 1):24–32.CrossRefPubMed

42.

Bradley JE, Mayfield MV, Mehta MP, Rukonge A. Participatory evaluation of reproductive health care quality in developing countries. Soc Sci Med. 2002;55:269–82. https://doi.org/10.1016/S0277-9536(01)00170-8.CrossRefPubMed

43.

Jayasuriya R, Jayasinghe UW, Wang Q. Health worker performance in rural health organizations in low- and middle-income countries: do organizational factors predict non-task performance? Soc Sci Med. 2014;113:1–4. https://doi.org/10.1016/j.socscimed.2014.04.042.CrossRefPubMed

44.

Leonard KL, Masatu MC. Professionalism and the know-do gap: exploring intrinsic motivation among health workers in Tanzania. Health Econ. 2010;19:1461–77.CrossRefPubMed

45.

Frimpong JA, Helleringer S, Awoonor-Williams JK, Yeji F, Phillips JF. Does supervision improve health worker productivity? Evidence from the upper east region of Ghana. Trop Med Int Health. 2011;16:1225–33.CrossRefPubMed

46.

Rowe AK, Onikpo F, Lama M, Osterholt DM, Rowe SY, Deming MS. A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin. Am J Public Health. 2009;99:837–46.CrossRefPubMedPubMedCentral

47.

Shen GC, Nguyen HTH, Das A, Sachingongu N, Chansa C, Qamruddin J, et al. Incentives to change: effects of performance-based financing on health workers in Zambia. Hum Resour Health. 2017;15:20. https://doi.org/10.1186/s12960-017-0179-2.CrossRefPubMedPubMedCentral

48.

Brugha R, Kadzandira J, Simbaya J, Dicker P, Mwapasa V, Walsh A. Health workforce responses to global health initiatives funding: a comparison of Malawi and Zambia. Hum Resour Health. 2010;8:19. https://doi.org/10.1186/1478-4491-8-19.CrossRefPubMedPubMedCentral

49.

Crettenden IF, McCarty MV, Fenech BJ, Heywood T, Taitz MC, Tudman S. How evidence-based workforce planning in Australia is informing policy development in the retention and distribution of the health workforce. Hum Resour Health. 2014;12:7.CrossRefPubMedPubMedCentral

50.

Jansen C, Codjia L, Cometto G, Yansané ML, Dieleman M. Realizing universal health coverage for maternal health services in the Republic of Guinea: the use of workforce projections to design health labor market interventions. Risk Manag Healthc Policy. 2014;7:219–32.CrossRefPubMedPubMedCentral

51.

Lagarde M, Blaauw D, Cairns J. Cost-effectiveness analysis of human resources policy interventions to address the shortage of nurses in rural South Africa. Soc Sci Med. 2012;75:801–6. https://doi.org/10.1016/j.socscimed.2012.05.005.CrossRefPubMed

52.

Mandeville KL, Hanson K, Muula AS, Dzowela T, Ulaya G, Lagarde M. Specialty training for the retention of Malawian doctors: a cost-effectiveness analysis. Soc Sci Med. 2017;194:87–95.CrossRefPubMedPubMedCentral

53.

McPake B, Edoka I, Witter S, Kielmann K, Taegtmeyer M, Dieleman M, et al. Cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya. Bull World Health Organ. 2015;93:631–639A. https://doi.org/10.2471/BLT.14.144899.CrossRefPubMedPubMedCentral

54.

Razee H, Whittaker M, Jayasuriya R, Yap L, Brentnall L. Listening to the rural health workers in Papua New Guinea - the social factors that influence their motivation to work. Soc Sci Med. 2012;75:828–35. https://doi.org/10.1016/j.socscimed.2012.04.013.CrossRefPubMed

55.

El-Jardali F, Hammoud R, Younan L, Nuwayhid HS, Abdallah N, Alameddine M, et al. The making of nursing practice law in Lebanon: a policy analysis case study. Health Res Policy Syst. 2014;12:52. https://doi.org/10.1186/1478-4505-12-52.CrossRefPubMedPubMedCentral

56.

George AS, Paina L, Scott K, Abimbola S. Social contexts and relations shaping health worker profiles. In: George AS, Scott K, Govender V, editors. A health policy and systems reader on human resources for health. Geneva: WHO; 2017. p. 43–57.

57.

Mandeville KL, Lagarde M, Hanson K. The use of discrete choice experiments to inform health workforce policy: a systematic review. BMC Health Serv Res. 2014;14:367. https://doi.org/10.1186/1472-6963-14-367.CrossRefPubMedPubMedCentral

58.

Chandler CIR, Chonya S, Mtei F, Reyburn H, Whitty CJM. Motivation, money and respect: a mixed-method study of Tanzanian non-physician clinicians. Soc Sci Med. 2009;68:2078–88. https://doi.org/10.1016/j.socscimed.2009.03.007.CrossRefPubMed

59.

Maes KC, Shifferaw S, Hadley C, Tesfaye F. Volunteer home-based HIV/AIDS care and food crisis in Addis Ababa, Ethiopia: sustainability in the face of chronic food insecurity. Health Policy Plan. 2011;26:43–52.CrossRefPubMed

60.

Martineau T, Mirzoev T, Pearson S, Ha BTT, Xu Q, Ramani KV, et al. Coherence between health policy and human resource strategy: lessons from maternal health in Vietnam, India and China. Health Policy Plan. 2015;30:111–20.CrossRefPubMed

61.

Nigenda G, Solorzano A. Doctors and corporatist politics: the case of the Mexican medical profession. J Health Polit Policy Law. 1997;22:73–99.CrossRefPubMed

62.

Hurley EA, Warren NE, Doumbia S, Winch PJ. Exploring the connectedness of rural auxiliary midwives to social networks in Koutiala, Mali. Midwifery. 2014;30:123–9. https://doi.org/10.1016/j.midw.2013.03.002.CrossRefPubMed

63.

El-Jardali F, Alameddine M, Jamal D, Dimassi H, Dumit NY, McEwen MK, et al. A national study on nurses’ retention in healthcare facilities in underserved areas in Lebanon. Hum Resour Health. 2013;11:49. https://doi.org/10.1186/1478-4491-11-49.CrossRefPubMedPubMedCentral

64.

Scott K, George AS. Health worker profiles: boundaries, metrics, and modelling. In: George A, Scott K, Govender V, editors. A Health Policy and Systems Reader on Human Resources for Health. Geneva: WHO; 2017. p. 31–42.

65.

Newman C. Time to address gender discrimination and inequality in the health workforce. Hum Resour Health. 2014;12:25.CrossRefPubMedPubMedCentral

66.

George A. Nurses, community health workers, and home carers: gendered human resources compensating for skewed health systems. Glob Public Health. 2008;3(Suppl 1):75–89.CrossRefPubMed

67.

Bedford K. Care and the 53rd commission on the status of women: a transformative policy space? Reprod Health Matters. 2011;19:197–207. https://doi.org/10.1016/S0968-8080(11)38576-X.CrossRefPubMed

68.

Kuhlmann E, Ovseiko PV, Kurmeyer C, Gutiérrez-Lobos K, Steinböck S, von Knorring M, et al. Closing the gender leadership gap: a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union. Hum Resour Health. 2017;15:2. https://doi.org/10.1186/s12960-016-0175-y.CrossRefPubMedPubMedCentral

69.

Bertone MP, Samai M, Edem-Hotah J, Witter S. A window of opportunity for reform in post-conflict settings? The case of human resources for health policies in Sierra Leone, 2002–2012. Confl Health. 2014;8:11. https://doi.org/10.1186/1752-1505-8-11.CrossRefPubMedPubMedCentral

70.

Sriram V. Brokering policies and politics for human resources for health. In: George A, Scott K, Govender V, editors. A health policy and systems research reader on human resources for health. Geneva: WHO; 2017. p. 115–27.

Title: Advancing the science behind human resources for health: highlights from the Health Policy and Systems Research Reader on Human Resources for Health
Authors: A.S. George
J. Campbell
A. Ghaffar
HPSR HRH reader collaborators
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Human Resources for Health / Issue 1/2018
Electronic ISSN: 1478-4491
DOI: https://doi.org/10.1186/s12960-018-0302-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2018

Willingness to migrate—a potential effect of burnout? A survey of Hungarian physicians

The effect of human resource management on performance in hospitals in Sub-Saharan Africa: a systematic literature review

Time motion study using mixed methods to assess service delivery by frontline health workers from South India: methods

The use of low-cost Android tablets to train community health workers in Mukono, Uganda, in the recognition, treatment and prevention of pneumonia in children under five: a pilot randomised controlled trial

Cost-effectiveness of the treatment of uncomplicated severe acute malnutrition by community health workers compared to treatment provided at an outpatient facility in rural Mali

Understanding HRH recruitment in post-conflict settings: an analysis of central-level policies and processes in Timor-Leste (1999–2018)