Strategic management of the health workforce in developing countries: what have we learned?
Human Resources for Health 2007,
5:4doi:10.1186/1478-4491-5-4. Open Access article distributed under the terms of the Creative Commons Attribution License.
study of the health workforce has gained in prominence in recent years,
as the dynamic interconnections between human resource issues and
health system effectiveness have come into sharper focus. This paper
reviews lessons relating to strategic management challenges emerging
from the growing literature in this area. Workforce issues are
strategic: they affect overall system performance as well as the
feasibility and sustainability of health reforms. Viewing workforce
issues strategically forces health authorities to confront the yawning
gaps between policy and implementation in many developing countries.
Lessons emerge in four areas. One concerns imbalances in workforce
structure, whether from a functional specialization, geographical or
facility lens. These imbalances pose a strategic challenge in that
authorities must attempt to steer workforce distribution over time
using a limited range of policy tools. A second group of lessons
concerns the difficulties of central-level steering of the health
workforce, often critically weak due to the lack of proper information
systems and the complexities of public sector decentralization and
service commercialization trends affecting the grassroots.
A third cluster examines worker capacity and motivation, often
shaped in developing countries as much by the informal norms and
incentives as by formal attempts to support workers or to hold them
accountable. Finally, a range of reforms centering on service
contracting and improvements to human resource management are emerging.
Since these have as a necessary (but not sufficient) condition some
flexibility in personnel practices, recent trends towards the sharing
of such functions with local authorities are promising.
The paper identifies a number of current lines of productive
research, focusing on the relationship between health policy reforms
and the local institutional environments in which the workforce, both
public and private, is deployed.