Strategic management of the health workforce in developing countries: what have we learned?

Abstract

The 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.

Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan

“…This study has identified and prioritized these factors under similar parameters of suitability of their implementation with possible revision of the HRH policies in Pakistan (Table 2). While other studies have generally focused on organizational context and physicians' individual attributes, 13,14 this study explored beyond this paradigm and identified the linkages between these and other attributes to develop a conceptual framework that would form basis for further research. In addition, the study also identified factors around organizational and external environment by focusing on the three tiers of the system namely, service providers (physicians), district level management and provincial and policy level participants.…”

“…These studies show that a set of financial and non-financial factors affect motivation of health staff at primary healthcare (PHC) facilities. Work compensation ensures professional survival and security of individuals 14 ; remuneration, appropriate with the relevant market, ensures staff retention in developing countries. 15 However, financial incentives are important for motivation of workforce but are not the only factor responsible for the lack of motivation.…”

Health Worker Performance

“…This chapter is not a comprehensive review of management of health workers in Africa. For that, see, for example, Fritzen (2007) and Egger and others (2005). Our perspective is more focused.…”

Nurses attitude and perceived factors that influence working in rural communities in Delta State, South-South Nigeria

“…It has in fact been reported that nurses value more hospital nursing practice than community health nursing. [6][7][8] Presently in Nigeria many nurses who accept postings to rural areas prefer to live in nearby urban centres and shuttle between the urban centres and the rural location of their professional assignment. This shuttling may affect their regularity, punctuality and commitment to work and consequently their work output.…”