A political economy analysis of human resources for health (HRH) in Africa

Abstract

BackgroundDespite a global recognition from all stakeholders of the gravity and urgency of health worker shortage in Africa, little progress has been achieved to improve health worker coverage in many of the African human resources for health (HRH) crisis countries. The problem consists in how policy is made, how leaders are accountable, how the World Health Organization (WHO) and foreign donors encourage (or distort) health policy, and how development objectives are prioritized in these countries.MethodsThis paper uses political economy analysis, which stems from a recognition that the solution to the shortage of health workers across Africa involves more than a technical response. A number of institutional arrangements dampen investments in HRH, including a mismatch between officials’ tenure in office and program results, the vertical nature of health programming, the modalities of Overseas Development Assistance (ODA) in health, the structures of the global health community, and the weak capacity in HRH units within Ministries of Health. A major change in policymaking would only occur with a disruption to the political or institutional order.Results/conclusionsThe case study of Ethiopia, who has increased its health workforce dramatically over the last 20 years, disrupted previous institutional arrangements through the power of ideas—HRH as a key intermediate development objective. The framing of HRH created the rationale for the political commitment to HRH investment. Ethiopia demonstrates that political will coupled with strong state capacity and adequate resource mobilization can overcome the institutional hurdles above. Donors will follow the lead of a country with long-term political commitment to HRH, as they did in Ethiopia.

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

“…gender and geographical balance of students selected) undoubtedly influenced policy-making. More recently, the trajectory in Timor-Leste took a different direction to many post-conflict countries, as national actors have emerged to play a more prominent role and their number and influence have increased in an increasingly fragmented political landscape [ 52 ]. It is important to note that the shift in actors’ roles is closely related to and driven by structural changes (specific to Timor-Leste’s economic history) and in particular the move from aid dependency in the first phases of the reconstruction, to financial independence due to oil revenues and, more recently, budget constraints related to the diminishing revenues.…”

“…Initially, the focus was on health workforce recruitment as is often the case [ 27 ], which was seen as fundamental not only for its contribution to the health sector but also in relation to the state-building efforts [ 6 ]. As in other settings [ 53 ], a key emerging issue was the challenge of achieving a balance between the ‘what’ (technical) with the ‘how’ (political) [ 52 ] and reconciliation of a technocratic recruitment process based on rules and merit with political, cultural, relational norms and practices.…”

Nurse‐Led Interventions for Hypertension: A Scoping Review With Implications for Evidence‐Based Practice

“…Sub‐Saharan East African countries are in the midst of an epidemiologic shift, with continued high rates of communicable diseases such as HIV and increasing prevalence of noncommunicable diseases (NCDs) such as hypertension (Barr et al., ; Lekoubou, Awah, Fezeu, Sobngwi, & Kengne, ). Primary healthcare access in these countries is limited due to the severe shortage of healthcare professionals and often results in poor patient outcomes (Fieno, Dambisya, George, & Benson, ). There is also inconsistent preparation of all types of healthcare providers for NCD care (Ibrahim & Damasceno, ).…”

“…Primary healthcare access in these countries is limited due to the severe shortage of healthcare professionals and often results in poor patient outcomes (Fieno, Dambisya, George, & Benson, 2016). There is also inconsistent preparation of all types of healthcare providers for NCD care (Ibrahim & Damasceno, 2012).…”

Alkaline peptone water enrichment with a dipstick test to quickly detect and monitor cholera outbreaks

“…Cholera detection, confirmation and monitoring in Uganda and many other developing countries is by laboratory isolation of V. cholerae bacteria by culture method [ 7 ]. The culture method has several challenges namely; it takes 24–48 h to get the test results, requires highly skilled laboratory staff who may not be available in most rural areas in Africa [ 8 ], many supplies and good laboratory infrastructure particularly electricity [ 9 , 10 ] to operate the equipments (incubators). There are only a few health facilities with the capacity to confirm cholera by culture in Africa; thus, samples are sent to a central laboratory whenever possible, but this takes additional time, sometimes weeks to obtain results [ 11 ].…”