Analysing public sector institutional capacity for health workforce governance in the South-East Asia region of WHO

Abstract

Background In order to analyse the institutional capacity for health workforce policy development and implementation in countries in the South-East Asia region, the WHO facilitated a cross-sectional analysis of functions performed, structure, personnel, management and information systems of human resources for health (HRH) units in Ministries of Health. Case presentation A self-assessment survey on the characteristics and roles of HRH units was administered to relevant Government officials; the responses were validated through face-to-face workshops and by the WHO staff. Findings were tabulated to produce frequency distributions of the variables examined, and qualitative elements categorized according to a framework for capacity building in the health sector. Ten countries out of the 11 in the region responded to the survey. Seven out of 10 reported having an HRH unit, though their scope, roles, capacity and size displayed considerable variability. Some functions (such as planning and health workforce data management) were reportedly carried out in all countries, while others (inter-sectoral coordination, research, labour relations) were only performed in few. Discussion and conclusions The strengthening of the HRH governance capacity in countries should follow a logical hierarchy, identifying first and foremost the essential functions that the public sector is expected to perform to optimize HRH governance. The definition of expected roles and functions will in turn allow identifying the upstream system-wide factors and the downstream capacity requirements for the strengthening of the HRH units. The focus should ultimately be on ensuring that all the key strategic functions are performed to quality standards, irrespective of institutional arrangements. Electronic supplementary material The online version of this article (10.1186/s12960-019-0385-1) contains supplementary material, which is available to authorized users.

Governance in health workforce: how do we improve on the concept? A network-based, stakeholder-driven approach

“…This included 12 case studies referencing domestic or regional governance in health workforce, either by outlining the general landscape and challenges (10) [ 14 - 23 ], or by promoting new governance-based approaches (2) [ 24 , 25 ]. Of the remaining sources, seven were broader systematic reviews, literature reviews, scoping studies, case studies or books that were able to consider governance more generally within health workforce [ 5 , 26 - 31 ], two were region-wide examinations of HRH units within countries [ 32 , 33 ], and six were editorials, research articles or other grey literature [ 7 , 34 - 38 ]. One publication was considered exceptionally due to its discussion of health workforce governance from a public administration perspective [ 39 ].…”

“…Meanwhile, an increase in complexity of governing institutions and issues [ 24 ] means that regulatory power is often shifted subnationally and/or transnationally away from the direct control of centralised authorities [ 30 ]. Priorities in setting health workforce policies are further influenced by interlinked factors such as fiscal space, current economic policy, employment practices and health workforce resistance to change [ 33 ], whilst interests and objectives beyond health—from national sovereignty issues to political manoeuvring alongside external stakeholders in education and training and financing—further muddle the picture. This inevitably leads to challenges in implementing and operationalising HRH policies [ 44 ].…”

Improving Health Workforce Governance: the Role of Multi-Stakeholder Coordination Mechanisms and Human Resources for Health Units in Ministries of Health

“…There is a distinct gap in the literature surrounding both the concept and function of health workforce governance across different contexts in terms of HRH coordination mechanisms and HRH units or departments. Two studies based on surveys in Africa [10] and South East Asia [11] provide information on HRH units, but lack detail on how they operate. Cometto et al call for more understanding of the political economy of HRH policy-making and "the characteristics and performance factors, gained through the speci c lens and focus on HRH units" [12, p2].…”

“…Coordination of HRH activities becomes yet more complex with the introduction of decentralised management structures. The speed of decentralisation may be unpredictable [32], but in Sudan this appeared to have been adequately planned for.There is a serious absence of expertise speci c to managing the complexities of the health workforce.Surveys in Africa and South-East Asia report on small numbers of 'technical' or 'professional' staff [11,28], but it is unclear if they have HRH expertise. However, much of this specialised knowledge -or 'HRH literacy' -can only really be learned on the job.…”

“…As intended, this study has investigated HRH coordination and HRH units in greater depth than the NHWA reporting and the more detailed surveys from several WHO regions [10,11,28]. In addition, it has identi ed important tangential issues -such as the HRH strategy and the interdependence of HRH coordination mechanisms and HRH units -which are central to effective HRH governance.…”