Human resource governance: what does governance mean for the health workforce in low- and middle-income countries?

Abstract

BackgroundResearch on practical and effective governance of the health workforce is limited. This paper examines health system strengthening as it occurs in the intersection between the health workforce and governance by presenting a framework to examine health workforce issues related to eight governance principles: strategic vision, accountability, transparency, information, efficiency, equity/fairness, responsiveness and citizen voice and participation.MethodsThis study builds off of a literature review that informed the development of a framework that describes linkages and assigns indicators between governance and the health workforce. A qualitative analysis of Health System Assessment (HSA) data, a rapid indicator-based methodology that determines the key strengths and weaknesses of a health system using a set of internationally recognized indicators, was completed to determine how 20 low- and middle-income countries are operationalizing health governance to improve health workforce performance.Results/discussionThe 20 countries assessed showed mixed progress in implementing the eight governance principles. Strengths highlighted include increasing the transparency of financial flows from sources to providers by implementing and institutionalizing the National Health Accounts methodology; increasing responsiveness to population health needs by training new cadres of health workers to address shortages and deliver care to remote and rural populations; having structures in place to register and provide licensure to medical professionals upon entry into the public sector; and implementing pilot programs that apply financial and non-financial incentives as a means to increase efficiency. Common weaknesses emerging in the HSAs include difficulties with developing, implementing and evaluating health workforce policies that outline a strategic vision for the health workforce; implementing continuous licensure and regulation systems to hold health workers accountable after they enter the workforce; and making use of health information systems to acquire data from providers and deliver it to policymakers.ConclusionsThe breadth of challenges facing the health workforce requires strengthening health governance as well as human resource systems in order to effect change in the health system. Further research into the effectiveness of specific interventions that enhance the link between the health workforce and governance are warranted to determine approaches to strengthening the health system.

Human resources for health and universal health coverage: fostering equity and effective coverage

“…[60][61][62][63] There is therefore a body of knowledge that can guide HRH policy, actions and commitments in relation to UHC. But evidence is not always transformed into policy and practice.…”

Exploring the nature of governance at the level of implementation for health system strengthening: the DIALHS experience

“…The World Health Organization (2007, p. 3) defines health system governance as a national function entailing that ‘ensuring strategic frameworks exist and are combined with effective oversight, coalition-building, the provision of appropriate regulations and incentives, attention to system design and accountability’. The limited body of existing health governance research also often focuses at national or global levels, adopting a macro-perspective that focuses on governance structures and forms ( Ruger 2007 ; Kaplan et al 2013 ), principles of state–society relationships ( Saltman and Ferroussier-Davis 2000 ; Brinkerhoff and Bossert 2008 ) or broad indicators for assessment ( Siddiqi et al 2009 ). The related work on health system decentralization, meanwhile, includes consideration of sub-national levels ( Mills 1994 ; Bossert and Beauvais 2002 ; Mitchell and Bossert 2010 ), and community accountability mechanisms and processes ( McCoy et al 2012 ; Molyneux et al 2012 ), but also tends to focus on governance form, structure or principles.…”

Assessment of dual practice among physicians in Cambodia

“…Other major factors include the lack of performance management in the public sector [4], possibly viewed as ad hoc permission to engage in dual practice in exchange for maintaining a public sector job [5], and a desire to see more patients and gain clinical skills. Doctors know they are needed in the public system, and quitting the public sector job in times of dire need could imply a stewardship problem [42].…”