Posting and transfer: key to fostering trust in government health services

Sheikh, Kabir; Freedman, Lynn P.; Ghaffar, Abdul; Marchal, Bruno; El‐Jardali, Fadi; McCaffery, J; Sardan, Jean‐Pierre Olivier de; Poz, Mário Roberto Dal; Flores, Walter; Garimella, Surekha; Schaaf, Marta

doi:10.1186/s12960-015-0080-9

Cited by 15 publications

(13 citation statements)

References 8 publications

(4 reference statements)

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“…Additionally, the fact that initially there were few actors in the decision-making arena limited the presence of competing agendas and disagreements. However, while this led to the re-establishment of a HRH recruitment system, the fact that the focus of our analysis rests predominantly on recruitment processes and doctors (rather than on other HR management issues or on other health professionals) highlights how these elements were priorities for policy-makers at central level, while other cadres and issues (such as, deployment) remained under-regulated and dealt with at decentralised level, with the lack of overall strategy and clear official policies to enact, as documented also elsewhere [ 11 , 12 , 54 ]. Additionally, policy-makers paid little or no attention to health workers’ job preferences [ 45 , 55 ] and decision-making remained a top-down exercise.…”

Section: Discussionmentioning

confidence: 87%

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

Bertone¹,

Martins²,

Pereira³

et al. 2018

Hum Resour Health

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BackgroundAlthough human resources for health (HRH) represent a critical element for health systems, many countries still face acute HRH challenges. These challenges are compounded in conflict-affected settings where health needs are exacerbated and the health workforce is often decimated. A body of research has explored the issues of recruitment of health workers, but the literature is still scarce, in particular with reference to conflict-affected states. This study adds to that literature by exploring, from a central-level perspective, how the HRH recruitment policies changed in Timor-Leste (1999–2018), the drivers of change and their contribution to rebuilding an appropriate health workforce after conflict.MethodsThis research adopts a retrospective, qualitative case study design based on 76 documents and 20 key informant interviews, covering a period of almost 20 years. Policy analysis, with elements of political economy analysis was conducted to explore the influence of actors and structural elements.ResultsOur findings describe the main phases of HRH policy-making during the post-conflict period and explore how the main drivers of this trajectory shaped policy-making processes and outcomes. While initially the influence of international actors was prominent, the number and relevance of national actors, and resulting influence, later increased as aid dependency diminished. However, this created a fragmented institutional landscape with diverging agendas and lack of inter-sectoral coordination, to the detriment of the long-term strategic development of the health workforce and the health sector.ConclusionsThe study provides critical insights to improve understanding of HRH policy development and effective practices in a post-conflict setting but also looking at the longer term evolution. An issue that emerges across the HRH policy-making phases is the difficulty of reconciling the technocratic with the social, cultural and political concerns. Additionally, while this study illuminates processes and dynamics at central level, further research is needed from the decentralised perspective on aspects, such as deployment, motivation and career paths, which are under-regulated at central level.Electronic supplementary materialThe online version of this article (10.1186/s12960-018-0325-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 87%

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

Bertone¹,

Martins²,

Pereira³

et al. 2018

Hum Resour Health

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“…The authors' previous experience in conducting HRH related research suggests there are gaps between HRH policy and its implementation, and the expectations of doctors. Health Policy and Systems Research (HPSR), specifically around HRM policies and systems suggests similar issues where such policies and systems are perceived to be bureaucratic, slow, sporadic, 'mission inconsistent', open to corruption, and disrupting career trajectories for doctors (3)(4)(5)(6)(7). Hence HRH related policy implementation and the methods that can examine it in public health sector is a critical that needs attention.…”

Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Experience and reflections of using individual work histories and events of public sector doctors to unpack Human Resource Management policies and systems: Job histories as powerful method in Human Resource for Health research

Purohit

Hill

2020

Preprint

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Background and methods: There is limited use of job histories in Human Resource for Health (HRH) research. This paper presents authors’ reflections of using job histories in HRH related research. In particular paper discusses how these can be useful method specifically to examine the implementation fidelity for health policy analysis of HRH and the strengths and limitations of this approach. Methods: The context of this exploration is a multiple case study research project examining the implementation of HRH policies in public health sector in two Indian States—Sikkim and Rajasthan. As the doctors were the main subjects of the study, semi-structured interviews were conducted with 33 doctors to understand their experiences and interactions with the health department in relation to four key HRH management functions: recruitment, initial posting, transfer and promotions. The interview process revealed construction of work life related chronology by the doctors as a means of structuring their responses. This emerging pattern was adapted for the subsequent interviews to formalise it in form of job histories. Key findings and reflection: Job histories constructed from the interviews gave rich descriptive accounts of doctors’ experiences with the HRM systems, and also unravelled how HRM policies and systems operate, specifically in relation to adherence and dosage aspects of implementation fidelity, represented as narrative and quantitative accounts. For instance, job histories clearly allude non-adherence to posting rules and norms. Similarly, examination of the dosage aspect suggests variable application of HRH related policies and practices, delivered inconsistently across the doctors (applied to some and not to others or not applied consistently to the same doctor across his/her work career) or not applied as often as required. The organic and fluid nature of the job histories grounded in the qualitative data presents itself as a very powerful case in narrating rich job related stories and experiences of doctors. Additionally, it offers the flexibility to collect data in a more structured way potentially demonstrating useful chronological patterns and offering valuable insights into attempts to unravel the complexities and conflicts and in unpacking the rich individual experience, conflicts and tensions that public sector rural doctors confront in interacting with HRM policies and systems. Job histories can serve as a useful method for data collection in the area of Health Policy and Systems Research implementation, especially in relation to HRH.

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“…How and why the health workforce is deployed across geographic settings is foundational to the delivery of public services because it affects attainment of health goals like universal health coverage through issues of maldistribution, absenteeism, poor morale, decreased efficiencies, and lowered health system accountability. The limited evidence to date shows that postings and transfers are mediated by a variety of complex factors, such as public administration standards, labour market forces, political dynamics, professional power, human resource management systems and accountability mechanisms [ 3 ]. There is much literature from Ghana and other low- and middle-income countries identifying factors which influence staff preferences to take up or stay in posts, such as remuneration, career progression opportunities, facility infrastructure and social amenities (e.g., schools for children, employment for spouses, road networks, and accommodation) [ 4 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Postings and transfers in the Ghanaian health system: a study of health workforce governance

Kwamie

Asiamah²,

Schaaf

et al. 2017

Int J Equity Health

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BackgroundDecision-making on postings and transfers – that is, the geographic deployment of the health workforce – is a key element of health workforce governance. When poorly managed, postings and transfers result in maldistribution, absenteeism, and low morale. At stake is managing the balance between organisational (i.e., health system) and individual (i.e., staff preference) needs. The negotiation of this potential convergence or divergence of interests provides a window on practices of postings and transfers, and on the micro-practices of governance in health systems more generally. This article explores the policies and processes, and the interplay between formal and informal rules and norms which underpin postings and transfers practice in two rural districts in the Greater Accra Region of Ghana.MethodsSemi-structured interviews were conducted with eight district managers and 87 frontline staff from the district health administration, district hospital, polyclinic, health centres and community outreach compounds across two districts. Interviews sought to understand how the postings and transfers process works in practice, factors in frontline staff and district manager decision-making, personal experiences in being posted, and study leave as a common strategy for obtaining transfers.ResultsDifferential negotiation-spaces at regional and district level exist and inform postings and transfers in practice. This is in contrast to the formal cascaded rules set to govern decision-making authority for postings and transfers. Many frontline staff lack policy clarity of postings and transfers processes and thus ‘test’ the system through informal staff lobbying, compounding staff perception of the postings and transfers process as being unfair. District managers are also challenged with limited decision-space embedded in broader policy contexts of systemic hierarchy and resource dependence. This underscores the negotiation process as ongoing, rather than static.ConclusionsThese findings point to tensions between individual and organisational goals. This article contributes to a burgeoning literature on postings and transfers as a distinct dynamic which bridges the interactions between health systems governance and health workforce development. Importantly, this article helps to expand the notion of health systems governance beyond ‘good’ governance towards understanding governance as a process of negotiation.

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Posting and transfer: key to fostering trust in government health services

Cited by 15 publications

References 8 publications

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

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

WITHDRAWN: Experience and reflections of using individual work histories and events of public sector doctors to unpack Human Resource Management policies and systems: Job histories as powerful method in Human Resource for Health research

Postings and transfers in the Ghanaian health system: a study of health workforce governance

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