The interface between health sector reform and human resources in health

Abstract

The relationship between health sector reform and the human resources issues raised in that process has been highlighted in several studies. These studies have focused on how the new processes have modified the ways in which health workers interact with their workplace, but few of them have paid enough attention to the ways in which the workers have influenced the reforms.The impact of health sector reform has modified critical aspects of the health workforce, including labor conditions, degree of decentralization of management, required skills and the entire system of wages and incentives. Human resources in health, crucial as they are in implementing changes in the delivery system, have had their voice heard in many subtle and open ways – reacting to transformations, supporting, blocking and distorting the proposed ways of action.This work intends to review the evidence on how the individual or collective actions of human resources are shaping the reforms, by spotlighting the reform process, the workforce reactions and the factors determining successful human resources participation. It attempts to provide a more powerful way of predicting the effects and interactions in which different "technical designs" operate when they interact with the human resources they affect. The article describes the dialectic nature of the relationship between the objectives and strategies of the reforms and the objectives and strategies of those who must implement them.

Full Issue

“…Access to quality education and health care is a human right, however health challenges and bottlenecks within developing countries remain on the rise (Brenner et al 2004;Chambers 1994;Rigoli and Dussault 2003;WHO 2000), and emerging advances and health interventions are…”

Autonomía en la gestión hospitalaria en Chile: los desafíos para el recurso humano en salud

“…24 In general the effects of health system reforms upon human resources for health have translated into changes in contract types and labor conditions, a duality in relation to public/private employment, new recruitment and retention mechanisms and changes to the skills needed for the reform processes, among others. 26 Due to these issues, some authors 21 recognize the need to discuss aspects such as increasing effi ciency, improving performance, greater equity in the distribution of human resources in services, the development of policy and planning capabilities and the development of a new perspective about human resources through identifying priorities in the process of health systems reform.…”

Tuberculosis control in the era of HIV

“…The current quality of staff is also inhibiting the scale up of TB-and HIV-control interventions 33 . Pressures to expand primary care, cut costs, decentralize and privatize have led staff to seek greener pastures by leaving public service, going into private practice (legally or otherwise) and migrating to richer countries, often in Europe and the United States 34 . Staff themselves have been particularly badly hit by the HIV and TB epidemics 35 .…”