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2008
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| |  | ONeil, M. L. | Human resource leadership: the key to improved results in health read moreAbstract: ABSTRACT: This article is the lead article in the Human Resources for Health journals first quarterly feature. The series of seven articles has been contributed by Management Sciences for Health (MSH) under the theme of leadership and management in public health and will be published article by article over the next few weeks. The journal has invited Dr Manuel M. Dayrit, Director of the WHO Department of Human Resources for Health and former Minister of Health for the Philippines to launch the feature with an opening editorial to be found in the journals blog.This opening article describes the human resource challenges that managers around the world report and analyses why solutions often fail to be implemented.Despite rising attention to the acute shortage of health care workers, solutions to the human resource (HR) crisis are difficult to achieve, especially in the poorest countries. Although we are aware of the issues and have developed HR strategies, the problem is that some old systems of leading and managing human resources for health do not work in todays context.The Leadership Development Program (LDP) is grounded on the belief that good leadership and management can be learned and practiced at all levels. The case studies in this issue were chosen to illustrate results from using the LDP at different levels of the health sector.The LDP makes a profound difference in health managers attitudes towards their work. Rather than feeling defeated by a workplace climate that lacks motivation, hope, and commitment to change, people report that they are mobilized to take action to change the status quo. The lesson is that without this capacity at all levels, global policy and national HR strategies will fail to make a difference. | 2008 |
2007
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| |  | Fraser, B. | Human resources for health in the Americas read moreAbstract: Sorry no abstract available for this article | 2007 |
| |  | Fritzen, S. A. | Strategic management of the health workforce in developing countries: what have we learned? read moreAbstract: The study of the health workforce has gained in prominence in recent years, as the dynamic interconnections between human resource issues and health system effectiveness have come into sharper focus. This paper reviews lessons relating to strategic management challenges emerging from the growing literature in this area. Workforce issues are strategic: they affect overall system performance as well as the feasibility and sustainability of health reforms. Viewing workforce issues strategically forces health authorities to confront the yawning gaps between policy and implementation in many developing countries. Lessons emerge in four areas. One concerns imbalances in workforce structure, whether from a functional specialization, geographical or facility lens. These imbalances pose a strategic challenge in that authorities must attempt to steer workforce distribution over time using a limited range of policy tools. A second group of lessons concerns the difficulties of central-level steering of the health workforce, often critically weak due to the lack of proper information systems and the complexities of public sector decentralization and service commercialization trends affecting the grassroots.A third cluster examines worker capacity and motivation, often shaped in developing countries as much by the informal norms and incentives as by formal attempts to support workers or to hold them accountable. Finally, a range of reforms centering on service contracting and improvements to human resource management are emerging. Since these have as a necessary (but not sufficient) condition some flexibility in personnel practices, recent trends towards the sharing of such functions with local authorities are promising.The paper identifies a number of current lines of productive research, focusing on the relationship between health policy reforms and the local institutional environments in which the workforce, both public and private, is deployed. | 2007 |
2006
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| |  | Dussault, G. | Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce read moreAbstract: Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. The health-related MDGs cannot be achieved if vulnerable populations do not have access to skilled personnel and to other necessary inputs. This paper focuses on the geographical dimension of access and on one of its critical determinants: the availability of qualified personnel. The objective of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health personnel, and to identify and assess the strategies developed to correct them. It reviews the recent literature on determinants, barriers and the effects of strategies that attempted to correct geographical imbalances, with a focus on empirical studies from developing and developed countries. An analysis of determinants of success and failures of strategies implemented, and a summary of lessons learnt, is included. Deep Structure; universal grammar; semantics; emergent theory; generative grammar; GIS; NRBIB: YOSE-0009 MANAGEMENT restoration Merced, Tuolumne Grove, Yosemite National Park, CA; PLANT STUDIES ECOLOGY land management ecology native american; ECOLOGY paleoclimates fire history paleoecology; NRBIB: YOSE-2436 ANIMAL STUDIES birds (Aves) frogs & toads (Salientia) alpine zone lakes & ponds Yosemite National Park, CA; ANIMAL STUDIES Non-native species fish bird communities habitat; NRBIB: YOSE-0007 PLANT STUDIES distribution Yosemite woollysunflower (Eriophyllum nubigenum) Yosemite National Park, CA; AQUATIC SCIENCES ECOLOGY algae study benthic invertebrates ecological survey Yosemite Valley water quality environment conditions; PHYSICAL SCIENCES communication electromagnetic signals dipole; NRBIB: YOSE-0003 ANIMAL STUDIES insects (Insecta) checklist Yosemite National Park, CA; NRBIB: YOSE-0415 PHYSICAL SCIENCES bedrock geology map Yosemite National Park, CA; NRBIB: YOSE-0169 ANIMAL STUDIES reintroduction (species) population dynamics mortality bighorn sheep (Ovis canadensis) Yosemite National Park, CA; PLANT STUDIES MANAGEMENT woodlitter firewood consumption Sierra Nevada; ANIMAL STUDIES landbirds survival avian productivity MAPS monitoring neotropical migrants Yosemite National Park survivorship; MANAGEMENT fishing regulations; ECOLOGY MANAGEMENT grazing game introductions wildlands management habitat non-indigenous game species public lands; ANIMAL STUDIES amphibian declines frog toad salamander survey Yosemite National Park, CA; ANIMAL STUDIES amphibians (Amphibia) frogs & toads (Salientia) mountain yellow-legged frog (Rana muscosa) Yosemite toad (Bufo canorus) Yosemite National Park, CA western toad (Bufo boreas) California newt (Taricha torosa) bullfrog (Rana catesbeiana); ANIMAL STUDIES amphibian declines survey protocol frog toad salamander; NRBIB: YOSE-0889 NRBIB: LAVO- NRBIB: SEKI-3218 NRBIB: PORE-2315 NRBIB: REDW- ANIMAL STUDIES habitats northern spotted owl (Strix occidentalis caurina) Yosemite National Park, CA Lassen Volcanic National Park, CA Sequoia and Kings Canyon National Parks, CA; PLANT STUDIES ATMOSPHERIC SCIENCES climatic variation tree ring chronology dendroclimatic Yosemite National Park, CA; PLANT STUDIES Whitebark pine Gibbs krummholz treeline subalpine vegetation stem layering; Sensor fusion; none; gen raster; hierarchical data structures; human resources; | 2006 |
2005
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| |  | Campos, F. E. | Contemporary specificities of labour in the health care sector: introductory notes for discussion read moreAbstract: BACKGROUND: This paper combines the literature on public health, on economics of health and on economics of technological innovation to discuss the peculiarities of labour in the health care sector. METHOD AND FRAMEWORK: The starting point is the investigation of the economic peculiarities of medical care. RESULTS AND DISCUSSIONS: This investigation leads to the identification of the prevalence of non-market forms of medical care in the countries of the Organisation for Economic Co-operation and Development (OECD). Furthermore, the health care system has a distinctive characteristic from other economic sectors: it is the intersection between social welfare and innovation systems. The relationship between technological innovation and cost in the health care sector is surveyed. Finally, the Brazilian case is discussed as an example of a developing country. CONCLUSION: The peculiarities of labour in the health care sector suggest the need to recognize the worth of sectoral labour and to cease to treat it separately. This process should take into account the rapid development of the health innovation system and one important consequence: the obsolescence of the acquired knowledge. One way to dignify labour is to implement continued education and training of health professions personnel. | 2005 |
| |  | Homedes, N. | Human resources: the Cinderella of health sector reform in Latin America read moreAbstract: Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies - decentralization and privatization - have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform.This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region.The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside. | 2005 |
2004
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| |  | Hongoro, C. | How to bridge the gap in human resources for health read moreAbstract: Sorry no abstract available for this article | 2004 |
| |  | Ferrinho, P. | Dual practice in the health sector: review of the evidence read moreAbstract: This paper reports on income generation practices among civil servants in the health sector, with a particular emphasis on dual practice. It first approaches the subject of public-private overlap. Thereafter it focuses on coping strategies in general and then on dual practice in particular.To compensate for unrealistically low salaries, health workers rely on individual coping strategies. Many clinicians combine salaried, public-sector clinical work with a fee-for-service private clientele. This dual practice is often a means by which health workers try to meet their survival needs, reflecting the inability of health ministries to ensure adequate salaries and working conditions.Dual practice may be considered present in most countries, if not all. Nevertheless, there is surprisingly little hard evidence about the extent to which health workers resort to dual practice, about the balance of economic and other motives for doing so, or about the consequences for the proper use of the scarce public resources dedicated to health.In this paper dual practice is approached from six different perspectives: (1) conceptual, regarding what is meant by dual practice; (2) descriptive, trying to develop a typology of dual practices; (3) quantitative, trying to determine its prevalence; (4) impact on personal income, the health care system and health status; (5) qualitative, looking at the reasons why practitioners so frequently remain in public practice while also working in the private sector and at contextual, personal life, institutional and professional factors that make it easier or more difficult to have dual practices; and (6) possible interventions to deal with dual practice. | 2004 |
| |  | Zurn, P. | Imbalance in the health workforce read moreAbstract: Imbalance in the health workforce is a major concern in both developed and developing countries. It is a complex issue that encompasses a wide range of possible situations. This paper aims to contribute not only to a better understanding of the issues related to imbalance through a critical review of its definition and nature, but also to the development of an analytical framework. The framework emphasizes the number and types of factors affecting health workforce imbalances, and facilitates the development of policy tools and their assessment. Moreover, to facilitate comparisons between health workforce imbalances, a typology of imbalances is proposed that differentiates between profession/specialty imbalances, geographical imbalances, institutional and services imbalances and gender imbalances. | 2004 |
| |  | Kolehmainen-Aitken, R. L. | Decentralizations impact on the health workforce: Perspectives of managers, workers and national leaders read moreAbstract: Designers and implementers of decentralization and other reform measures have focused much attention on financial and structural reform measures, but ignored their human resource implications. Concern is mounting about the impact that the reallocation of roles and responsibilities has had on the health workforce and its management, but the experiences and lessons of different countries have not been widely shared. This paper examines evidence from published literature on decentralizations impact on the demand side of the human resource equation, as well as the factors that have contributed to the impact. The elements that make such an impact analysis exceptionally complex are identified. They include the mode of decentralization that a country is implementing, the level of responsibility for the salary budget and pay determination, and the civil service status of transferred health workers.The main body of the paper is devoted to examining decentralizations impact on human resource issues from three different perspectives: that of local health managers, health workers themselves, and national health leaders. These three groups have different concerns in the human resource realm, and consequently, have been differently affected by decentralization processes. The paper concludes with recommendations regarding three key concerns that national authorities and international agencies should give prompt attention to. They are (1) defining the essential human resource policy, planning and management skills for national human resource managers who work in decentralized countries, and developing training programs to equip them with such skills; (2) supporting research that focuses on improving the knowledge base of how different modes of decentralization impact on staffing equity; and (3) identifying factors that most critically influence health worker motivation and performance under decentralization, and documenting the most cost-effective best practices to improve them. Notable experiences from South Africa, Ghana, Indonesia and Mexico are shared in an annex. | 2004 |
| |  | Narasimhan, V. | Responding to the global human resources crisis read moreAbstract: Sorry no abstract available for this article | 2004 |
2003
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| |  | Dussault, G. | Human resources for health policies: a critical component in health policies read moreAbstract: In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM.There are three broad arguments for modernizing the ways in which human resources for health are managed:bullet; the central role of the workforce in the health sector;bullet; the various challenges thrown up by health system reforms;bullet; the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems.The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs.Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH):bullet; to move beyond the traditional approach of personnel administration to a more global concept of HRM;bullet; to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy;bullet; to foster a more proactive attitude among human resources (HR) policy-makers and managers;bullet; to promote the full commitment of all professionals and sectors in all phases of the process.The development of explicit human resources policies is a crucial link in health policies and is needed both to address the imbalances of the health workforce and to foster implementation of the health services reforms. | 2003 |
2000
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| |  | Buchan, J. | Health sector reform and human resources: lessons from the United Kingdom read moreAbstract: The objective of the paper is to assess the human resource (HR) dimension of the National Health Service (NHS) reforms in the United Kingdom, and to highlight lessons for the health systems of countries undergoing reform or restructuring. Health sector reform in many countries in the 1980s and 1990s has focused on structural change, cost containment, the introduction of market mechanisms and consumer choice. This focus has inevitably challenged the ways that health professionals and other staff are employed and deployed. The methods used to manage human resources in health care may also in themselves be a major constraint or facilitator in achieving the objectives of health sector reform. The impact on the HR function of the NHS reforms is assessed in the paper by examining three central requirements of the HR function: to maintain effective staffing levels and skill mix; to establish appropriate employee relations policy and procedures; and to be involved in pay determination. The paper concludes that the most significant changes which have occurred as result of the NHS reforms have been in staffing change and organizational culture, and the individual attitudes of NHS management and staff. Attempts to alter methods of conducting employee relations and determining pay and conditions of employment have been less successful. However, an overall approach to HR management, which would have been unthinkable in the pre-reform NHS, is now accepted, albeit grudgingly by some, as the way forward. In general, the changes in the NHS HR function can be characterized as a partially successful attempt to adopt private sector HR management techniques to meet the challenges of public sector reform. | 2000 |