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Mehta V, Ajmera P, Kalra S, Miraj M, Gallani R, Shaik RA, Serhan HA, Sah R. Human resource shortage in India's health sector: a scoping review of the current landscape. BMC Public Health 2024; 24:1368. [PMID: 38773422 PMCID: PMC11110446 DOI: 10.1186/s12889-024-18850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND For healthcare delivery to be optimally effective, health systems must possess adequate levels and we must ensure a fair distribution of human resources aimed at healthcare facilities. We conducted a scoping review to map the current state of human resources for health (HRH) in India and the reasons behind its shortage. METHODS A systematic search was conducted in various electronic databases, from the earliest available date till February 2024. We applied a uniform analytical framework to all the primary research reports and adopted the "descriptive-analytical" method from the narrative paradigm. Inductive thematic analysis was conducted to arrange the retrieved data into categories based on related themes after creating a chart of HRH problems. RESULTS A total of 9675 articles were retrieved for this review. 88 full texts were included for the final data analysis. The shortage was addressed in 30.6% studies (n = 27) whereas 69.3% of studies (n = 61) addressed reasons for the shortage. The thematic analysis of data regarding reasons for the shortage yielded five kinds of HRH-related problems such as inadequate HRH production, job dissatisfaction, brain drain, regulatory issues, and lack of training, monitoring, and evaluation that were causing a scarcity of HRH in India. CONCLUSION There has been a persistent shortage and inequitable distribution of human resources in India with the rural expert cadres experiencing the most severe shortage. The health department needs to establish a productive recruitment system if long-term solutions are to be achieved. It is important to address the slow and sporadic nature of the recruitment system and the issue of job insecurity among medical officers, which in turn affects their other employment benefits, such as salary, pension, and recognition for the years of service.
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Affiliation(s)
- Vini Mehta
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India.
| | - Puneeta Ajmera
- Department of Public Health, School of Allied Health Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Sheetal Kalra
- School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Mohammad Miraj
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AlMajmaah, Saudi Arabia
| | | | - Riyaz Ahamed Shaik
- Department of Family and Community Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
| | - Ranjit Sah
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India.
- SR Sanjeevani Hospital, Kalyanpur, Siraha, Nepal.
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Ugargol AP, Mukherji A, Tiwari R. In search of a fix to the primary health care chasm in India: can institutionalizing a public health cadre and inducting family physicians be the answer? THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 13:100197. [PMID: 37383560 PMCID: PMC10305920 DOI: 10.1016/j.lansea.2023.100197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 06/30/2023]
Abstract
India's woes with an underprioritized and hence underfunded and understaffed public health system continue to plague public healthcare delivery. Though the need for appropriately qualified public health cadre to lead public health programmes is well established, a well-meaning conducive approach to implementing this is lacking. As the COVID-19 pandemic brought back the focus on India's fragmented health system and primary healthcare deficiencies, we discuss the primary healthcare conundrum in India in search of a quintessential fix. We argue for instituting a well-thought and inclusive public health cadre to lead preventive and promotive public health programmes and manage public health delivery. With the aim being to increase community confidence in primary health care, along with the need to augment primary healthcare infrastructure, we argue for a need to augment primary healthcare with physicians trained in family medicine. Provisioning medical officers and general practitioners trained in family medicine can salvage community's confidence in primary care, increase primary healthcare utilization, stymie over-specialization of care, channelize and prioritize referrals, and guarantee competence in healthcare quality for rural communities.
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Affiliation(s)
| | - Arnab Mukherji
- Centre for Public Policy, Indian Institute of Management Bangalore (IIMB), Bengaluru, India
| | - Ritika Tiwari
- School of Human Sciences, Faculty of Education, Health & Human Sciences (FEHHS), University of Greenwich, UK
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Patel G, Brosnan C, Taylor A, Garimella S. The dynamics of TCAM integration in the Indian public health system: Medical dominance, countervailing power and co-optation. Soc Sci Med 2021; 286:114152. [PMID: 34465489 DOI: 10.1016/j.socscimed.2021.114152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/06/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022]
Abstract
Hierarchies of power among healthcare professionals are well documented, nonetheless, power remains neglected, understudied and under-theorised in health systems analysis and policy discussions, especially in the domain of Traditional, Complementary and Alternative Medicine (TCAM). Sociological and public health scholarship has documented the persistence of medical dominance in the health system, theorised as the limitation, subordination, exclusion and incorporation of other professions. This paper explores how interprofessional power dynamics shape the integration of TCAM into Indian primary healthcare centres, as part of a nationwide policy of TCAM integration and medical pluralism implemented since 2005. We conducted interviews (n = 37) with health system administrators, nurses, pharmacists, TCAM and biomedicine doctors, and observed day-to-day activities of primary healthcare centres for six months in Odisha state, India. Thematic analysis enabled the identification of themes and exploration of sub-themes. The analysis revealed multilayered forms of medical dominance within the primary healthcare system and identified multiple sites where everyday power is mobilised. Biomedicine practitioners exercised authoritative power and restricted TCAM doctors' access to facility-level resources, i.e. financial and workforce support, which inhibited the integration policy implementation. Significantly, TCAM doctors were 'ordered' to practice biomedicine at primary healthcare centres, which was beyond the scope of the integration policy. However, TCAM doctors were also able to exercise countervailing power in their day-to-day activities in the primary healthcare centres and sought to assist patients' health behaviour change through their authoritative knowledge about 'how to live a healthy life'. The health system actors involved in policy implementation hold a range of forms of power specific to the circumstances, influencing the integration processes. We explain these dynamics in relation to existing theories of medical dominance and countervailing power, while introducing a previously unreported dimension of dominance: 'co-optation', which enrols TCAM practitioners in the practice of biomedicine.
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Affiliation(s)
- Gupteswar Patel
- School of Humanities and Social Sciences, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Caragh Brosnan
- School of Humanities and Social Sciences, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Ann Taylor
- School of Humanities and Social Sciences, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Surekha Garimella
- The George Institute for Global Health, Third Floor, Elegance Tower, Plot No. 8, Jasola, District Centre, New Delhi, 110025, India.
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Dhatt H, Marupuru S, Warholak TL. A motivational factors assessment instrument for medication management center employees providing medication therapy management services: A Rasch analysis. J Am Pharm Assoc (2003) 2020; 61:34-43.e2. [PMID: 32981849 DOI: 10.1016/j.japh.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/15/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Telephonic medication management centers (MMCs) provide medication therapy management services to help alleviate medication-related issues and improve health outcomes. Motivation factors driving the performance of MMC personnel are key components in achieving these goals. Yet, published literature is limited on how motivation affects MMC personnel performance. OBJECTIVE To assess validity and reliability of the employee motivation questionnaire (EMQ), a 19-item measure of barriers and facilitators to motivation associated with MMC employees' work performance. METHODS Pharmacist, nurse, pharmacy technician, and intern employees (N = 534) from 5 telephonic-based U.S. MMCs were invited to complete the electronic EMQ. Rasch analysis was conducted in Winsteps software using a rating scale model. Construct and content validity and reliability were analyzed with employee and item separation index (SI) and reliability coefficient (RC). Linear regression was conducted to test the association of employee characteristics with individual work performance motivation. RESULTS A total of 319 employees completed the EMQ, 59.7% response rate. Principal components analysis suggested a unidimensional construct. Employee and item infit and outfit mean squared values met recommended fit criteria (0.5-1.5), suggesting that the data fit the model. An item-person map identified items that were easiest (joy of helping patients) and most difficult (motivated to work harder if incentives were tied to goal achievements) to agree with. Mismatch of employee motivation and item difficulty level on the measurement continuum (-1 to 0.92 logits) indicated a need for additional items that employees perceive as more difficult to agree with. The employee RC was 0.81 and the SI was 2.04; whereas, the item RC was 0.97 and the SI was 5.94. None of the variables tested illustrated statistically significant associations with the person motivation measure. CONCLUSIONS The EMQ illustrated reasonable content validity, good construct validity, and reliability evidence when used to measure motivation factors among MMC employees. Consideration of employee motivation factors may help to better meet MMC program goals and improve patient outcomes.
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Thanh ND, Hung PT, My Anh BT, Anh TQ, Anh PQ, Xiem CH. Developing a job motivation scale: A focus on cross-cultural adaptation and validation among hospital staff. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1752985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Nguyen Duc Thanh
- Department of Hospital Management, Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam
| | - Phung Thanh Hung
- Department of Human Resource Management, Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam
| | - Bui Thi My Anh
- Department of Hospital Management, Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam
| | - Tran Quynh Anh
- Department of Health Policy and Intergration, Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam
| | - Pham Quynh Anh
- Department of Pharmaceutical Management, Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam
| | - Chu Huyen Xiem
- Department of Hospital Management, Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam
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Ghasi NC, Ogbuabor DC, Onodugo VA. Perceptions and predictors of organizational justice among healthcare professionals in academic hospitals in South-Eastern Nigeria. BMC Health Serv Res 2020; 20:301. [PMID: 32293438 PMCID: PMC7158107 DOI: 10.1186/s12913-020-05187-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/05/2020] [Indexed: 08/29/2023] Open
Abstract
Background Research on organizational justice in hospitals in African countries are limited despite being important for workforce performance and hospital operational efficiency. This paper investigated perceptions and predictors of organizational justice among health professionals in academic hospitals in South-east Nigeria. Methods The study was conducted in two teaching hospitals in Enugu State, South-east Nigeria using mixed-methods design. Randomly sampled 360 health professionals (doctors = 105, nurses = 200 and allied health professionals, AHPs = 55) completed an organizational justice scale. Additionally, semi-structured, in-depth interview with purposively selected 18 health professionals were conducted. Univariate and bivariate statistics and multivariable linear regression were used to analyze quantitative data. Statistical significance was set at alpha 0.05 level. Qualitative data were analyzed thematically using NVivo 11 software. Results The findings revealed moderate to high perception of different dimensions of organizational justice. Doctors showed the highest perception, whereas AHPs had the least perception. Among doctors, age and education predicted distributive justice (adjusted R2 = 22%); hospital ownership and education predicted procedural justice (adjusted R2 = 17%); and hospital ownership predicted interactional justice (adjusted R2 = 42%). Among nurses, age, gender and marital status predicted distributive justice (adjusted R2 = 41%); hospital ownership, age and gender predicted procedural justice (adjusted R2 = 28%); and hospital ownership, age, marital status and tenure predicted interactional justice (R2 = 35%). Among AHPs, marital status predicted distributive justice (adjusted R2 = 5%), while hospital ownership and tenure predicted interactional justice (adjusted R2 = 15%). Qualitative findings indicate that nurses and AHPs perceive as unfair, differences in pay, access to hospital resources, training, work schedule, participation in decision-making and enforcement of policies between doctors and other health professionals due to medical dominance. Overall, supervisors have a culture of limited information sharing with, and disrespectful treatment of, their junior colleagues. Conclusion Perceptions of organizational justice range from moderate to high and predictors vary among different healthcare professionals. Addressing specific socio-demographic factors that significantly influenced perceptions of organizational justice among different categories of health professionals and departure from physician-centered culture would improve perceptions of organizational justice among health professionals in Nigeria and similar settings.
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Affiliation(s)
- Nwanneka Chidinma Ghasi
- Department of Management, Faculty of Business Administration, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria
| | - Daniel Chukwuemeka Ogbuabor
- Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria.
| | - Vincent Aghaegbunam Onodugo
- Department of Management, Faculty of Business Administration, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria
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Ogbuabor DC, Okoronkwo IL. The influence of quality of work life on motivation and retention of local government tuberculosis control programme supervisors in South-eastern Nigeria. PLoS One 2019; 14:e0220292. [PMID: 31339944 PMCID: PMC6655736 DOI: 10.1371/journal.pone.0220292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 07/12/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Significant gap exists in knowledge about employee-centred human resources practices that address motivation and retention of local government tuberculosis control programme supervisors (LGTBS) in Nigeria. The study examined the role of quality of worklife (QWL) in motivating and retaining LGTBS. Materials and methods The study was conducted in south-eastern region of Nigeria comprising five states and 95 local government areas. The design was mixed-methods. We used cross-sectional survey to collect quantitative data on socio-demographic factors, QWL, motivation and retention from a total sample of LGTBS. The qualitative component involved focus group discussions (n = 3) with 26 LGTBS. Quantitative data were analysed using exploratory factor analysis, descriptive statistics, Spearman correlation, Mann-Whitney test, Kruskal-Wallis test and multiple linear regression. Qualitative data were analysed using a thematic framework approach. Results The final 40-item QWL scale was found to be valid and reliable. The LGTBS had high QWL (M = 5.15, SD = 0.88) and motivation (M = 5.92, SD = 1.08), but low intention to leave their jobs (M = 2.68, SD = 1.59). Education significantly predicted satisfaction with overall QWL, work-family balance and work design; but tenure predicted satisfaction with work context. Work design and work-family balance significantly predicted motivation of LGTBS. Motivation mediated the relationship between QWL and intention to leave and accounted for 29% variance in intention to leave. Whereas LGTBS were motivated by responsibility, learning opportunities, achievement and recognition; they were dissatisfied with lack of flexible work schedules, involvement in non-TB tasks, long hours at work, limited opportunities for vacation, resource inadequacy, work-related stigma, lack of promotional opportunities, and pay disparity and delay. Conclusion Addressing work design, work-family balance and working conditions may increase the motivation and retention of LGTBS and improve human resources for TB at the district level and performance of the TB control programme.
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Affiliation(s)
- Daniel Chukwuemeka Ogbuabor
- Department of Health Systems and Policy, Sustainable Impact Resource Agency, Enugu, Enugu State, Nigeria
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria
- * E-mail:
| | - Ijeoma Lewechi Okoronkwo
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria
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Malik AA, Yamamoto SS, Haque A, Butt NS, Baig M, Sauerborn R. Developing and assessing a tool to measure motivation among physicians in Lahore, Pakistan. PLoS One 2018; 13:e0209546. [PMID: 30596679 PMCID: PMC6312213 DOI: 10.1371/journal.pone.0209546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/08/2018] [Indexed: 01/09/2023] Open
Abstract
Physicians' motivation plays a vital role in health systems particularly in dense and urban cities, which deal with high volumes of patients in a variety of settings. The loss of physicians due to low motivation to developed countries is also a critical aspect affecting the quality of care in many regions. Fewer studies have explored health provider and particularly physicians' motivation in developing countries, which is critical to health service delivery. In addition, limited relevant tools have been developed and tested in low and middle-income settings like Pakistan. The purpose of this study was to create and test a tool for measuring physician motivation. A tool was developed to explore physicians' motivation in the Lahore district, Pakistan. Three sections of the questionnaire, which included intrinsic, socio-cultural and organizational factors, were tested with a stratified, random sample of 360 physicians from the public and private health facilities. Factor analysis produced six factors for 'intrinsic motivation,' seven for 'organizational motivation' and three for 'socio-cultural motivation' that explained 47.7%, 52.6% and 40.6% of the total variance, respectively. Bartlett's test of sphericity and the KMO were significant. Cronbach's α and confirmatory factor analysis were found satisfactory for all three sections of questionnaires. In addition to identifying important intrinsic, socio-cultural and organizational factors study found the questionnaires reliable and valid and recommend further testing the applicability of the instrument in similar and diverse settings.
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Affiliation(s)
- Ahmad Azam Malik
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdul Aziz University, Jeddah, KSA
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Shelby Suzanne Yamamoto
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Aminul Haque
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
| | - Nadeem Shafique Butt
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdul Aziz University, Jeddah, KSA
| | - Mukhtiar Baig
- Department of Biochemistry and Medical Education, Faculty of Medicine in Rabigh, King Abdul Aziz University, Jeddah, KSA
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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George A, Campbell J, Ghaffar A. Advancing the science behind human resources for health: highlights from the Health Policy and Systems Research Reader on Human Resources for Health. HUMAN RESOURCES FOR HEALTH 2018; 16:35. [PMID: 30103757 PMCID: PMC6090660 DOI: 10.1186/s12960-018-0302-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/22/2018] [Indexed: 06/08/2023]
Abstract
Health workers are central to people-centred health systems, resilient economies and sustainable development. Given the rising importance of the health workforce, changing human resource for health (HRH) policy and practice and recent health policy and systems research (HPSR) advances, it is critical to reassess and reinvigorate the science behind HRH as part of health systems strengthening and social development more broadly. Building on the recently published Health Policy and Systems Research Reader on Human Resources for Health (the Reader), this commentary reflects on the added value of HPSR underpinning HRH. HPSR does so by strengthening the multi-disciplinary base and rigour of HRH research by (1) valuing diverse research inferences and (2) deepening research enquiry and quality. It also anchors the relevance of HRH research for HRH policy and practice by (3) broadening conceptual boundaries and (4) strengthening policy engagement. Most importantly, HPSR enables us to transform HRH from being faceless numbers or units of health producers to the heart and soul of health systems and vital change agents in our communities and societies. Health workers' identities and motivation, daily routines and negotiations, and training and working environments are at the centre of successes and failures of health interventions, health system functioning and broader social development. Further, in an increasingly complex globalised economy, the expansion of the health sector as an arena for employment and the liberalisation of labour markets has contributed to the unprecedented movement of health workers, many or most of whom are women, not only between public and private health sectors, but also across borders. Yet, these political, human development and labour market realities are often set aside or elided altogether. Health workers' lives and livelihoods, their contributions and commitments, and their individual and collective agency are ignored. The science of HRH, offering new discoveries and deeper understanding of how universal health coverage and the Sustainable Development Goals are dependent on millions of health workers globally, has the potential to overcome this outdated and ineffective orthodoxy.
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Affiliation(s)
- A.S. George
- School of Public Health, University of the Western Cape, Private Bag x17, Bellville, Cape Town, 7535 South Africa
| | - J. Campbell
- Health Workforce, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - A. Ghaffar
- The Alliance for Health Policy and Systems Research, 20 Avenue Appia, 1211 Geneva, Switzerland
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George A, Campbell J, Ghaffar A. Advancing the science behind human resources for health: highlights from the Health Policy and Systems Research Reader on Human Resources for Health. Health Res Policy Syst 2018; 16:80. [PMID: 30103778 PMCID: PMC6090771 DOI: 10.1186/s12961-018-0346-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
Health workers are central to people-centred health systems, resilient economies and sustainable development. Given the rising importance of the health workforce, changing human resource for health (HRH) policy and practice and recent health policy and systems research (HPSR) advances, it is critical to reassess and reinvigorate the science behind HRH as part of health systems strengthening and social development more broadly. Building on the recently published Health Policy and Systems Research Reader on Human Resources for Health (the Reader), this commentary reflects on the added value of HPSR underpinning HRH. HPSR does so by strengthening the multi-disciplinary base and rigour of HRH research by (1) valuing diverse research inferences and (2) deepening research enquiry and quality. It also anchors the relevance of HRH research for HRH policy and practice by (3) broadening conceptual boundaries and (4) strengthening policy engagement. Most importantly, HPSR enables us to transform HRH from being faceless numbers or units of health producers to the heart and soul of health systems and vital change agents in our communities and societies. Health workers' identities and motivation, daily routines and negotiations, and training and working environments are at the centre of successes and failures of health interventions, health system functioning and broader social development. Further, in an increasingly complex globalised economy, the expansion of the health sector as an arena for employment and the liberalisation of labour markets has contributed to the unprecedented movement of health workers, many or most of whom are women, not only between public and private health sectors, but also across borders. Yet, these political, human development and labour market realities are often set aside or elided altogether. Health workers' lives and livelihoods, their contributions and commitments, and their individual and collective agency are ignored. The science of HRH, offering new discoveries and deeper understanding of how universal health coverage and the Sustainable Development Goals are dependent on millions of health workers globally, has the potential to overcome this outdated and ineffective orthodoxy.
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Affiliation(s)
- A.S. George
- School of Public Health, University of the Western Cape, Private Bag x17, Bellville, Cape Town, 7535 South Africa
| | - J. Campbell
- Health Workforce, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - A. Ghaffar
- The Alliance for Health Policy and Systems Research, 20 Avenue Appia, 1211 Geneva, Switzerland
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