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Optimizing the management of the health workforce is necessary for the progressive realization of universal health coverage. Here we discuss the six main action fields in health workforce management as identified by the Human Resources for Health Action Framework: leadership; finance; policy; education; partnership; and human resources management systems. We also identify and describe examples of effective practices in the development of the health workforce, highlighting the breadth of issues that policy-makers and planners should consider. Achieving success in these action fields is not possible by pursuing them in isolation. Rather, they are interlinked functions that depend on a strong capacity for effective stewardship of health workforce policy. This stewardship capacity can be best understood as a pyramid of tools and factors that encompass the individual, organizational, institutional and health system levels, with each level depending on capacity at the level below and enabling actions at the level above. We focus on action fields covered by the organizational or systemwide levels that relate to health workforce development. We consider that an analysis of the policy and governance environment and of mechanisms for health workforce policy development and implementation is required, and should guide the identification of the most relevant and appropriate levels and interventions to strengthen the capacity of health workforce stewardship and leadership. Although these action fields are relevant in all countries, there are no best practices that can simply be replicated across countries and each country must design its own responses to the challenges raised by these fields. Il est necessaire d'optimiser la gestion du personnel de sante pour parvenir progressivement a la couverture sanitaire universelle. Dans cet article, nous nous interessons aux six grands domaines d'action en matiere de gestion du personnel de sante qui sont definis dans le Cadre d'action concernant les ressources humaines pour la sante: leadership; finances; politiques; education; partenariats; et systemes de gestion des ressources humaines. Nous decrivons egalement des exemples de pratiques efficaces pour renforcer le personnel de sante, en mettant en avant l'etendue des questions que les responsables politiques et les planificateurs devraient prendre en compte. Il n'est pas possible de reussir dans ces domaines d'action en les abordant de maniere separee. Ce sont des fonctions etroitement liees qui dependent d'une forte capacite a gerer efficacement les politiques relatives au personnel de sante. Cette capacite de gestion peut etre mieux comprise sous la forme d'une pyramide d'outils et de facteurs englobant les niveaux des individus, des organisations, des institutions et des systemes de sante, dans laquelle chaque niveau depend de la capacite du niveau inferieur et permet d'agir au niveau superieur. Nous nous interessons ici aux domaines d'action qui correspondent aux niveaux des organisations ou des systemes et qui concernent le renforcement du personnel de sante. Selon nous, il est indispensable d'analyser le cadre strategique et les structures de gouvernance, ainsi que les mecanismes d'elaboration et de mise en oeuvre des politiques relatives au personnel de sante. Cette analyse devrait permettre de determiner les niveaux et les interventions les plus appropries pour renforcer la capacite de gestion et de direction du personnel de sante. Bien que ces domaines d'action concernent tous les pays, aucune meilleure pratique ne peut etre simplement reproduite dans tous les pays. Chaque pays doit trouver ses propres reponses aux questions soulevees par ces domaines. La optimizacion de la gestion de la fuerza laboral sanitaria es necesaria para la realizacion progresiva de la cobertura sanitaria universal. La optimizacion de la gestion de la fuerza laboral sanitaria es necesaria para la realizacion progresiva de la cobertura sanitaria universal. En este documento se examinan los seis campos de accion principales de la gestion de la fuerza laboral sanitaria identificados en el Marco de Accion de Recursos Humanos para la Salud: liderazgo, finanzas, politicas, educacion, asociaciones y sistemas de gestion de los recursos humanos. Tambien se identifican y describen ejemplos de practicas efectivas en el desarrollo de la fuerza laboral sanitaria, destacando la amplitud de los temas que los responsables de formular politicas y los planificadores deben considerar. No es posible alcanzar el exito en estos campos de accion si se persiguen de forma aislada. Mas bien, se trata de funciones interrelacionadas que dependen de una fuerte capacidad de gestion eficaz de la politica de la fuerza laboral sanitaria. Esta capacidad de gestion puede entenderse mejor como una piramide de herramientas y factores que abarcan los niveles individual, organizativo, institucional y del sistema de salud, en la que cada nivel depende de la capacidad en el nivel inferior y de las medidas de habilitacion en el nivel superior. Se hace enfasis en los campos de accion cubiertos por los niveles de la organizacion o de todo el sistema que se relacionan con el desarrollo de la fuerza laboral sanitaria. En este contexto, es necesario realizar un analisis del entorno normativo y de gobernanza y de los mecanismos para el desarrollo y la implementacion de las politicas de la fuerza laboral sanitaria, y debe guiar la identificacion de los niveles e intervenciones mas pertinentes y apropiados para fortalecer la capacidad de gestion y liderazgo de la fuerza laboral sanitaria. Aunque estos campos de accion son relevantes en todos los paises, no hay mejores practicas que puedan ser simplemente replicadas a traves de los paises y cada pais debe disenar sus propias respuestas a los desafios planteados por estos campos., === Introduction There is growing recognition that the progressive realization of universal health coverage (UHC) is dependent on a sufficient, equitably distributed and well performing health workforce. (1) Optimizing the [...]

The availability of a functioning primary health-care system for populations in rural and underserved areas is crucial for reducing morbidity and mortality, and improving health indicators. A fully functioning primary [...]

Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Parvenir a la couverture sanitaire universelle (CSU) implique la repartition des ressources, et en particulier des ressources humaines pour la sante (RHS), afin de repondre aux besoins de la population. Cet article etudie les lecons politiques sur les RHS de quatre pays ayant accompli des progres durables en matiere de CSU: le Bresil, le Ghana, le Mexique et la Thallande. Son but est d'informer sur les politiques globales et les engagements flnanciers dans les RHS visant a promouvoir la CSU. L'article decrit les experiences des pays a l'aide d'un cadre analytique examinant la couverture efficace par rapport a la disponibilite, l'accessibilite, l'accepta bilite et la qualite (DAAQ) des RHS. Les dimensions DAAQ permettent de realiser une analyse de tracage des actions politiques en RHS depuis 1990 dans les quatre pays etudies, par rapport aux tendances nationales des statistiques de main-d'oeuvre et des taux de mortalite de la population. Les resultats indiquent quels sont les principes cles pour la prise de decisions basees sur les faits sur les RHS visant a promouvoir la CSU. Premierement, les RHS sont essentielles a l'expansion de la couverture des services de sante et de l'ensemble des avantages; deuxiemement, des strategies RHS pour chacune des dimensions DAAQ favorisent collectivement les progres vers une couverture efficace; et troisiemement, le succes est atteint a travers des partenariats impliquant des acteurs tant medicaux que non medicaux. Repondre aux defis sans precedent dans les domaines de la sante et d u developpement, qui concernent tous les pays, et transformer les faits RHS en politiques et en pratiques doivent etre a la base du programme de CSU et de l'agenda de developpement post-2015. C'est un imperatif politique qui exige un engagement et un leadership nationaux pour optimiser l'impact des ressources financieres et humaines disponibles et accroitre l'esperance de vie en bonne sante, avec la reconnaissance que les progres dans le domaine des soins de sante ne sont possibles qu'avec une main-d'oeuvre de sante adequate. [TEXT NOT REPRODUCIBLE IN ASCII] Lograr una cobertura sanitaria universal implica una distribucion de los recursos, en particular, de los recursos humanos para la salud (RHS), a fin de satisfacer las necesidades de la poblacion. Este documento examina las lecciones sobre politicas relacionadas con los RHS de cuatro paises que han conseguido avances ininterrumpidas en materia de cobertura sanitaria universal: Brasil, Ghana, Mexico y Tailandia. Su objetivo consiste en exponer la politica mundial y los compromisos financieros sobre RHS como ayuda para una cobertura sanitaria universal. El documento explica las experiencias de los paises mencionados por medio de un marco de trabajo analitica que examina la eficacia de una cobertura en funcion de la disponibilidad, accesibilidad, aceptabilidad y calidad (DAAC) de los RHS. Los aspectos DAAC permiten llevar a cabo analisis de seguimiento sobre las acciones politicas relativas a los RHS desde 1990 en los cuatro paises de interes en relacion con las tendencias nacionales en el numero de trabajadores y las tasas de mortalidad de la poblacion. Los resultados muestran los principios fundamentales para la toma de decisiones basadas en pruebas cientificas sobre los RHS como apoyo a una cobertura sanitaria universal. En primer lugar, los RHS son esenciales para expandir la cobertura de los servicios sanitarios y el conjunto de prestaciones. En segundo lugar, las estrategias RHS en cada uno de los aspectos DAAC respaldan de forma colectiva los logros en la eficacia de la cobertura y, en tercer lugar, los buenos resultados solo pueden conseguirse a traves de la asociacion de actores sanitarios y no sanitarios. Hacer frente a los desafios sanitarios y de desarrollo sin precedentes que afecta n a todos los paises y traducir las pruebas cientificas sobre RHS en politicas y practicas deben convertirse en los puntos centrales de la cobertura sanitaria universal y de la agenda de desarrollo a partir del ano 2015. Se trata de un imperativo politico que requiere un compromiso y liderazgo nacionales para potenciar el impacto de los recursos financieros y humanos disponibles, y asi mejorar la esperanza de vida saludable, sin olvidar que las mejoras en materia de asistencia sanitaria son posibles gracias a un personal sanitario apto para tal proposito., Introduction In December 2012, the United Nations General Assembly called upon all governments to 'urgently and significantly scale up efforts to accelerate the transition towards universal access to affordable and [...]

The maldistribution of health workers between urban and rural areas is a policy concern in virtually all countries. It prevents equitable access to health services, can contribute to increased health-care costs and underutilization of health professional skills in urban areas, and is a barrier to universal health coverage. To address this long-standing concern, the World Health Organization (WHO) has issued global recommendations to improve the rural recruitment and retention of the health workforce. This paper presents experiences with local and regional adaptation and adoption of WHO recommendations. It highlights challenges and lessons learnt in implementation in two countries--the Lao People's Democratic Republic and South Africa--and provides a broader perspective in two regions--Asia and Europe. At country level, the use of the recommendations facilitated a more structured and focused policy dialogue, which resulted in the development and adoption of more relevant and evidence-based policies. At regional level, the recommendations sparked a more sustained effort for cross-country policy assessment and joint learning. There is a need for impact assessment and evaluation that focus on the links between the rural availability of health workers and universal health coverage. The effects of any health-financing reforms on incentive structures for health workers will also have to be assessed if the central role of more equitably distributed health workers in achieving universal health coverage is to be supported. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] La mauvaise repartition des travailleurs de la sante entre les zones urbaines et rurales demeure une preoccupation politique dans pratiquement tous les pays. Elle empeche l'acces equitable aux services de sante, elle peut contribuer a une augmentation du cout des soins de sante et de sous-utilisation des competences des professionnels de la sante dans les zones urbaines, et elle represente un obstacle a la mise en place d'une couverture maladie universelle. Pour repondre a cette preoccupation qui existe depuis longtemps, l'Organisation mondiale de la Sante (OMS) a emis des recommandations visant a ameliorer le recrutement et la retention des travailleurs du secteur de la sante en milieu rural. Ce document presente differentes experiences locales et regionales concemant l'adaptation et l'adoption des recommandations de l'OMS. Il souligne les defis et les lecons tirees de mises en oeuvre dans deux pays--en Republique democratique populaire lao et en Afrique du Sud--et il offre une perspective plus vaste dans deux regions--en Asie et en Europe. Au niveau des pays, l'application des recommandations a permis un dialogue plus structure et plus cible sur les reglementations, qui a abouti a l'elaboration et a l'adoption de politiques plus pertinentes basees sur les faits. Au niveau regional, les recommandations ont suscite un effort plus soutenu en ce qui concerne l'evaluation des politiques entre les pays et leur apprentissage commun. Il faut evaluer l'impact des liens qui existent entre la disponibilite des travailleurs de la sante dans les zones rurales et la couverture maladie universelle. Les effets de toutes les reformes flnancieres sur les structures d'incitation des travailleurs de la sante devront egalement etre evalues si le but principal est de repartir plus equitablement les travailleurs de la sante et d'atteindre une couverture maladie universelle. [TEXT NOT REPRODUCIBLE IN ASCII] La distribucion ineficaz del personal sanitaria entre las zonas urbanas y rurales constituye una preocupacion politica en casi todos los paises, pues impide el acceso equitativo a los servicios sanitarios, puede contribuir al aumento de los castes de atenci6n sanitaria y la infrautilizacion de las capacidades profesionales sanitarias en las zonas urbanas, y obstaculiza la cobertura sanitaria universal. Para solucionar este problema de larga data, la Organizacion Mundial de la Salud (OMS) ha publicado una serie de recomendaciones generales para mejorar la contratacion a nivel rural y la conservad6n del personal sanitaria. Este informe presenta las experiencias en relacion con la adaptacion local y regional, y la adopcion de los recomendaciones de la OMS. Ademas, subraya los desafios y las lecciones aprendidas de la aplicacion en dos paises, la Republica Democratica Popular Lao y Sudafrica, y proporciona una perspectiva mas amplia en dos regiones, en concreto, Asia y Europa. A nivel nacional, el usa de las recomendaciones facilito un dialogo politico mas organizado y especifico, lo que permitio el desarrollo y la adopci6n de politicas mas relevantes con base empirica. A nivel regional, las recomendaciones motivaron un esfuerzo mas firme para evaluar los politicas entre los poises y el aprendizaje conjunto. Es necesario realizar una evaluacion y una valoracion del impacto que se centren en la relacion entre la disponibilidad de personal sanitaria en zonas rurales y la cobertura sanitaria universal. Asimismo, deben evaluarse los efectos de las reformas financieras en asistencia sanitaria sabre las estructuras de incentivos para el personal sanitaria con miras a promover el papel central del mismo, distribuido de forma mas equitativa, en la consecucion de la cobertura sanitaria universal., Introduction Any shortage of health workers can prevent good access to health services and is a barrier to universal coverage. When such shortages are accompanied by an unequal distribution of [...]

This paper discusses the reasons for skill mix among health workers being important for health systems. It examines the evidence base (identifying its limitations), summarizes the main findings from a literature review, and highlights the evidence on skill mix that is available to inform health system managers, health professionals, health policy-makers and other stakeholders. Many published studies are merely descriptive accounts or have methodological weaknesses. With few exceptions, the published analytical studies were undertaken in the USA, and the findings may not be relevant to other health systems. The results from even the most rigorous of studies cannot necessarily be applied to a different setting. This reflects the basis on which skill mix should be examined - identifying the care needs of a specific patient population and using these to determine the required skills of staff. It is therefore not possible to prescribe in detail a "universal" ideal mix of health personnel. With these limitations in mind, the paper examines two main areas in which investigating current evidence can make a significant contribution to a better understanding of skill mix. For the mix of nursing staff, the evidence suggests that increased use of less qualified staff will not be effective in all situations, although in some cases increased use of care assistants has led to greater organizational effectiveness. Evidence on the doctor-nurse overlap indicates that there is unrealized scope in many systems for extending the use of nursing staff. The effectiveness of different skill mixes across other groups of health workers and professions, and the associated issue of developing new roles remain relatively unexplored.

This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States. We also examine the policy challenges for workforce planning and the design of health systems infrastructure. Data are derived from registries of professional nurses, censuses, interviews with key informants, case studies in source and destination countries, focus groups, and empirical modelling to examine the patterns and implications of the movement of nurses across borders. The flow of nurses to these destination countries has risen, in some cases quite substantially. Recruitment from lower-middle income countries and low-income countries, as defined by The World Bank dominate trends in nurse migration to the United Kingdom, Ireland, and the United States, while Norway and Australia, primarily register nurses from other high-income countries. Inadequate data systems in many countries prevent effective monitoring of these workforce flows. Policy options to manage nurse migration include: improving working conditions in both source and destination countries, instituting multilateral agreements to manage the flow more effectively, and developing compensation arrangements between source and destination countries. Recommendations for enhancements to workforce data systems are provided. Keywords Nurses/supply and distribution; Brain drain/trends; Emigration and immigration/trends: Foreign professional personnel/supply and distribution; Personnel selection/trends: Public policy; Developed countries; Developing countries; Australia; Ireland; Norway; United Kingdom; United States (source: MeSH, NLM). Mots cles Infirmieres et infirmiers/ressources et distribution; Exode des competences/orientations; Emigration et immigration/orientations; Personnel professionnel etranger/ressources et distribution; Selection personnel/orientations; Politique gouvernementale; Pays developpe; Pays en developpement; Australie; Irlande; Norvege; Royaume-Uni: Etats-Unis (source: MeSH, INSERM). Palabras clave Enfermeras/provision y distribucion; Exodo intelectual/tendencias; Migracion internacional/tendencias; Personal profesional extranjero/provision y distribucion; Seleccion de personal/tendencias; Politica social; Paises desarrollados; Paises en desarrollo; Australia; Irlanda; Noruega; Reino Unido; Estados Unidos (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII.], Resume Migration des personnels infirmiers : tendances et politiques Le present article examine le contexte de l'augmentation de la mobilite et de la migration internationales des personnels infirmiers. Il decrit [...]