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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 [...]

The reasons a skill mix among health workers is important to health care systems were examined. The analysis was based on a review of studies conducted primarily in the United States. "Skill mix" was defined as the mix of posts, grades, or occupations in an organization and the combinations of activities or skills needed for each job within the organization. The literature reviewed included the following types of publications: reviews; meta-analyses; large-scale data surveys; single-site examinations of roles and mix in nursing and other nonmedical health professions; single-site examinations of role overlap between doctors and other health professionals; and studies on the introduction of new types of workers. Significant limitations to the current evidence on skill mix in the health workforce were discovered. Many published studies on the topic were merely descriptive accounts, and the usefulness of many of the studies that moved beyond mere descriptions was constrained by methodological weaknesses, lack of appropriate evaluations of quality/outcome and cost, and/or use of small samples. Despite these limitations, the evidence suggests that increased use of less qualified (cheaper) nursing staff will not be effective in all situations, although greater use of assistants has improved organizational efficiency in some areas. (French and Spanish abstracts are included. The bibliography lists 41 references.) (MN)