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Background: Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015. Methods: Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies. Results: There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed. Conclusions: There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning. publishersversion published

Annex: Table S1. Summary of the papers included in the review. (DOC 120 kb)

Introdução: A migração, apesar de não ser um fenómeno recente entre as profissões de saúde assumiu nos últimos anos proporções significativas, sobretudo em África. Para a GB, a saída dos profissionais de saúde tem um impacto devastador no que concerne o desempenho do sistema de saúde e por conseguinte a saúde das populações. Portugal, pelas ligações histórias e pela proximidade que mantém com a GB, tem sido escolhido pelos profissionais de saúde como o país destino para a emigração. Neste sentido considerou-se importante aprofundar conhecimentos sobre o fenómeno migratório dos profissionais de saúde da GB para Portugal, incluindo as motivações dos profissionais de saúde, a realidade vivida em Portugal e os motivos para o regresso. Objectivos: Caracterizar o fenómeno migratório dos profissionais de saúde guineenses para Portugal, ao longo de todo o processo migratório, desde a decisão de emigrar, à decisão de retorno. Material e métodos: Este estudo teve por base uma abordagem qualitativa, optando-se pela realização de um estudo de caso único, com várias unidades de análise. O caso em estudo foi o fenómeno migratório, tendo como objecto de estudo os profissionais de saúde guineenses nele envolvidos. Utilizaram-se métodos não probabilísticos para a selecção das amostras. Foram realizadas um total de 4 entrevistas semi-estruturadas a profissionais de saúde, 3 grupos focais a enfermeiros e 3 entrevistas a informadores chave na GB. Em Portugal, foram realizadas 12 entrevistas semi-estruturadas. Posteriormente, realizou-se a análise de conteúdo e análise exploratória dos dados. Resultados: As condições de trabalho, o acesso a formação, o crescimento e valorização profissionais, assim como, a estabilidade político-militar e melhores condições de vida, são factores essenciais para a motivação e empenho dos profissionais de saúde, e por conseguinte, funcionam como factores impulsionadores da emigração quando não existentes. Enquanto imigrantes, os profissionais médicos e enfermeiros não têm o mesmo percurso em termos de integração profissional. Os enfermeiros recentemente emigrados não obtêm o reconhecimento das suas habilitações ao contrário dos médicos. Contudo, a melhoria das condições de vida é, na generalidade, alcançada. Existe na maioria dos profissionais o desejo de regressar ao país de origem, estando a sua concretização dependente de condições tanto na GB como em Portugal. Conclusão: O fenómeno migratório é algo complexo, com inúmeros factores e em constante evolução, dizendo respeito sobretudo à procura de melhores condições de trabalho e de vida. O presente estudo serviu para identificar alguns destes factores e caracterizar as etapas do processo migratório dos profissionais de saúde da GB para Portugal, desde a decisão de emigrar à decisão de regressar. Deixa também pistas para desafios que se impõem com a migração destes profissionais. Introduction: Although not a recent phenomenon in the healthcare job sector, migration has reached significant proportions, specially in Africa. For Guinea-Bissau, the exit of healthcare professionals has had a devastating impact in what concerns the health system, and consequently the health of the population. Given the historical relation and proximity between Portugal and Guinea-Bissau, guinean healthcare professionals increasingly choose the former as their destination of emigration. In face of this reality, it was considered important to analyze in depth the migratory phenomenon of healthcare professionals emigrating from Guinea-Bissau to Portugal, including their motivations, the reality lived in Portugal and their reasons to return. Objectives: To characterize the migratory phenomenon of guinean healthcare professionals into Portugal, during the migratory process, from the decision to emigrate until the decision to return to the home country. Material and methods: This study’s base consists of a qualitative approach, opting for the realization of a single case study, with various units of analysis. The case study was the migratory phenomenon, being the object the guinean healthcare professionals involved in it. Non-probabilistic methods were used to determine the samples of study. A total of 4 semi-structured interviews were conducted to healthcare professions, 3 focus-groups with the participation of nurses and 3 interviews to key actors in Guinea-Bissau. In Portugal, 12 semi-structured interviews were conducted. Posteriorly, a content analysis and exploratory analysis of the data was made. Results: The work conditions, the access to information, the growth and valorization of their careers, and also, the politic and military stability and higher living standards were essential factors of motivation and commitment for the healthcare professionals, thus functioning as boosters of emigration when not present in the home country. As immigrants, healthcare professionals and nurses have different paths of professional integration. Recently emigrated nurses do not obtain the recognition of their habilitations, whereas doctors do. However, the improvement of living standards is usually attained. Most of the professionals express a desire of returning to their home country, being the decisive factor the evolution of conditions both in Guinea-Bissau and Portugal. Conclusion: The migratory phenomenon is complex, with a big number of factors in constant evolution, mostly concerning the search of better work conditions and living standards. This study serves as a mean of identifying some of those factors and characterizing the steps in the migratory process that healthcare professionals from Guinau-Bissau go through when transferring to Portugal, from the decision to emigrate all the way to the possible moment of return. It also offers insight into the challenges that emerge from the migration of these professionals.