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Human Resources for Health

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“Health systems can only function with health workers; improving health service coverage and realizing the right to the enjoyment of the highest attainable standard of health is dependent on their availability, accessibility, acceptability and quality”

Global strategy on human resources for health: workforce 2030; WHO; 2016

Many countries face difficulties in the education, deployment, retention, and performance of their health workforce. Health priorities aiming for Universal Health Coverage will remain aspirational unless accompanied by strategies aiming to strengthen health workforces. A knowledgeable, skilled and motivated health workforce is critical for reaching national goals. Strengthening Human Resources are, therefore, a fundamental part of the effort to build resilient and sustainable systems for health.

UNDP's offer

UNDP focuses on building capacity to aim for sufficient staffing and skill levels; adequate structures, roles and responsibilities; plans for addressing human resource gaps; effective staff retention and staff development strategies.
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  1. Strengthening capacity for effective policy-making governing human resources.
  2. Strengthening workforce planning for both short and long-term.
  3. Increasing the supply and competencies of human resources through education and training.
  4. Improving motivation and retention through monetary or non-monetary incentives, such as staff development programmes.
  5. Strengthen communications, leadership, and mentoring.

UNDP in Afghanistan

As part of its capacity development in challenging operating environments UNDP has supported the participatory development of Capacity Development Plans for both the Ministry of Health and civil society groups in Afghanistan.
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UNDP has worked with the Afghan Ministry of Public Health and the Global Fund to set up six nursing schools training female nurses. According to WHO, around 40 percent of health facilities in Afghanistan are without female staff, a significant problem in a country where community norms often mean that women are not allowed to receive care from men unless accompanied by a male family member.

The civil society groups are small and have difficulties recruiting and retaining staff in a demanding environment. UNDP has supported the groups in developing a Human Resources manual to begin the process of improving staff development and retention. It will also be working with the Ministry of Health in carrying out a functional analysis to review what skills and positions are required to achieve the ambitious health goals in Afghanistan.

Coverage versus Quality

Human resources are an integral part of the health system providing the link between the theoretical health services provision and the actual performance of the health service.
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The health sector is not only labour-intensive but it also depends on a precise application of the knowledge and skills of its workforce to ensure patient security and health. The mere availability of health workers is not sufficient: only when they are evenly distributed and accessible by the population, when they possess the required competencies, are motivated and empowered to deliver quality care, and when they are adequately supported by the health system, does this translate into effective service coverage.

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Human Resource for Health Strategies

Human Resource for Health (HRH) Strategies should outline the development of the health workforce and find sustainable solutions to issues such as the education, migration and retention of health workers, and long-term health workforce planning.
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Many countries have a high turnover of skilled health personnel in the form of migration to more developed countries offering better remuneration, better working conditions, opportunities for postgraduate education and training and better standards of living.

The challenge is to produce the required number of key health workers and ensure that they remain motivated to stay. Ad hoc interventions consistently fail to correct workforce imbalances in health care. It takes years to educate and train health professionals, thus a long-term approach needs to be taken. Human resource decisions have long lasting effects and are often difficult to reverse. This means that, rather than respond reactively, a strategic approach is needed which supports the development of a more resilient health system.

Countries in, or emerging from, armed conflict or natural or man-made disasters present specific health workforce challenges that should be taken into account.

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HRH Strategy Development

A comprehensive analysis of the HRH situation is essential. This forms the basis upon which a policy or a plan can be developed or reviewed. It also provides a baseline from which measurements can be made as to whether the situation has improved or not.

A national human resources for health policy is a guide for action for health personnel. The policy describes the priorities that a country wants to achieve in the area of HRH as it responds to implementation of health priorities. It also identifies the main strategies for attaining those priorities, in the short-term, medium-term and long-term. The goals of the HRH policy should be consistent with the broader national health objectives.

The main objective of an HRH policy is to ensure availability of health workers in sufficient quantity and quality, at all levels, at the right place at the right time, and well-motivated to perform their functions.

An HRH strategic plan tries to elaborate on what the policy will achieve and how it will be implemented. The plan contains information on the situation analysis, the issues, the objectives and the strategies to solve the identified challenges.

The plan specifies and sets targets with expected results, and makes proposals for financing the implementation. A good strategic plan also indicates what to observe if it is being implemented according to plan and provides the flexibility for amendment, review or adjustment.

Human versus Physical Resources

The health workforce includes those that provide direct health services such as doctors, nurses etc. and those that support the health services such as hospital managers, provincial and district managers, accountants reporting on health budgets, etc.
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Skilled health workers are unable to deliver services effectively without appropriate support personnel (accountants; IT support Officers etc) as well as physical capital such as adequate facilities, equipment and consumables such as medicines. Thus, health systems and the supporting HRH strategies need to balance these three vital demands – human resources, physical capital and consumables.
Innovation

Making good use of information and communications technology (ICT) is one way to improve impact in HRH. ICT investments can focus on software and systems to contribute to issues such as workforce planning, professional development and improving the working environment.

ICT can support the analysis of where health workers are most required, the development of e-learning modules to motivate and improve on-the-job learning, electronic health records improving links between health workers and patients improving morale, payroll management, and performance management.

The Global Fund recognises Human Resources for Health as one of the key elements to creating resilient and sustainable health systems, and identifies that it can be a critical bottleneck to the scale-up and delivery of high quality health services
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Most countries supported by the Global Fund face human resources challenges, including shortages and mal-distribution, high turnover, inadequate skills, poor working conditions and a lack of appropriate health workforce information. In addition, human resources manage and make decisions about the use of all the other inputs to the health system. HRH are, therefore, a fundamental part of the effort to achieve the health-related sustainable development goals and to build resilient and sustainable systems for health.

The Global Fund prioritises HRH investments in funding applications if health workforce challenges represent a barrier to the availability, accessibility, acceptability or quality of services, especially in countries with high disease burden and low economic status.

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Suggested Indicators

  • Human Resource Strategy in place.
  • Staff development plan exists.
  • Percentage of health staff with appropriate certification levels.
  • Percentage staff turnover per year.
  • Number of senior staff at primary health care facilities who received in-service training (using nationally approved curriculum) in the past 12 months.

Guidance & Tools