BOX 4-4Health Sector Human Resource Strategies to Address the Workforce Crisis

Workforce policies focused on simply increasing the number of health workers to address health needs (without understanding the dynamics of the labor market, such as supply and demand) often fail to achieve their objectives (Glassman et al., 2008; Vujicic and Zurn, 2006). Policies that incorporate more explicitly the behavior of those who supply labor (doctors, nurses, midwives, and other providers) and those who demand labor (local governments, the private sector, and foreign governments) and endeavor to understand how each group responds to incentives can be successful (Vujicic and Zurn, 2006).

The supply of healthcare professionals at the country level can be thought of as the number of individuals with the necessary qualifications who are willing to work in the healthcare sector. Supply is influenced by opportunities to migrate, as well as access to training, labor conditions, and wages. By understanding how these factors influence the supply of viable healthcare professionals, countries can create public policies to address their health workforce shortages (Vujicic and Zurn, 2006).

Given that resources are limited, what is desirable or needed is not always feasible. Thus, the demand for healthcare services—the quantity of healthcare services that individuals or governments are willing to pay for—does not always correspond to healthcare needs. For example, in many cases, hospitals need more doctors and nurses to achieve the desired level of health service delivery, but do not have the resources to pay their wages and thus do not demand more healthcare providers. Other factors, such as the length of time required to educate physicians, can delay changes in the available supply, thus delaying balance in the labor market (Zurn et al., 2004).

Providing Educational Incentives

Targeted subsidies, grants, and scholarships are examples of incentives that can be used not only to attract more students, but also to retain students who are more likely to remain in the country and work in underserved areas (Marchal and Kegels, 2003). Thailand provides an example of such incentive-based placement of doctors to address urban and rural healthcare disparities (Wibulpolprasert and Pengpaibon, 2003). Another measure to retain health workers could be to identify,

at the time of entry to health worker education, those candidates who are likely to stay in their country and work where they are most needed (Marchal and Kegels, 2003). A Ugandan study of nursing students found that those wanting to emigrate would be least likely to work in rural areas (Nguyen et al., 2008). Governments could then create incentives to target the students who do not aspire to migrate as being the most inclined to work in rural and underserved areas.

Improving Working Conditions

Wage increases, additional benefits, and flexibility in working hours are other examples of commonly used incentives to attract or retain workers. Yet recruiting and retaining health staff requires an overall conducive environment that offers opportunities and favorable working conditions. Health personnel working in underserved areas require special incentives that go beyond educational incentives and reasonable salaries, such as hardship and transportation allowances; subsidized school fees for children and housing; and opportunities for continued education and career development. Reducing the brain drain within countries among doctors requires “clear-cut, merit-based career structures that offer attractive posts in clinical or research fields, accompanied by adequate remuneration” (Marchal and Kegels, 2003).

Reforming the Skill Mix

In some instances, resource-limited countries are making greater use of mid-level health workers, such as assistant medical officers, clinical officers, and surgical technicians (Heller and Mills, 2002; Marchal and Kegels, 2003). These workers supplement the work of doctors and nurses to provide medical, obstetrical, and surgical care in underserved areas. Midlevel workers can provide quality care if appropriately trained, monitored, and given the opportunity to attend continuous skill improvement courses (Dovlo, 2003; Vaz et al., 1999).

Overall, such incentives and policies can bring more workers into the public health system and improve its effectiveness. National policies that improve labor conditions by offering a mix of these incentives have been successful, but they require a commitment by governments to formulate health resource plans. These plans should be led by countries because the policies to address the local labor market must be planned, implemented, and owned within national settings (Chen et al., 2004).

From: 4, Invest in People, Institutions, and Capacity Building with Global Partners

Cover of The US Commitment to Global Health: Recommendations for the Public and Private Sectors
The US Commitment to Global Health: Recommendations for the Public and Private Sectors.
Institute of Medicine (US) Committee on the US Commitment to Global Health.
Washington (DC): National Academies Press (US); 2009.
Copyright © 2009, National Academy of Sciences.

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