Table 1 Linkages between health workforce and governance a
Governance principle | Health workforce/governance link | HSAbindicator | HAFcaction field |
|---|---|---|---|
Information | Information systems facilitate production of data to inform decisions about planning/training/supporting the health workforce. | Availability/use of HRHd information systems | Human resource management systems |
Bottom up information from health workers assists government to: formulate evidence-based policy, plan direction of health sector, and monitor performance. | Public/private sector providers report information to government | ||
Accountability | Environment where health workers know responsibilities and have supportive supervision, and supervision enables them to better fulfill duties. | Enabling environment exists to achieve goals and targets | |
Existence/use of tools to measure health worker performance enables managers to hold workers accountable to set expectations. | Availability of mechanisms to monitor and improve performance | ||
Scopes of practice (i.e., registration, licensure) ensure qualifications are met upon entry into profession and reassessment procedures are in place to ensure staff maintains qualified status. | Existence of clear and up-to-date scopes of practice | Policy | |
Strategic vision | Evidence-based and costed HRH policies/strategic plans provide a vision for the health workforce and help to coordinate activities within the health sector. | Existence and use of up-to-date HRH policies/strategic plan | |
Transparency | Documentation ensures clarity among health workers concerning the rules they are governed by. | Employment policies documented/used | |
Routine NHAe data enable stakeholders to track health expenditures from sources to providers. | NHA reports expenditure data | Finance | |
Transparent/comprehensive account of the budget process ensures clarity in decision-making. | Budgets/projections done for HRH | ||
Efficiency | If implemented appropriately, financial and non-financial incentives can ensure better performance with less waste. | Services organized/financed to incentivize providers to improve care | |
Performance contracting, whereby public sector collaborates/purchases services from private sector, can lead to delivery of better quality care at a lower cost. | Contracting mechanisms exist between MOHf/public/private providers | ||
Informal user fees act as a barrier to care and increase costs without improving quality or access to public health services. | Existence of informal user fees in the public sector | ||
Mechanisms used to pay health service providers serve as an incentives/affect the quality of care. | Type of provider payment mechanisms | ||
Equity | Perceptions of unfair wages and actual wage differences drive staff turnover. Salaries should be equitable among employees completing similar levels of work, and paid on time. | Salaries competitive in local/regional labor markets and paid on time | |
Providers recruited from and then posted to rural areas are more likely to stay in rural areas. | Urban versus rural admissions/graduates | Education | |
Responsiveness | Aligning pre-service education with the competencies needed to address population health enables the right numbers and cadres to enter the workforce with the right skills. | Production of new health care workers responsive to population health needs | |
Outdated curriculum is unresponsive to population health needs and a source of poorly trained workers. | Pre service education regularly updated | ||
In-service training should be linked to organizations’ priorities/changes in the health sector. Ad-hoc in-service training that is unrelated to staff needs often results in low attendance rates. | In-service training aligned with population/workforce needs | ||
High-level government officials (ministers, parliament, cabinet members, private health sector leaders) should be aware of HRH issues to develop calls for action/include HRH in donor requests. | Awareness of high-level government officials of HRH issues | Leadership | |
Voice and participation | Communities should have a voice to determine which services are provided/how funding is budgeted/provide feedback on service quality. | Mechanisms in place for patient and community feedback | Partnerships |