Developing the health workforce for universal health coverage

Giorgio Cometto,a James Buchanb & Gilles Dussaultb Abstract 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 system- wide 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.

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 management of the health workforce has the potential to improve health outcomes, enhance global health security and contribute to economic growth through the creation of qualified employment opportunities.2 The effective management of the health workforce includes the planning and regulation of the stock of health workers, as well as education, recruitment, employment, performance optimization and retention. Health workforce management is a difficult task for many reasons. For example, there can be skills shortages and funding constraints. Health workers can also form groups (associations, unions and councils) with political and social power; such groups can defend and promote objectives and interests that are not always aligned with national health priorities and objectives. Historically, the health labour market has been highly regulated through barriers at entry and restrictions on tasks that specific health workers can perform; the most highly qualified workers have also secured significant autonomy in performing their work. The health workforce development function is part of, and therefore needs to be integrated with, health system governance and management, health sector policy and legislation, and service delivery strategies and mechanisms. Here, we discuss the six main action fields in health workforce management identified by the Human Resources for Health Action Framework:3 leadership; finance, policy; education; partnership; and human resources management systems. We have adopted this framework because it is explicitly focused on actions required by policy-makers and planners (all six action fields) and managers (included in the last three action fields), as opposed to other frameworks that are based on the perspective of the individual health worker or more focused on the labour and finance elements. These six action fields are relevant in countries at all levels of socioeconomic development, including those affected by conflict and chronic complex emergencies. As a result of their intrinsic complexity, and the need to adapt interventions to the specific context and vested interests of a country, these action fields require long-term strategic vision and commitment. We elucidate the logical hierarchy and links between the six different action fields (Fig. 1). We identify and describe illustrative examples of effective practices in health workforce development according to these six action fields, highlighting the breadth of issues that policy-makers and planners should consider.

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