It has taken unusually long for international efforts in\ud health systems development to give human resources the\ud special attention they rightly deserve given the unique and\ud complex circumstances under which health workers operate\ud in the developing world. Health workers continue to be\ud underpaid, demoralized and underproductive. This has\ud given rise to various forms of informal activities and dual\ud practice with implications for equity of access to quality\ud services (Killingsworth et al. 1999; McPake et al. 1999).\ud Problems of health worker training, deployment and, most\ud importantly, retention, remain ubiquitous. Migration of\ud health workers to greener pastures within regions or to\ud richer countries is emerging as a serious global problem.\ud Imbalances in the skill mix of those health workers who\ud remain present further challenges for efficient health\ud service delivery
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