Human resources: the Cinderella of health sector reform in Latin America

Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside

Additive and non-additive genetic parameters for multipurpose traits in a clonally replicated incomplete factorial test of Castanea spp.

14 páginas, 3 tablas, 3 figurasSecond-year traits of growth, stem form, terminal flushing, and survival were assessed in 1770 ramets from 295 clones of 16 full-sib families of Castanea spp. Additive, dominance, and epistatic genetic variances were estimated in a clonally replicated incomplete 5 × 4 factorial test. Parents of the mating design were selected mainly on their phenotypes for wood quality (Castanea sativa traditional varieties) and their proven resistance to Phytophthora spp. (Asiatic species and Castanea crenata × C. sativa hybrids). Additive genetic variances were estimated to be 1.7–9 times greater than the dominance components. Inferred epistatic variance components showed a significant role in controlling growth traits and branch length. Narrow- and broad-sense heritability estimates showed that terminal flushing date was the most heritable trait, followed by height. The high estimates of half-sib, full-sib, and clonal mean heritabilities for almost all traits suggest that different strategies of backwards and forwards selection could be proposed. The ranking of the breeding values of parents allow us to select the best parents for new crosses and extend the mating design. Favorable genetic correlations were found between growth traits and straightness, so multi-trait selection looks promising. Our results provide the first information on the partitioning of genetic variance in Castanea spp. and a starting point for devising new selection strategies.This study was supported by the project “Conservation and breeding of chestnut (2013–2015),” funded by the sub-measure 323.2.3 of the Plan “Conservation and improvement of natural heritage, convergence region” from European Agricultural Fund for Rural Development (EAFRD).Peer reviewe