Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges

It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised. However, data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills. The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed. The paper is divided into six sections. In the first, the different types of migration are reviewed. Some global trends are depicted in the second section. Scarcity of data on health worker migration is one major challenge and this is addressed in section three, which reviews and discusses different data sources. The consequences of health worker migration and the financial flows associated with it are presented in section four and five, respectively. To illustrate the main issues addressed in the previous sections, a case study based mainly on the United Kingdom is presented in section six. This section includes a discussion on policies and ends by addressing the policy options from a broader perspective

A realist evaluation of the management of a well- performing regional hospital in Ghana

<p>Abstract</p> <p>Background</p> <p>Realist evaluation offers an interesting approach to evaluation of interventions in complex settings, but has been little applied in health care. We report on a realist case study of a well performing hospital in Ghana and show how such a realist evaluation design can help to overcome the limited external validity of a traditional case study.</p> <p>Methods</p> <p>We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews.</p> <p>Results</p> <p>We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment.</p> <p>Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development.</p> <p>Conclusion</p> <p>This case suggests that a well-balanced HRM bundle can stimulate organisational commitment of health workers. Such practices can be implemented even with narrow decision spaces. Realist evaluation provides an appropriate approach to increase the usefulness of case studies to managers and policymakers.</p

As políticas e a gestão de recursos humanos em saúde: 1984 a 1995 Health human resources politics and management: from 1984 to 1995

A implantação do Sistema Único de Saúde - SUS, aprovada pela Constituição Federal de 1988, representou uma inovação política cuja característica central é a descentralização. Esta reforma do sistema de saúde vem transferindo aos municípios a missão de gestor único dos serviços de saúde no seu nível, numa inflexão nas normas e práticas até então vigentes. Este artigo trata das repercussões da reforma do sistema de saúde sobre as políticas de recursos humanos, focalizando o Estado do Rio de Janeiro e o nível municipal. Busca-se explicar algumas de suas insuficiências e contribuir para estabelecer novas bases e modelos para a política e gestão de recursos humanos no SUS. A pesquisa, que serviu de base ao artigo e à tese de doutorado, foi realizada no Estado do Rio de Janeiro e nos Municípios de Niterói e Angra dos Reis, que estavam enquadrados na categoria de gestão semiplena, segundo a Norma Operacional SUS Ol/93. Utilizando-se metodologia qualitativa foram feitas observações, coleta de documentos e entrevistas com gestores, técnicos e dirigentes de órgãos de representação de interesses dos trabalhadores, en quanto atores privilegiados das políticas e do processo de gestão de recursos humanos. Para a análise foi feito um recorte em torno de duas categorias: objetos do processo de regulação do trabalho e filosofia de gestão. Na primeira categoria foram consideradas como variáveis as definições dos planos de cargos e carreiras, da remuneração e da jornada de trabalho e, para a segunda, a participação na gestão, o processo de negociação e os programas de capacitação.<br>The implantation of lhe SUS, approved by the 1988 Federal Constitution, represented a political innovation whose main characteristic is decentralization. This reform of the heallh system gave the municipalities the mission of' being the only manager of heallh system on their levels, in a shift in the rules and practices so far in force. This study discusses lhe repercussions of the health reform in the field of human health politics, focusing on the state of Rio de Janeiro and its municipalities. It tries to explain some of the its insuf'iciencies and to contribute to improve the establishment of new base and models for the policy and management of human resources within the SUS. The research was carrid out on the state of Rio de Janeiro and the municipalities of Niterói and Angra dos Reis, which fit the category of "semiplena" rnanagement, according to the Operational SUS Regulation 01/ 93. Employing qualitative methodology, one has carried out observation, analysis of documents and interviews with administrators, technicians and managers of institutions, who represent the worker's interests, as privileged actors of the policies and process of human resources management. The analysis was based on two categories: subjects of the labor regulation and management philosophy. In the first category the variables were: definitions of job and careers plan, remuneration and work shift; in the second one, participation in the management, negotiation process and training programs