Public health workforce: challenges and policy issues

This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce, including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems. The available evidence to shed light on these policy issues is limited. The World Health Organization is supporting the development of evidence to inform discussion on the best approaches to strengthening public health capacity in developing countries. WHO's priorities are to build an evidence base on the size and structure of the public health workforce, beginning with ongoing data collection activities, and to map the current public health training programmes in developing countries and in Central and Eastern Europe. Other steps will include developing a consensus on the desired functions and activities of the public health workforce and developing a framework and methods for assisting countries to assess and enhance the performance of public health training institutions and of the public health workforce

Sub-national assessment of inequality trends in neonatal and child mortality in Brazil

<p>Abstract</p> <p>Objective</p> <p>Brazil's large socioeconomic inequalities together with the increase in neonatal mortality jeopardize the MDG-4 child mortality target by 2015. We measured inequality trends in neonatal and under five mortality across municipalities characterized by their socio-economic status in a period where major pro poor policies were implemented in Brazil to infer whether policies and interventions in newborn and child health have been successful in reaching the poor as well as the better off.</p> <p>Methods</p> <p>Using data from the 5,507 municipalities in 1991 and 2000, we developed accurate estimates of neonatal mortality at municipality level and used these data to investigate inequality trends in neonatal and under five mortality across municipalities characterized by socio-economic status.</p> <p>Results</p> <p>Child health policies and interventions have been more effective in reaching the better off than the worst off. Reduction of under five mortality at national level has been achieved by reducing the level of under five mortality among the better off. Poor municipalities suffer from worse newborn and child health than richer municipalities and the poor/rich gaps have increased.</p> <p>Conclusion</p> <p>Our analysis highlights the importance of monitoring progress on MDGs at sub-national level and measuring inequality gaps to accurately target health and inter-sectoral policies. Further efforts are required to improve the measurement and monitoring of trends in neonatal and under five mortality at sub-national level, particularly in developing countries and countries with large socioeconomic inequalities.</p

The abiding, hidden, and pervasive centrality of the health research workforce

Funding Information: MRDP is full professor at the University of the State of Rio de Janeiro, Brazil, a public funded university, and has projects co-funded by “Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001”, “Conselho Nacional de Desenvolvimento Científico e Tecnológico”and “Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro”. Funding Information: PF acknowledges Fundação para a Ciência e Tecnologia for funds to GHTM UID/04413/2020. Funding Information: MM is employed by the EDCTP2 programme supported by the European Union. Publisher Copyright: © 2023, The Author(s).Research for health and development (R4HD) acknowledges that many of the determinants of health lie outside the boundaries of the health system. The size and quality of the health and care workforce (HCWF) are key drivers towards the future trajectory of many of these factors. We consider researchers for health and development an abiding, pervasive but neglected constituent part of this HCWF. This workforce straddles many professional groups and sectors. The diversity of occupations, lack of standardization in occupational cadres, the complexity and gendered aspects of the labour market, and the variable demographic, epidemiological, socio-economic and health systems’ contexts in the global south and the global north, led to a kaleidoscopic perception of the health research workforce that have kept it hidden from public opinion. This led to neglect by science as well as health policymakers and created an orphan sub-set of the HCWF. Understanding the health researchers’ labour market will help to identify means to develop, retain and utilize the health research workforce, addressing size, composition, role, skills transferability, careers and social impact through building, enabling or sustaining its research functions, capacity, employment opportunities and career tracks, among other issues. This thematic series of the Human Resources for Health Journal, calls for papers that go beyond narrow conceptual approaches and professional understandings of health care workers and the health research workforce, and requests that contributors examine important workforce issues through the broad lens of R4HD within a sustainable development goals framework.publishersversionpublishe

Skill mix in the health care workforce : reviewing the evidence

This paper discusses the reasons for skill mix among health workers being important for health systems. It examines the evidence base (identifying its limitations), summarizes the main findings from a literature review, and highlights the evidence on skill mix that is available to inform health system managers, health professionals, health policy-makers and other stakeholders. Many published studies are merely descriptive accounts or have methodological weaknesses. With few exceptions, the published analytical studies were undertaken in the USA, and the findings may not be relevant to other health systems. The results from even the most rigorous of studies cannot necessarily be applied to a different setting. This reflects the basis on which skill mix should be examined-identifying the care needs of a specific patient population and using these to determine the required skills of staff. It is therefore not possible to prescribe in detail a ''universal'' ideal mix of health personnel. With these limitations in mind, the paper examines two main areas in which investigating current evidence can make a significant contribution to a better understanding of skill mix. For the mix of nursing staff, the evidence suggests that increased use of less qualified staff will not be effective in all situations, although in some cases increased use of care assistants has led to greater organizational effectiveness. Evidence on the doctor-nurse overlap indicates that there is unrealized scope in many systems for extending the use of nursing staff. The effectiveness of different skill mixes across other groups of health workers and professions, and the associated issue of developing new roles remain relatively unexplored.sch_nur1. The World Health Report, 2000 - Health systems: improving performance. Geneva: World Health Organization; 2000. 2. WHO estimates of health personnel: physicians, nurses, midwives, dentists and pharmacists (around 1998). Geneva: World Health Organization. Available from: URL: http://www3.who.int/whosis (click on ''heath personnel''). 3. Buchan J, Ball J, O'May F. Determining skill mix in the health workforce: guidelines for managers and health professionals. Geneva: World Health Organization; 2000 (document OSD discussion paper 3). 4. Buchan J. Determining skill mix: lessons from an international review. Human Resources for Health Development Journal 1999;3:80-90. 5. Feldman M, Ventura M, Crosby F. Studies of nurse practitioner effectiveness. Nursing Research 1987;36:303-8. 6. Brown S, Grimes D. A meta-analysis of nurse practitioners and nurse midwives in primary care. Nursing Research 1995;44:332-9. 7. Richardson G, Maynard A, Cullum N, Kindig K. Skill mix changes: substitution or service development? Health Policy 1998;45:119-32. 8. Richards A, Carley J, Jenkins CS, Richards DA. Skill mix between nurses and doctors working in primary care-delegation or allocation: a review of the literature. International Journal of Nursing Studies 2000;37:185-97. 9. Anderson RA, Hsieh P, Su H. Resource allocation and resident outcomes in nursing homes: comparisons between the best and worst. Research in Nursing and Health 1998;21: 297-313. 10. Bond CA, Raehl CL, Pitterle M E, Franke T. Health care professional staffing, hospital characteristics, and hospital mortality rates Pharmacotherapy 1999;19:130-8. 11. Kovner C, Gergen PJ. Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image: Journal of Nursing Scholarship 1998;30:315-21. 12. Aiken L, Sloane D. Advances in hospital outcomes research. Journal of Health Services Research & Policy 1998;3:249-50. 13. Sochalski J, Estabrooks C, Humphrey C. Nurse staffing and patient outcomes: evolution of an international study. Canadian Journal of Nursing Research 1999;31:69-88. 14. Carpenter GI, Ikegami N, Ljunggren G, Carrillo E, Fries BE. RUG-III and resource allocation: comparing the relationship of direct care time with patient characteristics in five countries. Resource Utilization Groups. Age and Ageing 1997;26. Suppl. 2:61-5. 15. Wharrad H, Robinson J. The global distribution of physicians and nurses. Journal of Advanced Nursing 1999;1:109-20. 16. Hoff W.Traditional practitioners as primary health care workers. Geneva: World Health Organization; 1995. Unpublished document WHO/SHS/DHS/TRM/95.6. 17. Taylor B. Parents as partners in care. Paediatric Nursing 1996;8:24-7. 18. Ukanda U, Sharma U, Saini K. Care provided by 'skill mix' and 'informal care givers' to critically ill patients. Nursing Journal of India 1999;90:53-4. 19. Wasserbauer LI, Arrington DT, Abraham IL. Using elderly volunteers to care for the elderly: opportunities for nursing, Nursing Economics 1996;14:232-8. 20. Ellis B, Connell NAD, Ellis HC. Role, training and job satisfaction of physiotherapy assistants. Physiotherapy 1998;84:608-16. 21. Edwards M. The health care assistant: usurper of nursing? British Journal of Community Health Nursing 1997;10:490-4. 22. Orne RM, Garland D, O'Hara M, Perfetto L, Stielau J. Caught in the cross fire of change: nurses' experience with unlicensed assistive personnel. Applied Nursing Research 1998;11:101-10. 23. Gardner DL. Issues related to the use of nurse extenders. Journal of Nursing Administration 1991;21:40-5. 24. Krapohl G, Larson E. The impact of unlicensed assistive personnel on nursing care delivery. Nursing Economics 1996;14:99-112. 25. Siehoff AM. Impact of unlicensed assistive personnel on patient satisfaction: an integrative review of the literature. Journal of Nursing Care Quality 1998; 13:1-10. 26. Hesterly SC, Robinson M. Alternative caregivers: cost effective utilisation of RNs. Nursing Administration Quarterly 1990;14:45-57. 27. Bostrom J, Zimmerman J. Restructuring nursing for a competitive health care environment. Nursing Economics 1993;11:35-41,54. 28. Powers P, Dickey C, Ford A. Evaluating an RN/co-worker model. Journal of Nursing Administration 1990;20:11-15. 29. Garfink C, Kirby KK, Bachman SS. The University Hospital nurse extender program: Part IV. Nursing Management 1991;21:26-31. 30. Carr-Hill RA, Dixon P, Griffiths M, Higgins M, McCaughan D, Rice N, Wright K. The impact of nursing grade on the quality and outcome of nursing care. Health Economics 1995;4:57-72. 31. Castillo A, Manfredi M. Estudio sobre la situacio n de la formacio n de personal te cnico en salud: algunos pases de la regio n [Study on the training of health technicians' situation in some countries of Latin American and Caribbean]. Washington (DC): Pan American Health Organzation;1999. 32. Holt MR, Hand MM. The pharmacist's role in reducing patient delay in seeking treatment for acute myocardial infarction. Journal of the American Pharmaceutical Association 1999;39:752-7. 33. Rodgers S, Avery A, Meecham D, Briant S, Geraghty M, Doran K et al. Controlled trial of pharmacist intervention in general practice: the effect on prescribing costs. British Journal of General Practice 1999;49:717-20. 34. Bogden PE, Abbot R, Williamson P, Onopa J, Koontz L. Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension. Journal of General Internal Medicine 1998;13:740-5. 35. Chant A. A confusion of roles: manpower in the National Health Service. Journal of the Royal Society of Medicine 1998;91:63-5. 36. Calpin-Davies PJ, Akehurst RL. Doctor-nurse substitution: the workforce equation. Journal of Nursing Management 1999;7:71. 37. Shum C, Humphreys A, Wheeler D, Cochrane M, Skoda S, Clement S. Nurse management of patients with minor illnesses in general practice: a multi centre randomised control trial. BMJ 2000;320:1038-43. 38. Kinnersley P, Anderson E, Parry K, Clement J, Archard L, Turton P, et al. Randomised control trial of nurse practitioner versus general practitioner care for patients requesting same day consultation in primary care. BMJ 2000;320:1043-48. 39. Venning P, Durie A, Roland M, Roberst C, Leese B. Randomised control trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care. BMJ 2000;320:1048-53. 40. Svitone EC, Garfield R, Vasconcelos MI, Craveiro VA. Primary health care lessons from the northeast of Brazil: the Agentes de Sau de Program. Pan-American Journal of Public Health 2000;7:293-302. 41. Buchan J, Ball J, O'May F. If changing skill mix is the answer, what is the question? Journal of Health Services Research and Policy 2002;6:233-8. 58080pub92pub

remembering the future?

Funding Information: Fundação para a Ciência e Tecnologia for funds to GHTM UID/04413/2020.publishersversionpublishe

Relevant HRH leadership during public health emergencies

Background: Inadequate leadership capacity compounds the world’s workforce lack of preparedness for outbreaks of all sizes, as illustrated by the COVID-19 pandemic. Traditional human resources for health (HRH) leadership has focused on determining the health workforce requirements, often failing to fully consider the unpredictability associated with issues such as public health emergencies (PHE). Main arguments: The current COVID-19 pandemic demonstrates that policy-making and relevant leadership have to be efective under conditions of ethical uncertainty and with inconclusive evidence. The forces at work in health labor markets (HLM) entail leadership that bridges across sectors and all levels of the health systems. Developing and applying leadership competencies must then be understood from a systemic as well as an individual perspective. To address the challenges described and to achieve universal health coverage (UHC) by 2030, countries need to develop efective HRH leaderships relevant to the complexity of HLM in the most diverse contexts, including acute surge events during PHE. In complex and rapidly changing contexts, such as PHE, leadership needs to be attentive, nimble, adaptive, action oriented, transformative, accountable and provided throughout the system, i.e., authentic, distributed and participatory. This type of leadership is particularly important, as it can contribute to complex organizational changes as required in surge events associated with PHE, even in in the absence of formal management plans, roles, and structures. To deal with the uncertainty it needs agile tools that may allow prompt human resources impact assessments. Conclusions: The complexity of PHE requires transformative, authentic, distributed and participatory leadership of HRH. The unpredictable aspects of the dynamics of the HLM during PHE require the need to rethink, adapt and operationalize appropriate tools, such as HRH impact assessment tools, to redirect workforce operations rapidly and with precision

A privatização do ensino superior em enfermagem no Brasil: perfil, desafios e tendências

Objective: this study aims to analyze and characterize the movement of expansion of Nursing undergraduate courses in Brazil since the 1990s. The characteristics of this expansion are discussed, as well as the socio-political setting where such movement occurred, and the quality of education available based on the data collected. Method: this is a descriptive and cross-sectional study with a quali-quantitative approach, with the use of secondary databases. Results: an accelerated and disordered growth of Nursing undergraduate courses was identified, as well as the number of vacancies, especially due to the participation of the private sector, especially since the year 2000. Geographical inequalities in the distribution of these courses and vacancies were also identified. Conclusion: the strong expansion of higher education in Nursing, along with other health professions, resulted in the strengthening of private higher education institutions associated with economic groups, regional concentration, as well as the excessive offer of distance learning without adequate evaluation of its quality or repercussions.Objetivo: o presente estudo visa analisar e caracterizar o movimento de expansão dos cursos de graduação de enfermagem no Brasil a partir dos anos 90. Discutem-se as características desta expansão, o cenário sócio-político em que ocorreu tal movimento, bem como a qualidade do ensino disponível com base nos dados coletados. Método: trata-se de um estudo descritivo, transversal e de abordagem quali-quantitativa, com o uso de bases de dados secundárias. Resultados: foi identificado um crescimento acelerado e desordenado dos cursos de graduação em enfermagem, bem como do número de vagas, devido especialmente à participação do setor privado, em especial a partir do ano 2000. Desigualdades geográficas na distribuição desses cursos e vagas também foram identificadas. Conclusão: a forte expansão do ensino superior em enfermagem, ao lado de outras profissões de saúde, resultou no fortalecimento de instituições privadas de ensino superior associadas a grupos econômicos, na concentração regional, bem como na oferta excessiva da modalidade de ensino a distância sem avaliação adequada de sua qualidade ou repercussões.Objetivo: el presente estudio tiene como objetivo analizar y caracterizar el movimiento de expansión de las carreras de grado en enfermería en Brasil a partir de la década del 90. Se discuten las características de esta expansión, el escenario sociopolítico en el que ocurrió este movimiento, así como la calidad de la educación disponible según los datos recopilados. Método: se trata de un estudio descriptivo, transversal con enfoque cualitativo y cuantitativo, utilizando bases de datos secundarias. Resultados: se identificó un crecimiento acelerado y desordenado de las carreras de licenciatura en enfermería, así como el número de cupos, debido fundamentalmente a la participación del sector privado, especialmente a partir del año 2000. También se identificaron desigualdades geográficas en la distribución de las carreras y los cupos. Conclusión: la fuerte expansión de la educación superior en enfermería, junto con otras profesiones de la salud, favoreció el fortalecimiento de las instituciones privadas de educación superior asociadas a grupos económicos, la concentración regional y la oferta excesiva de educación a distancia sin la correcta evaluación de calidad o de las repercusiones

Addressing the health workforce crisis: towards a common approach

The challenges in the health workforce are well known and clearly documented. What is not so clearly understood is how to address these issues in a comprehensive and integrated manner that will lead to solutions. This editorial presents – and invites comments on – a technical framework intended to raise awareness among donors and multisector organizations outside ministries of health and to guide planning and strategy development at the country level