我国卫生人力资源及其研究现状

目的：了解我国卫生人力资源特点及其研究现状，为规划预测卫生人力资源及规范卫生人力配置提供参考依据。方法：运用计算机与手工检索相结合的方式对国内相关医学文献数据库及学术刊物进行检索。结果：1.卫生人力数量快速增长，分布不平衡，专业结构不平衡，学历偏低，职称结构不合理。2.卫生人力资源的研究多属描述性研究，研究的视角比较单一，忽视了卫生人力数量的流动性与质量的研究。结论：加强卫生人力资源的微观研究，开发卫生人力的潜在能量，搞好卫生人力资源的配置与规划，开展卫生人力与医学教育互动关联的研究，探讨卫生人力资源的补充途径、模式及创新型学科带头人的培养。     

黑龙江省卫生人力供求发展研究

卫生资源包括人力资源、物力资源及财力资源。人力资源特别是掌握现代科学技术的人力资源是卫生资源中最重要的资源。一个国家或地区卫生人力的规模、结构、层次和布局,直接关系到卫生资源优化配置。卫生人力发展研究就是要分析、研究卫生人力的数量、质量、结构及分布上的特点,用科学的方法预测卫生人力的供求发展趋势,找出供求之间的差距,从而明确开发、利用卫生人力资源     

以医学教育改革为基础推动我国卫生人力资源发展

文章从卫生人力资源和医学教育的关系入手,从我国卫生人力需求与医学教育脱节的情况出发,寻求解决我国卫生人力资源问题的途径。我国卫生人力资源现状与卫生人力规划之间存在较大差距,在人力的质量、结构和分布等方面也存在多重挑战,成为影响医改工作进展的重要因素;我国医学教育的数量规模不断扩大,但医学毕业生流失严重;目前,我国医学教育的结构和质量也难以满足卫生人力资源的需求。未来医学教育应与医疗卫生体系发展和人力规划相适应,重视基层卫生人力的培养,同时,应该在提高医学教育质量的基础上进行医学教育改革。     

卫生人力发展研究

第二次世界大战以后,由于经济的发展,各国卫生人力也获得了空前的发展,一些国家已出现了卫生人力过剩,因此各国普遍开展了卫生人力发展预测研究,以防止出现卫生人力失衡,造成人力资源的浪费。     

襄阳县乡(镇)卫生院编外卫生人力资源现状调查

在诸多的卫生资源中,卫生人力资源是最宝贵的资源。卫生技术人员的构成和素质是决定一个地区卫生事业发展的关键。人们往往注意了在编的卫生人力资源,而忽视了编外的卫生人力资源。在编外卫生人力调查方面还未见报道。为了加强对编外卫生技术人员的.管理,为今后制订农村卫生人力规划提供科学依据,本文就襄阳县乡(镇)卫生院的编外卫生人力资源现状作调查分析。     

基于聚集度的我国城乡卫生人力资源规划评价

目的对我国城乡卫生人力资源的数量、种类及分布进行评价,为缩小城乡差距、改善城乡卫生人力资源可及性等问题提供参考依据。方法基于集聚度的概念对卫生人力资源进行评价,分析不同区域间城乡卫生人力资源集聚度。结果(1)城市卫生人力集聚度明显高于农村,农村卫生人力资源集聚度普遍小于1,反映出城乡卫生人力资源地理可及性差异明显;(2)城市部分地区卫生人力集聚度明显大于人口集聚度,而农村卫生人力集聚度普遍与人口集聚度接近,城市集聚的卫生人力资源相对过剩;(3)医师和护士在城乡间的分布明显不均衡,尤其是护士集聚度城市明显高于农村。结论为促进我国卫生人力资源配置的合理性,应进一步提高农村卫生人力资源可及性,改善护理人员在城乡间分布的合理性,并科学设置资源配置标准,促进我国卫生人力资源布局的公平性。     

试论卫生人力成本的控制与优化

本文通过对卫生人力成本的含义、使用现状及其成因进行分析，指明目前我国卫生人力成本表现出低水平、低收益、低效率的特征。笔者认为要控制和优化卫生人力成本结构，可以分别从人力资源的取得成本、维持成本、发展成本的控制与优化上采取措施。具体包括：拓宽卫生人力提供渠道，优化人力资源结构；市场竞争机制参与卫生服务价格调控；完善的卫生人力资源管理体系等。     

大同市卫生人力资源配置现状分析

目的：调查分析大同市卫生人力资源配置现状，剖析其存在的问题，为大同市开展区域卫生规划、合理配置卫生人力资源、制定卫生人力发展规划提供科学依据。方法：采用普查的方法，对2006年大同市卫生人力构成进行描述性分析。结果：大同市卫生人力资源总量供需基本平衡，但分布不合理，城乡差距较大（农村卫生人员数量明显不足）；总体素质偏低（农村尤为明显）。建议：进行区域卫生规划，合理调整卫生人力资源分布，适当增加护理人员数量，提高卫生人力整体素质，重定医学教育方向。     

卫生人力资源配置方法研究现状

该文介绍了趋势外推法、卫生人力需要法等12种卫生人力资源配置的方法，为合理科学配置卫生人力资源提供参考：     

中外卫生人力配置比较

通过比较我国与几个典型国家卫生人力的配置情况发现:我国卫生人力配置总量不高;人力资源的专业结构不合理,尤其表现在医护比方面;人力资源的机构分布不尽合理;人力资源的教育速度并不低于发达国家.根据上述情况,并结合卫生改革需要,提出制定新的卫生人力发展规划,加强护理人才教育,加强基层卫生人才教育;将医学教育规划与人才需求有机结合等四项建议.     

Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study

The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi‐structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision‐makers and planners are urged to identify HRH as the most important input for the success of PHC programmes and interventions, especially in the growing fields of mental health and geriatric care.     

The dynamics of the health labour market

One of the most important components of health care systems is human resources for health (HRH)--the people that deliver the services. One key challenge facing policy makers is to ensure that health care systems have sufficient HRH capacity to deliver services that improve or maintain population health. In a predominantly public system, this involves policy makers assessing the health care needs of the population, deriving the HRH requirements to meet those needs, and putting policies in place that move the current HRH employment level, skill mix, geographic distribution and productivity towards the desired level. This last step relies on understanding the labour market dynamics of the health care sector, specifically the determinants of labour demand and labour supply. We argue that traditional HRH policy in developing countries has focussed on determining the HRH requirements to address population needs and has largely ignored the labour market dynamics aspect. This is one of the reasons that HRH policies often do not achieve their objectives. We argue for the need to incorporate more explicitly the behaviour of those who supply labour--doctors, nurses and other providers--those who demand labour, and how these actors respond to incentives when formulating health workforce policy.     

Mapping the governance of human resources for health in Serbia

This article maps the current governance of human resources for health (HRH) in relation to universal health coverage in Serbia since the health sector reforms in 2003.The study adapts the Global Health Workforce Alliance/World Health Organization four-dimensional framework of HRH in the context of governance for universal health coverage. A set of proxies was established for the availability, accessibility, acceptability and quality of HRH. Analysis of official HRH documentation from relevant institutions and reports were used to construct a governance profile of HRH for Serbia from the introduction of the reform in 2003 up to 2013. The results show that all Serbian districts (except Sremski) surpass the availability threshold of 59.4 skilled midwives, nurses and physicians per 10,000 inhabitants. District accessibility of health workforce greatly differed from the national average with variances from +26% to −34%. Analysis of national averages and patient load of general practitioners showed variances among districts by ±21%, whilst hospital discharges per 100 inhabitants deviated between +52% and −45%. Pre-service and in-service education of health workforce is regulated and accredited. However, through its efforts to respond to population health needs Serbia lacks a single coordinating entity to take overall responsibility for effective and coordinated HRH planning, management and development within the broader landscape of health strategy development.     

Scaling up priority health interventions in Tanzania: the human resources challenge

The international community has set ambitious goals (Millennium Development Goals) to improve health in developing countries by 2015. Effective and often cheap interventions exist to achieve these goals. In the mainland of Tanzania, one of the poorest countries of the world, we explored the human resources challenges of expanding the coverage of such priority interventions. We projected human resources for health (HRH) availability using a standard approach and estimated human resource requirements using a novel method (QTP) that produces estimates by task-specific skill categories and explicitly considers productivity. In this paper, we present the findings of the case study in Tanzania and discuss the strengths and weaknesses of the QTP model. On the whole, the HRH challenge of expanding priority interventions in mainland Tanzania is daunting. HRH requirements exceed by far the estimates of HRH availability for 2015. The scaling up of the HIV/AIDS related intervention cluster, in particular the treatment and care of people living with HIV/AIDS, was the primary driver of increases in HRH requirements between the study's base year, 2002, and 2015, and thus of the overall imbalance. Scenario analysis points to three key areas for change in HRH policy and practice to reduce future imbalances: the increment-attrition balance, staff and service productivity, and the match between task-specific skill and occupational categories. However, even in an optimistic scenario, human resource availability will limit the extent to which priority interventions can be expanded in the mainland of Tanzania, and the government will not be able to avoid adjusting the globally set targets for service coverage and health outcomes to local realities and priorities.     

Strengthening human resources for health through information,coordination and accountability mechanisms: the case of the Sudan

Problem

Human resources for health (HRH) in the Sudan were limited by shortages and the maldistribution of health workers, poor management, service fragmentation, poor retention of health workers in rural areas, and a weak health information system.

Approach

A “country coordination and facilitation” process was implemented to strengthen the national HRH observatory, provide a coordination platform for key stakeholders, catalyse policy support and HRH planning, harmonize the mobilization of resources, strengthen HRH managerial structures, establish new training institutions and scale up the training of community health workers.

Local setting

The national government of the Sudan sanctioned state-level governance of the health system but many states lacked coherent HRH plans and policies. A paucity of training institutions constrained HRH production and the adequate and equitable deployment of health workers in rural areas.

Relevant changes

The country coordination and facilitation process prompted the establishment of a robust HRH information system and the development of the technical capacities and tools necessary for data analysis and evidence-based participatory decision-making and action.

Lessons learnt

The success of the country coordination and facilitation process was substantiated by the stakeholders’ coordinated support, which was built on solid evidence of the challenges in HRH and shared accountability in the planning and implementation of responses to those challenges. The support led to political commitment and the mobilization of resources for HRH. The leadership that was promoted and the educational institutions that were opened should facilitate the training, deployment and retention of the health workers needed to achieve universal health coverage.     

Challenges in physician supply planning: the case of Belgium

Introduction  

Planning human resources for health (HRH) is a complex process for policy-makers and, as a result, many countries worldwide swing from surplus to shortage. In-depth case studies can help appraising the challenges encountered and the solutions implemented. This paper has two objectives: to identify the key challenges in HRH planning in Belgium and to formulate recommendations for an effective HRH planning, on the basis of the Belgian case study and lessons drawn from an international benchmarking.     

Human resources for health and universal health coverage: fostering equity and effective coverage

Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC.The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates.The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors.Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose.     

Strengthening human resources for health through multisectoral approaches and leadership: the case of Cameroon

Problem

Cameroon has a severe shortage of human resources for health (HRH) and those that are available are concentrated in urban areas.

Approach

As the result of a national emergency plan for the years 2006–2008, innovative strategies and a multisectoral partnership – led by the Ministry of Public Health and supported by diverse national and international organizations – were developed to address the shortages and maldistribution of HRH in Cameroon.

Local setting

At the time that the emergency plan was developed, Cameroon had health services of poor quality, an imbalance between HRH training and employment, a maldistribution of HRH between urban and rural areas and a poor allocation of financial resources for HRH. It also lacked an accreditation system for use in the training of health workers.

Relevant changes

Between 2007 and 2009, the number of active health workers in Cameroon increased by 36%, several new institutions for higher education in health care and training schools for paramedical staff and midwives were opened, and a national strategy for universal health coverage was developed.

Lessons learnt

In the improvement of HRH, strong leadership is needed to ensure effective coordination and communication between the many different stakeholders. A national process of coordination and facilitation can produce a consensus-based view of the main HRH challenges. Once these challenges have been identified, the stakeholders can plan appropriate interventions that are coordinated, evidence-based and coherent.     

Migration of health workers in the pacific islands: a bottleneck to health development

Human resources for health (HRH) are a crucial component of a well-functioning health system. Problems in the global HRH supply and distribution are an obstacle to achieving the health-related Millennium Development Goals and other health outcomes. The Pacific Island region, covering 20 000 to 30 000 islands in the South Pacific Ocean, is suffering a serious HRH crisis. Yet updated evidence and data are not available for the 22 Pacific Island Countries and Territories. The objective of this study was thus to explore the current HRH situation in the Pacific Island region, focusing particularly on the issue of health workforce migration. HRH trends and gaps differ by country, with some showing increases in HRH density over the past 20 years whereas others have made negligible progress. Currently, three Pacific Island countries are facing critical HRH shortages, a worsening of the situation from 2006, when HRH issues were first brought to widespread global attention. In this region, skilled personnel migration is a major issue contributing to the limited availability of HRH. Political commitment from source and destination countries to strengthen HRH would be a key factor toward increasing efforts to train new health personnel and to implement effective retention strategies.     

Human resources for health and decentralization policy in the Brazilian health system

Background

The Brazilian health reform process, following the establishment of the Unified Health System (SUS), has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH), through the Secretary of Labour Management and Health Education, is responsible for establishing national policy guidelines for health labour management, and also for implementing strategies for the decentralization of management of labour and education in the federal states. This paper assesses whether the process of decentralizing human resources for health (HRH) management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level.

Methods

The research methods used comprise a survey of HRH managers of states and major municipalities (including capitals) and focus groups with these HRH managers - all by geographic region. The results were obtained by combining survey and focus group data, and also through triangulation with the results of previous research.

Results

The results of this evaluation showed the evolution policy, previously restricted to the field of 'personnel administration', now expanded to a conceptual model for health labour management and education-- identifying progress, setbacks, critical issues and challenges for the consolidation of the decentralized model for HRH management. The results showed that 76.3% of the health departments have an HRH unit. It was observed that 63.2% have an HRH information system. However, in most health departments, the HRH unit uses only the payroll and administrative records as data sources. Concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them, specialization courses account for 61.4% and short courses for 56.1%.

Conclusions

Due to decentralization, the HRH area has been restructured and policies beyond traditional administrative activities have been developed. However, twenty years on from the establishment of the SUS, there remains a low level of institutionalization in the HRH area, despite recent efforts of the MoH.