Health workforce governance: Processes,tools and actors towards a competent workforce for integrated health services delivery

A competent health workforce is a vital resource for health services delivery, dictating the extent to which services are capable of responding to health needs. In the context of the changing health landscape, an integrated approach to service provision has taken precedence. For this, strengthening health workforce competencies is an imperative, and doing so in practice hinges on the oversight and steering function of governance. To aid health system stewards in their governing role, this review seeks to provide an overview of processes, tools and actors for strengthening health workforce competencies. It draws from a purposive and multidisciplinary review of literature, expert opinion and country initiatives across the WHO European Region's 53 Member States. Through our analysis, we observe distinct yet complementary roles can be differentiated between health services delivery and the health system. This understanding is a necessary prerequisite to gain deeper insight into the specificities for strengthening health workforce competencies in order for governance to rightly create the institutional environment called for to foster alignment. Differentiating between the contribution of health services and the health system in the strengthening of health workforce competencies is an important distinction for achieving and sustaining health improvement goals.     

应对卫生人力挑战： 国际视角下的关键问题

卫生人力资源投入短缺和地区分布不均是低收入国家贫困人口不能获得卫生服务的主要原因。本文回顾了近期国际卫生人力政策研究的动向,探讨了加强卫生人力资源的几个关键问题,并且列举了一些旨在应对卫生人力挑战的可能举措。     

中国参与全球环境与卫生治理:机遇、挑战与对策

中国参与全球环境与卫生治理机遇与挑战并存。主要机遇包括:(1)全球环境与卫生治理的走向与中国在此领域的战略部署高度吻合,为其积极参与全球环境与卫生治理提供了强大的内生动力。(2)全球环境与卫生领域的资源为中国提供了有益的参考和借鉴,有利于加快和完善国内环境与卫生领域的治理。(3)全球环境与卫生问题具有公益性质,是中国展现负责任大国形象的重要领域。(4)当前全球环境与卫生治理的相关制度还有待规范和完善,这为中国争取更多的话语权提供了机遇。主要挑战包括:(1)中国国内环境与卫生问题层出不穷,从而使得中国参与全球环境与卫生治理时精力有限,同时也面临较大的国际压力。(2)中国缺乏全球环境与卫生战略。(3)全球"大卫生观"尚未完全建立,有待进一步拓展和完善。(4)智力支撑不足。(5)在中国国际定位方面,中外存在分歧且呈现扩大趋势。为有效参与全球环境与卫生治理,中国应统筹国内和国际两个层面采取一系列应对措施。     

Health workforce planning in Europe: Creating learning country clusters

In this article, the different dimensions and determinants of health workforce planning (HWF) are investigated to improve context-sensitivity and mutual learning among groups of countries with similar HWF characteristics. A novel approach to scoring countries according to their HFW characteristics and type of planning is introduced using data collected in 2012 by a large European Union project involving 35 European countries (the ‘Matrix Study’ [8]). HWF planning is measured in terms of three major dimensions: (1) data infrastructure to monitor the capacities and dynamics of health workforces, (2) the institutions involved in defining and implementing labour market regulations, and (3) the availability of models to estimate supply–demand gaps and to forecast imbalances. The result shows that the three dimensions of HWF planning are weakly interrelated, indicating that countries invest in HWF in different ways. Determinant analysis shows that countries with larger health labour markets, National Healthcare Service (NHS), mobility, and strong primary health care score higher on HWF planning dimensions than others. Consequently, the results suggest that clustering countries with similar conditions in terms of HWF planning is a way forward towards mutual and contextual learning.     

Mental health: market power and governance

This paper is concerned with the pricing behaviour of providers of residential care for people with mental health problems. Two aspects of pricing were considered. First, are there differences between providers' market power and their actual mark-up rates (e.g. due to differences in motivation)? Second, do the different governance arrangements used in sectors of the industry, such as unified public and non-profit organisation and private bilateral contracting, affect pricing behaviour? A theoretical model was developed to underpin the empirical analysis of 496 residents in 112 mental health care facilities. Private, bilateral organisation was found to be associated with comparatively lower potential price-cost mark-up but a greater propensity to use this power to make profits/surpluses.     

参与型口腔健康教育对口腔卫生知信行的影响

目的评价参与型口腔健康教育对牙周健康状况及相关知识、行为改善的影响。方法将北京市两个城区中8个社区或单位的300名15～64岁的志愿参加者分为实验组（参与组）和对照组（常规教育组）。参加者在基线、6个月和12个月时，接受牙周健康状况的检查和问卷调查。基线检查后，对所有参加者进行龈上洁治术。随后对实验组在专题小组访谈的基础上，进行小组讨论形式的参与型口腔健康教育，在6个月当中，提供在家使用的保健牙刷、牙间隙刷、牙膏和菌斑染色片。同时，提供专为口腔健康教育设计的阅读材料。对照组发给同样内容的健康教育阅读材料。最后比较两组间在牙周健康状况、口腔卫生知识和行为方面的改善情况。结果12个月后实验组牙石指数的均值明显低于对照组（P〈0．05），并有显著性差异。在口腔卫生知识和行为方面，实验组也在刷牙方法、选择保健牙刷、更换牙刷频率和使用牙间隙刷上比对照组提高了8．7％～31．3％。结论参与型口腔健康教育方法能明显改善牙周健康状况，能提高参与者的口腔卫生知识和行为。     

Putting your money where your mouth is: Parents' valuation of good oral health of their children

The aim of this study was to investigate the parental willingness to invest in good oral health for their child in terms of money and time and to relate this to oral health related knowledge and behavioral aspects. 290 parents of 6-year-old children, participating in a RCT on caries preventive strategies in the Netherlands were asked to provide information on education, oral health habits, dietary habits, knowledge on dental topics, willingness to pay and perceived resistance against investing in preventive oral health actions for their children. Despite the fact that parents overall valued oral health for their child highly, still 12% of the parents were unwilling to spend any money, nor to invest any time by brushing their children's teeth to maintain good oral health for their child. Additionally, they indicated that they were unwilling to visit the dentist for preventive measures more than once a year. These children may certainly be considered at higher risk of developing oral diseases because worse oral hygiene habits and dietary habits were found in this group. Given the results, it may be necessary to differentiate in allocating caries prevention programmes to target parents or (school-based) children directly.     

Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia

At the beginning of the 21st century, planning the public health workforce requirements came into the focus of policy makers. The need for improved provision of essential public health services, driven by a challenging non-communicable disease and causes of death and disability within Serbia, calls for a much needed estimation of the requirements of the public health professionals. Mid and long-term public health specialists’ supply and demand estimations out to 2025were developed based on national staffing standards and regional distribution of the workforce in public health institutes of Serbia. By 2025, the supply of specialists, taking into account attrition rate of −1% reaches the staffing standard. However, a slight increase in attrition rates has the impact of revealing supply shortage risks. Demand side projections show that public health institutes require an annual input of 10 specialists or 2.1% annual growth rate in order for the four public health fields to achieve a headcount of 487 by 2025 as well as counteract workforce attrition rates. Shortage and poor distribution of public health specialists underline the urgent need for workforce recruitment and retention in public health institutes in order to ensure the coordination, management, surveillance and provision of essential public health services over the next decade.     

Promoting integration of the health and built environment agendas through a workforce development initiative

There is a renewed and growing recognition of the links between public health and the built environment, which has underlined the need for improved joint working between public health and built environment professionals. However, currently there is little engagement between these two sectors. This paper outlines a workforce development initiative that aims to increase capacity for such joint working, through shared learning and reflection between professionals from the built environment sector and those from the specialist public health workforce. This paper demonstrates how shared learning through facilitated learning sets and other activities has identified issues that both hinder and potentially help the greater integration of health into built environment thinking. It documents a number of responses to the issues that have arisen, as well as suggesting ways forward and future work that can help to bring public health and built environment professionals closer together for the benefit of society.     

成都市口腔卫生资源配置现状及公平性分析

目的 了解成都市口腔卫生资源配置的现状和公平性,以期为改善与合理配置口腔卫生资源提供参考。方法 收集成都市22个区（市）县口腔卫生资源相关数据,运用基尼系数、泰尔系数和洛伦茨曲线从人口、地理和经济维度对口腔卫生资源配置的公平性进行分析。结果 成都市拥有各级各类口腔医疗机构1 725家,口腔医师人口比为1∶4 002,按人口和地理分布口腔卫生资源配置基尼系数在0.4以上,按经济分布在0.19～0.3之间,处于比较公平状态,公平性经济分布＞人口分布＞地理分布。卫生资源集中在城区,城区资源配置公平性低,郊区卫生资源少,但配置相对较公平。结论 成都市口腔卫生资源配置较为丰富,但整体均衡性较差,城区和郊区内部配置公平性差异明显。建议优化口腔卫生资源的区域分布,推动资源的均衡化。     

Enumerating the preventive youth health care workforce: Size,composition and regional variation in the Netherlands

The progress in workforce planning in preventive youth health care (YHC) is hampered by a lack of data on the current workforce. This study aimed to enumerate the Dutch YHC workforce. To understand regional variations in workforce capacity we compared these with the workforce capacity and the number of children and indicators of YHC need per region.A national survey was conducted using online questionnaires based on WHO essential public health operations among all YHC workers. Respondents (n = 3220) were recruited through organisations involved in YHC (participation: 88%).The YHC workforce is multi-disciplinary, 62% had >10 years working experience within YHC and only small regional variations in composition existed. The number of children per YHC professional varied between regions (range 688–1007). All essential public health operations were provided and could be clustered in an operational or policy profile. The operational profile prevailed in all regions. Regional differences in the number of children per YHC professional were unrelated to the indicators of YHC need.The essential public health operations provided by the YHC workforce and the regional variations in children per YHC professional were not in line with indicators of YHC needs, indicating room for improvement of YHC workforce planning. The methodology applied in this study is probably relevant for use in other countries.     

Choice and solidarity: the health sector in Eastern Europe and proposals for reform

The citizens of Eastern Europe have witnessed an unprecedented social and economic transformation during the past decade of transition from socialism to market-based economies. We describe the legacy of socialism and summarize the current state of the health sector in ten Eastern European countries, including financing, delivery, purchasing, physician incomes and the widespread phenomenon of under-the-table payments. The proposals for reform, derived from explicit guiding principles, are based on organized public financing for basic care, private financing for supplementary care, pluralistic delivery of services, and managed competition, with attention to incentives and regulation to impose a constraint on overall health spending.     

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.     

Dilemmas of health promotion and political changes in Eastern Europe

Mortality and morbidity trends in the Western and the Easternparts of Europe have differed considerably during the past threedecades. The ‘socialist’ political regimes havebeen largely responsible for the deterioration of health ofthe population. The main features of this unfavourable situationcan be summarized as follows: low value set on man, on humanlife and health; extreme tensions between depressed living standards,aspirations and their gratification; negative effects of thereproduction of the social structure; chronic lack of genuinehuman communities, human relationships and social support, disordersof the value system. The author presents in case study the dilemmasthe Hungarian health promotion programme has to face. In the1990s in Eastern Europe health promotion has to face the followingchallenges: How is it possible to carry out effective preventiveactivities under circumstances of economic crisis, lack of resourcesand the population's declining living standards? What will bethe new responsibilities in prevention related to poverty, deprivationand unemployment? What will the new health care system be like?How should health be promoted in reorganizing local societies,communities? In the Eastern Europe of today, there is a greaterneed than ever before for health promotion.