Guest editorial: toward a systemic approach to the global health workforce.

here are several interrelated themes in the global health workforce literature. Some writers focus on broad issues of supply and metrics for assessing need and the adequacy of the health workforce. Attention is given to provider/population ratios, benchmarking, population and needs-based estimates of need, institutional staffing ratios, and other approaches to health workforce planning. The quantitative nature of this approach and presumed ease of measurement have made it popular with ministries of health and other governmental and non-governmental bodies. However, each approach is fraught with difficulties and drawbacks. Measurement is far more complex than appears at first glance, and interpreting numbers and ratios often presents more questions than answers (Ricketts 2008). Another theme in global workforce writing and research deals with issues of recruitment, deployment and retention of the health workforce. That is, once need is established for health workers through some methodology, how do we recruit, deploy and retain health workers? It is here that the focus of attention moves from estimates of need to the development and implementation of effective management practices. Some of this literature also deals with alternative ways of organizing work, such as job sharing and task shifting. Among the themes addressed are questions of motivation and job satisfaction, training, reward systems, quality improvement and patient safety, organizational climate, performance management and emigration (Chopra et al. 2008). More recently, another area of focus is on integrating various “vertical” interventions and programs with health system strengthening. This comes at a time when vast sums of money have been spent on disease-specific (e.g., HIV/AIDS) initiatives, but often without addressing the attendant needs for sustainable health system infrastructure improvement – including workforce development (Oliveira-Cruz et al. 2003). This issue of World Health and Population provides a current sample of recent work in each of these thematic areas. We hope in this issue to convey the importance of addressing the complexity of the health workforce crisis through multiple perspectives and points of leverage. In his article on the Global Health Initiative, Middleberg argues that US global health strategies have traditionally focused on specific disease programs but have neglected specific strategies to address broad health workforce problems. Middleberg argues that all health programs share a common need for a well-trained workforce, yet a measured way to address this issue has been absent oRlD HeAltH & PoPUlAtioN W