Human Resources Development: The Challenge of Health Sector Reform

Executive Summary p. 1 1. Introduction p. 10 2. The goals of health sector reform p. 14 3. The performance of the workforce in health and its determinants p. 16 4. Distortions in the production and utilization of HRH and their impact p. 18 5. Approaches to achieving the objectives of sector reform p. 27 6. The nature and objectives of HRD p. 34 7. The scope of HRD p. 35 8. Actors involved in HRD, their roles, and the HRD environment p. 37 9. HRD responses to labor market distortions p. 43 10. Additional bibliography on geographical deployment issues p. 78 Annex 1: Matrix for the mapping of roles played in relation to HRD p. 82 Annex 2: Note on approaches to workforce planning in the health sector p. 84 Box 1: The usefulness of analysis of the HRH situation in the health sector p. 19 Box 2 : Examples of imbalances in the geographical distribution of doctors p. 25 Box 3 : The scope of HRD activities p. 37 Box 4 : Health For All for the 21st Century and HRD p. 39 Box 5: Examples of mechanisms of maintenance and improvement of the quality of education for the health professions p. 57 Box 6: Examples of relevant research topics p. 64 Figure 1: HRH and Health Reform Objectives p. 11 Figure 2: The relationship between needs and objectives p. 35 Table 1: Nurse/population and nurse/doctor ratios in selected countries p. 24 He is a sociologist by training and is research interests are the development of human resources policies in health, the training of health care managers, and the regulation of professional work. He has been an invited-researcher Acknowledgments Most of this paper was prepared during a sabbatical year (august 1997-1998) which I spent at the World Bank, in the Human Development Department of the Latin America and the Caribbean Region (HDLAC). The idea of spending one year in an international agency, rather than visiting another university as is traditional during sabbaticals, was first suggested by Alexander S. Preker, Senior Economist at the World Bank. I am very grateful to him for making my stay at the Bank possible and for the continuous support he gave subsequently. Alex has been a leader in the thinking about health sector reform and I have benefited very much from his experience and his ideas. As could be expected, I had a …