Assessing the health workforce implications of health policy and programming: how a review of grey literature informed the development of a new impact assessment tool

BACKGROUND In their adoption of WHA resolution 69.19, World Health Organization Member States requested all bilateral and multilateral initiatives to conduct impact assessments of their funding to human resources for health. The High-Level Commission for Health Employment and Economic Growth similarly proposed that official development assistance for health, education, employment and gender are best aligned to creating decent jobs in the health and social workforce. No standard tools exist for assessing the impact of global health initiatives on the health workforce, but tools exist from other fields. The objectives of this paper are to describe how a review of grey literature informed the development of a draft health workforce impact assessment tool and to introduce the tool. METHOD A search of grey literature yielded 72 examples of impact assessment tools and guidance from a wide variety of fields including gender, health and human rights. These examples were reviewed, and information relevant to the development of a health workforce impact assessment was extracted from them using an inductive process. RESULTS A number of good practice principles were identified from the review. These informed the development of a draft health workforce impact assessment tool, based on an established health labour market framework. The tool is designed to be applied before implementation. It consists of a relatively short and focused screening module to be applied to all relevant initiatives, followed by a more in-depth assessment to be applied only to initiatives for which the screening module indicates that significant implications for HRH are anticipated. It thus aims to strike a balance between maximising rigour and minimising administrative burden. CONCLUSION The application of the new tool will help to ensure that health workforce implications are incorporated into global health decision-making processes from the outset and to enhance positive HRH impacts and avoid, minimise or offset negative impacts.