Health workforce

In many low-income countries, severe shortages of health workers has led to poor service delivery, inequalities in health and stalled development.

Research will identify effective policy interventions to strengthen the health workforce in underserved areas.

Human resource constraints, including global shortages, skill imbalances, low motivation and poor performance, have been well documented by recent global initiatives. However, there has been much less progress in identifying effective interventions to address these constraints. Research in several key areas is needed to inform human resource policy development.

RESYST research in this area will focus on identifying practical interventions that attract health workers to rural areas where the vast majority of poor and disadvantaged patients live. We will also critically evaluate the role of the private sector (both commercial and not-for-profit) in training health workers in developing countries, and investigate how different payment mechanisms influence the professional behaviour of health workers.

Research questions

1. What policy measures are most effective at attracting and retaining health workers to provide essential services in underserved areas?

The research builds on a cohort study developed under the Consortium for Research on Equitable Health Systems, which examined the factors influencing health professionals’ job location choices. In South Africa, a cohort of 377 new nursing graduates was established in 2008 and maintained 98% follow-up after two years. Current RESYST research aims to continue monitoring the job location choices of this nursing cohort for a further five years.

2. What role can the private (for profit and not-for-profit) sector play in addressing human resource constraints in lower income countries?

Descriptive audits of training institutions in Thailand, Kenya and Uganda will examine the emerging role of private nursing schools, and how these compare with public training institutions in terms of resources and financing, teaching staff and exposure of students to rural community health. The research also aims to look at where private training graduates end up working, and the benefits for the public health sector of private sector training.

3. What is the impact of different payment mechanisms on health care providers’ decisions and provider-patient relationships?

The three main methods of paying individual health care workers - salary, fee-for-service and capitation, influence health provider behaviour in different ways. However, this behaviour is not well understood and there is evidence that a wide range of factors including financial incentives, training, regulation, professional and ethical norms, influence their clinical decisions. Research in South Africa aims to investigate these dynamics in more detail, and considers their relevance to the design of reimbursement mechanisms and the implementation of national health insurance.