Capacity building in human resources for health: The experience of the region of the Americas.

SETTING: Since the year 2003, most countries of the Region of the Americas have experienced sustained economic growth and inclusive development policies. In the health sector, achieving universal access became the overarching goal. However, the structural limitations of the health workforce represented a formidable obstacle to change. National Health Authorities were confronted with the challenge of developing critical capacities to redress entrenched inequalities in access to qualified health personnel. INTERVENTION: Under the auspices of the Pan American Health Organization, the Ministers of Health of the Region adopted, in September 2007, twenty regional goals for Human Resources for Health 2007-2015, aligned with the renewed strategy of Primary Health Care. Subsequently, a set of indicators and a methodology were developed to assess the goals and to monitor progress at the country level. OUTCOMES: Fifteen countries carried out a baseline assessment in 2009 or 2010 and conducted a second assessment in 2013. Although differences were noted across goals and between countries, the results suggested improvements in all twenty goals overall. The goals linked to the distribution of personnel, the management of migration, and the cooperation with education institutions appeared to be more resilient to change. IMPLICATIONS: The twenty Regional Goals for Human Resources for Health provided a common vision for action and a framework for cooperation within and among countries, and was a catalyst for change. Faced with evolving challenges, the countries should consider adopting a new shared agenda that builds on progress made and further supports intergovernmental policy alignment and capacity building in health workforce development, governance and management.

Assessment of human resources for health programme implementation in 15 Latin American and Caribbean countries.

BACKGROUND: The health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care. An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007-2015, adopted in 2007 by the Pan American Sanitary Conference (CSPA). METHODS: The exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices. RESULTS: This paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability. CONCLUSIONS: The evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region.