Prioritization criteria in policies and manage- ment of human resources for health: a proposal for a validated methodology / Criterios para la asignación de prioridades en materia de políticas y gestión de recursos humanos para la salud: propuesta de una metodología validada / Critérios de priorização em políticas e gerenciamento de recursos humanos em saúde: proposta para uma metodologia validada

[ABSTRACT]. Objective. To create and validate criteria for prioritizing problems related to policies and management of the health workforce. Methods. This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research. Results. Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results. Conclusions. The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.

[RESUMEN]. Objetivo. Crear y validar criterios para priorizar los problemas relacionados con las políticas y la gestión de los recursos humanos para la salud. Métodos. Este estudio metodológico se dividió en tres etapas. En la primera se elaboraron los criterios mediante una revisión sistematizada de la bibliografía. En la segunda un comité de ocho especialistas evaluó en línea los criterios. Y la tercera consistió en una evaluación por parte del público destinatario en un taller híbrido. Los participantes evaluaron el material utilizando el instrumento de evaluación de la idoneidad de los materiales, que fue adaptado para la investigación. Resultados. Sobre la base de la revisión de la bibliografía, se elaboraron tres criterios para la asignación de prioridades (relevancia, ventana de oportunidad y aceptabilidad) y una escala de puntuación. En la evaluación realizada por el comité de especialistas, el porcentaje de aprobación de los criterios y del método de asignación de prioridades fue del 84%. Se realizaron modificaciones basadas en sugerencias planteadas con respecto al material presentado a los especialistas. En la etapa posterior de prueba preliminar, el porcentaje de aprobación varió en los distintos puntos, de tal manera que en seis puntos (es decir, en aproximadamente el 46% de los puntos) se alcanzó una aprobación máxima del 100%, en cuatro una aprobación del 92% y en tres una aprobación del 83% en cada uno, lo que indica unos resultados positivos. Conclusiones. Se consideró que los criterios elaborados son válidos para su uso en el contexto de las políticas y la gestión en el ámbito de los recursos humanos para la salud.

[RESUMO]. Objetivo. Criar e validar critérios para priorizar problemas relacionados a políticas e gerenciamento da força de trabalho em saúde. Métodos. O presente estudo metodológico foi dividido em três fases. Primeiro, foram elaborados critérios por meio de revisão sistematizada da literatura. A seguir, os critérios foram avaliados on-line por uma comissão de juízes composta por oito especialistas. Na terceira fase, o público-alvo fez uma avaliação dos critérios em uma oficina de formato híbrido. Os participantes avaliaram o material usando o instrumento Suitability Assessment of Materials, adaptado para esta pesquisa. Resultados. Com base na revisão da literatura, foram elaborados três critérios de priorização (relevância, janela de oportunidade e aceitabilidade) e uma escala de pontuação. Na avaliação da comissão de juízes, a porcentagem de aprovação dos critérios e do método de priorização foi de 84%. Foram feitas alterações com base em sugestões relacionadas ao material apresentado aos especialistas. Na fase de pré-teste, a porcentagem de aprovação variou de acordo com o item. Seis deles (aproximadamente 46% dos itens) atingiram aprovação máxima de 100%, quatro atingiram 92% e três atingiram 83%, indicando resultados positivos. Conclusões. Os critérios desenvolvidos foram considerados válidos para uso no contexto de políticas e ger- enciamento na área de recursos humanos em saúde.

Health workforce incentives and dis-incentives during the COVID-19 pandemic: experiences from Democratic Republic of Congo, Nigeria, Senegal, and Uganda.

BACKGROUND: The COVID-19 pandemic presented a myriad of challenges for the health workforce around the world due to its escalating demand on service delivery. A motivated health workforce is critical to effectual emergency response and in some settings, incentivizing health workers motivates them and ensures continuity in the provision of health services. We describe health workforce experiences with incentives and dis-incentives during the COVID-19 response in the Democratic Republic of Congo (DRC), Senegal, Nigeria, and Uganda. METHODS: This is a multi-country qualitative research study involving four African countries namely: DRC, Nigeria, Senegal, and Uganda which assessed the workplace incentives instituted in response to the COVID-19 pandemic. Key informant interviews (n = 60) were conducted with staff at ministries of health, policy makers and health workers. Interviews were virtual using the telephone or Zoom. They were audio recorded, transcribed verbatim, and analyzed thematically. Themes were identified and quotes were used to support findings. RESULTS: Health worker incentives included (i) financial rewards in the form of allowances and salary increments. These motivated health workers, sustaining the health system and the health workers' efforts during the COVID-19 response across the four countries. (ii) Non-financial incentives related to COVID-19 management such as provision of medicines/supplies, on the job trainings, medical care for health workers, social welfare including meals, transportation and housing, recognition, health insurance, psychosocial support, and supervision. Improvised determination and distribution of both financial and non-financial incentives were common across the countries. Dis-incentives included the lack of personal protective equipment, lack of transportation to health facilities during lockdown, long working hours, harassment by security forces and perceived unfairness in access to and inadequacy of financial incentives. CONCLUSION: Although important for worker motivation, financial and non-financial incentives generated some dis-incentives because of the perceived unfairness in their provision. Financial and non-financial incentives deployed during health emergencies should preferably be pre-determined, equitably and transparently provided because when arbitrarily applied, these same financial and non-financial incentives can potentially become dis-incentives. Moreover, financial incentives are useful only as far as they are administered together with non-financial incentives such as supportive and well-resourced work environments. The potential negative impacts of interventions such as service delivery re-organization and lockdown within already weakened systems need to be anticipated and due precautions exercised to reduce dis-incentives during emergencies.

Health workforce strategies during COVID-19 response: insights from 15 countries in the WHO Africa Region.

INTRODUCTION: The COVID-19 pandemic unveiled huge challenges in health workforce governance in the context of public health emergencies in Africa. Several countries applied several measures to ensure access to qualified and skilled health workers to respond to the pandemic and provide essential health services. However, there has been limited documentation of these measures. This study was undertaken to examine the health workforce governance strategies applied by 15 countries in the World Health Organization (WHO) Africa Region in responding to the COVID-19 pandemic. METHODS: We extracted data from country case studies developed from national policy documents, reports and grey literature obtained from the Ministries of Health and other service delivery agencies. This study was conducted from October 2020 to January 2021 in 15 countries - Angola, Burkina Faso, Chad, Eswatini, Ghana, Guinea, Guinea Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal and Togo. RESULTS: All 15 countries had national multi-sectoral bodies to manage the COVID-19 response and a costed national COVID-19 response plan. All the countries also reflected human resources for health (HRH) activities along the different response pillars. These activities included training for health workers, and budget for the recruitment or mobilization of additional health workers to support the response, and for provision of financial and non-financial incentives for health workers. Nine countries recruited additional 35,812 health workers either on a permanent or temporary basis to respond to the COVID-19 with an abridged process of recruitment implemented to ensure needed health workers are in place on time. Six countries redeployed 3671 health workers to respond to the COVID-19. The redeployment of existing health workers was reported to have impacted negatively on essential health service provision. CONCLUSION: Strengthening multi-sector engagement in the development of public health emergency plans is critical as this promotes the development of holistic interventions needed to improve health workforce availability, retention, incentivization, and coordination. It also ensures optimized utilization based on competencies, especially for the existing health workers.

Methods for health workforce projection model: systematic review and recommended good practice reporting guideline.

BACKGROUND: Health workforce projection models are integral components of a robust healthcare system. This research aims to review recent advancements in methodology and approaches for health workforce projection models and proposes a set of good practice reporting guidelines. METHODS: We conducted a systematic review by searching medical and social science databases, including PubMed, EMBASE, Scopus, and EconLit, covering the period from 2010 to 2023. The inclusion criteria encompassed studies projecting the demand for and supply of the health workforce. PROSPERO registration: CRD 42023407858. RESULTS: Our review identified 40 relevant studies, including 39 single countries analysis (in Australia, Canada, Germany, Ghana, Guinea, Ireland, Jamaica, Japan, Kazakhstan, Korea, Lesotho, Malawi, New Zealand, Portugal, Saudi Arabia, Serbia, Singapore, Spain, Thailand, UK, United States), and one multiple country analysis (in 32 OECD countries). Recent studies have increasingly embraced a complex systems approach in health workforce modelling, incorporating demand, supply, and demand-supply gap analyses. The review identified at least eight distinct types of health workforce projection models commonly used in recent literature: population-to-provider ratio models (n = 7), utilization models (n = 10), needs-based models (n = 25), skill-mixed models (n = 5), stock-and-flow models (n = 40), agent-based simulation models (n = 3), system dynamic models (n = 7), and budgetary models (n = 5). Each model has unique assumptions, strengths, and limitations, with practitioners often combining these models. Furthermore, we found seven statistical approaches used in health workforce projection models: arithmetic calculation, optimization, time-series analysis, econometrics regression modelling, microsimulation, cohort-based simulation, and feedback causal loop analysis. Workforce projection often relies on imperfect data with limited granularity at the local level. Existing studies lack standardization in reporting their methods. In response, we propose a good practice reporting guideline for health workforce projection models designed to accommodate various model types, emerging methodologies, and increased utilization of advanced statistical techniques to address uncertainties and data requirements. CONCLUSIONS: This study underscores the significance of dynamic, multi-professional, team-based, refined demand, supply, and budget impact analyses supported by robust health workforce data intelligence. The suggested best-practice reporting guidelines aim to assist researchers who publish health workforce studies in peer-reviewed journals. Nevertheless, it is expected that these reporting standards will prove valuable for analysts when designing their own analysis, encouraging a more comprehensive and transparent approach to health workforce projection modelling.

Health care managers' perspectives on workforce licensing practice in Ethiopia: A qualitative study.

BACKGROUND: Professional licensing bodies are valuable sources for tracking the health workforce, as many skilled health-care providers require formal training, registration, and licensure. Regulatory activities in Ethiopia were not effectively implemented due to poor follow-up and gaps in skilled human resources, budget, and information technology infrastructure. OBJECTIVE: The aim of this study was to explore and describe the lived experiences and challenges faced by health care managers in health professionals' licensure practices in Ethiopia. METHODS: A cross-sectional study design with a phenomenological approach was employed between March 26 and April 30, 2021, to collect qualitative data. We conducted in-depth interviews with a total of 32 purposively selected health system managers. An interview guide was prepared in English, translated into Amharic, and then pretested. Audio recorded data was transcribed verbatim, translated, and analysed manually by themes and sub-themes. A member check was done to check the credibility of the result. RESULTS: The data revealed four major themes: awareness of licensing practices, enforcement of licensing practices, systems for assuring the quality of licensing practices, and challenges to licensing practices. Lack of awareness among managers about health workforce licensing was reported, especially at lower-level employers. Regulators were clear on the requirements to issue a licence to the health workforce if they are competent in the licensing exam, while human resource managers do not emphasise whether the employees have a licence or not during employment. As a result of this, non-licenced health workers were employed. Health care managers mentioned that they did not know any monitoring tools to solve the issue of working without a licence. Fraudulent academic credentials, shortage of resources (human resources, finance, equipment, and supplies), and weak follow-up and coordination systems were identified as main practice challenges. CONCLUSIONS: This study reported a suboptimal health professionals' licensing practice in Ethiopia, which is against the laws and proclamations of the country that state to employ all health workers only with professional licenses. Challenges for health professionals' licensing practice were identified as fraudulent academic credentials, a shortage of resources (HR, finance, equipment, and supplies), and a weak follow-up and coordination system. Further awareness of licensing practices should be created, especially for lower-level employers. Regulators shall establish a reliable digital system to consistently assure the quality of licensing practices. Health care managers must implement mechanisms to regularly monitor the licensing status of their employees and ensure that government requirements are met. Collaboration and regular communication between regulators and employers can improve quality practices.

Why the Indian Health Care Improvement Act Has Failed to Effectively Fund Workforce Development for the Indian Health Service.

The Indian Health Service (IHS) faces severe workforce shortages due to underfunding and underdevelopment of clinical training programs. Unlike other direct federal health care systems that have implemented clinical training paradigms as central parts of their success, the IHS has no formalized process for developing such programs internally or in partnership with academic institutions. While the Indian Health Care Improvement Act (IHCIA) authorizes mechanisms by which the IHS can support overall workforce development, a critical portion of the act (U.S. Code 1616p) intended for developing clinical training programs within the agency remains unfunded. Here, we review the funding challenges of the IHCIA, as well as its authorized and funded workforce development programs that have only partially addressed workforce shortages. We propose that through additional funding to 1616p, the IHS could implement clinical training programs needed to prepare a larger workforce more capable of meeting the needs of American Indian/Alaska Native communities.

Barriers and strategies for primary health care workforce development: synthesis of evidence.

BACKGROUND: Having a sufficient and well-functioning health workforce is crucial for reducing the burden of disease and premature death. Health workforce development, focusing on availability, recruitment, retention, and education, is inseparable from acceptability, motivation, burnout, role and responsibility, and performance. Each aspect of workforce development may face several challenges, requiring specific strategies. However, there was little evidence on barriers and strategies towards comprehensive health workforce development. Therefore, this review explored barriers and strategies for health workforce development at the primary health care level around the world. METHODS: A scoping review of reviews was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews. The article search was performed in Google Scholar, PubMed, Web of Science, and EMBASE. We used EndNote x9 for managing the collected articles, screening processes, and citation purpose. The scoping review included any kind of review articles on the application of health workforce development concepts, such as availability, recruitment, retention, role and responsibility, education and training, motivation, and burnout, with primary health care and published in English anywhere in the world. Based on the concepts above, barriers and strategies for health workforce development were identified. The findings were synthesized qualitatively based on the building blocks of the health system framework. The analysis involved specific activities such as familiarization, construction of the thematic framework, indexing, charting, and interpretation. The results were presented in texts, tables, and figures. RESULTS: The search strategies yielded 7,276 papers were found. Of which, 69 were included in the scoping review. The most frequently cited barriers were financial challenges and issues related to health care delivery, such as workloads. Barriers affecting healthcare providers directly, including lack of training and ineffective teamwork, were also prominent. Other health system and governance barriers include lack of support, unclear responsibility, and inequity. Another notable barrier was the shortage of health care technology, which pertains to both health care supplies and information technology. The most common cited effective strategies were ongoing support and supervision, engaging with communities, establishing appropriate primary care settings, financial incentives, fostering teamwork, and promoting autonomous health care practice. CONCLUSIONS: Effective leadership/governance, a robust health financing system, integration of health information and technology, such as mobile health and ensuring a consistent supply of adequate resources are also vital components of primary health care workforce development. The findings highlight the importance of continuous professional development, which includes training new cadres, implementing effective recruitment and retention mechanisms, optimising the skill mix, and promoting workplace wellness. These elements are essential in fostering a well-trained and resilient primary health care workforce.

Topical review: Task shifting and the recruitment and retention of eye health workers in underserved areas.

Many populations experience difficulty accessing eye care, especially in rural areas. Implementing workforce recruitment and retention strategies, as well as task shifting through widening scope of practice, can improve eye care accessibility. This article provides novel evidence on the compatibility of these strategies aimed at enhancing ophthalmic workforce recruitment, retention, and efficacy. PURPOSE: The global burden of blindness is unequally distributed, affects rural areas more, and is frequently associated with limited access to eye care. The World Health Organization has specified both task shifting and increasing human resources for eye health as instruments to improve access to eye care in underserved areas. However, it is uncertain whether these two instruments are sufficiently compatible to provide positive synergic effects. To address this uncertainty, we conducted a structured literature review and synthesized relevant evidence relating to task shifting, workforce recruitment, retention, and eye care. Twenty-three studies from across the globe were analyzed and grouped into three categories: studies exploring recruitment and retention in human resources for eye health in general, studies discussing the relationship between task shifting and recruitment or retention of health workers in general, and studies specifically discussing task shifting and recruitment or retention in eye care workers. FINDINGS: Our findings demonstrate that incentives are effective for initiating task shifting and improving recruitment and retention in rural areas with a stronger effect noted in midlevel eye care professionals and trainees. Incentives can take various forms, e.g., financial and nonfinancial. The consideration of context-specific motivational factors is essential when designing strategies to facilitate task shifting and to improve recruitment and retention.

Administrative Frictions and the Mental Health Workforce.

This Viewpoint describes the administrative barriers experienced by mental health professionals and recommends strategies to address these barriers.

Defining Roles and Responsibilities of the Health Workforce to Respond to the Climate Crisis.

Importance: The adverse effects of climate change are now apparent, disproportionately affecting marginalized and vulnerable populations and resulting in urgent worldwide calls to action. Health professionals occupy a critical position in the response to climate change, including in climate mitigation and adaptation, and their professional expertise and roles as health messengers are currently underused in the society-wide response to this crisis. Observations: Clinical and public health professionals have important roles and responsibilities, some of which are shared, that they must fill for society to successfully mitigate the root causes of climate change and build a health system that can reduce morbidity and mortality impacts from climate-related hazards. When viewed through a preventive framework, the unique and synergizing roles and responsibilities provide a blueprint for investment in climate change-related prevention (primary, secondary, and tertiary), capacity building, education, and training of the health workforce. Substantial investment in increasing the competence and collaboration of health professionals is required, which must be undertaken in an urgent, coordinated, and deliberate manner. Conclusions and Relevance: Exceptional collaboration, knowledge sharing, and workforce capacity building are essential to tackle the complex ways in which climate change threatens health. This framework serves as a guide for health system leaders, education institutions, policy planners, and others seeking to create a more resilient and just health system.

On-the-Job Learning: Bright Spots of Governmental Public Health Employee Reflections on the COVID-19 Response.

This article is one of 3 research briefs that highlight valuable experiences and opportunities that can be thought of as "bright spots" of the governmental public health workforce's pandemic response. Using PH WINS 2021 data, we qualitatively examined responses to an open-ended survey question about workforce experiences during the pandemic response. On-the-job learning was emphasized as a critical component of employees' experiences. Seven "on-the-job learning" subthemes were identified among 91 responses. Findings indicate that the pandemic facilitated opportunities for on-the-job learning for various skills and workplace activities. Public health employees were appreciative of the opportunity to gain new technical and practical skills including communicating with the public and to experience new roles and responsibilities. Respondents reported other related benefits including career growth and leadership opportunities. Highlighting these unexpected benefits of the COVID-19 pandemic is important for employee morale and continued workforce development planning.

Nursing and allied health workforce in Australian public rheumatology departments is inadequate: a cross-sectional observational study.

Rheumatological conditions are complex and impact many facets of daily life. Management of people with rheumatological conditions can be optimised through multidisciplinary care. However, the current access to nursing and allied health professionals in Australia is unknown. A cross-sectional study of nursing and allied health professionals in Australian public rheumatology departments for adult and paediatric services was conducted. The heads of Australian public rheumatology departments were invited to report the health professionals working within their departments, referral pathways, and barriers to greater multidisciplinary care. A total of 27/39 (69.2%) of the hospitals responded. The most common health professionals within departments were nurses (n = 23; 85.2%) and physiotherapists (n = 10; 37.0%), followed by pharmacists (n = 5; 18.5%), psychologists (n = 4; 14.8%), and occupational therapists (n = 4; 14.8%). No podiatrists were employed within departments. Referral pathways were most common for physiotherapy (n = 20; 74.1%), followed by occupational therapy (n = 15; 55.5%), podiatry (n = 13; 48.1%), and psychology (n = 6; 22%). The mean full-time equivalent of nursing and allied health professionals per 100,000 population in Australia was 0.29. Funding was identified as the most common barrier. In Australia, publicly funded multidisciplinary care from nurses and allied health professionals in rheumatology departments is approximately 1.5 days per week on average. This level of multidisciplinary care is unlikely to meet the needs of rheumatology patients. Research is needed to determine the minimum staffing requirements of nursing and allied health professionals to provide optimal care.

Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges.

BACKGROUND: Ethiopia and Kenya have adopted the community-based integrated community case management (iCCM) of common childhood illnesses and newborn care strategy to improve access to treatment of infections in newborns and young infants since 2012 and 2018, respectively. However, the iCCM strategy implementation has not been fully integrated into the health system in both countries. This paper describes the extent of integration of iCCM program at the district/county health system level, related barriers to optimal integration and implementation of strategies. METHODS: From November 2020 to August 2021, Ethiopia and Kenya implemented the community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible using embedded implementation research (eIR) to mitigate the impact of COVID-19 on the delivery of this life-saving intervention. Both projects conducted mixed methods research from April-May 2021 to identify barriers and facilitators and inform strategies and summative evaluations from June-July 2022 to monitor the effectiveness of implementation outcomes including integration of strategies. RESULTS: Strategies identified as needed for successful implementation and sustainability of the management of PSBI integrated at the primary care level included continued coaching and support systems for frontline health workers, technical oversight from the district/county health system, and ensuring adequate supply of commodities. As a result, support and technical oversight capacity and collaborative learning were strengthened between primary care facilities and community health workers, resulting in improved bidirectional linkages. Improvement of PSBI treatment was seen with over 85% and 81% of estimated sick young infants identified and treated in Ethiopia and Kenya, respectively. However, perceived low quality of service, lack of community trust, and shortage of supplies remained barriers impeding optimal PSBI services access and delivery. CONCLUSION: Pragmatic eIR identified shared and unique contextual challenges between and across the two countries which informed the design and implementation of strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. The eIR participatory design also strengthened ownership to operationalize the implementation of identified strategies needed to improve the health system's capacity for PSBI treatment.

Health Quality 5.0: The Global Health Workforce Crisis - First Things First.

The future of quality is personal. Health Quality 5.0 moves people-centred, integrated health and social care systems to the forefront of our post-COVID-19 agenda - and that cannot happen without addressing our global workforce crisis. Building back a stronger, healthier workforce is the first of the five big challenges we address in our special series. Starting with the global health workforce crisis is fitting, given it is the most fundamental and formidable barrier to health and quality today. As we put the pieces of the Health Quality 5.0 puzzle together, a picture of a more resilient health system will emerge and a new leadership agenda to get there will take shape.

Can Answers to the Health Workforce Crisis Be Found in Equity-Informed Digital Health?

In this paper, we describe current pressures on health human resources (HHRs) in the Canadian context and related factors that impact equity-deserving communities/populations. We explore issues of HHR challenges in rural, remote and urban underserved contexts and explore the associated benefits and challenges of incorporating digital health (DH). We present examples and evidence of integrating hybrid models of care as a means of supporting HHRs via DH in the publicly funded health system.