The abiding, hidden, and pervasive centrality of the health research workforce.

Research for health and development (R4HD) acknowledges that many of the determinants of health lie outside the boundaries of the health system. The size and quality of the health and care workforce (HCWF) are key drivers towards the future trajectory of many of these factors. We consider researchers for health and development an abiding, pervasive but neglected constituent part of this HCWF. This workforce straddles many professional groups and sectors. The diversity of occupations, lack of standardization in occupational cadres, the complexity and gendered aspects of the labour market, and the variable demographic, epidemiological, socio-economic and health systems' contexts in the global south and the global north, led to a kaleidoscopic perception of the health research workforce that have kept it hidden from public opinion. This led to neglect by science as well as health policymakers and created an orphan sub-set of the HCWF. Understanding the health researchers' labour market will help to identify means to develop, retain and utilize the health research workforce, addressing size, composition, role, skills transferability, careers and social impact through building, enabling or sustaining its research functions, capacity, employment opportunities and career tracks, among other issues. This thematic series of the Human Resources for Health Journal, calls for papers that go beyond narrow conceptual approaches and professional understandings of health care workers and the health research workforce, and requests that contributors examine important workforce issues through the broad lens of R4HD within a sustainable development goals framework.

[Financialization of the health sector in Brazil: theoretical and methodological challenges to the investigation of companies and business groups]. / Financeirização do setor saúde no Brasil: desafios teóricos e metodológicos à investigação de empresas e grupos empresariais.

The article describes the history of the response to the theoretical and methodological challenges in research on companies and corporate groups in the Brazilian health sector that reorganized their shareholding structures, diversified their activities, and expanded their financial operations. Such movements in corporate concentration and expansion were analyzed with an approach to the frame of reference for financialization in contemporary capitalism in the analysis of selected companies and corporate groups. Corporate strategies were classified in three dimensions: shareholding, financial, and accounting structure and influence on the public agenda and the respective indicators orienting the organization of information from diverse sources for companies and corporate groups from 2008 and 2017. The study provides a profile of the intense and complex process of corporate reorganization in the health sector. Still, the study's exploratory design and difficulties in access to information and selection of companies and corporate groups mean that the observations are necessarily preliminary.

O artigo descreve a trajetória percorrida para responder aos desafios teóricos e metodológicos da pesquisa sobre empresas e grupos empresariais do setor saúde no Brasil que reorganizaram suas estruturas societárias, diversificaram atividades e ampliaram operações financeiras. Tais movimentos de concentração e expansão empresarial foram analisados mediante a aproximação do referencial da financeirização do capitalismo contemporâneo à análise de empresas e grupos empresariais selecionados. As estratégias empresariais foram classificadas em três dimensões: estrutura patrimonial societária, financeira contábil e influência na agenda pública. Seus respectivos indicadores orientam a organização de informações de distintas fontes para empresas e grupos empresariais no período de 2008 a 2017. O estudo traça um perfil do intenso e complexo processo de reorganização empresarial do setor saúde. Contudo, a natureza exploratória da investigação, bem como as dificuldades de acesso a informações e seleção de empresas e grupos empresariais tornam suas constatações necessariamente provisórias.

El artículo describe la trayectoria recorrida para responder a los desafios teóricos y metodológicos de la investigación sobre empresas y grupos empresariales del sector de salud en Brasil, que reorganizaron sus estructuras societarias, diversificaron actividades y ampliaron operaciones financieras. Tales movimientos de concentración y expansión empresarial fueron analizados mediante la aproximación al marco de referencia de la financiarización del capitalismo contemporáneao, así como al análisis de empresas y grupos empresariales seleccionados. Las estrategias empresariales fueron clasificadas en tres dimensiones: estructura patrimonial societaria, financiera contable e influencia en la agenda pública, así como sus respectivos indicadores que orientan la organización de la información de las distintas fuentes en empresas y grupos empresariales durante el período 2008 a 2017. El estudio traza un perfil del intenso y complejo proceso de reorganización empresarial del sector de salud. No obstante, la naturaleza exploratoria de la investigación, así como las dificultades de acesso a la información, selección de empresas y grupos empresariales convierten sus constataciones en necesariamente provisionales.

Physicians' income in Brazil: a study on information sources.

OBJECTIVE: Data on physicians' income are relevant for well-informed health policies, both due to their strategic role and the volume of resources that their activities represent to health systems. In Brazil, multiple sources of data measure the income of these professionals, each one with singularities that generate a complex and heterogeneous picture. This study explores the methodological aspects of different data sources, pointing to potentials and limitations to measuring the income of physicians. METHODS: We use the sources' documentation and data on the average monthly income in 2019, by gender and macro region, from four distinct surveys: Continuous Pnad (National Household Sample Survey), RAIS (Annual Listing of Social Information), Medical Demographics, and IRPF (Personal Income Tax). RESULTS: The results confirm the heterogeneity of definitions, variables, and methodologies. The data set can evidence phenomena such as the income difference between men and women. Regional inequalities are evident; however, the data interpretation is less assertive. CONCLUSIONS: Although eventual gaps and discrepancies among sources can limit some strong conclusions, the analysis of different methodologies employed can suggest relevant hypotheses for in-depth studies.

Physicians' income in Brazil: a study on information sources

SUMMARY OBJECTIVE: Data on physicians' income are relevant for well-informed health policies, both due to their strategic role and the volume of resources that their activities represent to health systems. In Brazil, multiple sources of data measure the income of these professionals, each one with singularities that generate a complex and heterogeneous picture. This study explores the methodological aspects of different data sources, pointing to potentials and limitations to measuring the income of physicians. METHODS: We use the sources' documentation and data on the average monthly income in 2019, by gender and macro region, from four distinct surveys: Continuous Pnad (National Household Sample Survey), RAIS (Annual Listing of Social Information), Medical Demographics, and IRPF (Personal Income Tax). RESULTS: The results confirm the heterogeneity of definitions, variables, and methodologies. The data set can evidence phenomena such as the income difference between men and women. Regional inequalities are evident; however, the data interpretation is less assertive. CONCLUSIONS: Although eventual gaps and discrepancies among sources can limit some strong conclusions, the analysis of different methodologies employed can suggest relevant hypotheses for in-depth studies.

Relevant HRH leadership during public health emergencies.

BACKGROUND: Inadequate leadership capacity compounds the world's workforce lack of preparedness for outbreaks of all sizes, as illustrated by the COVID-19 pandemic. Traditional human resources for health (HRH) leadership has focused on determining the health workforce requirements, often failing to fully consider the unpredictability associated with issues such as public health emergencies (PHE). MAIN ARGUMENTS: The current COVID-19 pandemic demonstrates that policy-making and relevant leadership have to be effective under conditions of ethical uncertainty and with inconclusive evidence. The forces at work in health labor markets (HLM) entail leadership that bridges across sectors and all levels of the health systems. Developing and applying leadership competencies must then be understood from a systemic as well as an individual perspective. To address the challenges described and to achieve universal health coverage (UHC) by 2030, countries need to develop effective HRH leaderships relevant to the complexity of HLM in the most diverse contexts, including acute surge events during PHE. In complex and rapidly changing contexts, such as PHE, leadership needs to be attentive, nimble, adaptive, action oriented, transformative, accountable and provided throughout the system, i.e., authentic, distributed and participatory. This type of leadership is particularly important, as it can contribute to complex organizational changes as required in surge events associated with PHE, even in in the absence of formal management plans, roles, and structures. To deal with the uncertainty it needs agile tools that may allow prompt human resources impact assessments. CONCLUSIONS: The complexity of PHE requires transformative, authentic, distributed and participatory leadership of HRH. The unpredictable aspects of the dynamics of the HLM during PHE require the need to rethink, adapt and operationalize appropriate tools, such as HRH impact assessment tools, to redirect workforce operations rapidly and with precision.

Financeirização do setor saúde no Brasil: desafios teóricos e metodológicos à investigação de empresas e grupos empresariais / Financialization of the health sector in Brazil: theoretical and methodological challenges to the investigation of companies and business groups / Financiarización del sector de salud en Brasil: desafíos teóricos y metodológicos para la investigación de empresas y grupos empresariales

O artigo descreve a trajetória percorrida para responder aos desafios teóricos e metodológicos da pesquisa sobre empresas e grupos empresariais do setor saúde no Brasil que reorganizaram suas estruturas societárias, diversificaram atividades e ampliaram operações financeiras. Tais movimentos de concentração e expansão empresarial foram analisados mediante a aproximação do referencial da financeirização do capitalismo contemporâneo à análise de empresas e grupos empresariais selecionados. As estratégias empresariais foram classificadas em três dimensões: estrutura patrimonial societária, financeira contábil e influência na agenda pública. Seus respectivos indicadores orientam a organização de informações de distintas fontes para empresas e grupos empresariais no período de 2008 a 2017. O estudo traça um perfil do intenso e complexo processo de reorganização empresarial do setor saúde. Contudo, a natureza exploratória da investigação, bem como as dificuldades de acesso a informações e seleção de empresas e grupos empresariais tornam suas constatações necessariamente provisórias.

The article describes the history of the response to the theoretical and methodological challenges in research on companies and corporate groups in the Brazilian health sector that reorganized their shareholding structures, diversified their activities, and expanded their financial operations. Such movements in corporate concentration and expansion were analyzed with an approach to the frame of reference for financialization in contemporary capitalism in the analysis of selected companies and corporate groups. Corporate strategies were classified in three dimensions: shareholding, financial, and accounting structure and influence on the public agenda and the respective indicators orienting the organization of information from diverse sources for companies and corporate groups from 2008 and 2017. The study provides a profile of the intense and complex process of corporate reorganization in the health sector. Still, the study's exploratory design and difficulties in access to information and selection of companies and corporate groups mean that the observations are necessarily preliminary.

El artículo describe la trayectoria recorrida para responder a los desafios teóricos y metodológicos de la investigación sobre empresas y grupos empresariales del sector de salud en Brasil, que reorganizaron sus estructuras societarias, diversificaron actividades y ampliaron operaciones financieras. Tales movimientos de concentración y expansión empresarial fueron analizados mediante la aproximación al marco de referencia de la financiarización del capitalismo contemporáneao, así como al análisis de empresas y grupos empresariales seleccionados. Las estrategias empresariales fueron clasificadas en tres dimensiones: estructura patrimonial societaria, financiera contable e influencia en la agenda pública, así como sus respectivos indicadores que orientan la organización de la información de las distintas fuentes en empresas y grupos empresariales durante el período 2008 a 2017. El estudio traza un perfil del intenso y complejo proceso de reorganización empresarial del sector de salud. No obstante, la naturaleza exploratoria de la investigación, así como las dificultades de acesso a la información, selección de empresas y grupos empresariales convierten sus constataciones en necesariamente provisionales.

The utilization of research evidence in Health Workforce Policies: the perspectives of Portuguese and Brazilian National Policy-Makers

Background: The production of knowledge on Human Resources for Health (HRH) issues has increased exponentially since 2000 but integration of the research in the policy-making process is often lagging. We looked at how research on HRH contributes or not to inform policy decisions and interventions affecting the health workforce in Portugal and Brazil. Methods: We designed a comparative case study of semi-structured interviews with present and past national decision-makers, policy advisors and researchers. Issues explored included the existence of a national HRH policy and the use, or non-use, of research evidence by policy makers and reasons to do so. Interviews were audio recorded, transcribed, anonymized and analysed thematically. Results: Policy-makers in Brazil recognize a greater use of evidence in the process of defining HRH policy when compared to Portugal’s. But the existence of formal instruments to support policy development is not sufficient to ensure that policies are informed by evidence. Conclusions: In both countries the importance of the use of evidence in the formulation of policies was recognized by policy-makers. However, the influence of other factors, such as political pressures from various lobby groups and from the media and the policy short timeframe which requires rapid responses, is predominant.

Right time, right place: improving access to health service through effective retention and distribution of health workers.

This editorial introduces the 'Right time, Right place: improving access to health service through effective retention and distribution of health workers' thematic series. This series draws from studies in a range of countries and provides new insights into what can be done to improve access to health through more effective human resources policies, planning and management. The primary focus is on health workforce distribution and retention.