Decision space and its contribution to the pursuit of human resources for health reform in local health systems: An exploratory review of literature

Efficiency gains is a potential strategy to expand Kenya’s fiscal space for health. We explored health sector stakeholders’ understanding of efficiency and their perceptions of the factors that influence the efficiency of county health systems in Kenya. We conducted a qualitative cross-sectional study and collected data using three focus group discussions during a stakeholder engagement workshop. Workshop participants included health sector stakeholders from the national ministry of health and 10 (out 47) county health departments, and non-state actors in Kenya. A total of 25 health sector stakeholders participated. We analysed data using a thematic approach. Health sector stakeholders indicated the need for the outputs and outcomes of a health system to be aligned to community health needs. They felt that both hardware aspects of the system (such as the financial resources, infrastructure, human resources for health) and software aspects of the system (such as health sector policies, public finance management systems, actor relationships) should be considered as inputs in the analysis of county health system efficiency. They also felt that while traditional indicators of health system performance such as intervention coverage or outcomes for infectious diseases, and reproductive, maternal, neonatal and child health are still relevant, emerging epidemiological trends such as an increase in the burden of non-communicable diseases should also be considered. The stakeholders identified public finance management, human resources for health, political interests, corruption, management capacity, and poor coordination as factors that influence the efficiency of county health systems. An in-depth examination of the factors that influence the efficiency of county health systems could illuminate potential policy levers for generating efficiency gains. Mixed methods approaches could facilitate the study of both hardware and software factors that are considered inputs, outputs or factors that influence health system efficiency. County health system efficiency in Kenya could be enhanced by improving the timeliness of financial flows to counties and health facilities, giving health facilities financial autonomy, improving the number, skill mix, and motivation of healthcare staff, managing political interests, enhancing anticorruption strategies, strengthening management capacity and coordination in the health sector.

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Examining Health Sector Stakeholder Perceptions on the Efficiency of County Health Systems in Kenya

10.1101/2020.09.17.20196378 ◽

2020 ◽

Author(s):

Lizah Nyawira ◽

Rahab Mbau ◽

Julie Jemutai ◽

Kara Hanson ◽

Sassy Molyneux ◽

...

Keyword(s):

Public Finance ◽

Human Resources ◽

Health System ◽

Health Systems ◽

Human Resources For Health ◽

Health Sector ◽

System Efficiency ◽

Efficiency Gains ◽

Finance Management ◽

Health System Efficiency

Efficiency gains is a potential strategy to expand Kenyas fiscal space for health. We explored health sector stakeholders understanding of efficiency and their perceptions of the factors that influence the efficiency of county health systems in Kenya. We collected data during a stakeholder engagement workshop. Workshop participants included health sector stakeholders from the national ministry of health and 10 (out 47) county health departments, and non-state actors in Kenya. We divided stakeholders into three groups and carried out facilitated group discussions followed by whole group feedback and discussion session. A total of 25 health sector stakeholders participated. We analysed data using a thematic approach. Health sector stakeholders indicated the need for the outputs and outcomes of a health system to be aligned to community health needs. They felt that both hardware aspects of the system (such as the financial resources, infrastructure, human resources for health) and software aspects of the system (such as health sector policies, public finance management systems, actor relationships) should be considered as inputs in the analysis of county health system efficiency. They also felt that while traditional indicators of health system performance such as intervention coverage or outcomes for infectious diseases, and reproductive, maternal, neonatal and child health (RMNCH) are still relevant, emerging epidemiological trends characterized by an increase in the burden of non-communicable diseases (NCDs) should also be considered. The stakeholders identified public finance management, human resources for health, political interests, corruption, management capacity, and poor coordination as factors that influence the efficiency of county health systems. An in-depth examination of the factors that influence the efficiency of county health systems could illuminate potential policy levers for generating efficiency gains. Mixed methods approaches could facilitate the study of both hardware and software factors that are considered inputs, outputs or factors that influence health system efficiency.

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Community health workers at the dawn of a new era: 2. Planning, coordination, and partnerships

Health Research Policy and Systems ◽

10.1186/s12961-021-00753-7 ◽

2021 ◽

Vol 19 (S3) ◽

Cited By ~ 6

Author(s):

Muhammad Mahmood Afzal ◽

George W. Pariyo ◽

Zohra S. Lassi ◽

Henry B. Perry

Keyword(s):

Global Health ◽

Human Resources ◽

Community Health ◽

Community Health Workers ◽

Health Systems ◽

Health Workforce ◽

Health Workers ◽

Human Resources For Health ◽

Critical Role ◽

New Era

Abstract Background Community health workers (CHWs) play a critical role in grassroots healthcare and are essential for achieving the health-related Sustainable Development Goals. While there is a critical shortage of essential health workers in low- and middle-income countries, WHO and international partners have reached a consensus on the need to expand and strengthen CHW programmes as a key element in achieving Universal Health Coverage (UHC). The COVID-19 pandemic has further revealed that emerging health challenges require quick local responses such as those utilizing CHWs. This is the second paper of our 11-paper supplement, “Community health workers at the dawn of a new era”. Our objective here is to highlight questions, challenges, and strategies for stakeholders to consider while planning the introduction, expansion, or strengthening of a large-scale CHW programme and the complex array of coordination and partnerships that need to be considered. Methods The authors draw on the outcomes of discussions during key consultations with various government leaders and experts from across policy, implementation, research, and development organizations in which the authors have engaged in the past decade. These include global consultations on CHWs and global forums on human resources for health (HRH) conferences between 2010 and 2014 (Montreux, Bangkok, Recife, Washington DC). They also build on the authors’ direct involvement with the Global Health Workforce Alliance. Results Weak health systems, poor planning, lack of coordination, and failed partnerships have produced lacklustre CHW programmes in countries. This paper highlights the three issues that are generally agreed as being critical to the long-term effectiveness of national CHW programmes—planning, coordination, and partnerships. Mechanisms are available in many countries such as the UHC2030 (formerly International Health Partnership), country coordinating mechanisms (CCMs), and those focusing on the health workforce such as the national Human Resources for Health Observatory and the Country Coordination and Facilitation (CCF) initiatives introduced by the Global Health Workforce Alliance. Conclusion It is imperative to integrate CHW initiatives into formal health systems. Multidimensional interventions and multisectoral partnerships are required to holistically address the challenges at national and local levels, thereby ensuring synergy among the actions of partners and stakeholders. In order to establish robust and institutionalized processes, coordination is required to provide a workable platform and conducive environment, engaging all partners and stakeholders to yield tangible results.

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The Role of a Network of Human Resources for Health Managers in Supporting Leadership for Health Systems Strengthening in Francophone African Countries

Health Systems & Reform ◽

10.1080/23288604.2016.1220778 ◽

2016 ◽

Vol 2 (3) ◽

pp. 254-264 ◽

Cited By ~ 2

Author(s):

Noriko Fujita ◽

Mari Nagai ◽

Ibrahima Souka Ndella Diouf ◽

Takayuki Shimizu ◽

Toyomitsu Tamura

Keyword(s):

Human Resources ◽

Health Systems ◽

Human Resources For Health ◽

Health Systems Strengthening ◽

African Countries ◽

Health Managers

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Management of human resources for health in health districts in Uganda: A decision space

The International Journal of Health Planning and Management ◽

10.1002/hpm.3359 ◽

2021 ◽

Author(s):

Wesam Mansour ◽

Adelaine Aryaija‐Karemani ◽

Tim Martineau ◽

Justine Namakula ◽

Paul Mubiri ◽

...

Keyword(s):

Human Resources ◽

Human Resources For Health ◽

Decision Space ◽

Health Districts

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The Use of Intersectional Analysis in Assessing Women’s Leadership Progress in the Health Workforce in LMICs: A Review

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.06 ◽

2021 ◽

Author(s):

Zahra Zeinali ◽

Kui Muraya ◽

Sassy Molyneux ◽

Rosemary Morgan

Keyword(s):

Human Resources ◽

Gender Equity ◽

Health Systems ◽

Health Workforce ◽

Human Resources For Health ◽

Health Sector ◽

Women's Leadership ◽

Social Identities ◽

Diverse Range ◽

Intersectional Analysis

Background: Human resources are at the heart of health systems, playing a central role in their functionality globally. It is estimated that up to 70% of the health workforce are women, however, this pattern is not reflected in the leadership of health systems where women are under-represented. Methods: This systematized review explored the existing literature around women’s progress towards leadership in the health sector in low- and middle-income countries (LMICs) which has used intersectional analysis. Results: While there are studies that have looked at the inequities and barriers women face in progressing towards leadership positions in health systems within LMICs, none explicitly used an intersectionality framework in their approach. These studies did nevertheless show recurring barriers to health systems leadership created at the intersection of gender and social identities such as professional cadre, race/ethnicity, financial status, and culture. These barriers limit women’s access to resources that improve career development, including mentorship and sponsorship opportunities, reduce value, recognition and respect at work for women, and increase the likelihood of women to take on dual burdens of professional work and childcare and domestic work, and, create biased views about effectiveness of men and women’s leadership styles. An intersectional lens helps to better understand how gender intersects with other social identities which results in upholding these persisting barriers to career progression and leadership. Conclusion: As efforts to reduce gender inequity in health systems are gaining momentum, it is important to look beyond gender and take into account other intersecting social identities that create unique positionalities of privilege and/or disadvantage. This approach should be adopted across a diverse range of health systems programs and policies in an effort to strengthen gender equity in health and specifically human resources for health (HRH), and improve health system governance, functioning and outcomes.

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