Human Resources for Health in India: Strategic Options for Transforming Health Systems Towards Improving Health Service Delivery and Public Health

2021 ◽  
pp. 097206342199500
Author(s):  
Sanjay Zodpey ◽  
Himanshu Negandhi ◽  
Ritika Tiwari
Keyword(s):  
Public Health ◽  
Health Service ◽  
Service Delivery ◽  
Human Resources ◽  
Health System ◽  
Human Resources For Health ◽  
National Level ◽  
Health Service Delivery ◽  
Lessons Learnt ◽  
Strategic Options

Introduction: The health workforce is the channel for delivering health interventions to populations. A critical mass of health professionals is necessary to manage a health system and is often a crucial limiting factor in the delivery of quality health services. India’s current situation, juxtaposed with its medium-term and long-term HRH (human resources for health) requirements, necessitates reassessing the policy levers that are available at the national level. Objective: To suggest strategic options to recommend India’s way forward to meet challenges related to health service delivery and public health with an HRH focus. Methodology: We reviewed and compared studies from different countries which focused on strengthening HRH at the national level. A two-step approach towards identifying and selecting HRH strategic options was adopted: desk review and discussions. A list of strategic options for reforming the current state of HRH in India was developed on the basis of lessons learnt from the review. These options were then scored and plotted on a grid (for innovation, disruption, difficulty of implementation, budget for implementation, importance and time period for implementation) in discussion with experts. Result: Based on the lessons learnt, eight strategic options were suggested for India: instituting a national HRH body; developing partnership models for the public sector and the private sector; setting benchmark HRH ratios; allocating at least 2.5% of the GDP to health; allocating at least 25% of all development assistance for health to HRH; halving the current levels of disparity in health worker distribution between urban and rural areas; evaluating HRH support through the National Health Mission (NHM); and maintaining a live register of HRH. Conclusion: The research is timely as India moves towards the implementation of the Sustainable Development Goals (SDGs) with a particular focus on universal health coverage (UHC) and Ayushman Bharat Yojana. The suggested strategic options for the way forward shall help India in dealing with the current health crisis to emerge with a strong public health system.

scholarly journals Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in Kenya

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Joshua Munywoki ◽  
Nancy Kagwanja ◽  
Jane Chuma ◽  
Jacinta Nzinga ◽  
Edwine Barasa ◽  
...  
Keyword(s):  
Service Delivery ◽  
Human Resources ◽  
Priority Setting ◽  
Human Resources For Health ◽  
Health Sector ◽  
Health Service Delivery ◽  
County Level ◽  
Health Coverage ◽  
Middle Income

Abstract Background Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH. Methods We used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county. Results We found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county. Conclusion Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country’s efforts for promoting service delivery equity as a key goal – both for the devolution and the country’s quest towards Universal Health Coverage (UHC).

scholarly journals Influence of Politics on Accountability of Health Professionals in Bangladesh: An Analysis of the Quality of Health Service Delivery

2017 ◽  
Vol 12 (1) ◽  
pp. 75-82
Author(s):  
Mohammad Shafiqul Islam
Keyword(s):  
Health Service ◽  
Service Delivery ◽  
Health System ◽  
Healthcare Delivery ◽  
Health Service Delivery ◽  
Elected Officials ◽  
Political Commitment ◽  
Healthcare Provision ◽  
Administrative Authority ◽  
Political Actors

This study explored the role and responsibility of elected officials including political actors and addressed the factors of politics, decentralisation, bureaucratic management, and political commitment to understanding accountability in health service delivery. This study used qualitative case studies for which a total of 68 in-depth interviews and five focus group discussions were conducted in two areas of rural and urban Bangladesh. The findings show that political actors have poor commitment to improving accountability and healthcare delivery. The elected officials are not interested in organising regular meetings and they are even reluctant to organise a health service committee to make health officials accountable. The opposition political parties have no participation in health service organisations as the existing political culture does not allow it. Moreover, elected officials have a limited administrative authority because of an inadequate decentralised health system that leads to poor accountability and inadequate healthcare delivery. Further, bureaucrats want to capture power and are unwilling to decentralise the health system. The policy recommendation includes the decentralisation of healthcare provision and increased participation of elected representatives in a decentralised system. Abbreviations: ADP – Annual Development Plan; MP – Member of Parliament; NGO – Non Government Organisation; UHC – Upazilia Health Complex; UP – Upazilia Parishad.

scholarly journals Factors Influencing the Implementation of Foreign Innovations in Organization and Management of Health Service Delivery in China: A Systematic Review

2021 ◽  
Vol 1 ◽  
Author(s):  
Wenxing Wang ◽  
Jeroen van Wijngaarden ◽  
Hujie Wang ◽  
Martina Buljac-Samardzic ◽  
Shasha Yuan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Service ◽  
Service Delivery ◽  
Human Resources ◽  
Financial Incentives ◽  
Health Service Delivery ◽  
Urban China ◽  
Organizational Policies ◽  
Organization And Management ◽  
Factors Influencing

Background: China has been encouraged to learn from international innovations in the organization and management of health service delivery to achieve the national health reform objectives. However, the success and effectiveness of implementing innovations is affected by the interactions of innovations with the Chinese context. Our aim is to synthesize evidence on factors influencing the implementation of non-Chinese innovations in organization and management of health service delivery in mainland China.Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched seven databases for peer-reviewed articles published between 2009 and 2020. Data were analyzed and combined to generate a list of factors influencing the implementation of foreign innovations in China. The factors were classified in the categories context, system, organization, innovation, users, resources, and implementation process.Results: The 110 studies meeting the inclusion criteria revealed 33 factors. Most supported by evidence is the factor integration in organizational policies, followed by the factors motivation & incentives and human resources. Some factors (e.g., governmental policies & regulations) were mentioned in multiple studies with little or no evidence.Conclusion: Evidence on factors influencing the implementation of foreign innovations in organization and management of health service delivery is scarce and of limited quality. Although many factors identified in this review have also been reported in reviews primarily considering Western literature, this review suggests that extrinsic motivation, financial incentives, governmental and organizational policies & regulations are more important while decentralization was found to be less important in China compare to Western countries. In addition, introducing innovations in rural China seems more challenging than in urban China, because of a lack of human resources and the more traditional rural culture.

Afghan refugees’ experience of Iran’s health service delivery

2016 ◽  
Vol 9 (2) ◽  
pp. 75-85 ◽  
Author(s):  
Abbas Heydari ◽  
Rana Amiri ◽  
Nahid Dehghan Nayeri ◽  
Vedadhir AboAli
Keyword(s):  
Health Care ◽  
Health Service ◽  
Service Delivery ◽  
Health System ◽  
Health Care Providers ◽  
Medical Science ◽  
Health Service Delivery ◽  
Care Providers ◽  
Content Type ◽  
Afghan Refugees

Purpose – The purpose of this paper is to explore experiences of Afghan refugees from health service delivery in Mashhad, Iran. Design/methodology/approach – This is a descriptive study with contextual and qualitative design. Semi-structured interview conducted with 19 Afghan refugees and their caregivers and a focus group session were held with Afghan medical science students. Purposive sampling technique was used to select participants. Data were analysed by qualitative content analysis of Graneheim and Lundman. Lincoln and Guba’s criteria were implemented to ensure trustworthiness. Findings – The results with the core concept of “position of immigrants in the health system” were presented at four themes of “perceived discrimination”, “snowed with loneliness”, “feeling inferior”, and “gratitude”. Research limitations/implications – This study has some implications for researchers and practitioners. The present study is the first study that was done on the health of Afghan refugees in Iran, therefore it can be a ground for further research. In addition, it has valuable results regarding the Afghan immigrants’ experience of health care system of Iran. Practical implications – It can be useful for improving the condition of immigrants in Iran and for improving Iran’s health system. In order to improve the health system in Iran, authorities should pay much attention to transcultural caring and needs of minorities. Furthermore, health workers should be trained to appropriately take care of all patients, without prejudice. Originality/value – Overall the study revealed that there is inequity in access to health services among Afghan refugees in Iran. The findings, although not generalized, offer important insights into health care providers in Iran which should be delivering health service without prejudice. The authors recommended that policies of public medical insurance and assistance programme should be implemented for providing affordable health care services for Afghan refugees.

Applying changes made during the COVID-19 pandemic to the future: trauma and orthopaedics

2021 ◽  
Vol 27 (4) ◽  
pp. 1-7
Author(s):  
Hafiz Muhammad Umer ◽  
Hafiz Javaid Iqbal ◽  
Mark Webb ◽  
William James Harrison
Keyword(s):  
Public Health ◽  
Health Service ◽  
National Level ◽  
Waiting Lists ◽  
Operating Theatre ◽  
Specialty Training ◽  
Lessons Learnt ◽  
The Future ◽  
Collaborative Working ◽  
British Orthopaedic Association

The NHS has made significant changes to practice and specialty training in trauma and orthopaedics as a result of the COVID-19 pandemic. This article looks at the positive and innovative changes along with lessons learnt, which could affect policies in a new challenging post-pandemic health service. At a national level, Public Health England, the British Orthopaedic Association and the Royal Colleges have issued a number of guidelines, which have evolved throughout the pandemic. Developing resilient rotas, virtual clinics, teleconsultations, webinar-based training and operating theatre reorganisation are just some examples of how collaborative working has led to positive changes, despite the huge challenges and hardships created by COVID-19. As we emerge from this crisis, the field of trauma and orthopaedics will need to prepare for the challenges of patient backlogs, neglected trauma and long waiting lists. A continuation of the innovative and collaborative working seen during the pandemic will be crucial to cope with the post-COVID-19 world of orthopaedics.

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