The dynamics of the health labour market

Health, Nutrition and Population, Human Development Network, The World Bank, Washington, DC 20433, USA.
International Journal of Health Planning and Management (Impact Factor: 0.97). 04/2006; 21(2):101-15. DOI: 10.1002/hpm.834
Source: PubMed

ABSTRACT One of the most important components of health care systems is human resources for health (HRH)--the people that deliver the services. One key challenge facing policy makers is to ensure that health care systems have sufficient HRH capacity to deliver services that improve or maintain population health. In a predominantly public system, this involves policy makers assessing the health care needs of the population, deriving the HRH requirements to meet those needs, and putting policies in place that move the current HRH employment level, skill mix, geographic distribution and productivity towards the desired level. This last step relies on understanding the labour market dynamics of the health care sector, specifically the determinants of labour demand and labour supply. We argue that traditional HRH policy in developing countries has focussed on determining the HRH requirements to address population needs and has largely ignored the labour market dynamics aspect. This is one of the reasons that HRH policies often do not achieve their objectives. We argue for the need to incorporate more explicitly the behaviour of those who supply labour--doctors, nurses and other providers--those who demand labour, and how these actors respond to incentives when formulating health workforce policy.

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    ABSTRACT: Like many other countries in the developing world, South Africa's human resource problems are impeding progress towards more equitable and universal access to care for all. These issues include difficulties in attracting nurses into public service employment, retaining them in the country, and ensuring an equitable distribution between urban and rural locations. Understanding the factors that contribute to attract nurses to certain positions is a priority to address these issues. A discrete choice experiment was designed to investigate the individual factors that drive the job choices made by nurses, predict the uptake of the main job opportunities available to beginning nurses, and understand which policy interventions could be implemented to alter these choices. 337 final-year nursing students were asked to imagine that they were responding to four job adverts (corresponding to job in the private sector, a public rural position, a public urban position and a position overseas) and were then asked to rank the four positions, from most to least desired. The analysis used a rank-ordered mixed logit model.
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    ABSTRACT: Universal health coverage requires a health workforce that is available, accessible, and well-performing. This article presents a critical analysis of the health workforce needs for the delivery of maternal and neonatal health services in Guinea, and of feasible and relevant interventions to improve the availability, accessibility, and performance of the health workforce in the country. A needs-based approach was used to project human resources for health (HRH) requirements. This was combined with modeling of future health sector demand and supply. A baseline scenario with disaggregated need and supply data for the targeted health professionals per region and setting (urban or rural) informed the identification of challenges related to the availability and distribution of the workforce between 2014 and 2024. Subsequently, the health labor market framework was used to identify interventions to improve the availability and distribution of the health workforce. These interventions were included in the supply side modeling, in order to create a "policy rich" scenario B which allowed for analysis of their potential impact. In the Republic of Guinea, only 44% of the nurses and 18% of the midwives required for maternal and neonatal health services are currently available. If Guinea continues on its current path without scaling up recruitment efforts, the total stock of HRH employed by the public sector will decline by 15% between 2014 and 2024, while HRH needs will grow by 22% due to demographic trends. The high density of HRH in urban areas and the high number of auxiliary nurses who are currently employed pose an opportunity for improving the availability, accessibility, and performance of the health workforce for maternal and neonatal health in Guinea, especially in rural areas. Guinea will need to scale up its recruitment efforts in order to improve health workforce availability. Targeted labor market interventions need to be planned and executed over several decades to correct entrenched distortions and mismatches between workforce need, supply, and demand. The case of Guinea illustrates how to design and operationalize HRH interventions based on workforce projections to accompany and facilitate universal health coverage reforms.
    Risk Management and Healthcare Policy 01/2014; 7:219-232. DOI:10.2147/RMHP.S46418

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