Royal Tropical Institute, Mauritskade, Amsterdam, the Netherlands.
Hum Resour Health. 2011 Apr 12;9:10. doi: 10.1186/1478-4491-9-10.
Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy formulation and implementation is often poor. This article aims to describe how governance issues have influenced HRH policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC).
We performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In order to systematically address the term 'governance' a framework was developed and governance aspects were regrouped into four dimensions: 'performance', 'equity and equality', 'partnership and participation' and 'oversight'.
In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralization being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. Forms of partnership and participation described in the case studies are numerous and offer different lessons. Strikingly, in none of the articles was 'partnerships' a core focus. A common theme in the dimension of 'oversight' is local-level corruption, affecting, amongst other things, accountability and local-level trust in governance, and its cultural guises. Experiences with accountability mechanisms for HRH policy development and implementation were lacking.
This review shows that the term 'governance' is neither prominent nor frequent in recent HRH literature. It provides initial lessons regarding the influence of governance on HRH policy development and implementation. The review also shows that the evidence base needs to be improved in this field in order to better understand how governance influences HRH policy development and implementation. Tentative lessons are discussed, based on the case studies.
负责任的治理对于国家发展至关重要，也是实现千年发展目标的催化剂。迄今为止，治理似乎一直是人力资源管理领域（HRH）被忽视的问题，这可能是人力资源管理政策制定和实施往往不佳的一个重要原因。本文旨在描述治理问题如何影响人力资源管理政策的制定，并确定已用于改善中低收入国家（LMIC）人力资源管理政策实施的治理策略，无论这些策略是否成功。
我们对人力资源管理案例研究进行了描述性文献综述，这些研究描述或评估了中低收入国家在国家或地区一级与治理相关的干预措施。为了系统地解决“治理”一词，我们制定了一个框架，并将治理方面重新组合成四个维度：“绩效”、“公平和平等”、“伙伴关系和参与”以及“监督”。
共有 16 项研究被纳入综述，其中大多数选定的研究涵盖了治理的几个维度。“绩效”维度涵盖了人力资源管理治理核心的几个要素，权力下放尤为突出。尽管在一些干预措施中，提高公平性和平等性是一个目标，但在政策制定中的包容性以及政策实施中的公平性和透明度似乎不足以保证相应的理想卫生劳动力状况。案例研究中描述的伙伴关系和参与形式多种多样，提供了不同的经验教训。引人注目的是，在所有文章中，“伙伴关系”都不是核心焦点。“监督”维度的一个共同主题是地方一级的腐败，影响到问责制和地方一级对治理的信任，以及其文化伪装。人力资源管理政策制定和实施问责机制的经验缺乏。
本综述表明，在最近的人力资源管理文献中，“治理”一词既不突出也不常见。它提供了关于治理对人力资源管理政策制定和实施的影响的初步经验教训。该综述还表明，为了更好地理解治理如何影响人力资源管理政策的制定和实施，该领域的证据基础需要得到改善。基于案例研究，讨论了初步的经验教训。
