Human Development Network, The World Bank, 1818 H St NW, Washington DC 20433, USA.
Health Policy Plan. 2012 Dec;27(8):649-57. doi: 10.1093/heapol/czs012. Epub 2012 Feb 13.
Shortages, geographic imbalances and poor performance of health workers pose major challenges for improving health service delivery in developing countries. In response, multilateral agencies have increasingly recognized the need to invest in human resources for health (HRH) to assist countries in achieving their health system goals. In this paper we analyse the HRH-related activities of three agencies: the Global Alliance for Vaccines and Immunisation (GAVI); the Global Fund for Aids, Tuberculosis, and Malaria (the Global Fund); and the World Bank. First, we reviewed the type of HRH-related activities that are eligible for financing within each agency. Second, we reviewed the HRH-related activities that each agency is actually financing. Third, we reviewed the literature to understand the impact that GAVI, Global Fund and World Bank investments in HRH have had on the health workforce in developing countries. Our analysis found that by far the most common activity supported across all agencies is short-term, in-service training. There is relatively little investment in expanding pre-service training capacity, despite large health worker shortages in developing countries. We also found that the majority of GAVI and the Global Fund grants finance health worker remuneration, largely through supplemental allowances, with little information available on how payment rates are determined, how the potential negative consequences are mitigated, and how payments are to be sustained at the end of the grant period. Based on the analysis, we argue there is an opportunity for improved co-ordination between the three agencies at the country level in supporting HRH-related activities. Existing initiatives, such as the International Health Partnership and the Health Systems Funding Platform, could present viable and timely vehicles for the three agencies to implement this improved co-ordination.
卫生人力短缺、地理分布不均和业绩不佳，是发展中国家改善卫生服务提供面临的主要挑战。为此，多边机构日益认识到需要投资于卫生人力，以协助各国实现其卫生系统目标。本文分析了三个机构的卫生人力相关活动：全球疫苗和免疫联盟（免疫联盟）、全球抗击艾滋病、结核病和疟疾基金（全球基金）和世界银行。首先，我们审查了每个机构中符合供资条件的卫生人力相关活动类型。其次，我们审查了各机构实际供资的卫生人力相关活动。第三，我们查阅文献，以了解免疫联盟、全球基金和世界银行投资于卫生人力对发展中国家卫生工作队伍的影响。我们的分析发现，到目前为止，所有机构最常支持的活动是短期在职培训。尽管发展中国家卫生人力短缺严重，但在扩大职前培训能力方面的投资相对较少。我们还发现，免疫联盟和全球基金赠款的大部分用于支付卫生工作者薪酬，主要是通过补充津贴，而关于薪酬标准如何确定、如何减轻潜在的负面影响以及如何在赠款期结束后维持支付，信息很少。基于分析结果，我们认为三个机构在国家一级有机会改进协调，支持卫生人力相关活动。现有的倡议，如国际卫生伙伴关系和卫生系统供资平台，可为三个机构实施这种改进的协调提供可行和及时的手段。
