Arthika Sripathy (
Joachim Marti is a lecturer in health economics at the Centre for Health Policy, Imperial College London.
Health Aff (Millwood). 2017 Nov;36(11):1928-1936. doi: 10.1377/hlthaff.2017.0517.
Low- and middle-income countries are experiencing serious shortages in meeting health workforce requirements for universal health coverage. We examine how national-level policies can address these deficiencies and support the development of an appropriately skilled health workforce in line with population needs. We discuss three innovative, government-led solutions that are designed to align health workforce training with the demands of universal health coverage. Specifically, we discuss two initiatives to train and retain doctors in rural areas of Thailand, the large-scale training of community health workers within multidisciplinary primary health care teams in Brazil, and the introduction of a postgraduate diploma program in primary care for nurses in India. Several positive outcomes have been associated with these initiatives, including improvements in the rural retention of doctors in Thailand and reductions in infant and child mortality rates in Brazil. However, further research is needed to assess the impact of such initiatives on the long-term retention of workers-particularly doctors-and the adequacy of the training offered to lower-skilled workers to effectively plug medical personnel gaps. Systematic monitoring of program affordability and cost-effectiveness over time must be prioritized, alongside efforts to disseminate lessons learned.
中低收入国家在实现全民健康覆盖所需的卫生人力方面存在严重短缺。我们研究了国家政策如何能够解决这些不足，并根据人口需求支持发展一支具有适当技能的卫生人力队伍。我们讨论了三种创新的、由政府主导的解决方案，旨在使卫生人力培训与全民健康覆盖的需求保持一致。具体而言，我们讨论了在泰国农村地区培训和留住医生的两项举措、在巴西多学科基层医疗团队中大规模培训社区卫生工作者，以及在印度为护士开设初级保健研究生文凭课程。这些举措带来了一些积极成果，包括提高了泰国农村地区医生的留用率，以及降低了巴西婴儿和儿童的死亡率。然而，仍需要进一步研究来评估这些举措对工人，特别是医生的长期留用的影响，以及对低技能工人提供的培训的充分性，以有效填补医务人员的缺口。必须优先考虑系统地监测方案的承受能力和成本效益，并努力传播经验教训。
