a Department of Environmental Health, University of Johannesburg , Johannesburg , South Africa.
Glob Health Action. 2019;12(1):1646037. doi: 10.1080/16549716.2019.1646037.
: The global health workforce crisis remains a challenge undermining health system strengthening in low-income peri-urban areas. Whilst the 2018 Astana Declaration and the 2030 Global Health Workforce Strategy are helping guide effort to address this challenge, the Decision Space Approach presents an opportunity through which to further understand decision space and its impact on innovation and performance, and what it can contribute towards the goal of health-care worker reform. : To use the Decision Space Approach to understand how national policy interventions on health workers impact local health-care worker systems in Epworth, Zimbabwe. : A case study design, within which cross-sectional studies were carried out at the principal and agent level, was used. At the principal level, data were collected through a documentary search and key informant interviews and generated a Human Resource for Health Policy Decision Space Mapping Analysis Conceptual Tool. The Conceptual Tool guided data collection at the agent level, where a documentary search, in-depth interviews and focus group discussions were carried out. The Tool facilitated discussion of findings and was complemented by interpretive thematic analysis and descriptive statistics. : Intervention by the health ministry resulted in moderate decision space within which functional innovation, in partnership with the local board and church mission, revived financial budgeting, human resources planning, deployment, and retention. However, low capacity of the principal undermined the implementation of choices generated from narrow decision space in training, performance management, labor relations, safety, and information and research. : Whilst collaborative intervention by the principal may help revive health-care worker systems in low-income peri-urban areas, financial and technical incapacity of the principal and agent may undermine performance. Narrow decision space brings health-care worker reform policy direction but incapacity undermines progression towards universal health coverage and the Sustainable Development Goals in low-income peri-urban areas.
全球卫生人力危机仍是一个挑战，破坏了低收入城市周边地区的卫生系统加强工作。虽然 2018 年《阿斯塔纳宣言》和 2030 年全球卫生人力战略有助于指导应对这一挑战的努力，但决策空间方法提供了一个机会，可以进一步了解决策空间及其对创新和绩效的影响，以及它可以为卫生工作者改革的目标做出什么贡献。
使用决策空间方法了解国家对卫生工作者的政策干预如何影响津巴布韦埃普沃思的地方卫生保健工作者系统。
采用案例研究设计，在该设计中，在主要和代理层面进行了横断面研究。在主要层面，通过文件检索和关键知情人访谈收集数据，并生成了人力资源卫生政策决策空间映射分析概念工具。该工具指导代理层面的数据收集，在代理层面进行了文件检索、深入访谈和焦点小组讨论。该工具促进了对调查结果的讨论，并通过解释性主题分析和描述性统计进行了补充。
卫生部的干预措施导致了适度的决策空间，在这个空间内，通过与地方董事会和教会使命合作，实现了功能性创新，恢复了财务预算、人力资源规划、部署和保留。然而，主要机构能力低下破坏了从狭隘的决策空间中产生的选择在培训、绩效管理、劳动关系、安全以及信息和研究方面的实施。
虽然主要机构的协作干预可能有助于恢复低收入城市周边地区的卫生保健工作者系统，但主要机构和代理机构的财务和技术能力不足可能会影响绩效。狭隘的决策空间为卫生保健工作者改革政策指明了方向，但能力不足会阻碍在低收入城市周边地区实现全民健康覆盖和可持续发展目标的进程。
