The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
School of Public Health, University of Sydney, Sydney, NSW, Australia.
Int J Health Policy Manag. 2022 Dec 6;11(11):2404-2414. doi: 10.34172/ijhpm.2022.6168. Epub 2022 Feb 7.
As a fundamental human right, the right to health (RTH) can influence state actors' behaviour towards health inequities. Human rights advocates have invoked the RTH in a collective demand for improved access to essential medicines in low- and middle-income countries (LMICs). Similarly, scholars have used the RTH as a framework for analysing health problems. However, its utility for addressing skilled health worker (SHW) shortages in LMICs has been understudied. Realising that SHW shortages occur due to existing push-and-pull factors within and between LMICs and high-income countries (HICs), we sought to answer the question: "how, why, and under what circumstance does the RTH offer utility for addressing SHW shortages in LMICs?"
We conducted a realist synthesis of evidence identified through a systematic search of peer-reviewed articles in Embase, Global Health, Medline (Ovid), ProQuest - Health & Medical databases, Scopus (Elsevier), Web of Science (Clarivate), CINAHL (EBSCO), APAIS-Health, Health Systems Evidence and PDQ-EVIDENCE; as well as grey literature from Google Scholar.
We found that the RTH offers utility for addressing SHW shortages in LMICs through HIC state actors' concerns for their countries' reputational risk, recognition of their obligation to support health workforce strengthening in LMICs, and concerns for the cost implication. State actors in LMICs will respond to adopt programs inspired by the RTH when they are convinced that it offers tangible national benefits and are not overly burdened with ensuring its success. The socio-economic and institutional factors that constrain state actors' response include financial cost and sustainability of rights'-based options.
State and non-state actors can use the RTH as a resource for promoting collective action towards addressing SHW shortages in LMICs. It can also inform negotiations between state actors in LMICs and their HIC counterparts.
作为一项基本人权，健康权（RTH）可以影响国家行为者对健康不平等的态度。人权倡导者援引 RTH，集体要求在中低收入国家（LMICs）改善获得基本药物的机会。同样，学者们也将 RTH 用作分析健康问题的框架。然而，它在解决 LMICs 中熟练卫生工作者（SHW）短缺方面的效用尚未得到充分研究。我们意识到 SHW 短缺是由于 LMICs 和高收入国家（HICs）内部和之间存在现有推拉因素造成的，因此我们试图回答以下问题：“在什么情况下，RTH 对解决 LMICs 中的 SHW 短缺具有实用价值？”
我们通过对 Embase、Global Health、Medline（Ovid）、ProQuest-Health & Medical 数据库、Scopus（Elsevier）、Web of Science（Clarivate）、CINAHL（EBSCO）、APAIS-Health、Health Systems Evidence 和 PDQ-EVIDENCE 进行系统搜索，对同行评议文章进行了证据的真实主义综合分析；以及来自 Google Scholar 的灰色文献。
我们发现，通过 HIC 国家行为者对其国家声誉风险的关注、对支持 LMIC 卫生人力强化的义务的认识以及对成本影响的关注，RTH 对解决 LMICs 中的 SHW 短缺具有实用价值。当 LMIC 中的国家行为者确信 RTH 能带来切实的国家利益，并且不会因确保其成功而负担过重时，他们会对受其启发的方案做出回应。限制国家行为者做出回应的社会经济和体制因素包括基于权利的选择的财务成本和可持续性。
国家和非国家行为者可以利用 RTH 来促进解决 LMICs 中 SHW 短缺的集体行动。它还可以为 LMIC 中的国家行为者与其 HIC 对应方之间的谈判提供信息。
