Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
KIT Royal Tropical Institute, Amsterdam, The Netherlands.
Hum Resour Health. 2023 Jul 24;21(1):57. doi: 10.1186/s12960-023-00838-0.
There is a worldwide shortage of health workers against WHO recommended staffing levels to achieve Universal Health Coverage. To improve the performance of the existing health workforce a set of integrated human resources (HR) strategies are needed to address the root causes of these shortages. The PERFORM2Scale project uses an action research approach to support district level management teams to develop appropriate workplans to address service delivery and workforce-related problems using a set of integrated human resources strategies. This paper provides evidence of the feasibility of supporting managers at district level to design appropriate integrated workplans to address these problems.
The study used content analysis of documents including problem trees and 43 workplans developed by 28 district health management teams (DHMT) across three countries between 2018 and 2021 to identify how appropriate basic planning principles and the use of integrated human resource and health systems strategies were used in the design of the workplans developed. Four categories of HR strategies were used for the analysis (availability, direction, competencies, rewards and sanctions) and the relationship between HR and wider health systems strategies was also examined.
About half (49%) of the DHMTs selected service-delivery problems while others selected workforce performance (46%) or general management (5%) problems, yet all workplans addressed health workforce-related causes through integrated workplans. Most DHMTs used a combination of strategies for improving direction and competencies. The use of strategies to improve availability and the use of rewards and sanctions was more common amongst DHMTs in Ghana; this may be related to availability of decision-space in these areas. Other planning considerations such as link between problem and strategy, inclusion of gender and use of indicators were evident in the design of the workplans.
The study has demonstrated that, with appropriate support using an action research approach, DHMTs are able to design workplans which include integrated HR strategies. This process will help districts to address workforce and other service delivery problems as well as improving 'health workforce literacy' of DHMT members which will benefit the country more broadly if and when any of the team members is promoted.
全球卫生工作者短缺，远低于世界卫生组织建议的人员配备水平，无法实现全民健康覆盖。为提高现有卫生工作者队伍的绩效，需要采取一整套综合人力资源（HR）战略，从根本上解决这些短缺问题。PERFORM2Scale 项目采用行动研究方法，支持区级管理团队制定适当的工作计划，以利用一整套综合人力资源战略来解决服务提供和劳动力相关问题。本文提供了支持区级管理人员设计适当的综合工作计划以解决这些问题的可行性证据。
本研究对包括问题树在内的文件进行了内容分析，并对 2018 年至 2021 年间三个国家的 28 个区卫生管理团队（DHMT）制定的 43 项工作计划进行了分析，以确定在制定工作计划时如何适当运用基本规划原则和综合人力资源与卫生系统战略。对四类人力资源战略（供给、方向、能力、奖惩）进行了分析，并研究了人力资源战略与更广泛的卫生系统战略之间的关系。
约一半（49%）的 DHMT 选择了服务提供方面的问题，而其他的则选择了劳动力绩效（46%）或一般管理（5%）问题，但所有的工作计划都通过综合工作计划解决了与卫生劳动力相关的原因。大多数 DHMT 都采用了一系列战略来提高方向和能力。在加纳的 DHMT 中，更常见的是提高供给和使用奖惩的战略；这可能与这些领域的决策空间可用性有关。其他规划考虑因素，如问题与战略之间的联系、性别纳入和指标使用，在工作计划的设计中都有体现。
研究表明，在适当的行动研究方法的支持下，DHMT 能够设计出包括综合人力资源战略的工作计划。这一过程将有助于解决劳动力和其他服务提供问题，提高 DHMT 成员的“卫生劳动力素养”，如果团队成员中的任何一人得到提升，这将使国家从中受益。
