Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada.
Soc Sci Med. 2024 Aug;355:117095. doi: 10.1016/j.socscimed.2024.117095. Epub 2024 Jul 8.
There is a critical shortage of health professionals globally which is affecting the possibility of attaining universal health coverage. Developing countries in sub-Saharan Africa such as Ghana and Nigeria are disproportionately affected and the shortfall in health professionals is envisaged to worsen over the next decade. Countries have responded differently in addressing this shortage. To understand the differing response to the same policy issue in two countries that share similar characteristics in terms of geolocation, socioeconomic indices and disease burden, this paper offers a comparative policy analysis of the two countries using the 3-I framework and punctuated equilibrium theory as comparative policy analysis tools. The analysis identified the ideas, interests, and institutions at play and how they have led to different policy outcomes in both countries. The analysis also shows the interaction between subsystems, policy images and policy venues and how this interaction led to policy change, in the case of Ghana and lag in the case of Nigeria. Our findings show four critical areas in addressing health workforce shortages in both countries - a general approach to addressing the issue, welfare and remuneration, workforce autonomy and career progression, and financing for workforce improvement. For Ghana, there has been significant policy change including implementing strategies for increasing the production of health professionals and addressing remuneration and welfare issues. For Nigeria, there has been seems to be a lag in policy change. While the findings show that Ghana's approach has seemingly put them on a good path toward universal health coverage, applying any lessons should, however, be contextual, considering other country-level and health systems factors that are relevant to addressing health workforce shortages.
全球范围内存在着卫生专业人员的严重短缺，这影响了实现全民健康覆盖的可能性。加纳和尼日利亚等撒哈拉以南非洲的发展中国家受到的影响尤为严重，预计未来十年卫生专业人员的短缺情况将进一步恶化。各国在应对这一短缺问题上采取了不同的措施。为了理解在地理位置、社会经济指数和疾病负担方面具有相似特征的两个国家对同一政策问题的不同反应，本文使用 3-I 框架和间断平衡理论作为比较政策分析工具，对这两个国家进行了比较政策分析。该分析确定了在这两个国家发挥作用的思想、利益和机构，以及它们如何导致两国政策结果的不同。该分析还展示了子系统、政策形象和政策场所之间的相互作用，以及这种相互作用如何导致加纳的政策变化和尼日利亚的政策滞后。我们的研究结果表明，解决两国卫生人力短缺问题有四个关键领域——解决问题的一般方法、福利和薪酬、劳动力自主权和职业发展以及劳动力改善的融资。加纳采取了重大政策变革，包括实施增加卫生专业人员数量和解决薪酬和福利问题的战略。尼日利亚的政策变革似乎滞后。虽然研究结果表明，加纳的方法似乎使他们走上了实现全民健康覆盖的良好道路，但在应用任何经验教训时，应考虑到与解决卫生人力短缺相关的其他国家层面和卫生系统因素，这些因素具有相关性。
