A novel analytical framework could help to strengthen health systems in post-conflict countries
An analytical framework that gives equal focus to the production, deployment, and retention of health workers could help to strengthen and develop health systems in post-conflict countries, such as Afghanistan, the Democratic Republic of Congo, and Cambodia. These are the conclusions of a Policy Forum article in this week's PLoS Medicine.
Noriko Fujita, Mari Nagai, and Hidechika Akashi from the National Center for Global Health and Medicine in Tokyo, Japan and Anthony Zwi from the School of Social Science and International Studies at The University of New South Wales in Sydney, Australia argue that efforts of development partners and governments typically concentrate on some components of the human resource system, usually educational institutions and in-service training for health workers, while neglecting other important elements and the essential links between them.
However, innovations that build on and support link across different components of the human resource system are more effective, as seen in the authors' description of the recruitment and contracting of local students for deployment in Afghanistan and Cambodia. Furthermore, balancing emphasis on quantity and quality of human resources is difficult without considering other contextual factors that affect the whole health system, such as the reforms to the health sector and education in Cambodia, say the authors.
According to the authors, national Ministries of Health and related ministries typically have limited capacity while external agencies bring in significant resources along with their own agendas. However, coordination mechanisms that involve all players are key to reconstructing, developing, and monitoring the human resource system such as those that occurred with the Human Resource Task Force in Afghanistan and the engagement of national stakeholders in DR Congo.
The authors call their analytical framework a "house model" and conclude: "A meaningful, comprehensive, and visual framework that is easy to understand and identifies key components of the human resources system is of value."
"While the 'house model' contains elements similar to the World Health Organization [Human Resources for Health] Action Framework, some functions are extracted in order to draw more attention to them. Issues such as the legal and regulatory framework, coordination, and monitoring are often neglected. We also place particular emphasis on the linkages among elements by highlighting some core functions of human resource management (production deployment-retention), or by separating the foundation components (policy and planning, finances, legal) as primarily the responsibility of the government."
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Fujita N, Zwi AB, Nagai M, Akashi H (2011) A Comprehensive Framework for Human Resources for Health System Development in Fragile and Post-Conflict States. PLoS Med 8(12): e1001146. doi:10.1371/journal.pmed.1001146