Regional health workforce monitoring as governance innovation: a German model to coordinate sectoral demand, skill mix and mobility

Global health workforce research: Comparative analyses of the scientific publication trends in PubMed

AIM

To analyse the amount of Human Resources for Health (HRH) research publication trends [1990-2019], compared to the broader health policy, systems, and services research (HPSSR).

METHODS

PubMed and its indexation system with Medical Subject Headings (MeSH) are used for this time-trend study. Searches combine MeSH terms for research publications and HPSSR or HRH subjects, except education. Sub-group searches are conducted on: funding support, and high- versus low- and middle-income countries (HICs vs. LMICs). Linear regressions are used for the analysis.

RESULTS

HRH research publications rose exponentially (r²  = 0.94; p < 0.001) from 129 yearly publications in 1990, to 867 in 2018. Yet, HRH research publications had a logarithmic decrease (p < 0.001) in percentage of broader HPSSR publications, from 2.5% to 1.5% [1990-2018]. Funding support increased significantly and linearly (p < 0.001 r²  = 0.88), up to 44% in 2018. The percentage of HRH research publications addressing LMICs grew linearly (p < 0.001; r²  = 0.75), up to 23% in 2018.

CONCLUSION

HRH research publications in the PubMed database increased especially in the more recent years but did not outpace (in earlier times was outpaced) by the growth of HPSSR publications overall. Yearly, HICs still accounted for more than three-quarters of HRH research. These findings can inform global and health research policies.

Mapping the occupational therapy workforce research worldwide: Study protocol for a scoping review

BACKGROUND

Human Resources for Health (HRH) research informs the development of evidence-based, population-centered HRH policies and practices. Occupational therapists are key human resources for meeting the health, rehabilitation, and occupational needs of the population worldwide. Yet, the global status of the occupational therapy workforce research remains unchartered.

OBJECTIVES

This study protocol depicts the methods to map out and synthesize the occupational therapy workforce research worldwide.

METHODS

Six scientific-literature databases and key international institutional websites will be systematically searched, complemented by snowballing searches and recommendations from key global, regional, or national representatives of the World Federation of Occupational Therapists. Two independent reviewers will screen titles-and-abstracts and then full-texts against the eligibility criteria, e.g., 10 categories of workforce research. Educational research, non-empirical papers, and papers (or their summaries) not available in English, Spanish or Portuguese are excluded. Data extraction (e.g., methods, geographies, aims, key findings) will be conducted by one author and fully verified by another. The extracted data will be computed as well as subject to content analysis to provide quantitative map of the literature and of the contents addressed, e.g., per inclusion category.

CONCLUSION

The results of this review can inform wide consultation processes and strategic, concerted local and global developments of the occupational therapy workforce.

Governance in health workforce: how do we improve on the concept? A network-based, stakeholder-driven approach

BACKGROUND

Health workforce governance has been proposed as key to improving health services delivery, yet few studies have examined the conceptualisation of health workforce governance in detail and exploration in literature remains limited.

METHODS

A literature review using PubMed, Google Scholar and grey literature search was conducted to map out the current conceptualisation of health workforce governance. We identified all published literature relating to governance in health workforce since 2000 and analysed them on two fronts: the broad definition of governance, and the operationalisation of broad definition into key dimensions of governance.

RESULTS

Existing literature adopts governance concepts established in health literature and does not adapt understanding to the health workforce context. Definitions are largely quoted from health literature whilst dimensions are focused around the sub-functions of governance which emphasise operationalising governance practices over further conceptualisation. Two sub-functions are identified as essential to the governance process: stakeholder participation and strategic direction.

CONCLUSIONS

Although governance in health systems has gained increasing attention, governance in health workforce remains poorly conceptualised in literature. We propose an improved conceptualisation in the form of a stakeholder-driven network governance model with the national government as a strong steward against vested stakeholder interests. Further research is needed to explore and develop on the conceptual thinking behind health workforce governance.

Human resources for health interventions in high- and middle-income countries: findings of an evidence review

Many high- and middle-income countries face challenges in developing and maintaining a health workforce which can address changing population health needs. They have experimented with interventions which overlap with but have differences to those documented in low- and middle-income countries, where many of the recent literature reviews were undertaken. The aim of this paper is to fill that gap. It examines published and grey evidence on interventions to train, recruit, retain, distribute, and manage an effective health workforce, focusing on physicians, nurses, and allied health professionals in high- and middle-income countries. A search of databases, websites, and relevant references was carried out in March 2019. One hundred thirty-one reports or papers were selected for extraction, using a template which followed a health labor market structure. Many studies were cross-cutting; however, the largest number of country studies was focused on Canada, Australia, and the United States of America. The studies were relatively balanced across occupational groups. The largest number focused on availability, followed by performance and then distribution. Study numbers peaked in 2013-2016. A range of study types was included, with a high number of descriptive studies. Some topics were more deeply documented than others-there is, for example, a large number of studies on human resources for health (HRH) planning, educational interventions, and policies to reduce in-migration, but much less on topics such as HRH financing and task shifting. It is also evident that some policy actions may address more than one area of challenge, but equally that some policy actions may have conflicting results for different challenges. Although some of the interventions have been more used and documented in relation to specific cadres, many of the lessons appear to apply across them, with tailoring required to reflect individuals' characteristics, such as age, location, and preferences. Useful lessons can be learned from these higher-income settings for low- and middle-income settings. Much of the literature is descriptive, rather than evaluative, reflecting the organic way in which many HRH reforms are introduced. A more rigorous approach to testing HRH interventions is recommended to improve the evidence in this area of health systems strengthening.

Strengthening stakeholder involvement in health workforce governance: why we need to talk about power

There is now widespread agreement on the benefits of an integrated, people-centred health workforce, but the implementation of new models is difficult. We argue that we need to think about stakeholders and power, if we want to ensure change in the health workforce. We discuss these issues from a governance perspective and suggest a critical approach to stakeholder involvement as an indicator of good governance. Three models of involving stakeholders in health workforce governance can be identified: corporatist professional involvement either in a continental European model of conservative corporatism or in a Nordic model of public corporatism; managerialist and market-centred involvement of professions as organizational agents; and a more inclusive, network-based involvement of plural professional experts at different levels of governance. The power relations embedded in these models of stakeholder involvement have different effects on capacity building for an integrated health workforce.