Human resources for health: a framework synthesis to put health workers at the centre of healthcare

Abstract

Background: Human resources are a key determinant for the quality of healthcare and health outcomes. Several human resource management approaches or practices have been proposed and implemented to better understand and address health workers' challenges with mixed results particularly in low- and middle-income countries (LMICs). The aim of this framework synthesis was to review the human resources frameworks commonly available to address human resources for health issues in LMIC.

Methods: We searched studies in Medline, Embase, CAB Global Health, CINAHL (EBSCO) and WHO global Index Medicus up to 2021. We included studies that provided frameworks to tackle human resources for health issues, especially for LMICs. We synthesised the findings using a framework and thematic synthesis methods.

Results: The search identified 8574 studies, out of which 17 were included in our analysis. The common elements of different frameworks are (in descending order of frequency): (1) functional roles of health workers; (2) health workforce performance outcomes; (3) human resource management practises and levers; (4) health system outcomes; (5) contextual/cross-cutting issues; (6) population health outcomes and (7) the humanness of health workers. All frameworks directly or indirectly considered themes around the functional roles of health workers and on the outcomes of health workforce activities, while themes concerning the humanness of health workers were least represented. We propose a synthesised Human-Centred Health Workforce Framework.

Conclusions: Several frameworks exist providing different recurring thematic areas for addressing human resources for health issues in LMIC. Frameworks have predominantly functional or instrumental dimensions and much less consideration of the humanness of health workers. The paradigms used in policy making, development and funding may compromise the effectiveness of strategies to address human resources challenges in LMIC. We propose a comprehensive human resources for health framework to address these pitfalls.

Keywords: Health policy; Health services research; Health systems; Systematic review.

Figure 1. PRISMA flowchart of studies. PRISMA, Preferred Reporting Items for Systematic reviews and Meta-analyses.

Figure 2. Representation of the ‘managerial’ frameworks towards Health Workforce.

Figure 3. The Human-Centred Health Workforce.

The new framework in figure 3 compared with figure 2 highlights the humanness components in orange arrows and red tone colour. The difference between this new framework (figure 3) compared with the old one (figure 2) lies in highlighting additionally the often overlooked path of implementation of HR strategies/interventions targeting the humanness of health workers (empowerment of health workers to proffer solutions to the problems and challenges witnessed in the HRH). This is not in keeping with the conventional method as seen in figure 2, which targets interventions towards health workers' functional roles and may seem to overlook health workers' humanness. The new framework highlights the prime recognition of the agency of health workers and the need for implementation of rewiring of the ‘intangible software’ of the health system unlike the conventional method which seeks for implementation of strategies targeting the hardware of the health system, for example, human resource, finance, service delivery, etc, based on their utility as a resource for achievement of desired health outcomes. The new framework in figure 3 compared with the previous ones (figure 2) highlights all seven thematic areas synthesised from all the 17 frameworks reviewed in a vivid form while providing the linkages of each theme to one another and yet brings to the fore the place of human agency (humanness theme) in issues related to HRH (coloured in orange and red tone).