Systemic Management of Human Resources for Health An Introduction for Health Managers Authors Edgar Necochea Manjushree Badlani Débora Bossemeyer Outputs and Outcomes Management Human and Resources Support Administration Production Deployment Regulation and Planning and Policies Quality Assurance Strategic Decision-Making Systemic Management of Human Resources for Health An Introduction for Health Managers Authors Edgar Necochea Manjushree Badlani Débora Bossemeyer Jhpiego is an international, non-profit health organization affiliated with The Johns Hopkins University. For 40 years, Jhpiego has empowered frontline health workers by designing and implementing effective, low-cost, hands-on solutions to strengthen the delivery of health care services for women and their families. By putting evidence-based health innovations into everyday practice, Jhpiego works to break down barriers to high-quality health care for the world’s most vulnerable populations. Published by: Jhpiego Corporation Brown’s Wharf 1615 Thames Street Baltimore, Maryland 21231-3492, USA www.jhpiego.org © Jhpiego Corporation, 2013. All rights reserved. Authors: Edgar Necochea Manjushree Badlani Débora Bossemeyer TABLE OF CONTENTS ABBREVIATIONS AND ACRONYMS ..................................................................................... iv ACKNOWLEDGMENTS ........................................................................................................... v INTRODUCTION .................................................................................................................... 1 WHY WRITE THIS MANUAL AND WHO CAN BENEFIT FROM IT? ................................. 2 THE HRH SYSTEMIC MANAGEMENT FRAMEWORK ....................................................... 2 The Importance of a HRH Systemic View ................................................................................... 2 The Components of the HRH System ......................................................................................... 3 Strategic components ............................................................................................................... 3 Operational components .......................................................................................................... 4 Support components ................................................................................................................ 4 The External Environment ........................................................................................................... 4 THE ELEMENTS OF THE EXTERNAL ENVIRONMENT ..................................................... 5 The Health Sector Goals, Strategies, and Leadership .................................................................... 5 The National Macro-Economic Policies and Labor Market .......................................................... 6 The Political and Administrative Context of the Country ............................................................ 7 The Social and Cultural Environment .......................................................................................... 8 THE COMPONENTS OF THE HRH SYSTEM ....................................................................... 9 Strategic Components ................................................................................................................ 9 Policies ......................................................................................................................................... 9 Macro-level policies .................................................................................................................. 9 Workplace-level policies ......................................................................................................... 11 Planning and Strategic Decision-Making ................................................................................... 14 Operational Components ........................................................................................................ 19 Production ................................................................................................................................. 19 What types of health workers should be produced? ................................................................ 20 Production of health service providers .................................................................................... 20 Production of health management and support workers ......................................................... 26 Production of community health workers .............................................................................. 26 Post-basic education ............................................................................................................... 27 Deployment ............................................................................................................................... 27 Creating a staffing plan .......................................................................................................... 29 Proper placement of new staff: key for quality and effective services ....................................... 32 Systemic Management of Human Resources for Health: An Introduction for Health Managers i Orientation of the new workforce: speeding up the learning curve ......................................... 33 Performance Management and Support ..................................................................................... 34 Ensuring a competent workforce (workers that know what and how to do) ............................ 34 Providing resources, tools, and managerial support (workers that are able to do) .................... 38 Enhancing motivation (workers who want to do) ................................................................... 40 Support Components .............................................................................................................. 44 Human Resources Administration.............................................................................................. 44 Entering the workforce ........................................................................................................... 44 Permanence in the active workforce ....................................................................................... 46 Exit from the workforce ......................................................................................................... 51 Regulation and Quality Assurance .............................................................................................. 52 Licensure/registration ............................................................................................................. 53 Certification ........................................................................................................................... 53 Accreditation .......................................................................................................................... 54 HRH System Outputs and Outcomes ...................................................................................... 57 Policies ................................................................................................................................... 58 Planning and strategic decision-making .................................................................................. 58 Production ............................................................................................................................. 59 Deployment ........................................................................................................................... 60 Performance management and support .................................................................................. 60 Human resources administration ............................................................................................ 61 Regulation and quality assurance ............................................................................................ 62 System outputs and outcomes ................................................................................................ 62 CONCLUSION ....................................................................................................................... 63 FIGURES AND TABLES Figure 1. HRH Systemic Management Framework .......................................................................... 5 Figure 2. Mapping Outflows with a Labor Market Approach. An Example: Mozambican Doctors from the 1980–2007 Cohort ................................... 17 Figure 3. Three Generations of Reform .......................................................................................... 21 Figure 4. Continuing Education for Competencies, Performance, and Results Framework ............ 35 Figure 5. Continuing Education Elements ..................................................................................... 36 ii Systemic Management of Human Resources for Health: An Introduction for Health Managers Table 1. Options for Continuing Education .................................................................................. 37 Table 2. Summary of Quality Assurance Mechanisms .................................................................... 55 Table 3. Production Indicators and Potential Sources of Information ............................................ 59 Table 4. Deployment Indicators and Potential Sources of Information .......................................... 60 Table 5. Performance