CapacityPlus Experts Contribute to Special Issue of the Bulletin of the World Health Organization Focusing on Human Resources for Universal Health Coverage

Global commitment to achieving universal health coverage is growing, but improved health service coverage requires concerted efforts to address human resources for health (HRH) challenges.

A special issue of the Bulletin of the World Health Organization addresses the topic of human resources for universal health coverage from a variety of angles. Among the special issue’s offerings are three papers—including two of the Bulletin’s four “policy and practice” articles—by CapacityPlus experts. The three articles focus on retention of rural health workers, integration of community health workers, and leveraging of information and communication technologies, respectively.

Health worker retention
Article coverEarly Implementation of WHO Recommendations for the Retention of Health Workers in Remote and Rural Areas is coauthored by CapacityPlus’s Wanda Jaskiewicz. The article considers 16 evidence-based recommendations formulated by the WHO in 2010 to encourage retention of health workers in remote and rural areas. Lead author James Buchan and the six coauthors (who represent academic institutions, government ministries, and the WHO as well as CapacityPlus) review progress implementing the WHO recommendations in the Lao People’s Democratic Republic, South Africa, member countries of the Asia-Pacific Action Alliance on Human Resources for Health, and Europe.

The article documents specific successes as well as broader questions, such as the need to assess how different types of retention interventions actually work, identify contextual factors that influence intervention success, and apply theoretical frameworks to ensure intervention logic. Overall, the article indicates that the WHO recommendations “have been a useful guide in many countries, particularly for initiating a more structured and focused policy dialogue, strengthening the collection of evidence and supporting policy development.”

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Community health worker integration
Article coverIn Community Health Workers for Universal Health-Care Coverage: From Fragmentation to Synergy, CapacityPlus’s Kate Tulenko and coauthors consider six key policy and practice challenges for scale-up and sustainability of community health worker (CHW) programs.

Describing the “legacy of parallel [CHW] initiatives funded separately, delivering separately, and reporting separately,” the authors outline challenges pertaining to neglect of CHWs in health workforce planning; the problem of multiple actors working without coordination; the fragmented, disease-specific focus of many CHW programs; the failure to clearly link CHWs to health systems; competition among nongovernmental organizations as a barrier to synergy; and CHWs’ unclear identity as the interface between communities and formal health systems. As the article makes clear, “The aim [instead] must be to optimize a health team approach at the front line of the health system, fit for the local context, with facility-based and community-based health workers working together.”

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Leveraging of information and communication technologies
Article coverThe article Leveraging Information Technology to Bridge the Health Workforce Gap focuses on the potential for new information and communication technologies (ICTs) to mitigate health workforce education and training challenges and strengthen health systems. Robert Bollinger, CapacityPlus’s Dykki Settle, and other coauthors note that rapid technological advances create “an unprecedented opportunity to scale up health worker training and improve its quality, as well as to optimize health service delivery.”

The article reviews innovations such as eLearning, eHealth, mHealth, and social media, touching on the many ways that these tools are transforming health care training and service delivery. Discussing eLearning, the authors insist that it “is not a second-rate alternative to traditional health worker education” but “adds value and makes it possible to overcome the limitations of existing educational strategies.” Challenges to making wider use of eLearning and ICTs include the limitations of ICT infrastructure and technologies as well as cultural, societal, and regulatory barriers. The article shares ten recommendations, a critical one being to promote computer literacy and ICT access for women, since women represent the majority of health workers. Other recommendations include increasing coordination across ministries, developing more public-private partnerships, and ensuring adequate ICT technical support.

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