The impact of human resource management on health systems
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The impact of human resource management on health systems    . [email protected] HRH Management. HRH Challenges HRH Dynamics Impact of recession HR Interventions. Common challenges: Policy maker priorities.

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Hrh management
HRH Management    

  • HRH Challenges

  • HRH Dynamics

  • Impact of recession

  • HR Interventions

Common challenges policy maker priorities
Common challenges: Policy maker priorities    

  • How do we plan how many doctors, nurses, and other health workers to educate, and employ?

  • How can we improve recruitment, retention and return?

  • Which incentives are effective in motivatingdoctors, nurses etc

  • How can we determine and deploy the most effective skill mix of doctors, nurses and other staff?

  • How can we improve productivity of health workers?

  • How do we maintain workload with reasonable limits, for individuals and for teams of health workers?

Common hrh challenges
Common HRH Challenges    

  • Skills shortages

  • Geographic maldistribution

  • Fragmented planning

  • Education- employer linkages

  • Managing Staff Performance

  • Effective Skill mix

  • Migration

  • (Data; research/evaluation; informing policy)

Dynamics in europe
Dynamics in Europe    

  • European health care labour markets are dynamic- will change in response to demographic change (ageing populations) ; general economic conditions; -health sector reform

  • Accession- countries with relatively low paid health professionals – outflow to established “richer” EU countries? (Knock on effect to East/ CIS?)

  • Patient safety/ country level regulatory issues

  • “Stocks and Flows” : Different data sets- different pictures

Flows maldistribution



“poor” districts

public sector

health sector

“poorer” countries



“richer” districts

private sector

other sectors

“richer” countries

“Flows” (Maldistribution)

Distribution of physicians in the European Region    


Source: WHO HFA database, 2007

Diversity in the european region health professionals 100 000 population 2002
Diversity in the European region    Health professionals / 100.000 population, 2002

Source: WHO HFA database, 2007

Impact of recession crisis
Impact of recession/crisis    

  • “multidimensional and severe”(WHO,2009)

  • Many European countries will be in economic recession this year; employment decline most evident in [export oriented] manufacturing, finance, construction

  • Countries with financial resources are funding “stimulus” packages- those with limited resources have less scope for fiscal interventions

  • Depreciation of national currencies in Central/ East / South East Europe (and UK) in comparison to euro and $

Recession impact on hrh
Recession: Impact on HRH    

  • Reduced demand for “new” HRH because of funding constraints, and increased retention of workers already working in health sector

  • Labour cost reductions/ improved productivity= skill mix changes, increased workload/ stress

  • Pay “freezes” or pay reductions in health sector

  • Increased pressure to migrate, but reduced job opportunities in many countries

  • Increase in unemployment/ underemployment of health workers as supply increases and demand reduces or stagnates

Policy options
Policy options    

  • Establish “anti-crisis unit” in Ministry of Health: monitor situation, explore strategic options, link to other Ministries (particularly Ministry of Finance)

  • Maintain/develop communication links with other stakeholders (donors, professions, civil society, NGOs etc)- “we are all in this together”

  • Develop advocacy/ influence to protect health budgets

  • Review HRH cost containment/ productivity options to identify action with potential for positive impacts (assess HRH impact)

  • Review workforce planning and projections to assess if oversupply of ”new “ staff

Hrm evidence base
HRM Evidence Base    

  • about 30 studies examining links between HRM and organisational performance:

  • “Fit” : HRM must be aligned with organisational context and objectives

  • “Bundles” : co-ordinated HRM interventions are more effective than single interventions

  • HRM can make a positive difference to performance(Buchan, 2004)


  • WHO (2009) Health in times of global economic crisis: implications for the WHO European region

  • Buchan J (2004) What Difference Does (Good) HRM make? Human Resources for Health 2004:6