Combining health and social protection measures to reach the ultra ...

Decision-makingreviews in this field, but the final number of studies that metthe selection criteria is very limited, too, compared to theinitial pool of abstracts. This may mean that either theselection criteria for systematic reviews were too rigid, or theactual number of good quality evaluative studies in the fieldof human resources for health has been limited (see Table 1for a detailed analysis of three of the systematic reviews).Also, most of the studies come from developed countries.Second, much of the research is descriptive. For example,available studies have pointed to global shortages, regionalimbalances and increasing migration of health workers, aswell as dissatisfaction of health workers with their workingconditions 5-9 . On the other hand, many country-basedsituation analyses have pointed towards geographicalimbalances and significant understaffing in rural areas. Thereare paradoxical in-country shortages of nurses even wheremany nurses remain unemployed. And there are situationswhere doctors engage in dual employment 10, 11 .Third, the knowledge about effective solutions to addresschallenges described is far less developed 5, 12, 13 . And hereinlies a major gap. From a country perspective, policy-makersneed to know what solutions are available to them. Theywould also like to know how much an intervention will cost,how difficult it is to implement and its likely impact in theshort run. Knowing what sort of interventions have worked inother settings would give them an idea of what they can tryin their own context.Currently, there are very few evaluation studies of effectiveinterventions or impact assessment studies on humanresources for health. Also, there are very few sources of bestpractice collections in health workforce development. Effortshave started to systematize the knowledge about effectiveinterventions, but only a very small number of promisingpolicy levers were identified through an extensive search ofrecent systematic reviews 14 .Need for more operations and contextspecificresearchWhat is really needed is more operational research andcontext-specific research. Policy-makers in countries may nothave the means to support sophisticated research such assystematic reviews, but they should certainly have thecapacity to use it. Hence there is a need to develop the criticalmass of researchers in countries, with the appropriate skills todo research, use it and make its relevance evident to policymakers.Also, country-based studies should be encouraged bypolicy-makers, within the umbrella of a national strategy ofhealth research that should accommodate the priorities ofHuman Resources for Health (HRH) research within thepriorities of overall health system research.In general, preference should be given to research that:✜ develops and evolves from purely descriptive studies toconceptual research, policy analysis and operationsresearch;✜ promotes international and comparative research byconsidering multi-site, multi-level and multi-countryresearch projects to improve comparability andtransferability of findings, such as the African migrationstudy or the European nursing exit study;✜ integrates research into ongoing or planned interventionsand processes such as health sector reforms so thatlessons can be drawn, compared and shared from theexperiences of different countries 1 .Bringing the answers into the policy-makingprocessOnce research has provided us with the answers we need, weshould move to the next stage: using that knowledge.In the field of human resources for health, effective actionmust cut across many sectors. These include, among others:health, education, labour, civil service, the private sector –which operates many educational institutions – and theregulatory system. Gathering all the various actors,researchers and policy-makers from the different sectorsaround the same table will take some doing. A recentexample from Canada may provide inspiration for similarprocesses to be developed in other settings.In the year 2000, the Canadian government established anew national programme of Research Chairs to attract andretain some of the best researchers. One of the specific aimsof the Chairs is to promote the best possible use of researchresources through strategic institutional planning and throughcollaboration among institutions and between sectors. Forexample, in the domain of health workforce research at theUniversity of Toronto, research topics are both agreed uponand discussed with local and national policy-makers. Theprocess of engaging policy-makers in the development ofresearch topics, keeping them informed of the results ofresearch and cultivating champions among policy-makershas helped to address some crucial policy issues in nursingworkforce development in Canada (L O’Brien-Pallas, oralpresentation at World Health Organization (WHO), Geneva,January 2006).Regional and national observatories are other potentialmechanisms for harvesting and disseminating newknowledge, provided they effectively engage the full range ofstakeholders and their institutions. The experience of theObservatory on Human Resources for Health in the region ofthe Americas demonstrates that the observatory can be aneffective mechanism to improve information and evidenceand to advance the advocacy for human resources issues.The recently launched Africa HRH Observatory is hopedto provide a new impetus for research and evidence forthat region 15 .The way forward: encourage local productionand reach out to external researchIn conclusion, without good research to answer the policyquestions in health workforce development, we will failto find innovative solutions to long-festering problems. Policymakersmust reach out to researchers in their own countriesand facilitate the development of national research withinthe framework of a national strategy of health systemsresearch.Therefore, this policy brief recommends that both policymakersand researchers at country level:Global Forum Update on Research for Health Volume 4 ✜ 161