MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Objectives and Methods
In order to produce this policy analysis, the general approach adopted was qualitative. As such,
GW researchers relied on a combination of documentary reviews and interviews with key
informants from the four GHIs included in this study as well as individuals knowledgeable about
the GHIs studied. Our main questions guiding the analysis were:
• What are the policies that guide the operations of each GHI and what are some of the
common and different traits shared by the four GHIs in this respect?
• What do these policies indicate about funding priorities related to HRH, one of the six
health system elements identified by WHO?
A typology was developed to guide the systematic analysis and extraction of language from
official GHI documents (e.g. laws, policies, guidances) and from a select number of country
applications (see Table 3, which displays the countries included for analysis for each GHI, which are
a subset of the MPS country case studies). Key domains of the typology were: 1) Education – preservice,
in-service, general workforce capacity strengthening, producing different types of health
workers; 2) Financial incentives – salary payment, top-ups, rural allowances, pay-for-performance,
general recruitment support; 3) Management – general improvements in infrastructure, training of
health managers, support for continuous professional developments, career paths. These domains
were examined for three types of health workforce – providers who are involved in direct clinical
care, providers who are involved in indirect clinical care, and workers who are non-clinical but
support the health system in some capacity (e.g. health managers, health planners).
Collection of all of the documents publicly available on the websites of each GHI, including
country applications, as well as other relevant publications from think tanks and other
organizations, occurred over a 1.5 month period and analysis of these documents took place over
the following 2.5 month period. While the documentary review was underway, key informant
interviews were conducted in person or by telephone. At least one representative from each GHI
agreed to participate in the interviews, but in one case we were unable to secure a date and time
due to the need to reschedule multiple times. Because key informants were assured
confidentiality, the information gathered is not directly quoted or attributed and was strictly used
to complement the document reviews in developing the policy analysis.
All of the language found in GHI official documents and country applications was extracted and
inputted in tables for easier reference and comparison (see Table 4 for several of these tables). The
George Washington University Institutional Review Board (GWU IRB) determined this study to be
exempt research under #010924.
Results
GHIs differed in how extensive their official, written guidance was to country applicants, but GHI
documents, informants, and country applications highlighted the inherent flexibility that exists
around the use of funding for health system-related activities, including interventions pertaining
to the health workforce. Guidance is generally, and not surprisingly, worded quite broadly and can
be interpreted to encompass many different aspects of strengthening the workforce in a given
country. It also varied in what aspect of HRH was emphasized. This section summarizes key
findings in three key areas: 1) types of fundable HRH interventions; 2) types of fundable health
workers; 3) comparison of approved country applications and GHI guidance.
223