Middle- and low-income countries do not have enough evidence to make informed policies regarding their human resources for health, according to an article published on February 22, 2008 in The Lancet's Human Resources for Health Special Issue.

A major challenge of all policy makers is to guarantee a proper supply and distribution of trained health workers. This is especially true in low- and middle-income countries where resources are often limited. In this study, Dr Mickey Chopra, Health Systems Research Unit, Medical Research Council, Western Cape, South Africa, and colleagues performed a meta-analysis of literature published since 1979 related to policy options that might affect the training, distribution, regulation, financing, management, organization, or performance of health workers. Additionally, the policies were examined for the objectiveness of their effects, the suitability of scaling up, and the potential applications to countries with low- and middle- incomes.

The researchers systematically reviewed 759 data sets, and found that only 28 considered the effects above and were eligible for the study. These included only a few studies from low- and middle-income countries. Most of the materials focused on the organization for human resources, substitution or shifting of tasks between health workers, methods for education, teamwork, and workflow reforms. The use of lay health workers encompassed the greatest number of reviews in countries with all ranges of income.

The authors conclude, stating a demand for studies examining these issues in low- and middle-income countries. "We have identified a need for more systematic reviews on the effects of policy options to improve human resources for health in countries with low and middle incomes, for assessments of any interventions that policy makers introduce to plan and manage human resources for health, and for other research to aid policy makers in these countries...moreover, policy makers must also contend with values and beliefs; stakeholder power; institutional constraints; flows of donor funding; and other types of information such as local assessments of need, costs, and the availability of resources."

William Pick, Professor Emeritus University of the Witwatersrand, Johannesburg and honorary Professor Schools of Public Health, Universities of Cape Town and Western Cape, Cape Town, South Africa, wrote an accompanying Comment in the same issue. According to him, the call for more study in this area is wise. He writes: "At a time when there is a resurgence of interest in this field, Chopra and colleagues' overview serves as a timely reminder that much more information is needed if we are to persuade those responsible for health services, and especially human resources for health, to take decisions that will contribute to the solution of the global crisis in staffing health systems...I hope that their appeal will not fall on deaf ears."

Effects of policy options for human resources for health: an analysis of systematic reviews
Mickey Chopra MSc, Salla Munro MA, John N Lavis MD, Gunn Vist PhD and Sara Bennett PhD
The Lancet 2008; 371:668-674
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Anna Sophia McKenney

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