Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect

Article English OPEN
Ssengooba, Freddie ; Rahman, Syed Azizur ; Hongoro, Charles ; Rutebemberwa, Elizeus ; Mustafa, Ahmed ; Kielmann, Tara ; McPake, Barbara (2007)
  • Publisher: BioMed Central
  • Journal: Human Resources for Health, volume 5, pages 3-3 (eissn: 1478-4491)
  • Related identifiers: doi: 10.1186/1478-4491-5-3, pmc: PMC1800303
  • Subject: Public Administration | Research | RA | Public Health, Environmental and Occupational Health
    mesheuropmc: health care economics and organizations

Background\ud Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers' responses to the changes in their working environments by taking a 'realistic evaluation' approach.\ud \ud Methods\ud The study findings were generated by triangulating both qualitative and quantitative methods of data collection and analysis among policy technocrats, health managers and groups of health providers. Quantitative surveys were conducted with over 700 individual health workers in both Bangladesh and Uganda and supplemented with qualitative data obtained from focus group discussions and key interviews with professional cadres, health managers and key institutions involved in the design, implementation and evaluation of the reforms of interest.\ud \ud Results\ud The reforms in both countries affected the workforce through various mechanisms. In Bangladesh, the effects of the unification efforts resulted in a power struggle and general mistrust between the two former workforce tracts, family planning and health. However positive effects of the reforms were felt regarding the changes in payment schemes. Ugandan findings show how the workforce responded to a strong and rapidly implemented system of decentralisation where the power of new local authorities was influenced by resource constraints and nepotism in recruitment. On the other hand, closer ties to local authorities provided the opportunity to gain insight into the operational constraints originating from higher levels that health staff were dealing with.\ud \ud Conclusion\ud Findings from the study suggest that a) reform planners should use the proposed dynamic responses model to help design reform objectives that encourage positive responses among health workers b) the role of context has been underestimated and it is necessary to address broader systemic problems before initiating reform processes, c) reform programs need to incorporate active implementation research systems to learn the contextual dynamics and responses as well as have inbuilt program capacity for corrective measures d) health workers are key stakeholders in any reform process and should participate at all stages and e) some effects of reforms on the health workforce operate indirectly through levels of satisfaction voiced by communities utilising the services.
  • References (34)
    34 references, page 1 of 4

    1. Wiskow C: The effects of reforms on the health workforce. Background paper to the World Health Report 2006; funded by DFID 2006.

    2. Alwan A, Hornby P: The implications of health sector reform for human resources development. Bulletin of the World Health Organization 2002, 80:56-60.

    3. Franco LM, Bennett S, Kanfer R: Health sector reform and public sector health work motivation: A conceptual framework. Social Science and Medicine 2002, 54:1255-1266.

    4. Ngufor GF: Public service reforms and their impact on health sector personnel in Cameroon. In ILO/WHO Public service reforms and their impact on health sector personnel: Case studies on Cameroon Geneva: International Labour Organization/World Health Organization; 1999.

    5. Kohlemainen-Aitken RL: Decentralization and Human Resources: Implications and Impact. Human Resources for health Development Journal 1998, 2:1.

    6. Mutizwa-Mangiza D: The Impact of Health Sector Reform on Public Sector Health Worker Motivation in Zimbabwe. In Major Applied Research 5, Working Paper 4 Bethesda, MD: Partnerships for Health Reform Project, Abt Associates Inc; 1998.

    7. Rigoli F, Dussault G: The interface between health sector reform and human resources in health. Hum Resour Health 2003, 1:9 [].

    8. Ambegaokar M: Managing people in the health sector: Considering district team performance contracts in Cameroon. HPU, London School of Hygiene and Tropical Medicine. London; 2004.

    9. Martineau T, Buchan J: Human resources and the success of health sector reform. In American Public Health Association (APHA) Washington DC; 2000.

    10. Humedes N, Ugalde A: Human resources: the Cinderella of health sector reform in Latin America. Human Resources for Health 2005, 3:1.

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