This paper synthesizes the human resources for health (HRH) health financing work conducted to date and sets out the topics requiring additional academic and field research. The analysis for the paper was conducted by the Secretariat  of the Financing Task Force  of the Global Health Workforce Alliance (GHWA).

The purpose of this paper is to provide a single synthesis of all available information concerning financial and economic issues around human resources for health in low-income countries. In addition, the paper suggests what could and should be done with the information and the tools in hand, and what additional work is desirable in this domain.

The audience for the paper includes policymakers in low-income countries and their supporting analysts, international development assistance agencies involved in the health sector, other GHWA task forces, the GHWA Secretariat and Board, and researchers interested in HRH issues.

The paper is structured in seven sections, each presenting a distinct issue area. Each section consists of information on the issue background, including the key issue questions and basic definitions.

Issue areas

The seven issue areas below were identified upon a review of the HRH literature and programs in the field: 

1. Employment costs and fiscal space constraints: Discussion of the fiscal space and macroeconomic constraints on countries’ ability to finance the employment costs of scaling up HRH
2. Pre-service training/production costs:  Review of the necessary financing of capital and recurrent costs for roducing HRH to meet the needs of scaling up
3. Equitable deployment costs: Analysis of the costs of and incentives for achieving more equitable deployment of HRH
4. Retention costs:  Analysis of the costs, incentives,  tradeoffs and effectiveness of programs and approaches for improved HRH retention
5. Efficiency/productivity costs and savings:  Review of the cost-effectiveness of methods for increasing the efficiency of HRH and analysis of the potential to reduce the numbers of HRH needed for scale-up through various productivity improvements
6. Human resource management costs: Synthesis of the costs associated with  strengthening HRH management systems
7. Private sector engagement costs and savings:  Review of the impact on costs of engaging both the private and the public sector in HRH scale-up

Agenda for further action

The agenda for further work defines two broad categories of action items: one that relates to improving the knowledge base of global HRH financing issues and another that concerns the implementation of country-specific HRH interventions.

We recommend that GHWA, as a provider of global public goods, take the lead in mobilizing resources and coordinating partners to address the global HRH financing work.  Example tasks to be completed by GHWA include creating a global inventory of retention and deployment practices; conducting systematic analysis of the costs, benefits and economic tradeoffs of various practices and programs, including variations by gender, region, and sector; and providing a roadmap for ministries of health to create HRH scale-up plans that fit overall health system strengthening strategies.  In contrast, we recommend that the country-specific work be led by ministries of health with technical and financial assistance from development partners.  Examples of such country work include collecting private sector HRH data and using it for overall planning efforts; strengthening human resource management systems; and integrating data on skill mix and cost into planning for HRH.  GHWA could play a role in country-specific work as well:  as countries scale up their HRH financing work, GHWA could aggregate, synthesize, and disseminate cross-sectional country data.