Publication: The Interface between Sector Reform and Human Resources in Health

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Dussault, Gilles
Rigoli, Felix
The relationship between health sector reform and the human resources issues raised in that process has been highlighted in several studies. These studies have focused on how new processes have modified the ways in which the health workers interact. However, few studies have paid enough attention to the ways in which workers have influenced the reforms. The impact of health sector reform has modified critical aspects of the health workforce, including labor conditions, degree of decentralization of management, required skills and the entire system of wages and incentives. Human resources in health, crucial as they are in implementing changes in the delivery system, have had their voice heard in many subtle and open ways, reacting to transformations, supporting, blocking and distorting the proposed ways of action. This work reviews the evidence on how the individual or collective actions of human resources are shaping health reforms, highlighting the reform process, workforce reactions and the factors determining successful human resources participation. It attempts to provide a more powerful way of predicting the effects and interactions of different "technical designs" when they interact with the human resources they affect. The article describes the dialectic nature of the relationship between the objectives and strategies of reforms and the objectives and strategies of those that have to implement them.
Dussault, Gilles; Rigoli, Felix. 2003. The Interface between Sector Reform and Human Resources in Health. Health, Nutrition and Population (HNP) discussion paper;. © World Bank, Washington, DC. License: CC BY 3.0 IGO.
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