Assessment of human resources for health using cross-national comparison of facility surveys in six countries.
Assessment of human resources for health using cross-national comparison of facility surveys in six countries.
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DOI：
10.1186/1478-4491-7-22
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发表时间：
2009-03-12
影响因子：
4.5
通讯作者：
Dal Poz, Mario R
中科院分区：
文献类型：
--
作者：
Gupta, Neeru;Dal Poz, Mario R
背景：卫生设施评估越来越多地被用于衡量和监测卫生工作人员绩效指标，但全球证据基础仍然薄弱。这在一定程度上是由于评估方法和工具的差异很大，妨碍了国家之间、国家内部和时间上的可比性。世界卫生组织在乍得、科特迪瓦、牙买加、莫桑比克、斯里兰卡和津巴布韦六个国家协调了一系列以设施为基础的调查。目标有两个：为各国卫生人力资源(HRH)政策的制定和监测提供信息；以及在不同情况下测试和验证基于设施的标准化人力资源评估工具的使用。根据调查的双重目标，本文提供了一些与政策相关的监测和评估卫生保健指标的描述性统计数据，并对用于比较分析的数据收集工具的有用性进行了定性评估。结果：调查结果显示，在被调查的国家中，卫生服务提供的组织，特别是机构卫生工作者的分布和活动都存在很大的多样性。同时，观察到了一些共性，包括护理和助产人员在技能组合中的重要性，以及医生更倾向于从事双重执业。虽然标准化问卷的使用提供了增强结果的跨国可比性的优势，但也注意到了一些局限性，特别是在用于职业和资格的类别方面，这些类别不一定符合国家的情况。结论：随着卫生设施评估用于HRH监测的经验不断增加，更有必要建立和推广关于实施这些评估的方法和工具的最佳做法，以及传播和使用结果，以进行循证决策。以多国机构为基础的调查的总体结果应有助于各国和合作伙伴发展更大的能力，通过这种方法确定和衡量卫生部门绩效的指标，并最终有助于更好地了解国家和国际一级的卫生人力动态。
BACKGROUND: Health facility assessments are being increasingly used to measure and monitor indicators of health workforce performance, but the global evidence base remains weak. Partly this is due to the wide variability in assessment methods and tools, hampering comparability across and within countries and over time. The World Health Organization coordinated a series of facility-based surveys using a common approach in six countries: Chad, Cote d'Ivoire, Jamaica, Mozambique, Sri Lanka and Zimbabwe. The objectives were twofold: to inform the development and monitoring of human resources for health (HRH) policy within the countries; and to test and validate the use of standardized facility-based human resources assessment tools across different contexts.METHODS: The survey methodology drew on harmonized questionnaires and guidelines for data collection and processing. In accordance with the survey's dual objectives, this paper presents both descriptive statistics on a number of policy-relevant indicators for monitoring and evaluation of HRH as well as a qualitative assessment of the usefulness of the data collection tool for comparative analyses.RESULTS: The findings revealed a large diversity in both the organization of health services delivery and, in particular, the distribution and activities of facility-based health workers across the sampled countries. At the same time, some commonalities were observed, including the importance of nursing and midwifery personnel in the skill mix and the greater tendency of physicians to engage in dual practice. While the use of standardized questionnaires offered the advantage of enhancing cross-national comparability of the results, some limitations were noted, especially in relation to the categories used for occupations and qualifications that did not necessarily conform to the country situation.CONCLUSION: With increasing experience in health facility assessments for HRH monitoring comes greater need to establish and promote best practices regarding methods and tools for their implementation, as well as dissemination and use of the results for evidence-informed decision-making. The overall findings of multi-country facility-based survey should help countries and partners develop greater capacity to identify and measure indicators of HRH performance via this approach, and eventually contribute to better understanding of health workforce dynamics at the national and international levels.