Improving Health Workforce Governance: the Role of Multi-Stakeholder Coordination Mechanisms and Human Resources for Health Units in Ministries of Health

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Abstract Background:A cohesive and strategic governance approach is needed to improve the health workforce (HW). To achieve this, the WHO Global Strategy on Human Resources for Health(HRH)promotesmechanisms to coordinate HRHstakeholders,HRH structures and capacity within the health sector to support the development and implementation of a comprehensive HW agenda and regular reportingthrough WHO’s National Health Workforce Accounts (NHWA)Methods:Using an adapted HRH governance framework for guidance and analysis we explored the existence and operation of HRH coordination mechanisms and HRH structures in Malawi, Nepal, Sudan andadditionally from a global perspective through 28 key informant interviews and a reviewof 165 documents.Results: A unified approach is needed to coordination of stakeholders who support the timely development and oversight of an appropriate HRH strategy subsequently implemented and monitored by an HRH unit. Multiple HRH stakeholder coordination mechanisms co-exist, but the broader, embeddedmechanisms seemed more likely to support and sustain a comprehensive HW agenda.Including all stakeholders is challenging and the private sector and civil society were noted for their absence.The credibility of coordination mechanisms increases participation. Factors contributing to credibility included:high level leadership, organisational support and the generation and availability of timely HRH data and clear ownership by the ministry of health.HRH units were identified in two study countries and were reported to exist in many countries but were not necessarily functional.There is a lack of specialist knowledge needed for the planning and management of the HWamongst staff in HRH unitsor equivalent structures, coupled with high turnover in many countries. Donor support has helped with provision of technical expertise and HRH data systems, though the benefits may not besustained.Conclusion:While is it important to monitor the existence of HRH coordination mechanisms and HRH structure through the NHWA, improved ‘HRH literacy’ for both stakeholders and operational HRH staff anda deeper understanding of the operation of these functions is needed tostrengthen their contribution to HW governance and ultimately, wider health goals.

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