Health human resources

Health human resources (HHR) – also known as human resources for health (HRH) or health workforce – is defined as "all people engaged in actions whose primary intent is to enhance positive health outcomes", according to World Health Organization's World Health Report 2006. Human resources for health are identified as one of the six core building blocks of a health system. They include physicians, nursing professionals, pharmacists, midwives, dentists, allied health professions, community health workers, and other social service and health care providers.

Health human resources are further composed of health management and support personnel: those who do not provide direct patient care but add important value to enhance health system efficiency, effectiveness and equity. They include health services managers, medical records and health information technicians, health economists, health supply chain managers, medical secretaries, facility maintenance workers, and others.

The field of HHR deals with issues such as workforce planning and policy evaluation, recruitment and retention, training and development of skilled personnel, performance management, health workforce information systems, and research on health workforce strengthening. Raising awareness of the critical role of human resources in the health care sector - particularly as exacerbated by health labour shortages stemming from the Covid-19 pandemic - has placed the health workforce as one of the highest priorities of the global health agenda.

Global situation
The World Health Organization (WHO) raised the profile of HHR as a global health concern with its landmark 2006 published estimate of a shortage of almost 4.3 million physicians, midwives, nurses and support workers to meet the Millennium Development Goals, especially in sub-Saharan Africa. The situation was declared on World Health Day 2006 as a "health workforce crisis" – the result of decades of underinvestment in health worker education, training, wages, working environment and management. The WHO currently projects a global shortfall of 10 million health workers by 2030, mostly in low- and lower-middle income countries.

Shortages of skilled for health workers are also reported in many specific care areas. For example, there is an estimated shortage of 1.18 million mental health professionals, including 55,000 psychiatrists, 628,000 nurses in mental health settings, and 493,000 psychosocial care providers needed to treat mental disorders in 144 low- and middle-income countries. Shortages of skilled birth attendants in many developing countries remains an important barrier to improving maternal health outcomes. Physiotherapists and rehabilitation medical specialists have been found to be less available in low- and middle-income countries, despite greater need. Many countries, both developed and developing, report geographical maldistribution of skilled health workers leading to shortages in rural and underserved areas.

Regular statistical updates on the global health workforce situation are collated by the WHO's Global Health Observatory. However, the evidence base remains fragmented and incomplete, largely related to weaknesses in the underlying human resource information systems (HRIS) within countries.

In order to learn from best practices in addressing health workforce challenges and strengthening the evidence base, an increasing number of HHR practitioners from around the world are focusing on issues such as HHR advocacy, equity, surveillance and collaborative practice. Some examples of global HRH partnerships include:
 * Global Health Workforce Network
 * Women in Global Health
 * Health Workforce Information Reference Group (HIRG)

Research
Health workforce research is the investigation of how social, economic, organizational, political and policy factors affect access to health care professionals, and how the organization and composition of the workforce itself can affect health care delivery, quality, equity, and costs.

Many government health departments, academic institutions and related agencies have established research programs to identify and quantify the scope and nature of HHR problems leading to health policy in building an innovative and sustainable health services workforce in their jurisdiction. Some examples of HRH information and research dissemination programs include:


 * Human Resources for Health journal
 * HRH Knowledge Hub, University of New South Wales, Australia
 * Center for Health Workforce Studies, University of Albany, New York
 * Canadian Institute for Health Information: Spending and Health Workforce
 * Public Health Foundation of India: Human Resources for Health in India
 * National Human Resources for Health Observatory of Sudan
 * OECD Human Resources for Health Care Study

Policy and planning
In some countries and jurisdictions, health workforce planning is distributed among labour market participants. In others, there is an explicit policy or strategy adopted by governments and systems to plan for adequate numbers, distribution and quality of health workers to meet health care goals. For one, the International Council of Nurses reports: "The objective of HHRP [health human resources planning] is to provide the right number of health care workers with the right knowledge, skills, attitudes, and qualifications, performing the right tasks in the right place at the right time to achieve the right predetermined health targets."

An essential component of planned HRH targets is supply and demand modeling, or the use of appropriate data to link population health needs and/or health care delivery targets with human resources supply, distribution and productivity. The results are intended to be used to generate evidence-based policies to guide workforce sustainability. In resource-limited countries, HRH planning approaches are often driven by the needs of targeted programmes or projects, for example, those responding to the Millennium Development Goals or, more recently, the Sustainable Development Goals.

The WHO Workload Indicators of Staffing Need (WISN) is an HRH planning and management tool that can be adapted to local circumstances. It provides health managers a systematic way to make staffing decisions in order to better manage their human resources, based on a health worker's workload, with activity (time) standards applied for each workload component at a given health facility.

Global Code of Practice on the International Recruitment of Health Personnel
The main international policy framework for addressing shortages and maldistribution of health professionals is the Global Code of Practice on the International Recruitment of Health Personnel, adopted by the WHO's 63rd World Health Assembly in 2010. The Code was developed in a context of increasing debate on international health worker recruitment, especially in some higher income countries, and its impact on the ability of many third-world countries to deliver primary health care services. Although non-binding on the Member States and recruitment agencies, the Code promotes principles and practices for the ethical international recruitment of health personnel. It also advocates the strengthening of health personnel information systems to support effective health workforce policies and planning in countries.

Gender and health workforce
The WHO estimates women comprise approximately 70% of the global health workforce, but gender equality remains elusive. Women’s contributions to health and social care services are markedly undervalued; health labour markets around the world continue to be characterized with gender-based occupational segregation, inadequate work conditions free from gender bias and sexual harassment, gender pay gaps, and lack of gender parity in leadership. Numerous HHR studies have shown women healthcare providers earn significantly less on average than men despite similar professional titles, qualifications and job responsibilities. Meanwhile, an estimated 75% of HHR leadership roles are held by men.