Service and population-based exemptions: are these the way forward for equity and efficiency in health financing in low income countries?

The importance of human resources management (HRM) to the success or failure of health systemperformance has, until recently, been generally overlooked. In recent years it has been increasinglyrecognised that getting HR policy and management right has to be at the core of any sustainablesolution to health system performance. In comparison to the evidence base on health care reformrelatedissues of health system finance and appropriate purchaser/provider incentive structures,there is very limited information on the HRM dimension or its impact.Despite the limited, but growing, evidence base on the impact of HRM on organisationalperformance in other sectors, there have been relatively few attempts to assess the implications ofthis evidence for the health sector. This paper examines this broader evidence base on HRM inother sectors and examines some of the underlying issues related to good HRM in the healthsector.The paper considers how human resource management (HRM) has been defined and evaluated inother sectors. Essentially there are two sub-themes: how have HRM interventions been defined?and how have the effects of these interventions been measured in order to identify whichinterventions are most effective? In other words, what is good HRM?The paper argues that it is not only the organisational context that differentiates the health sectorfrom many other sectors, in terms of HRM. Many of the measures of organisational performanceare also unique. Performance in the health sector can be fully assessed only by means of indicatorsthat are sector-specific. These can focus on measures of clinical activity or workload (e.g. staff peroccupied bed, or patient acuity measures), on measures of output (e.g. number of patients treated)or, less frequently, on measures of outcome (e.g. mortality rates or rate of post-surgerycomplications).The paper also stresses the need for a fit between the HRM approach and the organisationalcharacteristics, context and priorities, and for recognition that so-called bundles of linked andcoordinated HRM interventions will be more likely to achieve sustained improvements inorganisational performance than single or uncoordinated interventions.sch_iihpub3306pub2