Do national human resource for health interventions impact successfully on local human resource for health systems : a case study of Epworth Zimbabwe

Abstract

The need to overcome the global health workforce crisis is a challenge undermining health system reform throughout the world. Whilst policy interventions have been made towards human resource for health reform throughout the world, available literature does not provide a detailed narrative on how national human resource for health policy interventions impact local human resource for health systems in peri-urban communities. This study sought to detemine how national human resource for health policy interventions of 2009 to 2014 impacted the local human resource for health system of Epworth, a peri-urban community in south-east Harare, Zimbabwe. It is based on the Decision Space Approach developed by Dr. Thomas Bossert of the Harvard School of Public Health. In this context, analysis sought to determine decision space between the principal (Ministry of Health) and the agent (Epworth peri-urban community), innovation (decisions made), and change (policy outcomes/impact). The research design was a case study in which qualitative and quantitative methods were used. Data collected at the principal level, through key-informant interviews and poicy review generated a Human Resource for Health Policy Decision Space Mapping Analysis Conceptual Tool. It consisted six policy result areas around which data was then collected at the agent level through in-depth interviews, sample interviews, focus group discussions and a documentary search. The conceptual tool was then also used to facilitate analysis using the Decision Space Approach. It was established that intervention by the Ministry of Health, in which narrow decision space was retained on health personnel production, training, development, strategic partnerships, labour relations, safety, protection, and information and research was undermined by financial and technical constraints. The local board and mission who enjoyed moderate decision space engaged in functional innovation on human resource planning, budgeting, deployment, and retention, and performance management were also constrained. The local private sector enjoyed wide decision space on all policy functions but their capacity to contribute more was undermined by a narrow revenue base. Conclusively, ministerial intervention, collaboration and decision space between actors at the principal and agent levels was both necessary and inevitable as it helped revive the local human resource for health system between 2009 and 2014. It was recommended that decision space of 2009 to 2014 be reinforced and sustained until desired policy outcomes are realized. In addition, the conceptual tool developed is recommended for use with adaptive modification in similar studies around the world towards health system reform.