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

ABSTRACT

Background: The global health workforce crisis remains a challenge undermining health system strengthening in low-income peri-urban areas. Whilst the 2018 Astana Declaration and the 2030 Global Health Workforce Strategy are helping guide effort to address this challenge, the Decision Space Approach presents an opportunity through which to further understand decision space and its impact on innovation and performance, and what it can contribute towards the goal of health-care worker reform.

Objective: To use the Decision Space Approach to understand how national policy interventions on health workers impact local health-care worker systems in Epworth, Zimbabwe.

Methods: A case study design, within which cross-sectional studies were carried out at the principal and agent level, was used. At the principal level, data were collected through a documentary search and key informant interviews and generated a Human Resource for Health Policy Decision Space Mapping Analysis Conceptual Tool. The Conceptual Tool guided data collection at the agent level, where a documentary search, in-depth interviews and focus group discussions were carried out. The Tool facilitated discussion of findings and was complemented by interpretive thematic analysis and descriptive statistics.

Results: Intervention by the health ministry resulted in moderate decision space within which functional innovation, in partnership with the local board and church mission, revived financial budgeting, human resources planning, deployment, and retention. However, low capacity of the principal undermined the implementation of choices generated from narrow decision space in training, performance management, labor relations, safety, and information and research.

Conclusions: Whilst collaborative intervention by the principal may help revive health-care worker systems in low-income peri-urban areas, financial and technical incapacity of the principal and agent may undermine performance. Narrow decision space brings health-care worker reform policy direction but incapacity undermines progression towards universal health coverage and the Sustainable Development Goals in low-income peri-urban areas.

KEYWORDS:

• Decision space
• healthcare worker reform
• policy interventions
• impact
• Epworth

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

I am thankful to the Department of Environmental Health, University of Johannesburg, and the School of Health Systems and Public Health, University of Pretoria for their contribution towards this PhD study. I am most grateful for the African Doctoral Dissertation Research Fellowship Award (ADDRF Award 20152017 ADF 002) provided by the African Population and Health Research Centre in partnership with the International Development Research Centre that helped make this PhD possible. My heartfelt thanks also go to the Ministry of Health and the Health Services Board of the Republic of Zimbabwe, the Zimbabwe Association of Church Hospitals, Epworth Local Board, and the Epworth community in Zimbabwe. I also express my gratitude to my PhD supervisors, Professor Stephen Hendricks and Dr Yogan Pillay for their guidance and support throughout this study.

Disclosure statement

No potential conflict of interest was reported by the author.

Ethics and consent

This research received authorization from the Ministry of Health and Child Care of Zimbabwe, Health Services Board, Mashonaland East Provincial Medical Directorate, Seke District Medical Office, Epworth Local Board, and Zimbabwe Republic Police. It was also approved by the Academic Advisory Committee (AAC) of the University of Pretoria. The research received prior ethical approval from the Research Ethics Committee (REC) of the Faculty of Health Sciences, University of Pretoria (Reference number 413/2014). After this, ethical approval was granted by the Medical Research Council of Zimbabwe (Approval Number MRCZ/A/1941) (1). All respondents provided written informed consent to participate in the study, and this included consent for publication of findings [1, 14].

Paper context

The Decision Space Approach presents an opportunity through which to address the global health workforce crisis in pursuing HRH goals stated by the Astana Declaration and the 2030 Global Health Workforce Strategy. To this end, this review synthesizes findings from the Epworth study and provides a new perspective by drawing from findings that have since emerged from similar studies in Ghana and Uganda to reinforce the pursuit of health-care worker reform.

Additional information

Funding

This work was supported by the African Doctoral Dissertation Research Fellowship Award (ADDRF 20152017 ADF 002) awarded by the African Population and Health Research Centre in partnership with the International Development Research Centre, and the University of Pretoria Postgraduate Research Bursary (10443925).

Notes on contributors

Bernard Hope Taderera

BHT prepared the research proposal, carried out the research, analyzed data and wrote this paper.