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

Figures & data

Figure 1. Levels of HRH decision-making.

Reproduced with permission from BH Taderera et al. [1,4].

Figure 2. The decision space approach.

Source: Bossert [9].

Table 1. Health worker numbers at clinics in Epworth.

Facility Type	Human resource for health managers	Nursing staff	Other cadres	Total for all cadres (excluding medical doctors and sisters in charge)
Mission clinic	1 Sister in Charge	2 Primary Counsellors; 6 Registered General Nurses; and 2 Primary Care Nurses.	1 Environmental Health Officer/Technician; and 4 Nurse Aides.	15
Municipal ‘Polyclinic’ clinic	1 Sister in Charge	11 Registered General Nurses; 6 Midwives; 1 State Certified Nurse; 3 Primary Care Nurses; 2 Primary Counsellors.	1 Pharmacy Technician; 3 Laboratory Scientists; 3 Ambulance Drivers; and 1 Environmental Health Officer; 11 Nurse Aides.	42
Municipal ‘OI’ clinic	1 Sister in Charge	13 Registered General Nurses.	1 Dispensary Assistant; 1 Environmental Technician; 5 Nurse Aides; and 1 Pharmacy Technician.	21
Private clinic	1 General Practitioner.	1 Registered General Nurse; 1 Primary Care Nurse.	2 Nurse Aides.	4
Private clinic	1 General Practitioner.	1 Registered General Nurse.	3 Nurse Aides; 1 Lab Pathologist; 1 Radiologist; 1 Dental Surgeon.	7
Private clinic	1 General Practitioner.	1 Registered General Nurse; 1 Midwife.	2 Nurse Aides.	4
Private clinic	1 General Practitioner.	2 Registered General Nurses.	1 Nurse Aide.	3
Private clinic	1 General Medical Practitioner	1 Primary Care Nurse.	0	1
Private clinic	1 General Practitioner.	2 Registered General Nurses.	0	2
Private clinic	1 General Practitioner		2 Nurse Aides	2
Total		56	45	101

Reproduced with permission from BH Taderera [1,13].

Table 2. HRH decision space mapping analysis conceptual tool.

	Level of Decision Space
Result Areas	Narrow	Moderate	Wide
1. Human Resource Planning and Financing
● Demand and Supply Forecasting		MHCC;^aELB;^b Mission^c	Private clinics
● HRH Financial Budgeting		MHCC; ELB; Mission	Private clinics
● HRH Strategic Partnerships	MHCC
2. Production, Training, and Development
● Capacity building for training critical HRH	MHCC; MHTE^d
● Support for further training	MHCC		Private clinics
● Centers of specialization	MHCC
● Induction and exchange programs	MHCC		Private clinics
3. Deployment, Retention, Utilization and Management
● Deployment		MHCC; ELB; Mission	Private clinics
● Retention and motivation		MHCC; ELB; Mission	Private clinics
● Performance management and utilization	MHCC		Private clinics
4. Health Labour Relations
● Rights framework	MHCC
5. Health and Safety
● Health welfare			MHCC; ELB; Mission; Private Clinics.
● Safety and protection	MHCC
6. Human Resource Information and Research
● HRH Information System	MHCC		Private clinics
● HRH Research	MHCC		Private clinics

^aMHCC is the Ministry of Health and Child Care through the Health Services Board.

^bELB refers to the Epworth Local Board, which is the local municipal (local government) authority in Epworth.

^cMission is a church-owned but government-run clinic. In this context, the mission was the Methodist Church Mission.

^dMHTE refers to the Ministry of Higher and Tertiary Education.

Table 3. Proportion of expenditure from the share of the national budget.

	Proportion of expenditure from share of national budget
Year	2009	2010	2011	2012	2013	2014
Proportion of expenditure	8, 56%	8, 58%	9, 33%	8, 64%	10%	12, 7%

Source: BH Taderera [1].

Taderera BH. Do national human resource for health policy interventions impact successfully on local human resource for health systems: a case study of Epworth, Zimbabwe. University of Pretoria; 2016 [cited 2019 Jun 19]. Available from: https://repository.up.ac.za/handle/2263/56948

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Taderera BH, Hendricks SJH, Pillay Y. Human resource for health policy interventions towards health sector reform in a Zimbabwean peri-urban community: a decision space approach. Int J Healthcare Manage. 2017. DOI:10.1080/20479700.2017.1407523

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Bossert T, Larrananga O, Infante A, et al. Applied research on decentralization of health systems in Latin America; Chile case study. Health Sector Reform Initiative; 2000 [cited 2019 Jun 22]. Available from: https://www.hsph.harvard.edu/ihsg/publications/pdf/lac/Chilefinal.pdf

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Taderera B, Hendricks S, Pillay Y. Health system reform inperi-urban communities: an exploratory study of policy strategies towards healthcare worker reform in Epworth, Zimbabwe. Glob Health Action. 2016;9:32219.

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