Human resources for health and universal health coverage: fostering equity and effective coverage

TLDR

Universal health coverage demands equitable distribution of human resources for health amid demographic shifts, rising non‑communicable diseases, and emerging public health threats, yet many countries face challenges in allocating these resources efficiently within limited fiscal space. This study seeks to inform global policy and financial commitments on human resources for health by examining lessons from Brazil, Ghana, Mexico, and Thailand that have achieved sustained improvements in universal health coverage. The authors use an analytical framework that traces human‑resource policies across availability, accessibility, acceptability, and quality dimensions to evaluate their effect on effective coverage from 1990 onward in the four countries.

Abstract

tion coverage), what is covered (health-care benefits) and how much of the cost is covered (financial protection), all of which may expand over time. 4ddressing these three dimensions of UHC [5][6][7] within the boundaries of fiscal space 8 is challenging for all countries.It requires continuing political commitment and leadership to distribute available resources, especially human resources for health (HRH), 9 in an efficient, equitable and sustainable manner to match population needs.Overcoming the inequitable distribution of services is particularly critical. 10gh-, middle-and low-income countries alike are facing fundamental health challenges stemming from demographic changes, ageing populations, the growing burden of noncommunicable diseases and emerging public health threats such as drug-resistant malaria, tuberculosis and pandemics.Several countries of the Organisation for Economic Co-operation and Development (OECD), hit by the global financial crisis, are revisiting health benefits, coverage and protection -either to reaffirm commitments or cut services. 114][15] In the next decade, an increasing number of African and Asian countries will become able to finance essential health services from domestic resources and will then face critical decisions on how to invest these funds most effectively to accelerate progress towards UHC. 16he health workforce is central to a country's response to these challenges.Reaching a greater percentage of the population, extending the benefit package and improving the qual-Abstract Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs.This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand.Its purpose is to inform global policy and financial commitments on HRH in support of UHC.The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH.The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates.The findings inform key principles for evidence-based decision-making on HRH in support of UHC.First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors.Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda.It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose.