Examine the major components of Human Resources for Health Action

Framework.
The inefficiency of the health systems has been attributed to human resources or health
workforce. This has led to the designing of a comprehensive technical guideline that is the
Human Resources for Health Action Framework (HRHAF) in order to assist governments
and health managers to develop and implement strategies that equip the health workforce
with appropriate skills which lead to a fairly distributed, effective and sustainable health
workforce within a country. According to World Health Report (2006), Human Resources for
Health refers to all people that are engaged in actions whose primary intent is to enhance
health. On the other hand, the World Health Organisation (WHO) argues that Human
Resources for Health (HRH) includes all the personnel who diagnose and treat people, health
management and support workers- those who help make the health system functions but who
do not provide health services for example nurse tutors (WHO, 2006b). HRH has gone as far
as including para-professionals such as Community Health Workers and peer counsellors
providing services in communities and homes. Nevertheless, HRHAF has six interlinked
components or action fields which are: the Human Resource Management System, Policy,
Education, Finance, Partnership and Leadership. It is important to note that there are some
challenges associated with implementing this framework hence the visibility of its
effectiveness in a health system may be a bit blurred, as shall be discussed below.

Adapted from http://www.capacityproject.org

Human Resource Management System
The first main component of Human Resources for Health Action Framework is the Human
Resource Management System (HRMS). It is the core component upon which other five
components tend to build on as demonstrated by their intersection to HRMS on the diagram
above. According to WHO (2012: 7), HRMS is an integrated use of data, policy and practice
to plan for necessary staff as well as recruit, hire, deploy, develop and support health workers.
This therefore implies that the action field of HRMS presupposes that a health system of a
country should be able to absorb qualified personnel as well as retaining the workforce and
ensuring that there is equal distribution of health personnel across the country, for example,
the Republic of South Africa in its Human Resources for Health Strategy for health sector
2012/13- 2016/17 has the vision of attaining a workforce developed through innovative
education and training strategies and fit for purpose of meeting the needs of quality health
care for all. However, an analysis of the prevailing situation in most African countries has
indicated that the implementation of HRMS has been failing as evidenced by the failure to
retain the health workforce and train and develop them as well, as required by the framework.
For instance, MacKinnon and MacLaren (2012: 9) point out that due to severe economic
depression that plagued Zimbabwe from 1999 to 2008, the country witnessed the exodus of
primary health care professionals with the Ministry of Health and Child Welfare as it was
then, reported to have lost over 3, 500 health staff by around 2007 which left more than 60%
of physician positions vacant across the country. This left a gap that the health training
institutions in the country could not replenish as quickly as possible. It is against this
background that it can be appreciated that HRMS is a core component of HRHAF which
emphasises all issues that concern the health workforce. However, it has encountered a
number of challenges in implementation hence its practical effectiveness can be limited.
Education
Education is also another important component of the Human Resources for Health Action
Framework. This entails the production and maintenance of skilled workers who can achieve
an equitable, effective and efficient health care for all. For health professionals, the process of
education and training is split into several stages that are; pre-service education, postgraduate and speciality training, and in-service training including professional development.
For instance, according to the Emergency Human Resources Programme (2008: 5) of

Malawi, it is reported that Malawi recorded a 165% increase of pre-service training between
2003 and 2007; and a 59% increase in post-basic training, and by 2008 training institutions
such as Mzuzu University were able to help with pre-service training and a review by the
World Health Organisation indicated that educational quality was being maintained in these
trainings. On the other hand, health worker production in India has also increased due to
rapid expansion of medical education (Rao and Ramani, 2014: 256). It has also been reported
that in March 2014 India had 381 colleges offering MBBS course and this has increased the
number of health workforce in India (Ibid). However, it has been noted that the geographical
distribution of medical colleges in India puts states with higher disease burden at a
disadvantage as only states that account for 30% of Indian population have 53% of the total
medical colleges (Rao and Ramani, 2014: 256). It can therefore be noted that education is a
vital component of HRHAF which ensures necessary skills to the health workforce but the
limitations it encounters in implementation should not be undermined as they hinder its full
effectiveness as stated by the action framework.
Policy
Furthermore, policy is also another important component of the HRHAF. This entails setting
the guidelines or regulations upon which the HRH or health workforce will operate.
According to Dussault (2004: 11), policy for Human Resources for Health is a frame of
reference upon which human actions can be taken. This is in line with the Alma-Atta
Declaration (1978) article VIII which says that all governments should formulate national
policies, strategies, and plans of actions to launch and sustain primary health care as part of
comprehensive national health system and in coordination with other sectors, for example in
the Human Resources for Health Strategic Plan of South Africa 2012/13- 2016/17 (2012: 17),
the minister of health launched a new policy pertaining to the HRH to re-engineer primary
health care. One of its three streams was that there should be district specialist support teams
which will consist of specialist clinicians (paediatrician, family physician, obstetrician,
gynaecologist, and anaesthetist), an advanced midwife, advanced paediatric nurse and
advanced Primary Health Care nurse that will be deployed in each district. In this context it
can be noted that South Africa implemented the action field of HRHAF of policy particularly
on how the health workforce should be distributed in the country's districts. In Zimbabwe all
nurse in the public sector are required to register with the Nurses Council of Zimbabwe
(NCZ) for them to operate and NCZ has the powers to deregister any individual who violates
the code of conduct. However, it can be noted this action field may be associated with some

challenges of implementing the crafted policies because of financial constraints and also the
fact that those who craft the policies may not be the ones who implement them hence an
implementation gap is likely to exist.
Partnership
In addition, the HRHAF has another component which is partnership. This concurs with the
Alt-Ata Declaration of 1978 article IX which states that all countries should cooperate in a
spirit of partnership and service to ensure primary care for all people since the attainment of
health by people in any one country directly concerns and benefits every other country. On
the other hand, Berman et al (2004: 32) argue that partnership entails all lateral and horizontal
relations that are arrived at by stakeholders with the end result being to enhance health
provision of a country, community or region. Basing on this, it can be noted that partnerships
can therefore manifest or be realized through various avenues for example, partnerships with
nongovernmental organizations, partnerships with other governments. For instance, the
government of Zimbabwe partnered with the US government in order to strengthen its public
health leadership, management and governance, and this was meant to equip health managers
with necessary modern skills to deal with their workforce such that there can be improved
health provision to all. In this partnership it has been reported that all District Health
Executives in 61 districts of the country were successfully trained with the assurance of
continued process of training while on the other hand a total of 599 health workers were also
trained in these districts through this partnership. It can therefore be noted that partnership is
an important component of HRHAF and it increases the capacity of health workforces' skills.
However, it is important to note that the implementation of partnership as an action field of
the HRHAF can be affected by the fact that some of private actors particularly
Nongovernmental organizations that will be assisting may tend to influence the policy of a
health system of country thereby prioritizing their interests.
Leadership
Furthermore, leadership is also another critical component of the Human Resources for
Health Action Framework. Leadership entails the capacity to provide direction, align people,
mobilize resources, and reach the goals hence this suggests that management should have the
capacity to plan, budget, organize and guide the whole health workforce to achieve desired
health goals. For instance according to the Zimbabwe National Health Strategy (2009-2013:
96) the nation aimed at involving a wide range of stakeholders (professional associations,

researchers, unions, private sector among others) in its policy and decision making process.
This is because the effectiveness and efficiency of the health workforce can be attained if the
leadership is competent, committed and innovative. According to Jones et al (2009) in an
article titled Increasing Leadership Capacity for HIV programmes by strengthening public
health epidemiology and management training in Zimbabwe, the Zimbabwean public health
sector introduced a one-week HIV/AIDS course and it was delivered and incorporated to
MPH trainees beginning in 2002, in order to produce public health leaders explicitly
equipped to design and implement HIV intervention programmes. This therefore
demonstrates that Zimbabwe Health Sector is aware of leadership as a component of
HRHAF. However, it is also important to note that the effective implementation of this action
field can be hindered by various challenges in different countries, for example, in Malawi
there has been a chronic fragmentation and lack of capacity in the Ministry of Health's human
resources function which affected its ability to recognize and respond to the growing
difficulties in their Health System. (Emergency Human Resources Programme, 2008: 6).
Basing in this it can be noted that leadership is a key component of the Human Resource for
Health.
Finance
The six component of HRHAF is Finance. According to World Health Organization (2005),
this action field involves obtaining, allocating and disbursing of adequate funding for human
resources. This may therefore suggests that finance is the acts as the bloodstream to other
components and it facilitates the effective implementation of other action fields such as
policy, education and leadership. Finance also entails budgeting, setting of the health
workforce salaries and other benefits for example incentives that help the retention of skilled
and experienced personnel in the public health sector of developing countries. How the
mobilization and allocation of adequate financial resources had proved to be a challenge in
most developing countries as evidenced by their failure to allocate 15% of the national budget
to the health sector which is a requirement by the Abuja Declaration. Corruption or diversion
of funds meant for health to personal business by the top officials or leadership has also
hindered effective of the HRHAF components hence some health professionals have left the
public sector of a certain country in quest for greener pastures as what happened in
Zimbabwe around 2008. It can therefore be argued that finance is also an important
component of the HRHAF which facilitates the attraction of health workforce and it's
retention as well as the implementation of other HRH component.

In conclusion, it can therefore be argued that the Human Resource for Health Action
Framework is a fundamental guideline that assist governments and health managers to
absorb, direct and retain health workforce in a health system. Human Resource Management
System acts a basis for other five components, however, these components are interconnected
hence one component cannot be undermined. Nevertheless, implementation of the
components of HRHAF has faced some challenges which limit its practicability in various
health systems.