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      Health workforce governance: Processes, tools and actors towards a competent workforce for integrated health services delivery

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          Highlights

          • Strengthen health workforce competencies towards integrated health services delivery for improved health.

          • Strengthening competencies can be differentiated by health services and health systems.

          • Multiple actors are engaged in strengthening health workforce competencies.

          • Steward's role to govern should create conditions for aligned processes and actors.

          Abstract

          A competent health workforce is a vital resource for health services delivery, dictating the extent to which services are capable of responding to health needs. In the context of the changing health landscape, an integrated approach to service provision has taken precedence. For this, strengthening health workforce competencies is an imperative, and doing so in practice hinges on the oversight and steering function of governance. To aid health system stewards in their governing role, this review seeks to provide an overview of processes, tools and actors for strengthening health workforce competencies. It draws from a purposive and multidisciplinary review of literature, expert opinion and country initiatives across the WHO European Region's 53 Member States. Through our analysis, we observe distinct yet complementary roles can be differentiated between health services delivery and the health system. This understanding is a necessary prerequisite to gain deeper insight into the specificities for strengthening health workforce competencies in order for governance to rightly create the institutional environment called for to foster alignment. Differentiating between the contribution of health services and the health system in the strengthening of health workforce competencies is an important distinction for achieving and sustaining health improvement goals.

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          Most cited references44

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          Scoping studies: advancing the methodology

          Background Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides an excellent foundation for scoping study methodology, further clarifying and enhancing this framework will help support the consistency with which authors undertake and report scoping studies and may encourage researchers and clinicians to engage in this process. Discussion We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework. Recommendations include: clarifying and linking the purpose and research question (stage one); balancing feasibility with breadth and comprehensiveness of the scoping process (stage two); using an iterative team approach to selecting studies (stage three) and extracting data (stage four); incorporating a numerical summary and qualitative thematic analysis, reporting results, and considering the implications of study findings to policy, practice, or research (stage five); and incorporating consultation with stakeholders as a required knowledge translation component of scoping study methodology (stage six). Lastly, we propose additional considerations for scoping study methodology in order to support the advancement, application and relevance of scoping studies in health research. Summary Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework. Continued debate and development about scoping study methodology will help to maximize the usefulness and rigor of scoping study findings within healthcare research and practice.
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            Systems thinking for strengthening health systems in LMICs: need for a paradigm shift.

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              The promise of competency-based education in the health professions for improving global health

              Competency-based education (CBE) provides a useful alternative to time-based models for preparing health professionals and constructing educational programs. We describe the concept of ‘competence’ and ‘competencies’ as well as the critical curricular implications that derive from a focus on ‘competence’ rather than ‘time’. These implications include: defining educational outcomes, developing individualized learning pathways, setting standards, and the centrality of valid assessment so as to reflect stakeholder priorities. We also highlight four challenges to implementing CBE: identifying the health needs of the community, defining competencies, developing self-regulated and flexible learning options, and assessing learners for competence. While CBE has been a prominent focus of educational reform in resource-rich countries, we believe it has even more potential to align educational programs with health system priorities in more resource-limited settings. Because CBE begins with a careful consideration of the competencies desired in the health professional workforce to address health care priorities, it provides a vehicle for integrating the health needs of the country with the values of the profession.
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                Author and article information

                Contributors
                Journal
                Health Policy
                Health Policy
                Health Policy (Amsterdam, Netherlands)
                Elsevier Scientific Publishers
                0168-8510
                1872-6054
                1 December 2015
                December 2015
                : 119
                : 12
                : 1645-1654
                Affiliations
                [a ]Health Services Delivery Programme, Division of Health Systems and Public Health, WHO Regional Office for Europe, Marmorvej 51, DK-2100 Copenhagen, Denmark
                [b ]Division of Health Systems and Public Health, WHO Regional Office for Europe, Marmorvej 51, DK-2100 Copenhagen, Denmark
                Author notes
                [* ]Corresponding author. Tel.: +45 45 33 68 68; fax: +45 4533 7001. jet@ 123456euro.who.int
                Article
                S0168-8510(15)00246-8
                10.1016/j.healthpol.2015.09.009
                5357726
                26489924
                390459a0-fa0f-48cf-bfa6-3fc94e3bc8fd
                © 2015 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 19 August 2015
                : 21 September 2015
                : 22 September 2015
                Categories
                Article

                Social policy & Welfare
                health governance,health systems,health workforce,human resources for health,health services delivery,delivery of integrated health care

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