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      Informing investment in health workforce in Bangladesh: a health labour market analysis


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          As the 2016 Global Strategy on Human Resources for Health: Workforce 2030 (GSHRH) outlines, health systems can only function with health workforce (HWF). Bangladesh is committed to achieving universal health coverage (UHC) hence a comprehensive understanding of the existing HWF was deemed necessary informing policy and funding decisions to the health system.


          The health labour market analysis (HLMA) framework for UHC cited in the GSHRH was adopted to analyse the supply, need and demand of all health workers in Bangladesh. Government’s information systems provided data to document the public sector HWF. A national-level assessment (2019) based on a country representative sample of 133 geographical units, served to estimate the composition and distribution of the private sector HWF. Descriptive statistics served to characterize the formal and informal HWF.


          The density of doctors, nurses and midwives in Bangladesh was only 9.9 per 10 000 population, well below the indicative sustainable development goals index threshold of 44.5 outlined in the GSHRH. Considering all HWFs in Bangladesh, the estimated total density was 49 per 10 000 population. However, one-third of all HWFs did not hold recognized roles and their competencies were unknown, taking only qualified and recognized HWFs into account results in an estimated density 33.2. With an estimate 75 nurses per 100 doctors in Bangladesh, the second area, where policy attention appears to be warranted is on the competencies and skill-mix. Thirdly, an estimated 82% of all HWFs work in the private sector necessitates adequate oversight for patient safety. Finally, a high proportion of unfilled positions in the public sector, especially in rural areas where 67% of the population lives, account only 11% of doctors and nurses.


          Bangladesh is making progress on many of the milestones of the GSHRH, notably, the establishment of the HWF unit and reporting through the national health workforce accounts. However, particular investment on strengthening the intersectoral HWF coordination across sectors; regulation for assurance of patient safety and adequate oversight of the private sector; establishing accreditation mechanisms for training institutions; and halving inequalities in access to a qualified HWF are important towards advancing UHC in Bangladesh.

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          Human resources for health policies: a critical component in health policies

          In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM. There are three broad arguments for modernizing the ways in which human resources for health are managed: • the central role of the workforce in the health sector; • the various challenges thrown up by health system reforms; • the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems. The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs. Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH): • to move beyond the traditional approach of personnel administration to a more global concept of HRM; • to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy; • to foster a more proactive attitude among human resources (HR) policy-makers and managers; • to promote the full commitment of all professionals and sectors in all phases of the process. The development of explicit human resources policies is a crucial link in health policies and is needed both to address the imbalances of the health workforce and to foster implementation of the health services reforms.
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              The Path to Universal Health Coverage in Bangladesh: Bridging the Gap of Human Resources for Health


                Author and article information

                Hum Resour Health
                Hum Resour Health
                Human Resources for Health
                BioMed Central (London )
                12 October 2022
                12 October 2022
                : 20
                [1 ]WHO Bangladesh, Dhaka, Bangladesh
                [2 ]GRID grid.483403.8, ISNI 0000 0001 0685 5219, WHO South-East Asia Regional Office (Former HRH Advisor), ; New Delhi, India
                [3 ]GRID grid.3575.4, ISNI 0000000121633745, WHO Health Workforce Department, ; Geneva, Switzerland
                [4 ]GRID grid.466907.a, ISNI 0000 0004 6082 1679, Health Services Division, Ministry of Health and Family Welfare, ; Dhaka, Bangladesh
                [5 ]Centre for Medical Education, Directorate General of Medical Education, Dhaka, Bangladesh
                [6 ]GRID grid.10772.33, ISNI 0000000121511713, Global Health and Tropical Medicine, Instituto de Higiene E Medicina Tropical, Universidade NOVA de Lisboa, ; Lisbon, Portugal
                © The Author(s) 2022

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                Funded by: World Health Organization Bangladesh
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                Health & Social care
                health labour market analysis,health workforce,supply, need and demand,investment, bangladesh,who


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