Policy & practice Why do health labour market forces matter? 102495 Barbara McPake,a Akiko Maeda,b Edson Correia Araújo,b Christophe Lemiere,b Atef El Maghrabyc & Giorgio Comettod Abstract Human resources for health have been recognized as essential to the development of responsive and effective health systems. Low- and middle-income countries seeking to achieve universal health coverage face human resource constraints – whether in the form of health worker shortages, maldistribution of workers or poor worker performance – that seriously undermine their ability to achieve well-functioning health systems. Although much has been written about the human resource crisis in the health sector, labour economic frameworks have seldom been applied to analyse the situation and little is known or understood about the operation of labour markets in low- and middle-income countries. Traditional approaches to addressing human resource constraints have focused on workforce planning: estimating health workforce requirements based on a country’s epidemiological and demographic profile and scaling up education and training capacities to narrow the gap between the “needed” number of health workers and the existing number. However, this approach neglects other important factors that influence human resource capacity, including labour market dynamics and the behavioural responses and preferences of the health workers themselves. This paper describes how labour market analysis can contribute to a better understanding of the factors behind human resource constraints in the health sector and to a more effective design of policies and interventions to address them. The premise is that a better understanding of the impact of health policies on health labour markets, and subsequently on the employment conditions of health workers, would be helpful in identifying an effective strategy towards the progressive attainment of universal health coverage. The health status of a population, its health-care needs Health workforce challenges and its requirements in the area of human resources for health Human resources for health are central to any health system in- are linked in complex ways.2 For example, the employment sofar as health workers perform or mediate most health system opportunities available to health workers and the type of em- functions. They make treatment decisions at the point of service ployment conditions that health workers prefer are not always and their actions determine how efficiently other resources are aligned with priority health-care needs. Health workers may used.1 Health-care delivery is highly labour intensive. To be ef- be attracted to positions that do not respond to such needs or fective, a health-care system must have the right number and may choose to migrate in search of alternative employment mix of health-care workers and it must ensure that they possess opportunities. Sometimes a paradoxical situation arises: vacan- the means and motivation to skilfully perform the functions cies in high-priority positions in the public sector coexist with they are assigned. Many countries are facing a “crisis in human high unemployment rates among health workers. This paradox resources for health” that involves three dimensions: availability, is explained by the labour market failure to match the supply which relates to the supply of qualified health workers; distribu- and demand for health workers. For instance, several African tion, which relates to the recruitment and retention of health countries (e.g. Kenya, Mali and Senegal) are experiencing acute workers where their presence is most needed; and performance, under-employment among doctors and nurses, yet they are which relates to health worker productivity and to the quality simultaneously investing substantial public funds in produc- of the care that health workers provide. ing more health workers. This worsens underemployment and Traditional approaches to resolving human resource con- reduces the efficiency of government expenditures. The system straints in the health sector have relied primarily on workforce of posting health workers to rural areas further illustrates the planning, i.e. the practice of estimating health workforce require- limitations of traditional workforce planning. When health ments based on a country’s epidemiological and demographic workers are officially assigned to a remote rural area, they profile and of scaling up education and training capacities to often find unofficial ways to evade the assignment and find narrow the gap between the existing number of health workers employment in an urban area. These examples highlight the and the number required. However, focusing narrowly on the inadequacy of a human resource strategy focused exclusively production of health workers results in the neglect of other im- on the needs-based production of health workers.3 portant factors that influence human resource capacity, such as Labour market conditions such as low salaries and a lack labour market dynamics and the behaviour and preferences of the of other economic benefits are known to influence employ- health workers themselves. Thus, despite the extensive published ment processes, but their influence on the planned allocation literature on the human resource crisis in the health sector, few of resources is less widely recognized. Thus, an analysis of the analyses have been conducted using labour economic frame- labour market is essential to achieve a better understanding works and the dynamics of labour markets remain little known of the forces that drive health worker shortage, maldistribu- or understood, especially in low- and middle-income countries. tion and suboptimal performance and to develop policies and a Institute for International Health and Development, Queen Margaret University, Edinburgh, Scotland. b The World Bank, 1818 H Street, NW, Washington, DC, 20433, United States of America. c African Development Bank, Tunis, Tunisia d Global Health Workforce Alliance, World Health Organization, Geneva, Switzerland. Correspondence to Akiko Maeda (e-mail: amaeda@worldbank.org). (Submitted: 10 March 2013 – Revised version received: 12 June 2013 – Accepted: 13 June 2013 ) Bull World Health Organ 2013;91:841–846 | doi: http://dx.doi.org/10.2471/BLT.13.118794 841 Policy & practice Health labour market analysis for universal health coverage Barbara McPake et al. interventions tailored to different labour Fig. 1. Possible labour market scenarios market conditions. Labour shortage Market clearing equilibrium What is a labour market? P S A market is any structure that allows buyers and sellers to exchange goods, ser- vices or information of any type. A labour Unemployment market is the structure that allows labour services to be bought and sold.4 In a la- bour market, those who seek to employ staff are the “buyers” and those who seek employment are the “sellers”. A labour market can be delineated according to dif- ferent criteria: geographical (national or D international); occupational (specialized or unspecialized); and sectoral (formal or informal). A special feature of labour Q markets is that labour cannot be sold but Note: The supply curve (S) slopes upward because higher levels of P (price or, in this case, the wage rate) only rented. Furthermore, conditions of result in a higher quantity (Q) of supply: more health workers ready to offer their services or health workers employment (e.g. adequate infrastruc- willing to work more hours. The demand (D) curve slopes downward because, at higher levels of price, those ture, supportive management, opportu- that demand health workers’ services reduce the quantity they demand as the wage rate rises. nities for professional development and career progression) are as important as a supply crisis, with demand-side factors own volition. In health labour markets prices (wages) in determining labour receiving scant attention. The demand for both types of rigidities are common. The market outcomes. Thus, these outcomes health workers in a country is determined market clearing position may be politi- are driven by the behaviour of employers by what government, private sector and cally unacceptable. It may, for example, and workers in response to changes in the international actors, such as donors and result in unaffordable health services and, terms of employment (wages, compensa- multinational corporations, are willing in this respect, failure to “clear” may be a tion levels and working conditions). to pay to hire them. “Willingness to pay” foreseeable result of price control. In such In a well-functioning labour market, is dependent on the level of health-care cases, health labour market analysis will wages or “compensation” – which can be financing and the willingness to hire allow a forecast of the resulting difficulty understood as the overall return received health workers depends on the money in filling available posts. for employment in a particular post and available for doing so. “Willingness to To overcome these constraints, health not only the financial component of that pay” marks a distinction between de- labour markets may require regulatory return – act as the mechanism whereby mand and “need”. A mismatch commonly or institutional intervention to achieve the intentions of buyers and sellers are exists between the financial resources socially desirable and economically ef- reconciled. The demand and the supply of available – and hence, willingness to pay ficient outcomes. Health labour markets labour tend towards equilibrium. A point – for employing health workers and the can be regulated through a wide range is reached in which the amount of labour number of workers needed to cover the of interventions: licensing professional supplied equals the amount demanded at health-care needs of the population.2 The occupations, accrediting universities and the going level of compensation. Labour supply of health workers is influenced by institutions that offer professional degrees, markets are said to “clear” when the the level of remuneration and by many subsidizing medical education, restricting supply of labour matches the demand other factors that are economic, social, entry to the market and creating coercive for workers. However, labour markets technological, legal, demographic and measures (e.g. bonding and compulsory do not always “clear” in this way. When political. Fig. 2 illustrates the dynamics service) to direct health workers to rural they fail to do so, they exhibit either of the health labour market. and underserved areas.6 The selection of labour surplus or unemployment (i.e. Markets fail to “clear” for two rea- the appropriate balance of regulations and people seek jobs at the going rate of pay sons. Either prices are not flexible (e.g. policies requires a solid understanding of but cannot find them), or labour short- wages may be fixed by legislative or the dynamics of the health labour market. age (i.e. employers seek to fill posts at the bureaucratic process or tied to civil When conducting health labour going rate of pay but cannot find people service schedules that are insensitive to market analysis, it is also crucial to take to fill them). These possible scenarios are health market conditions), or demand into account market structures – i.e. the illustrated in Fig. 1. or supply does not adjust to price sig- degree of concentration on the demand A health labour market is a dynamic nals. This may be because “demand” is and supply sides. The organization of system comprising two distinct but predominantly defined by government health professionals through institu- closely related economic forces: the sup- and driven by legislative or bureaucratic tions such as labour unions or profes- ply of health workers and the demand for process rather than by market forces, or sional associations creates a degree of such workers, whose actions are shaped because supply is regulated. An example monopoly in the supply of health labour by a country’s institutions and regula- of such regulation is offered by gradu- through collective bargaining. Medical tions. Traditionally, analyses of human ates who are “bonded” and constrained professional associations may play a role resources for health have been framed as from exiting the labour market on their beyond that of a union and often take on 842 Bull World Health Organ 2013;91:841–846 | doi: http://dx.doi.org/10.2471/BLT.13.118794 Policy & practice Barbara McPake et al. Health labour market analysis for universal health coverage workers, which resulted in a contraction Fig. 2. Framework for analysis of health workers labour market dynamics of the hours worked in the public sector and an increase in the prevalence of dual Health needs Training and education, net migration, retirement and deaths practice. Health workers responded to their reduced pay by allocating more time to other occupations. These differential responses illustrate how four countries Demand for HRH Supply for HRH • Demand for health care • Number of graduates that introduced similar wage bill policies • WTP/ATP to hire health workers • Skill mix faced different health worker responses • Regulation • Competences because of their very different market situations. Supply responded flexibly to labour market conditions in the Do- minican Republic and Rwanda. In the HRH Employment • Number of employed HW Dominican Republic, the supply of health • Wages workers fell in response to declining pay, • Distribution (public/private, rural/urban) whereas in Rwanda the supply increased • Skill mix in response to non-wage measures that HRH regulation, HRH management, supported expansion. Despite having governance motivation and incentives a shortage of health workers relative to need, Kenya has a pool of long-term HRH performance (productivity and quality of care) surplus in human resources for health (i.e. unemployed health professionals). The “shortage” is thus generated by inad- equate demand – employment opportu- Health systems nities with adequate working conditions. performance By contrast, in Zambia the health labour market faces a long-term shortage, such ATP, ability to pay; HRH, human resources for health; HW, health workers; WTP, willingness to pay. that an increase in the demand for health Source: adapted from Soucat et al.5 workers did not increase employment, since there was an insufficient pool of internal regulation of health workers by to the unique conditions of each country. unemployed or under-employed work- setting the requirements for obtaining To illustrate this point, we now turn to ers wanting to take advantage of better a licence, defining minimum quality some examples of analyses that provide conditions. standards and determining the number useful insights into the dynamics of the Another example is that of Ma- of workers entering the profession. 6 health labour market. lawi, which faced a dire shortage, mal- Restricting supply in this way results In a comparative study, Vujicic et al. distribution and outmigration of health in higher wages and introduces inflex- (2009) 7 analysed the implications of workers in the early 2000s. Malawi has ibilities in the labour market. On the government wage bill policies in the subsequently succeeded in reversing a demand side, where potential employers Dominican Republic, Kenya, Rwanda negative trend through a combination of are well organized, for example, in the and Zambia for the health workforce. demand- and supply-side interventions. form of a single or dominant public sec- All four countries were implementing A 50% increase in training output for pri- tor employer, a health worker may have general government wage bill restriction ority cadres was accompanied by a 52% to accept the terms on offer or leave the policies and the study’s purpose was to salary top-up to enhance deployment sector altogether. These conditions can explore the effects of those policies on the and retention. This led to a significant explain why markets fail to “clear”, as the strategy for maintaining or expanding the improvement in health workforce avail- dominant roles of unions, professional health workforce. Their research suggests ability, as health worker density rose from associations and public sector employers that in Rwanda the health sector wage 0.87 to 1.44 per 1000 population between or single payer employers set conditions bill was maintained despite the general 2004 and 2009.8 that are often driven by political goals wage bill restriction and that the health A widely promoted solution for rather than market conditions. workforce was successfully expanded in increasing the availability of human re- line with the country’s health strategy. sources for health is to expand training In Kenya, on the other hand, the wage and increase funding for public sector bill for the health sector was reduced employment. But this requires funds, Health labour market in line with the general restrictions and largely from the public purse. Countries analysis and better policies this limited expansion of the workforce. such as Ethiopia and Niger, whose mac- Despite the limited number of studies In Zambia, the main obstacle to the roeconomic conditions prevented them on the health labour market dynamics expansion of the workforce was not from implementing this approach, chose in low- and middle-income countries, deemed to be the wage bill restrictions, to invest in community-based health recent analyses of underlying market but the difficulties in filling budgeted workers, who undergo shorter training scenarios are beginning to reveal the posts. In the Dominican Republic, wage and require less pay. In early experiences, importance of understanding such dy- bill restrictions constrained growth in these cadres have played a significant namics and of tailoring policy responses salaries but not in the number of health role in improving service coverage and Bull World Health Organ 2013;91:841–846 | doi: http://dx.doi.org/10.2471/BLT.13.118794 843 Policy & practice Health labour market analysis for universal health coverage Barbara McPake et al. health outcomes in underserved com- more comprehensive data on their al low- and middle-income countries munities. 9,10 Similarly, experiences in pay levels will be essential for under- to elucidate workers’ preferences in Mozambique11 and elsewhere show that standing the dynamics of the health terms of job characteristics and assess mid-level cadres respond differently to labour market. their willingness to be deployed to health labour market conditions and are • Technological changes require remote and rural areas.19,20 more easily retained in rural areas than transformation in the health system physicians. and are important determinants of These examples highlight why it labour market evolution, although is important to understand underlying little research is available to guide Conclusion market conditions when introducing government policies and invest- We have described how labour market human resource policies in the health ments. One important implication analysis can enhance our understand- sector, as summarized below: for labour markets of the growth of ing of the factors that constrain human • where constraints to supply are most medical technologies over the last resources for health and result in more important, policies such as expand- decade is the growing demand for effective policies and interventions to ing training opportunities may be highly skilled workers that cost more address these. We have also described the appropriate; to produce and employ.12,13 health labour force analytical framework • where constraints on demand are • Few studies have been conducted in and explained that labour markets are most important, policies such as low- and middle-income countries to eminently shaped by supply and demand increasing the funding available for measure the “elasticity” (responsive- and only indirectly by need. Although the health workforce are likely to be ness) of the supply of health workers any policy conclusions derived from appropriate; to changes in the wage rate. One labour market analysis are tentative at • an effective strategy will more often study conducted in China suggests this stage because of gaps in data and address both supply and demand that the elasticity of supply may be research, several country experiences constraints simultaneously; and considerably higher in that country point to important challenges in the • in some cases, solutions may require than in high-income countries, and health labour market and, depending structural changes to the labour mar- the authors conclude that increasing on the country context, such challenges ket, such as the reorganization of the health worker pay may be a more should be tackled by considering market service delivery system and changes cost-effective strategy to expand the forces from both a supply- and demand- in the skills required of health work- health workforce than expanding side perspective. The identification of ers (e.g. greater use of mid-level training programmes.14 More empiri- appropriate policy options will require health workers), which in turn will cal studies will be needed to establish further research and evaluation of ef- change the labour market dynamics. whether this is equally applicable to fective strategies, as well as a deeper low- and middle-income countries understanding of the underlying labour other than China. market conditions affecting the health Knowledge and research • Little research has been conducted worker situation in a specific country. gaps on the responsiveness of health A better understanding of the impact worker quality to economic variables. of health policies on health labour mar- One reason that labour market analysis Among the well-known human re- kets and, subsequently, on the employ- has received little attention in the debate source problems in the health sector ment conditions of health workers would surrounding human resources for health are low productivity, effort and mo- be helpful in identifying an effective is that data in this domain are scarce rale. There is a need to evaluate the strategy for the progressive attainment in low- and middle-income countries. impact of changes in salaries, training of universal health coverage. The human Some critical areas in terms of data and availability and other working condi- resource challenges faced by the health research are highlighted below: tions on health worker performance. sector should therefore be addressed • Central to any labour market analysis Some work in this area has already within a country’s broader development is an understanding of the absolute begun.15-18 Such studies will help to framework, where the factors affecting and relative levels of health worker generate hypotheses about the impact the dynamics of the health labour work- remuneration from all sources. This of pay and institutional variables on force – from education to regulation, is a very difficult variable to measure health worker effort and will inform incentives and the fiscal space for the in the health sector and doing so the effectiveness and sustainability wage bill – can be addressed in a holistic, requires considerable effort. Pay of of pay for performance and other integrated manner. ■ health professionals, especially in financial and non-financial incen- low- and middle-income countries, tives to elicit more effort and greater Acknowledgements consists of multiple components productivity from health workers. The authors are grateful to Christiane including salaries, informal payments • Health worker preferences and re- Wiskow (International Labour Organiza- and bonuses and allowances that can sponses to market conditions are also tion) and the participants of the African vary considerably among individual beginning to attract some research in Regional Workshop on Health Labour health workers. Furthermore, health the context of health worker recruit- Market Analysis held in Hammamat, professionals often hold multiple ment and retention in rural and Tunisia, in March 2013. jobs or generate income outside their remote areas. Discrete choice experi- primary employment. Availability of ments have been conducted in sever- Competing interests: None declared. 844 Bull World Health Organ 2013;91:841–846 | doi: http://dx.doi.org/10.2471/BLT.13.118794 Policy & practice Barbara McPake et al. Health labour market analysis for universal health coverage ‫ملخص‬ ‫ما سبب أمهية قوى سوق العاملة الصحية؟‬ ‫يف نطاق القدرات التعليمية والتدريبية لتضييق الفجوة بني العدد‬ ‫تم االعرتاف برضورة املوارد البرشية الصحية لتطوير أنظمة‬ ،‫ ومع ذلك‬.‫“املطلوب” من العاملني الصحيني والعدد املوجود‬ ‫ وتواجه البلدان املنخفضة‬.‫صحية فعالة ورسيعة االستجابة‬ ‫هيمل هذا األسلوب عوامل أخرى هامة تؤثر عىل قدرة املوارد‬ ‫واملتوسطة الدخل التي تسعى لتحقيق التغطية الصحية الشاملة‬ ‫ بام يف ذلك القوى املحركة لسوق العاملة واالستجابات‬،‫البرشية‬ ‫قيود ًا تتعلق باملوارد البرشية – سواء أكانت يف شكل نقص يف‬ ‫ ويصف هذا‬.‫السلوكية وتفضيالت العاملني الصحيني أنفسهم‬ ‫العاملني الصحيني أو سوء توزيع للعاملني أو األداء الضعيف‬ ‫البحث كيفية إسهام حتليل سوق العاملة يف التوصل إىل فهم أفضل‬ ‫هلم – والتي تضعف بشكل خطري من القدرة عىل إنشاء أنظمة‬ ‫للعوامل التي تقف وراء قيود املوارد البرشية يف القطاع الصحي‬ ‫ ورغم وجود أبحاث كثرية حول أزمة‬.‫صحية تعمل بشكل جيد‬ .‫وإىل تصميم أكثر فعالية للسياسات والتدخالت للتعامل معها‬ ‫ إال انه كان من النادر تطبيق‬،‫املوارد البرشية يف القطاع الصحي‬ ‫وتقوم الفرضية عىل أن الفهم األفضل لتأثري السياسات الصحية‬ ‫ وال يوجد سوى‬،‫أطر العمل االقتصادية للعاملة لتحليل املوقف‬ ‫ ومن ثم عىل ظروف توظيف العاملني‬،‫عىل أسواق العاملة الصحية‬ ‫القليل من املعرفة والفهم حول تشغيل أسواق العاملة يف البلدان‬ ‫ سيساعد يف حتديد إسرتاتيجية فعالة باجتاه اإلدراك‬،‫الصحيني‬ ‫ وركزت النهج التقليدية للتعامل مع‬.‫املنخفضة واملتوسطة الدخل‬ .‫املتدرج للتغطية الصحية الشاملة‬ ‫ تقدير متطلبات قوة‬:‫قيود املوارد البرشية عىل ختطيط قوة العمل‬ ‫العمل الصحية استناد ًا إىل احلالة الوبائية والسكانية للبلد والتوسع‬ 摘要 为什么卫生劳动力市场力量很关键？ 卫生人力资源被公认为发展灵敏有效的卫生系统不可 特征估计卫生工作人员需求，升级教育培训实力来缩 或缺的一环。努力实现全民医疗保障制度的中低收入 短“需要”卫生工作者数量和现有数量之间的差距。 国家面临着人力资源限制的问题——或是缺乏卫生工 但是，这种方法忽略了影响人力资源容量的其他重要 作者，或是卫生工作者配置不合理，或是卫生工作者 因素，包括劳动力市场动力和卫生工作者自身的行为 绩效差——这些问题严重削弱了实现完善卫生系统的 反应和偏好。本文描述了劳动力市场分析对更好理解 能力。尽管有关卫生部门人力资源危机的论述为数众 卫生部门人力资源限制因素的作用，以及对制定更有 多，却很少有研究应用劳动经济框架分析这种状况， 效应对政策和干预措施的作用。其论述的前提是 ：更 人们对中低收入国家劳动力市场的运作了解或认识得 好地理解卫生政策对卫生劳动力市场的影响，继而对 非常少。解决人力资源限制问题的传统方法将重点放 卫生工作者就业状况的影响，将有助于识别出逐步实 在劳动力规划上 ：基于国家的流行病学和人口统计学 现全民医保的有效战略。 Résumé Pourquoi les effectifs du marché du travail de la santé sont-ils importants? Les ressources humaines du secteur de la santé sont essentielles au au profil démographique et épidémiologique d’un pays, et intensifier développement de systèmes médicaux efficaces et réactifs. Les pays les capacités de formation et d’enseignement pour réduire l’écart entre à revenu faible et moyen qui cherchent à obtenir une couverture le nombre de travailleurs “nécessaire” et le nombre réel. Toutefois, cette maladie universelle souffrent de restrictions en matière de ressources approche néglige d’autres facteurs importants qui influent sur la capacité humaines - que ce soit sous forme de pénurie d’agents de santé, de des ressources humaines, notamment les dynamiques du marché du mauvaise répartition ou de faibles performances des travailleurs - qui travail et les réponses et préférences comportementales des travailleurs compromettent sérieusement leur capacité à créer un système de santé de la santé. Ce document explique comment l’analyse du marché du optimal. Même si on a beaucoup écrit au sujet de la crise des ressources travail peut aider à mieux comprendre les facteurs qui sont à l’origine humaines dans le secteur de la santé, des cadres économiques de travail des restrictions en matière de ressources humaines dans le secteur de la ont rarement été appliqués pour analyser la situation, et on connaît ou on santé, mais aussi à mettre en oeuvre des politiques et des interventions comprend peu de choses sur le fonctionnement des marchés du travail plus efficaces pour y remédier. L’hypothèse initiale est qu’une meilleure dans les pays à revenu faible et moyen. Les approches traditionnelles compréhension de l’impact des politiques de santé sur les marchés du dans le but de répondre aux restrictions en matière de ressources travail de la santé et, par ailleurs, sur les conditions d’emploi des travailleurs humaines accordent de l’importance à la planification des effectifs : de la santé, serait utile pour pouvoir identifier une stratégie efficace et estimer les besoins en matière de travailleurs de la santé par rapport progressivement mettre en place une couverture maladie universelle. Резюме Почему столь важны движущие силы рынка труда в сфере здравоохранения? Человеческие ресурсы в сфере здравоохранения были признаны медико-санитарными услугами, сталкиваются с нехваткой необходимым фактором для развития оперативной и эффективной человеческих ресурсов в виде либо нехватки работников системы здравоохранения. Страны с низким и средним уровнем здравоохранения, либо неравномерного распределения доходов, стремящиеся обеспечить всеобщий охват населения работников, либо низкой эффективности труда работников, Bull World Health Organ 2013;91:841–846 | doi: http://dx.doi.org/10.2471/BLT.13.118794 845 Policy & practice Health labour market analysis for universal health coverage Barbara McPake et al. что серьезно подрывает способность данных стран обеспечить Однако такой подход не учитывает других важных факторов, хорошее функционирование систем здравоохранения. Хотя которые влияют на человеческие ресурсы, в том числе динамику уже много написано на тему кризиса человеческих ресурсов рынка труда и поведенческие реакции и предпочтения самих в секторе здравоохранения, для анализа ситуации редко работников здравоохранения. В этой статье описывается то, как применялись экономические концепции, касающиеся труда, и о анализ рынка труда может способствовать лучшему пониманию функционировании рынков труда в странах с низким и средним факторов, обуславливающих нехватку человеческих ресурсов уровнем дохода мало что известно или мало кто понимает, в секторе здравоохранения, и разработке более эффективной как они функционируют. Традиционные подходы к решению политики и мероприятий по устранению данных факторов. проблем нехватки человеческих ресурсов были направлены на Исходной посылкой является то, что лучшее понимание планирование трудовых ресурсов, то есть на оценку потребности влияния политики в области здравоохранения на рынки труда в трудовых ресурсах в сфере здравоохранения на основе в данной сфере и, соответственно, на условия труда работников эпидемиологического и демографического профиля страны и здравоохранения может оказаться полезным при выборе пропорциональном наращивании возможностей образования эффективной стратегии по постепенному достижению всеобщего и подготовки с целью сократить разрыв между «необходимым» охвата населения медико-санитарными услугами. и имеющимся количеством работников здравоохранения. Resumen Por qué son importantes las fuerzas del mercado laboral sanitario El papel de los recursos humanos en el sector sanitario se considera el perfil epidemiológico y demográfico del país y la ampliación de los esencial para el desarrollo de sistemas sanitarios eficaces y con capacidad recursos educativos y formativos para reducir la brecha entre el número de respuesta. Los países de ingresos bajos y medianos que aspiran a «necesario» de personal sanitario y el número real. Sin embargo, este alcanzar la cobertura sanitaria universal se enfrentan a las limitaciones enfoque deja de lado otros factores importantes que influyen en la en materia de recursos humanos, sea por escasez de personal sanitario, capacidad de los recursos humanos, como la dinámica del mercado la distribución ineficaz del personal o el desempeño ineficiente del de trabajo, las respuestas de comportamiento y las preferencias del mismo, factores que socavan gravemente la capacidad para lograr personal sanitario. Este informe describe cómo el análisis del mercado sistemas sanitarios con un funcionamiento adecuado. Aunque se ha laboral pretende mejorar la comprensión de los factores que explican la vertido mucha tinta acerca de la crisis de recursos humanos en el sector escasez en materia de recursos humanos en el sector sanitario y ofrecer sanitario, rara vez se han aplicado los marcos económicos laborales para un diseño más eficaz de las políticas e intervenciones para abordarlos. analizar la situación y poco se sabe o entiende sobre el funcionamiento La premisa para ello es que una mejor comprensión del impacto de las de los mercados laborales en los países de ingresos bajos y medianos. políticas sanitarias en el mercado laboral sanitario, y por consiguiente, Los enfoques tradicionales para hacer frente a las limitaciones en materia en las condiciones laborales del personal sanitario, sería de gran ayuda de recursos humanos se han centrado en la planificación del personal, en la identificación de una estrategia eficaz para alcanzar la cobertura mediante el cálculo de las necesidades de personal sanitario basada en sanitaria universal de forma progresiva. 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