Country-specific contexts including labor markets

Decisions about human resource strategies need to be viewed in the context of the broader policy environment of the country. Major policies might be concerned with areas such as: the devolution of political power; stabilization or national reconciliation in the aftermath of war or conflict; improving the performance of government through civil service reform; public sector administrative and/or economic reforms; the expansion of the private sector; decreasing unemployment; achieving greater equity in resource distribution. Broader public sector reform may provide the opportunity to address a particular human resources problem such as the management of staff performance. On the other hand the poor economic situation in the country may mean that although salaries are low and it is therefore difficult to attract and retain staff, the Ministry of Finance is not going to support pay increases (see Finance).

A scan of the policy environment is needed as part of the situation analysis. The “labor market” refers to the market in which workers compete for jobs and employers compete for workers. It is important to carry out some sort of analysis of the labor market to establish the likely source of health workers and the type, volume and direction of losses that employers are experiencing. The analysis should also take into consideration socio-cultural norms, such as gender, that may affect the policy, labor market and workplace environment. For example, gender norms may affect the potential labor supply and impact workplace policies and procedures. In the health sector this is a global labor market that results in international migration as well as internal migration between employers and between different segments of the labor market (public sector, FBO/NGO, private-for-profit). It even occurs with a large single organization; for example, employees often try to move from rural postings to urban postings. Both the internal labor market and the position in the global labor market will differ from country to country. Therefore, some kind of labour market analysis needs to be included in the overall situational analysis.

The context in which health workforce strengthening takes place is important not only at the country level, but also at the district and facility level. For instance, districts with a nomadic population require different strategies compared to districts with permanent residents. Very poor and/or remote areas may require different approaches than wealthier and/or urban areas.