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[Balanced distribution]

Refers to appropriate allocation of health personnel, geographically and among levels of care and types of services, to ensure equitable provision of quality health services to all.

[Brain drain]

Outflow of health professionals to other countries, or from the public to the private sector within a country, or out of the health sector, usually in search of more employment opportunities, and better working and living conditions.

[Capacity building]

Continuing process of strengthening existing capacities and introducing more efficient technologies and systems in order to address a problem in a more effective manner.  UNDP defines capacity building as “the process by which individuals, groups, organizations, institutions and societies increase their ability to (1) Perform core functions, solve problems, define and achieve objectives and (2) Understand and deal with their development needs in a broad context and in a sustainable manner.”

UNDP, Capacity Development, Technical Advisory Paper II. In: Capacity Development Resource Book. Management Development and Governance Division. UNDP, 1997.

[Career]

The movement of individuals from one job or position to another job or position which has different (usually higher) levels of authority, income and or skills/requirements.

[Career structure]

Planned set of differentiated steps, posts or jobs through which one can progress professionally within a specific position or across positions along time to ensure the continued effectiveness of an organization.

[Career management]

Process of setting goals, identifying specific skills, capabilities, interests, and implementing a career plan. Providing career management assistance is one of the strategies employed to retain health professionals (see Retention of staff)

World Health Organization, Public Services International (PSI) Terms of Employment and Working Conditions in Health Sector Reforms: Points for discussion, 2001.  In: Workshop on Global Health Workforce Strategy. Annecy, France, 9-12 December 2000. Retrieved 03/18/02.

[Competences]

Knowledge, skills and attitudes which an individual possesses. Competencies are accumulated and developed through education and training and experience.

[Continuing professional development]

Process of systematic learning that allows health professionals to continue to meet the needs of the population being served by updating and enhancing their skills, whilst addressing health professionals’ career and educational aspirations

[Coping strategies]

Approaches employed by health personnel to overcome unsatisfactory remuneration or working conditions in order to fulfill professional and material expectations.  Examples of coping strategies are: (1) undertaking extra duties to supplement income (see fragmentation of work), (2) migrating to private practice or out of the health sector (see brain drain) and (3) being in a payroll without providing services (see ghost worker).

Ferrinho P, Van Lerberghe W, Providing health care under adverse conditions: Health personnel performance & individual coping strategies, Studies in Health Services Organisation & Policy, 16, 2000.

[Deployment]

Refers to the process of allocating personnel among types and levels of services and among regions and sub-regions of a country. (Dussault G,1999)

[Discipline]

A generic term covering the process and methods in an organization through which the conduct/behavior of the workforce is managed.

[Education; basic, specialization, continuing]

Education – development of competencies, or the process by which the appropriate number of each category of providers is produced and equipped with the knowledge, skills and attitudes needed to produce the kind of performance necessary to achieve health services objectives.

Basic - acquisition of fundamental professional competencies by new personnel. Provision of basic education is usually under the responsibility of professional schools and universities.

Specialization – process of acquiring specific competencies in addition to basic education.

Continuing education – all educational experiences, activities and resources engaged by a health professional after completion of professional training 

[Employment status: full-time, part-time, temporary, permanent]

Full-time (whole-time) – employment for or working for the amount of time considered customary or standard.

Part-time – employment for or working for less than the amount of time considered customary or standard.  The trend towards part-time or temporary employment with lower salaries is attributed to attempts by employers to develop more flexible employment practices, but can also be used positively as a way of retaining workers who wish to work reduced hours.

Permanent – Employment contracted for an indeterminate period.

Fixed term – employment contract for a fixed period of time

Temporary – short-term contracts or “casual” work, either for a definite period or for a specific activity.

[Feminization] –

Process by which number of female workers proportionately increases in specific occupations.

[Flexibility]

“Flexibility in the use of labor can be of two types: time-based, to match staffing to workload (use of different shift patterns, working hours etc.); or contract-based, for organizational flexibility (use of temporary staff and fixed-term contract staff, and even contracting-out whole sections of the service).“ (Martineau, Martinez, 1997). Flexibility can also cover pay flexibility and skill flexibility as well as other aspects.

[Fragmentation of work, multi-employment] [Roenen et all 1997]

Process by which health personnel seek alternative ways to increase income by undertaking other forms of paid employment either after or during official working hours. (Machado,  1997)    

[Gender]

Socially defined aspects of being male or female.  Gender roles refer to those activities considered by a given culture to be appropriate to a woman or a man.  When applied to human resources in health, gender refers to an understanding of the significance of gender in (1) employing people in the health sector workforce, (2) recognizing how gender affects occupational choices, career patterns and working practices and (3) considering the non-institutional care of the sick, usually carried out by female family members (see Gender Imbalance). (Dussault, 1999)

World Health Organization, “Public Services International (PSI) Terms of Employment and Working Conditions in Health Sector Reforms: Points for discussion”, 2001 In Workshop on Global Health Workforce Strategy. Annecy, France, 9-12 December 2000. Retrieved 03/18/02.

http://www.who.int/health-services-delivery/human/workforce/papers/PSI.pdf

Moser C, Tornqvist A, Bronkhorst B, Mainstream gender and development in the World Bank: progress and recommendations, World Bank Report, Washington, DC, 1998

[Ghost Worker]

Personnel formally on payroll but providing no service (See coping strategies)

[Grievance]

A generic term covering the processes and methods through which members of the workforce may express disagreement with the conditions of employment.

[Human capital]

The stock of accumulated skills, experiences and personnel that make workers more productive.

Or

Human skills and capabilities generated by investments in education and health. (WHO)

[Human resources development]

Human resource development (HRD) refers to functions involved in planning, managing and supporting the professional development of the health workforce within a health system, both at the strategic and policy levels (Martineau,Martinez, 1997). HRD aims at getting 'the right people with the right skills and motivation in the right place at the right time'. (Hornby, 1980)

Hornby P, Ray D, Shipp P, Hall T, Guidelines for health manpower planning: a course book. World Health Organization, Geneva: 1980.

Or

Systematic effort, within the limits of what a country is prepared to spend, to maximize the effective utilization of the workforce in the health sector (Dussault, 1999)

[Human resources management]

Process of creating an adequate organizational environment and ensuring that the personnel perform adequately using strategies to identify and achieve the optimal number, mix and distribution of personnel in a cost-effective manner (Martineau, Martinez, 1997)

[Human resources planning]

Process of estimating potential requirements for human resources in health and of designing ways of fulfilling those requirements (see Workforce planning).

[Human Resource Policies] Guidelines and directions that regulate the utilization of workforce both within the health sector and within the wider context (socio/political/economic)
Martineau and Martinez, 1997.

[Imbalances: regional, service, occupational, gender]  An imbalance occurs when there is shortage or surplus of health personnel as a result of a disequilibria between demand and supply for labor.   In the health sector, imbalances can be of the following types: (1) Profession/specialty imbalances, related to a disparity in various health professions, such as doctors or nurses, as well within professions, for example, a shortage of one type of specialist, (2) Geographic imbalances, which refers to urban-rural and poor-rich regions disparities of health personnel, (3) Institutional and services imbalances, related to differences between health care facilities, as well as between services, (4) Public/private imbalances, associated with differences in human resources allocation between the public and private health care system, and (5) Gender imbalances, which refers to disparities in the female/male representation in the health workforce.
Zurn P, Dal Poz M, Stilwell B, Adams O, 
Imbalances in the health workforce: Briefing paper, World Health Organization, Geneva, 2002.

[Industrial action]

Collective activities of workers to pressure management into agreeing to some demands. It can include strikes, demonstrations and other forms of expression of discontent.

[Job analysis]

Process of identifying the requirements and defining roles of specific tasks.

[Job equivalence]

The weighted values of the skills requirements and work conditions of a particular job that allow comparison to other jobs in an organization, most normally used to determine career development and pay.

[Labor legislation]

Policies and guidelines regulating the labor market. Laws and regulations that govern the functioning of the labor market.

[Labor markets]

Institutions and processes through which employment and wages are determined, affecting the supply and demand for labor.  Labor markets can be divided into regional, occupational or skills segments. Health labor market is the segment concerned with human resources in the health sector. Factors affecting health labor market are imbalances, mobility, and migration.

Mehmet O,  The emerging global labor market: some implications for international health, report prepared for WHO Consultation on Imbalances in the Health Workforce in Ottawa on 10-12 March 200. WHO, Geneva.

[Job analysis]

Process of identifying the requirements and defining roles of specific tasks.

[Job equivalence]

The weighted values of the skills requirements and work conditions of a particular job that allow comparison to other jobs in an organization, most normally used to determine career development and pay.

[Labor legislation]

Policies and guidelines regulating the labor market. Laws and regulations that govern the functioning of the labor market.

[Labor markets]

Institutions and processes through which employment and wages are determined, affecting the supply and demand for labor.  Labor markets can be divided into regional, occupational or skills segments. Health labor market is the segment concerned with human resources in the health sector. Factors affecting health labor market are imbalances, mobility, and migration.

Mehmet O,  The emerging global labor market: some implications for international health, report prepared for WHO Consultation on Imbalances in the Health Workforce in Ottawa on 10-12 March 200. WHO, Geneva.

[Labor relations, bargaining, conflicts]

Labor relations – relations between management and employees in relation to collective bargaining and maintenance of contract.

Bargaining – negotiation over the terms and conditions of an agreement or contract.

Conflicts – opposition or disagreement between parties that calls for an agreement or a contract

[Lay-off, downsizing, redundancies]

Staff reductions resulting from organizational changes or budget cuts; form of termination of employment without negative evaluation of performance.

[Management of change, change management]

The concept of change management encompasses three basic definitions: (1) the task of managing change, referring to (a) making changes in an organization in a planned and systematic way, or (b) “responding to changes over which the organization exercises little or no control”, such as legislation, social and political upheaval, changing economic situations, etc; (2) “an area of professional practice,” referring to experts or firms engaged in planning and managing change for their clients; (3) a body of knowledge, consisting of “ models, methods and techniques, tools, skills and other forms of knowledge that go into making up any practice.”  (Nickols,2002) http://home.att.net/~nickols/change.htm

[Migration]

Process of movement of people from one country, region or place to settle in another.  In the health sector, when related to movement of health workers, this process is also referred to as brain drain.

[Mismatches]

A bad match, a discrepancy, or a lack of correspondence between the competencies of a person and the requirements of a job, or an imbalance between required numbers/skills of staff and staff available.

[Mobility]

The capacity or facility of movement of personnel between positions, organizations and regions.  Mobility of health care personnel is an important issues in the allocation of personnel within a health care system (see deployment and brain drain). 

[Motivation, satisfaction]

Motivation – individuals’ degree of willingness to sustain efforts towards achieving certain goals.  (See System of Incentives)

Satisfaction - Contented state of mind that affects or motivates behavior. (See Systems of Incentives)

[Outsourcing, Outcontracting]

To obtain goods or services (sometimes already provided by the staff of the organization, thus implying a process of transfer) by contract from a source outside an organization or are

[Payment mechanisms]

Methods and systems through which health care service providers are reimbursed. Examples of payment mechanisms are fee-for-service, capitation, bonus payment and case payment.

Hicks V, Adams O, Pay and non-pay incentives, performance and motivation, prepared for the Global Health Workforce Strategy Group. World Health Organization, Geneva, December 2001.

Performance management, evaluation]

Performance Management – Process of optimizing productivity and quality of work of the workforce. This includes designing or adapting performance management and performance appraisal systems.
Martineau and Martinez, 1997)

Evaluation - assessment process that provides feedback to workers on their performance and ensures the quality and effectiveness of services provided.

[Personnel information system]

National and/ or local information system that provides, analyses, evaluates and distributes information needed to support decision-making and health personnel management and practices.  

[Productivity]

Refers to outputs extracted from given inputs, such as patients seen per doctor, number of procedure per provider, and so on.

[Psychological contract]

Describes a reciprocal relationship which may be defined as the mutual expectations of the individual and the organization with each other.  The psychological contract is often unwritten and unspoken, but nevertheless represents each party's expectations for the relationship's continued existence . Adams, O., Hicks, V.:Pay  and Non-Pay Incentives, Performance and Motivation,  Prepared for WHO’s December 2000 Global Health Workforce Strategy Group, Geneva

[Recruitment]

Process of searching for personnel to enter a particular job or position.

To strengthen or increase the supply of personnel to perform services.

[Regulation of practice: certification, licensing, accreditation, professional discipline monitoring and dealing with professional errors)]

Regulation of Practice – Formal recognition granted by a representative body (usually at national level)  to  an individual or group to verify that certain predetermined  educational requirements and/or professional standards  have been met.  Such mechanisms are implemented to ensure maintenance of standards and the quality of health care services provided. In some systems  there will be a requirement to re-certify or re-accredit at specified time intervals

Accreditation – approval of an educational program or an institution by a governmental or voluntary body

Certification – process by which a non-governmental agency grants recognition to an individual who has met certain qualifications

Licensing – (of health personnel): governmental authorization of a person to engage in a health profession occupation.

Registration - (of official recording of the names of persons who have certain qualifications to health personnel); practice a profession or occupation

World Health Organization.  HUMAN RESOURCES FOR HEALTH: A Toolkit for Planning, Training and Management, WHO, Geneva, 2001 

[Remuneration]

Payment of an equivalent to a person for a service or expense.

[Retention of staff]

Maintenance of health personnel by offering adequate opportunities for re-training and career management assistance (see career management).

[Skills mix]

Refers to the mix of posts in the organization, the mix of employees in a post, the combination of skills available at a specific time, or it may also refer to the combinations of activities that comprise each role, rather than the combination of different job titles. Skill mix is a strategy used to ensure the most cost-effective combination of roles and staff.

Buchan J, Ball J, O’May F,  Skill mix in the health workforce: Determining skill mix in the health workforce: guidelines for managers and health professionals, WHO working paper no.

[Staffing]

Process of recruiting, allocating and retaining staff or personnel, in terms of mix and number of personnel (the right combination of categories of personnel and adequate numbers per category), and its deployment, of its distribution by region (including internal migration pattern), by level of care, by type of establishments, by gender, in order to meet the service objectives.

(Martinez and Martineau, 1997)

[Stock]

Quantity of accumulated productive assets. In workforce planning, “stock” refers to the current composition of the workforce. In budgetary terms it can refer to  mobile clinics as well as fixed assets are part of the capital stock of the health care system.

[Stress : occupational stress]

An individual may perceive stress related to their occupation or job because of the interaction between personal factors and workplace characteristics; especially specific job role demands. Occupational or job-related stress adversely impacts productivity, absenteeism, worker turnover, and employee health and well-being (Reissman, D.; Orris, P.; Lacey, R.; Hartman, D.: Downsizing, Role Demands, and Job Stress. Journal of Occupational & Environmental Medicine. Volume 41(4) April 1999 pp 289-293)

[Substitution]

Process of delegating tasks to less qualified personnel with the goal of improving cost-effectiveness.

[Systems of incentives]

Sets of rewards and sanctions to improve staff performance and motivation by providing financial and non-financial benefits such as flexible working schedule and training, education and career development opportunities.

[Teamwork]

Work done by a group formed by associates with different skills and backgrounds, with each doing a part but all subordinating personal prominence to the efficiency of the whole (see Skills Mix)

[Training: in-service]

Training – maintenance and adaptation of the competencies of existing personnel within the context of their current position.

[Unemployment, underemployment]

Unemployment – The condition in which personnel available for work in a labor market are not employed.

Underemployment - The condition in which personnel available for full-time work in a labor market is (1) employed at less than full-time or regular jobs or (2) in  jobs where their full skills are not utilised, or are  inadequate for economic needs.

[Trade unions, Unions]

Representative bodies of personnel that act to protect and defend the legal rights and interests of their members.  Unions influence the contents and the pace of implementation of reforms agendas, especially in issues involving conditions of pay, terms of employment or job specifications.  

[Work organization]

Process of defining arrangements of work in an organization, coordinating tasks and assigning responsibilities.  Coordination of clinical departments in hospitals, which brings together professionals from different disciplines, is one example of work organization. (see Teamwork)

[Workforce dynamics]

The way the stock changes through movement into (entry of newly trained individuals, immigration, re-entry) and out (retirement, death, emigration, exit of the occupation) of the workforce.

[Workload]

The amount of work expected or assigned to a specific position or to one person (can also be a technical term related to “measures” of activity by individuals or teams.).

[Workforce planning: needs, supply and demand, surpluses, shortages]

Comprehensive process to provide a framework for staffing decision-making based on an organization's mission, strategic plan, budgetary resources, and a set of desired workforce competencies.  It incorporates an analysis of present workforce to identify competencies needed in the future and possible gaps and surpluses, preparation of plans for building workforce (See Capacity building), and evaluation process to assure objectives are being met. (See Performance Management and Human Resource Planning)

[Working conditions, terms of employment, benefits]

Working conditions - Characteristics of the environment in which a person is expected to work.  Includes terms of employment, benefits, physical and social climate.

Terms of employment - Conditions that regulate and define employment contracts (See Job Analysis)

Benefits - Advantages that a person is entitled to such as maternity leave and health insurance (See System of Incentives)

Thanks to the contribution of the following individuals: Dr. James Buchan (Queen Margaret University College, Edinburgh), Dr. Paulo Ferrinho (Department of Health, Lisbon, Portugal), Dr. Peter Hornby (Keele University), and Dr. Felix Rigoli (Paho), for their valuable comments and suggestions. 

 




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