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COVID‐19 has reinforced the centrality of health workers at the core of a well performing and resilient health system. It has concomitantly exposed the risks of staffing and skills shortages and the importance of protecting the health workforce. The present commentary focuses on highlighting some of the lessons learnt, challenges and future needs of the health workforce in Europe in the context of COVID‐19. During the pandemic innovative and flexible approaches were implemented to meet increasing demand for health workers and new skills and responsibilities were adopted over a short period of time. We have seen the rapid adaptation and use of new technologies to deliver care. The pandemic has underlined the importance of valuing, protecting and caring for our health workforce and the need to invest appropriately and adequately in the health workforce to have sufficient, capable and well‐motivated health workers. Some of the main challenges that lie ahead of us include the imperative for better investment, to need to improve recruitment and retraining whilst better retaining health workers, a focus on domestic sustainability, redeploying and developing new skills and competences among health workers, enabling more effective multi‐professional collaboration and team work, improving the quality of education and training, increasing the public health focus and promoting ethical and sustainable international recruitment of health workers. The WHO European Region through its European Programme of Work 2020–2025 is fully committed to support countries in their efforts to continue to respond to COVID‐19 and whilst addressing upcoming health workforce challenges.

Optimizing the management of the health workforce is necessary for the progressive realization of universal health coverage. Here we discuss the six main action fields in health workforce management as identified by the Human Resources for Health Action Framework: leadership; finance; policy; education; partnership; and human resources management systems. We also identify and describe examples of effective practices in the development of the health workforce, highlighting the breadth of issues that policy-makers and planners should consider. Achieving success in these action fields is not possible by pursuing them in isolation. Rather, they are interlinked functions that depend on a strong capacity for effective stewardship of health workforce policy. This stewardship capacity can be best understood as a pyramid of tools and factors that encompass the individual, organizational, institutional and health system levels, with each level depending on capacity at the level below and enabling actions at the level above. We focus on action fields covered by the organizational or system-wide levels that relate to health workforce development. We consider that an analysis of the policy and governance environment and of mechanisms for health workforce policy development and implementation is required, and should guide the identification of the most relevant and appropriate levels and interventions to strengthen the capacity of health workforce stewardship and leadership. Although these action fields are relevant in all countries, there are no best practices that can simply be replicated across countries and each country must design its own responses to the challenges raised by these fields.Il est nécessaire d'optimiser la gestion du personnel de santé pour parvenir progressivement à la couverture sanitaire universelle. Dans cet article, nous nous intéressons aux six grands domaines d'action en matière de gestion du personnel de santé qui sont définis dans le Cadre d'action concernant les ressources humaines pour la santé: leadership; finances; politiques; éducation; partenariats; et systèmes de gestion des ressources humaines. Nous décrivons également des exemples de pratiques efficaces pour renforcer le personnel de santé, en mettant en avant l'étendue des questions que les responsables politiques et les planificateurs devraient prendre en compte. Il n'est pas possible de réussir dans ces domaines d'action en les abordant de manière séparée. Ce sont des fonctions étroitement liées qui dépendent d'une forte capacité à gérer efficacement les politiques relatives au personnel de santé. Cette capacité de gestion peut être mieux comprise sous la forme d'une pyramide d'outils et de facteurs englobant les niveaux des individus, des organisations, des institutions et des systèmes de santé, dans laquelle chaque niveau dépend de la capacité du niveau inférieur et permet d'agir au niveau supérieur. Nous nous intéressons ici aux domaines d'action qui correspondent aux niveaux des organisations ou des systèmes et qui concernent le renforcement du personnel de santé. Selon nous, il est indispensable d'analyser le cadre stratégique et les structures de gouvernance, ainsi que les mécanismes d'élaboration et de mise en œuvre des politiques relatives au personnel de santé. Cette analyse devrait permettre de déterminer les niveaux et les interventions les plus appropriés pour renforcer la capacité de gestion et de direction du personnel de santé. Bien que ces domaines d'action concernent tous les pays, aucune meilleure pratique ne peut être simplement reproduite dans tous les pays. Chaque pays doit trouver ses propres réponses aux questions soulevées par ces domaines.La optimización de la gestión de la fuerza laboral sanitaria es necesaria para la realización progresiva de la cobertura sanitaria universal. La optimización de la gestión de la fuerza laboral sanitaria es necesaria para la realización progresiva de la cobertura sanitaria universal. En este documento se examinan los seis campos de acción principales de la gestión de la fuerza laboral sanitaria identificados en el Marco de Acción de Recursos Humanos para la Salud: liderazgo, finanzas, políticas, educación, asociaciones y sistemas de gestión de los recursos humanos. También se identifican y describen ejemplos de prácticas efectivas en el desarrollo de la fuerza laboral sanitaria, destacando la amplitud de los temas que los responsables de formular políticas y los planificadores deben considerar. No es posible alcanzar el éxito en estos campos de acción si se persiguen de forma aislada. Más bien, se trata de funciones interrelacionadas que dependen de una fuerte capacidad de gestión eficaz de la política de la fuerza laboral sanitaria. Esta capacidad de gestión puede entenderse mejor como una pirámide de herramientas y factores que abarcan los niveles individual, organizativo, institucional y del sistema de salud, en la que cada nivel depende de la capacidad en el nivel inferior y de las medidas de habilitación en el nivel superior. Se hace énfasis en los campos de acción cubiertos por los niveles de la organización o de todo el sistema que se relacionan con el desarrollo de la fuerza laboral sanitaria. En este contexto, es necesario realizar un análisis del entorno normativo y de gobernanza y de los mecanismos para el desarrollo y la implementación de las políticas de la fuerza laboral sanitaria, y debe guiar la identificación de los niveles e intervenciones más pertinentes y apropiados para fortalecer la capacidad de gestión y liderazgo de la fuerza laboral sanitaria. Aunque estos campos de acción son relevantes en todos los países, no hay mejores prácticas que puedan ser simplemente replicadas a través de los países y cada país debe diseñar sus propias respuestas a los desafíos planteados por estos campos.يعد تحسين إدارة القوى العاملة في القطاع الصحي أمراً ضرورياً لتنفيذ التغطية الصحية الشاملة بشكل تدريجي. سوف نناقش هنا مجالات العمل الستة الرئيسية في إدارة القوى العاملة في القطاع الصحي وفقاً للتوضيح الوارد في "الموارد البشرية لإطار العمل الصحي": القيادة؛ والشؤون المالية؛ والسياسات؛ والتعليم؛ والشراكة؛ ونظم إدارة الموارد البشرية. كما نقوم كذلك بتوضيح ووصف أمثلة للممارسات الفعالة في تطوير القوى العاملة في القطاع الصحي، مع التركيز على مجموعة القضايا التي يجب أن يضعها واضعو ومخططو السياسات في الاعتبار. من غير الممكن تحقيق النجاح في مجالات العمل هذه من خلال السعي لتحقيقها بمعزل عن غيرها. بل هي وظائف مترابطة تعتمد على قدرة قوية على الإشراف الفعال لسياسة القوى العاملة في القطاع الصحي. يمكن الوصول لأفضل فهم لقدرة الإشراف تلك على أنها هرم من الأدوات والعوامل التي تشمل مستويات النظام الفردية والتنظيمية والمؤسسية والصحية، حيث يعتمد كل مستوى على قدرة المستوى أدناه، ويقوم بتمكين الإجراءات على المستوى أعلاه. نحن نركز على مجالات العمل التي تغطيها المستويات التنظيمية، أو على مستوى النظام، والتي تتعلق بتطوير القوى العاملة بالقطاع الصحي. نحن نعتبر أنه من المطلوب القيام بتحليل وتنفيذ السياسات وبيئة الحكم وآليات تطوير سياسة القوى العاملة بالقطاع الصحي، كما يجب أن نقوم بالتوجيه في تحديد المستويات الملائمة والأكثر صلة، والتدخلات المطلوبة لدعم الإشراف على القوى العاملة بالقطاع الصحي وقيادتها. على الرغم من أن مجالات العمل تلك مناسبة لكل البلدان، إلا أنه ليست هناك ممارسات مُثلى يمكن ببساطة تكرارها عبر البلدان، ويجب على كل بلد تصميم الاستجابات الخاصة بها للتحديات التي تطرحها هذه المجالات.优化卫生人力管理是逐步实现全民健康覆盖的必然要求。这里我们讨论的是《卫生人力资源行动框架》中确定的卫生人力资源管理的六大行动领域：领导力；财政；政策；教育；伙伴关系；和人力资源管理系统。我们还确立并描述了发展卫生人力中有效做法的例子，强调政策制定者和规划者应注重思考问题时的广度。在这些行动领域取得成功是不可能分开进行的。相反，环环相扣、相互关联才能发挥出它们的价值，而这取决于有效管理卫生人力政策的强大能力。这种管理能力的最佳理解是由工具和因素组成的金字塔，它包括个人、组织、机构和卫生系统，每一级都取决于下一级的能力，并扶持上一级的行动。我们重点关注与卫生人力资源发展相关的组织或系统等级所涵盖的行动领域。我们认为，需要对政策和治理环境以及制定和执行卫生人力政策的机制进行分析，并应指导确定最相关和最适当的等级和干预措施，以加强卫生人力管理的管理和领导能力。尽管这些行动领域在所有国家都具有相关性，但没有一个可以适用于各个国家的最佳做法，每个国家都必须设计自己的应对措施，克服来自这些领域的挑战。.Оптимизация управления кадровыми ресурсами в сфере здравоохранения необходима для последовательной реализации программы всеобщего охвата услугами здравоохранения. Авторы обсуждают шесть основных областей деятельности в сфере управления трудовыми ресурсами здравоохранения, которые определены в Рамочной программе действий в области кадровых ресурсов здравоохранения: лидерство, финансирование, политику, образование, партнерство и системы управления кадровыми ресурсами. Авторы также выявляют и описывают примеры эффективных методов по развитию кадровых ресурсов здравоохранения, подчеркивая широкий спектр вопросов, которые следует учитывать лицам, формирующим политику, и специалистам по планированию. Добиться успеха в данных областях деятельности невозможно, если работать над ними изолированно. Напротив, они являются взаимосвязанными функциями, которые зависят от того, существует ли значительный потенциал эффективного руководства политикой кадровых ресурсов здравоохранения. Такой руководящий потенциал легче всего представить как пирамиду инструментов и факторов, охватывающих индивидуальный, организационный, ведомственный уровни и уровень системы здравоохранения, причем каждый уровень зависит от потенциала нижестоящего уровня и стимулирующих мер на вышестоящем уровне. Авторы уделяют особое внимание областям деятельности на организационном и общесистемном уровнях, которые связаны с развитием кадровых ресурсов здравоохранения. Они считают, что необходим анализ политики и культуры управления, а также механизмов разработки и реализации политики в области кадровых ресурсов здравоохранения, который должен послужить основанием для определения наиболее актуальных и подходящих уровней и мероприятий для укрепления потенциала управления кадрами здравоохранения и их лидерства. Несмотря на то что данные области деятельности актуальны для всех стран, универсальных методов, которые можно применять в разных странах, не существует. Следовательно, каждая страна должна разработать свои собственные решения для проблем, возникающих в указанных областях.

Context: Most prior software visualisation (SV) research has focused primarily on making aspects of intangible software product artefacts more evident. While undoubtedly useful, this focus has meant that software process visualisation has received far less attention. Objective: This paper presents Conceptual Visualisation, a novel SV approach that builds on the well-known CodeCity metaphor by situating software code artefacts alongside their software development processes, in order to link and synchronise these typically separate components. Method: While the majority of prior SV research has focused on representing what is already available in the code (i.e., the implementation) or information derived from it (i.e., various metrics), the presented approach instead makes the design concepts and original developers' intentions -- both significant sources of information in terms of software development and maintenance -- readily and contextually available in a visualisation environment that tightly integrates the code artefacts with their original functional requirements and development activity. Results: Our approach has been implemented in a prototype tool called ScrumCity with the proof of concept being demonstrated using six real-world open source systems. A preliminary case study has further been carried out with real world data. Conclusion: Conceptual Visualisation, as implemented in ScrumCity, shows early promise in enabling developers and managers (and potentially other stakeholders) to traverse and explore multiple aspects of software product and process artefacts in a synchronised manner, achieving traceability between the two., Journal paper, 18 pages, 4 figures

Context: User involvement is generally considered to contributing to user satisfaction and project success and is central to Agile software development. In theory, the expectations about user involvement, such as the PO's, are quite demanding in this Agile way of working. But what are the expectations seen in practice, and are the expectations of user involvement aligned among the development team and users? Any misalignment could contribute to conflict and miscommunication among stakeholders that may result in ineffective user involvement. Objective: Our aim is to compare and contrast the expectations of two stakeholder groups (software development team, and software users) about user involvement in order to understand the expectations and assess their alignment. Method: We have conducted an exploratory case study of expectations about user involvement in an Agile software development. Qualitative data was collected through interviews to design a novel method for the assessing the alignment of expectations about user involvement by applying Repertory Grids (RG). Results: By aggregating the results from the interviews and RGs, varying degrees of expectation alignments were observed between the development team and user representatives. Conclusion: Alignment of expectations can be assessed in practice using the proposed RG instrument and can reveal misalignment between user roles and activities they participate in Agile software development projects. Although we used RG instrument retrospectively in this study, we posit that it could also be applied from the start of a project, or proactively as a diagnostic tool throughout a project to assess and ensure that expectations are aligned., Conference paper, 10 pages, 1 figure, 7 tables

The Australian Nursing and Midwifery Federation has published the Australian Journal of Advanced Nursing since 1983. In 2020, the World Health Organization-designated Year of the Nurse and Midwife, we are pleased to introduce the new-look journal along with new guidance for authors for preparing their publications for submission. The Australian Journal of Advanced Nursing will continue the journal’s previous character and aligns and advances the Australian Nursing and Midwifery Federation’s overall strategic objectives as Australia’s largest professional nursing and midwifery organisation. The Australian Nursing and Midwifery Federation’s diverse and dispersed membership works in many sectors including but not limited to public and private health, aged care, schools, tertiary education, research, the community, and disability care across a wide variety of metropolitan, regional, and remote locations. Accordingly, the Australian Journal of Advanced Nursing will seek to showcase and promote a wide variety of original research and scholarly work to inform and empower nurses, midwives, and other healthcare professionals to improve the health and wellbeing of all communities and be prepared for the future. We look forward to working with authors, readers, and our Editorial Board to enhance the reach, readership, and profile of the Australian Journal of Advanced Nursing. https://doi.org/10.37464/2020.371.1

Mob Programming, or "mobbing", is a relatively new collaborative programming practice being experimented with in different organizational contexts. There are a number of claimed benefits to this way of working, but it is not clear if these are realized in practice and under what circumstances. This paper describes the experience of one team's experiences experimenting with Mob Programming over an 18-month period. The context is programming in a software product organization in the Financial Services sector. The paper details the benefits and challenges observed as well as lessons learned from these experiences. It also reports some early work on understanding others' experiences and perceptions of mobbing through a preliminary international survey of 82 practitioners of Mob Programming. The findings from the case and the survey generally align well, as well as suggesting several fruitful areas for further research into Mob Programming. Practitioners should find this useful to extract learnings to inform their own mobbing experiments and its potential impact on collaborative software development., 6 pages. Best Paper in Industry Collaboration Track at EASE'18

Background Mounting evidence suggests that holding multiple concurrent jobs in public and private (dual practice) is common among health workers in low- as well as high-income countries. Nurses are world’s largest health professional workforce and a critical resource for achieving Universal Health Coverage. Nonetheless, little is known about nurses’ engagement with dual practice. Methods We conducted a scoping review of the literature on nurses’ dual practice with the objective of generating hypotheses on its nature and consequences, and define a research agenda on the phenomenon. The Arksey and O’Malley’s methodological steps were followed to develop the research questions, identify relevant studies, include/exclude studies, extract the data, and report the findings. PRISMA guidelines were additionally used to conduct the review and report on results. Results Of the initial 194 records identified, a total of 35 met the inclusion criteria for nurses’ dual practice; the vast majority (65%) were peer-reviewed publications, followed by nursing magazine publications (19%), reports, and doctoral dissertations. Twenty publications focused on high-income countries, 16 on low- or middle-income ones, and two had a multi country perspective. Although holding multiple jobs not always amounted to dual practice, several ways were found for public-sector nurses to engage concomitantly in public and private employments, in regulated as well as in informal, casual fashions. Some of these forms were reported as particularly prevalent, from over 50% in Australia, Canada, and the UK, to 28% in South Africa. The opportunity to increase a meagre salary, but also a dissatisfaction with the main job and the flexibility offered by multiple job-holding arrangements, were among the reported reasons for engaging in these practices. Discussion and conclusions Limited and mostly circumstantial evidence exists on nurses’ dual practice, with the few existing studies suggesting that the phenomenon is likely to be very common and carry implications for health systems and nurses’ welfare worldwide. We offer an agenda for future research to consolidate the existing evidence and to further explore nurses’ motivation; without a better understanding of nurse dual practice, this will continue to be a largely ‘hidden’ element in nursing workforce policy and practice, with an unclear impact on the delivery of care. Electronic supplementary material The online version of this article (10.1186/s12960-018-0276-x) contains supplementary material, which is available to authorized users.

In seeking to complement consultants' and tool vendors' reports, there has been an increasing academic focus on understanding the adoption and use of software development methods and practices. We surveyed practitioners working in Brazil, Finland, and New Zealand in a transnational study to contribute to these efforts. Among our findings we observed that most of the 184 practitioners in our sample focused on a small portfolio of projects that were of short duration. In addition, Scrum and Kanban were used most; however, some practitioners also used conventional methods. Coding Standards, Simple Design and Refactoring were used most by practitioners, and these practices were held to be largely suitable for project and process management. Our evidence points to the need to properly understand and support a wide range of software methods., Comment: Conference Paper, 5 pages, 1 figure, 1 table

Many European countries are faced with health workforce shortages and the need to develop effective recruitment and retention (R&R) strategies. Yet comparative studies on R&R in Europe are scarce. This paper provides an overview of the measures in place to improve the R&R of health professionals across Europe and offers further insight into the evidence base for R&R; the interaction between policy and organisational levels in driving R&R outcomes; the facilitators and barriers throughout these process; and good practices in the R&R of health professionals across Europe. The study adopted a multi-method approach combining an extensive literature review and multiple-case study research. 64 publications were included in the review and 34 R&R interventions from 20 European countries were included in the multiple-case study. We found a consistent lack of evidence about the effectiveness of R&R interventions. Most interventions are not explicitly part of a coherent package of measures but they tend to involve multiple actors from policy and organisational levels, sometimes in complex configurations. A list of good practices for R&R interventions was identified, including context-sensitivity when implementing and transferring interventions to different organisations and countries. While single R&R interventions on their own have little impact, bundles of interventions are more effective. Interventions backed by political and executive commitment benefit from a strong support base and involvement of relevant stakeholders. publisher: Elsevier articletitle: Recruitment and retention of health professionals across Europe: A literature review and multiple case study research journaltitle: Health Policy articlelink: http://dx.doi.org/10.1016/j.healthpol.2015.08.003 content_type: article copyright: Copyright © 2015 Elsevier Ireland Ltd. All rights reserved. ispartof: Health Policy vol:119 issue:12 pages:1517-1528 ispartof: location:Ireland status: published

It is generally acknowledged that software testing is both challenging and time-consuming. Understanding the factors that may positively or negatively affect testing effort will point to possibilities for reducing this effort. Consequently there is a significant body of research that has investigated relationships between static code properties and testability. The work reported in this paper complements this body of research by providing an empirical evaluation of the degree of association between runtime properties and class-level testability in object-oriented (OO) systems. The motivation for the use of dynamic code properties comes from the success of such metrics in providing a more complete insight into the multiple dimensions of software quality. In particular, we investigate the potential relationships between the runtime characteristics of production code, represented by Dynamic Coupling and Key Classes, and internal class-level testability. Testability of a class is considered here at the level of unit tests and two different measures are used to characterise those unit tests. The selected measures relate to test scope and structure: one is intended to measure the unit test size, represented by test lines of code, and the other is designed to reflect the intended design, represented by the number of test cases. In this research we found that Dynamic Coupling and Key Classes have significant correlations with class-level testability measures. We therefore suggest that these properties could be used as indicators of class-level testability. These results enhance our current knowledge and should help researchers in the area to build on previous results regarding factors believed to be related to testability and testing. Our results should also benefit practitioners in future class testability planning and maintenance activities., 10 pages, conference paper, 9th International Conference on Evaluation of Novel Approaches to Software Engineering (ENASE), 2014

Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose.Parvenir à la couverture sanitaire universelle (CSU) implique la répartition des ressources, et en particulier des ressources humaines pour la santé (RHS), afin de répondre aux besoins de la population. Cet article étudie les leçons politiques sur les RHS de quatre pays ayant accompli des progrès durables en matière de CSU: le Brésil, le Ghana, le Mexique et la Thaïlande. Son but est d'informer sur les politiques globales et les engagements financiers dans les RHS visant à promouvoir la CSU.L'article décrit les expériences des pays à l'aide d'un cadre analytique examinant la couverture efficace par rapport à la disponibilité, l'accessibilité, l'acceptabilité et la qualité (DAAQ) des RHS. Les dimensions DAAQ permettent de réaliser une analyse de traçage des actions politiques en RHS depuis 1990 dans les quatre pays étudiés, par rapport aux tendances nationales des statistiques de main-d'oeuvre et des taux de mortalité de la population. Les résultats indiquent quels sont les principes clés pour la prise de décisions basées sur les faits sur les RHS visant à promouvoir la CSU. Premièrement, les RHS sont essentielles à l'expansion de la couverture des services de santé et de l'ensemble des avantages; deuxièmement, des stratégies RHS pour chacune des dimensions DAAQ favorisent collectivement les progrès vers une couverture efficace; et troisièmement, le succès est atteint à travers des partenariats impliquant des acteurs tant médicaux que non médicaux.Répondre aux défis sans précédent dans les domaines de la santé et du développement, qui concernent tous les pays, et transformer les faits RHS en politiques et en pratiques doivent être à la base du programme de CSU et de l'agenda de développement post-2015. C'est un impératif politique qui exige un engagement et un leadership nationaux pour optimiser l'impact des ressources financières et humaines disponibles et accroître l'espérance de vie en bonne santé, avec la reconnaissance que les progrès dans le domaine des soins de santé ne sont possibles qu'avec une main-d'oeuvre de santé adéquate.Lograr una cobertura sanitaria universal implica una distribución de los recursos, en particular, de los recursos humanos para la salud (RHS), a fin de satisfacer las necesidades de la población. Este documento examina las lecciones sobre políticas relacionadas con los RHS de cuatro países que han conseguido avances ininterrumpidos en materia de cobertura sanitaria universal: Brasil, Ghana, México y Tailandia. Su objetivo consiste en exponer la política mundial y los compromisos financieros sobre RHS como ayuda para una cobertura sanitaria universal.El documento explica las experiencias de los países mencionados por medio de un marco de trabajo analítico que examina la eficacia de una cobertura en función de la disponibilidad, accesibilidad, aceptabilidad y calidad (DAAC) de los RHS. Los aspectos DAAC permiten llevar a cabo análisis de seguimiento sobre las acciones políticas relativas a los RHS desde 1990 en los cuatro países de interés en relación con las tendencias nacionales en el número de trabajadores y las tasas de mortalidad de la población.Los resultados muestran los principios fundamentales para la toma de decisiones basadas en pruebas científicas sobre los RHS como apoyo a una cobertura sanitaria universal. En primer lugar, los RHS son esenciales para expandir la cobertura de los servicios sanitarios y el conjunto de prestaciones. En segundo lugar, las estrategias RHS en cada uno de los aspectos DAAC respaldan de forma colectiva los logros en la eficacia de la cobertura y, en tercer lugar, los buenos resultados solo pueden conseguirse a través de la asociación de actores sanitarios y no sanitarios.Hacer frente a los desafíos sanitarios y de desarrollo sin precedentes que afectan a todos los países y traducir las pruebas científicas sobre RHS en políticas y prácticas deben convertirse en los puntos centrales de la cobertura sanitaria universal y de la agenda de desarrollo a partir del año 2015. Se trata de un imperativo político que requiere un compromiso y liderazgo nacionales para potenciar el impacto de los recursos financieros y humanos disponibles, y así mejorar la esperanza de vida saludable, sin olvidar que las mejoras en materia de asistencia sanitaria son posibles gracias a un personal sanitario apto para tal propósito.يتضمن تحقيق التغطية الصحية الشاملة توزيع الموارد، لاسيما الموارد البشرية الصحية، لتلبية احتياجات السكان. وتستكشف هذه الورقة الدروس السياسية المعنية بالموارد البشرية الصحية المستفادة من أربعة بلدان حققت تحسينات مستدامة في التغطية الصحية الشاملة، هي: البرازيل وغانا والمكسيك وتايلند. وتهدف هذه الورقة إلى توفير المعلومات اللازمة للسياسة العالمية والالتزامات المالية للموارد البشرية الصحية دعماً للتغطية الصحية الشاملة. تقدم هذه الورقة تقارير عن خبرات البلدان باستخدام إطار تحليلي يدرس التغطية الفعالة فيما يتصل بتوافر وإتاحة ومقبولية وجودة الموارد البشرية الصحية. وتتيح أبعاد التوافر والإتاحة والمقبولية والجودة تنفيذ تتبع التحليل المعني بإجراءات سياسة الموارد البشرية الصحية منذ عام 1990 في البلدان الأربع محل الاهتمام فيما يتصل بالاتجاهات الوطنية في أعداد القوى العاملة ومعدلات وفيات السكان. توفر النتائج المعلومات اللازمة حول المبادئ الرئيسية لاتخاذ القرار المستند على البيّنات المعني بالموارد البشرية الصحية دعماً للتغطية الصحية الشاملة. أولاً، الموارد البشرية الصحية بالغة الأهمية في توسيع تغطية الخدمات الصحية وحزمة المزايا؛ ثانياً، تدعم استراتيجيات الموارد البشرية الصحية في كل بعد من أبعاد التوافر والإتاحة والمقبولية والجودة في مجموعها الإنجازات في التغطية الفعالة؛ ثالثاً، يتحقق النجاح من خلال الشراكات التي تضم جهات فاعلة في المجال الصحي وغير الصحي. يجب أن تكون مواجهة التحديات الصحية والإنمائية غير المسبوقة التي تؤثر على كل البلدان وتحويل بينّات الموارد البشرية الصحية إلى سياسة وممارسة محور التغطية الصحية الشاملة وجدول أعمال التنمية بعد عام 2015. وتمثل زيادة أثر الموارد المالية والبشرية المتاحة إلى أقصى قدر ممكن، وتحسين متوسط العمر المأمول لدى الأصحاء مع الإقرار بتمكين القوى العاملة الصحية المناسبة للغرض من إدخال تحسينات في الرعاية الصحية واجباً سياسياً يتطلب التزاماً وقيادة على الصعيد الوطني.实现全民医保（UHC）涉及满足人们需求的资源分配，尤其是卫生人力资源（HRH）的分配。文本探讨了巴西、加纳、墨西哥和泰国四国HRH相关政策的经验教训，这四个国家在UHC方面取得了持续改进。本文旨在为HRH的相关全球政策和财务规划提供信息，用以支持UHC。本文使用考查HRH可用性、可及性、可接受性和质量（AAAQ）相关有效覆盖的分析框架来报告国家经验。采用AAAQ维度可以对四个受关注国家执行1990 年以来有关劳动力数量和人口死亡率国家趋势的HRH政策行为跟踪分析。研究结果可以为基于证据的相关HRH决策的基本原则提供参考信息，对UHC加以支持。首先，HRH对于扩大卫生服务覆盖和福利制度非常关键；其次，每个AAAQ维度中的HRH战略对实现有效覆盖共同起支持作用；第三，成功通过合作关系实现，这种合作关系涉及卫生工作者，也牵涉到非卫生行动者。面对影响所有国家的前所未有的卫生和发展挑战，将HRH证据转化为政策和实践必须居于UHC和2015 年后发展议程的核心。一个需要国家承诺和领导的政治要务就是，通过认识到专业对口的卫生劳动力能实现医疗卫生事业的改善，将可用财政和人力资源的效力最大化，并改善健康预期寿命。Достижение всеобщего охвата медико-санитарной помощью (ВОМСП) подразумевает распределение ресурсов, особенно кадровых ресурсов здравоохранения (КРЗ), в соответствии с потребностями населения. В данной статье исследуются результаты проведения политики в области КРЗ в четырех странах, добившихся устойчивых улучшений в области ВОМСП: Бразилии, Ганы, Мексики и Таиланда. Целью статьи является информирование о глобальной политике и финансовых обязательствах по КРЗ в целях обеспечения ВОМСП.В статье сообщается об опыте стран с применением аналитической основы, когда эффективность охвата медицинскими услугами рассматривается на основе таких параметров КРЗ, как наличие, доступность, приемлемость и качество (НДПК). Использование параметров НДПК дало возможность выполнить исторический анализ политики КРЗ в этих четырех странах с 1990 года с учетом национальных тенденций численности рабочей силы и смертности населения.В результате были выделены основные принципы научно обоснованных решений по КРЗ для поддержки ВОМСП. Во-первых, КРЗ имеет решающее значение для расширения охвата медицинским обслуживанием и связанных с ним комплексных улучшений; во-вторых, стратегии КРЗ по каждому параметру НДПК совместно обеспечивают более эффективный охват услугами; и в-третьих, успех достигается благодаря партнерским отношениям с организациями, как связанными со здравоохранением, так и работающими вне этой области.Эффективное преодоление беспрецедентных трудностей в области здравоохранения и развития, затрагивающих все страны, и воплощение результатов, полученных в ходе исследования КРЗ, в политику и практику, должно стать основой стратегии ВОМСП и сформировать повестку дня в целях развития после 2015 года. Политическим императивом сегодня является национальная заинтересованность и обеспечение руководства развитием здравоохранения, что позволит оптимально использовать имеющиеся финансовые и людские ресурсы и увеличить ожидаемую продолжительность здоровой жизни. При этом необходимо признание того, что улучшения в области медицинского обслуживания возможны только при наличии кадров работников здравоохранения, соответствующих данным целям.

OBJECTIVE: This paper focuses on the policy context for the deployment of nurses in advanced roles, with particular reference to Portugal. The health sector in Portugal, as in all countries, is labour intensive, and the scope to utilise nurses in more advanced roles is currently being debated. METHODS: Mixed methods were used: an analysis of international data on the nursing workforce; an analysis of documents and media articles; interviews with key-informants; an online survey of managers, and a technical workshop with key-informants. CONCLUSIONS: The limited evidence base on nurses in advanced roles in Portugal is a constraint on progress, but it is not an excuse for inaction. Further research in Portugal on health professionals in innovative roles would assist in informing policy direction. There is the need to move forward with a fully informed policy dialogue, taking account of the current political, economic and health service realities of Portugal. OBJETIVO: Este estudio se focaliza en el contexto político del desarrollo de competencias avanzadas de enfermería, con énfasis en el caso portugués. El sector de la salud en Portugal, como en todos los países, es intensivo en mano de obra, y la posibilidad de utilizar enfermeros en funciones más avanzadas está actualmente en debate. MÉTODOS: Fue utilizado una aproximación mixta: análisis de datos internacionales sobre la fuerza de trabajo de enfermería; análisis de documentos y noticias; entrevistas con informadores clave; un cuestionario online y una oficina técnica con informadores clave. CONCLUSIONES: La limitada base de evidencia sobre la extensión de competencias de los enfermeros en Portugal es un obstáculo para el progreso pero no es una excusa para la inacción. Investigación adicional sobre profesionales de la salud en papeles innovadores podría ayudar a informar y direccionar la decisión política. Es necesario avanzar con un diálogo político plenamente informado, considerando la realidad político económica actual y el sistema de servicios de salud en Portugal. OBJETIVO: este artigo foca o contexto político da implementação de competências avançadas em enfermagem, com ênfase no caso português. O setor da saúde em Portugal, assim como em outros países, usa mão de obra intensa, e a prática de enfermeiros com competências avançadas está atualmente em debate. MÉTODOS: abordagem de métodos mistos com análise de dados internacionais sobre a mão de obra em enfermagem, documentos e notícias na mídia, entrevistas com informantes-chave, questionário online e um workshop técnico com informantes-chave. CONCLUSÕES: existe base de evidência limitada sobre enfermeiros com funções avançadas em Portugal, o que é um entrave ao progresso, mas não uma desculpa para a inércia. Mais estudos conduzidos em Portugal, abordando funções inovadoras para profissionais da saúde, ajudariam a informar e direcionar políticas na área. É necessário avançar para informar, de forma plena, o diálogo político, levando em consideração a realidade atual em termos políticos, econômicos e do sistema de saúde em Portugal.

This paper examines issues related to the future supply of registered nursing staff, midwives and health visitors in the National Health Service (NHS) in England at a time when there are major public sector funding constraints and as more of these staff are reaching retirement age. Based on available workforce data, the paper reviews different possible scenarios for the supply of NHS nurses over a ten year period, assessing the impact of different numbers of new staff being trained and of varying retirement patterns from the ageing profession. The government in England has more policy levers available than is the case in many other countries. It determines the number of pre-registration training places that are commissioned and funded, it is the major employer, and it also controls the inflow of nurses from other countries through migration policies. Scenario models provide a picture of what the future might look like under various assumptions. These outcomes can be quantified and the results used to assess the risks and opportunities of alternate policy decisions. The approach used in this paper is that of the aggregate deterministic supply model. As part of this exercise, eight scenarios were selected and modelled. These were: A. “No change”- current inflows and outflows B. “Redundancies” - current inflow with higher outflow C. “Improved retention” - current inflow with lower outflow D. “Reduced training intakes A” - lower inflows with lower outflow E. “Reduced training intakes B” - lower inflow with higher outflows F. “Pension time-bomb”- current inflow with a higher rate of retirement G. “Pension delayed”- current inflow with a lower rate of retirement H. “Worst case” - lower inflow and higher outflow including higher retirement Most of the scenarios indicate that a reduction in the supply of nursing staff to NHS England is possible over the next ten years. Small changes in assumptions can make a substantial difference to outcomes and therefore emphasize the point that it is unwise to base policy decisions on a single projection. It is important that different scenarios are considered that may be regarded as possible futures, based on a realistic assessment of the available workforce data, policies and broader labour market and funding outlook.

Background This paper reports on progress in implementing human resources for health (HRH) policies in Brazil, in the context of the implementation and expansion of the Unified Health System (Sistema Unico de Saúde - SUS). The three main objectives were: i) to reconstruct the chronology of long term HRH change in Brazil, and to identify and discuss the precursors, drivers, and enablers for these changes over a long time period; (ii) to examine how change was achieved by describing facilitators and constraints, and how policies were adapted to deal with the latter; and (iii) to report on the current situation and draw policy implications. Methods A mixed methods approach was used. A literature review was conducted using pre-defined keywords; and stakeholders were contacted and asked to provide relevant information, data and policy reports. Results There are two key features of HRH change which are related to the implementation of SUS which merit attention: the achievement of staffing growth, and the improvement in HRH policy making and management. Staff growth rates across the period have been high enough to exceed population growth rates. As a consequence, the ratio of staff to population has improved. In 1990 the physician ratio per 1000 inhabitants was 1.12. In 2007, it was 1.74. Another critical factor in achieving staffing growth has been HRH policy making capacity and influence within the political establishment. Conclusions Policies have had to adapt to changing circumstances, whilst focusing on sequential improvements aimed at achieving long term goals. The end objectives, of improving care and access to care, have been kept in view. No one Ministry could secure all the resources and impetus for change that has been required, hence the need for inter-ministry, inter-governmental and inter-agency collaboration, and the development of alliances of shared interest. Across the period of thirty years or more, not all initiatives have been equally successful, but a momentum has been maintained. There was no single long term plan or strategy, but in Brazil this has enabled the progress to be adapted and re-oriented as the broader context changed over the years.

This paper draws from research commissioned by the Scottish Executive Health Department (SEHD). It provides a case study in the introduction of a new health care worker role into an already well established and "mature" workforce configuration It assesses the role of US style physician assistants (PAs), as a precursor to planned "piloting" of the PA role within the National Health Service (NHS) in Scotland. The evidence base for the use of PAs is examined, and ways in which an established role in one health system (the USA) could be introduced to another country, where the role is "new" and unfamiliar, are explored. The history of the development of the PA role in the US also highlights a sometimes somewhat problematic relationship between P nursing profession. The paper highlights that the concept of the PA role as a 'dependent practitioner' is not well understood or developed in the NHS, where autonomous practice within regulated professions is the norm. In the PA model, responsibility is shared, but accountability rests with the supervising physician. Clarity of role definition, and engendering mutual respect based on fair treatment and effective management of multi-disciplinary teams will be pre-requisites for effective deployment of this new role in the NHS in Scotland.

The importance of human resources management (HRM) to the success or failure of health system performance has, until recently, been generally overlooked. In recent years it has been increasingly recognised that getting HR policy and management "right" has to be at the core of any sustainable solution to health system performance. In comparison to the evidence base on health care reform-related issues of health system finance and appropriate purchaser/provider incentive structures, there is very limited information on the HRM dimension or its impact. Despite the limited, but growing, evidence base on the impact of HRM on organisational performance in other sectors, there have been relatively few attempts to assess the implications of this evidence for the health sector. This paper examines this broader evidence base on HRM in other sectors and examines some of the underlying issues related to "good" HRM in the health sector. The paper considers how human resource management (HRM) has been defined and evaluated in other sectors. Essentially there are two sub-themes: how have HRM interventions been defined? and how have the effects of these interventions been measured in order to identify which interventions are most effective? In other words, what is "good" HRM? The paper argues that it is not only the organisational context that differentiates the health sector from many other sectors, in terms of HRM. Many of the measures of organisational performance are also unique. "Performance" in the health sector can be fully assessed only by means of indicators that are sector-specific. These can focus on measures of clinical activity or workload (e.g. staff per occupied bed, or patient acuity measures), on measures of output (e.g. number of patients treated) or, less frequently, on measures of outcome (e.g. mortality rates or rate of post-surgery complications). The paper also stresses the need for a "fit" between the HRM approach and the organisational characteristics, context and priorities, and for recognition that so-called "bundles" of linked and coordinated HRM interventions will be more likely to achieve sustained improvements in organisational performance than single or uncoordinated interventions.

It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised. However, data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills. The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed. The paper is divided into six sections. In the first, the different types of migration are reviewed. Some global trends are depicted in the second section. Scarcity of data on health worker migration is one major challenge and this is addressed in section three, which reviews and discusses different data sources. The consequences of health worker migration and the financial flows associated with it are presented in section four and five, respectively. To illustrate the main issues addressed in the previous sections, a case study based mainly on the United Kingdom is presented in section six. This section includes a discussion on policies and ends by addressing the policy options from a broader perspective.

Background Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS) in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions), and case studies conducted with senior human resource managers in ten NHS hospitals in England Results Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact variations. Similarly, the lack of any full and systematic evaluation constrained the overall potential for Agenda for Change to deliver improvements to the NHS.