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Planning for Health Workforces and Health Care Systems Based on Population Health Needs

Health human resources (HHR) planning involves matching the supply of HHR with health care service requirements. This process requires a combination of short-term planning to address urgent needs, and long-term planning to develop a workforce and overall health system flexible enough to respond to future requirements, which are often difficult to anticipate. Several approaches to HHR planning exist internationally. In publicly funded systems such as in Canada, where health services are provided based on need as opposed to ability to pay, a needs-based approach to HHR is essential. A synthesis of the existing knowledge on needs-based HHR and health systems planning was conducted based on a systematic review of the peer-reviewed and grey literature published between 1990 and 2013. The researchers identified 35 relevant articles, the bulk of which focused on Canada. In total, 12 health professional groups were considered; roughly half of the articles took a system-level perspective that was not specific to any particular health care professional group, while, within the remaining papers, nurses were the most common focus, followed by physicians.

Future Projections

hhr planning future projectHHR planning approaches described in the literature either estimated current requirements alone, or estimated both current and future needs. Projected future requirements were forecasted from 10 and 40 years. While estimates of such requirements decrease in accuracy over time, they are valuable to illustrate potential consequences of various policy scenarios, such as increasing enrolment in health care provider education programs, or improving HHR productivity.

Defining and Measuring Need

Data on planning and measures of health care needs were essential to the various HHR approaches, and rates of incidence or prevalence of specific health conditions, including chronic and infectious diseases, mental health conditions, and injuries were most commonly used. Self-assessed measures of overall health and of long-standing activity-limiting health conditions were also used. Although governments and other organizations have invested in the collection of health status information using standardized, relatively objective assessment tools, only one of the papers applied such a measure to HHR or health systems planning. Some studies used more objective indicators, such as standardized mortality ratios and fertility rates. Relatively few approaches incorporated measures of social determinants of health – such as socioeconomic status or tobacco use – in addition to measures of actual health status.

HHR Data Availability

Challenges existed in obtaining the required data on HHR supply, but obtaining data on the number and type of health care services to be provided to individuals according to different levels of need (levels of service) was more challenging still. Levels of service were estimated either by using current levels (e.g., from administrative data and population health surveys) as a 'baseline' for analysis and comparison of different scenarios, or some established guideline or other service model was used as a target or 'standard' (e.g., from peer-reviewed literature and/or established clinical practice guidelines).

Supports Required

Planners and policy makers must recognize the interdependency of health systems and HHR; planning for each must be done in concert. In addition, firm commitment from health care planners and policy makers is required to reform practices that are not aligned with meeting population health needs. Moreover, effective health systems and HHR planning is a political as well as a technical exercise, requiring collaboration between planners and policy makers as well as the collectors, stewards, and analysts of planning data and health care providers themselves. Partnership between these groups is required to build consensus and support for the approach to planning and, by extension, the potential policy changes which may arise from it.

Conclusions

A range of planning methods, frame-works and tools are available to HHR planners and policy makers seeking to make their health care systems more responsive to population health needs. Although there is growing endorsement of the principles of needs-based HHR planning, practical implementation of such methods is only emerging in a few countries. Besides the growth in the number and range of these tools, factors supporting their implementation include improved access and quality of HHR data that reflect a broad understanding of health, the integration of needs-based HHR planning into broader health and systems planning, and improved partnerships between researchers and research users. Potential directions for future research and collaboration include:

  • The enhancement of measurement and collection of data on health care needs, including consideration of the potential use of prospective data to inform HHR planning;
  • Continuing the evaluation of new and existing models of care delivery and the impact of those models on patient, provider and system outcomes; and
  • Evaluation of the performance of needs-based health systems and HHR planning policies

Reference:  Planning for Health Workforces and Health Care Systems Based on Population Health Needs. CHHRN Knowledge Synthesis. Available at hhr-rhs.ca.

Health Canadacihr logo1This initiative has been generously funded by grants from Health Canada and the Canadian Institutes of Health Research. The views expressed here do not necessarily reflect those of the funders.