title: Coherence between health policy and human resource strategy: lessons from maternal health in Vietnam, India and China.
abstract: The failure to meet health goals such as the Millennium Development Goals (MDG) is partly due to the lack of appropriate resources for the effective implementation of health policies. The lack of coherence between the health policies and human resource (HR) strategy is one of the major causes. This article explores the relationship and the degree of coherence between health policy--in this case maternal health policy--processes and HR strategy in Vietnam, China and India in the period 2005-09. Four maternal health policy case studies were explored [skilled birth attendance (SBA), adolescent and sexual reproductive health, domestic violence and medical termination of pregnancy] across three countries through interviews with key respondents, document analysis and stakeholder meetings. Analysis for coherence between health policy and HR strategy was informed by a typology covering 'separation', 'fit' and 'dialogue'. Regarding coherence we found examples of complete separation between health policy and HR strategy, a good fit with the SBA policy though modified through 'dialogue' in Vietnam, and in one case a good fit between policy and strategy was developed through successive evaluations. Three key influences on coherence between health policy and HR strategy emerge from our findings: (1) health as the lead sector, (2) the nature of the policy instrument and (3) the presence of 'HR champions'. Finally, we present a simple algorithm to ensure that appropriate HR related actors are involved; HR is considered at the policy development stage with the option of modifying the policy if it cannot be adequately supported by the available health workforce; and ensuring that HR strategies are monitored to ensure continued coherence with the health policy. This approach will ensure that the health workforce contributes more effectively to meeting the MDGs and future health goals.
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, UK Nuffield Centre for International Health and Development, University of Leeds, LS2 9LJ, UK Hanoi School of Public Health, 138 Giang vo - Ba Dinh,Vietnam School of Public Health, Fudan University, Shanghai 200032, P.R. China Public Systems Group, Centre for Management of Health Services, Indian Institute of Management, Ahmedabad 380 015, Gujarat, India and China Centre for Health Development Studies, Peking University, Beijing 100191, P.R. China.
authors.forename: Tim
authors.initials: T
authors.lastname: Martineau
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, UK Nuffield Centre for International Health and Development, University of Leeds, LS2 9LJ, UK Hanoi School of Public Health, 138 Giang vo - Ba Dinh,Vietnam School of Public Health, Fudan University, Shanghai 200032, P.R. China Public Systems Group, Centre for Management of Health Services, Indian Institute of Management, Ahmedabad 380 015, Gujarat, India and China Centre for Health Development Studies, Peking University, Beijing 100191, P.R. China.
authors.forename: Tolib
authors.initials: T
authors.lastname: Mirzoev
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, UK Nuffield Centre for International Health and Development, University of Leeds, LS2 9LJ, UK Hanoi School of Public Health, 138 Giang vo - Ba Dinh,Vietnam School of Public Health, Fudan University, Shanghai 200032, P.R. China Public Systems Group, Centre for Management of Health Services, Indian Institute of Management, Ahmedabad 380 015, Gujarat, India and China Centre for Health Development Studies, Peking University, Beijing 100191, P.R. China.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pearson
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, UK Nuffield Centre for International Health and Development, University of Leeds, LS2 9LJ, UK Hanoi School of Public Health, 138 Giang vo - Ba Dinh,Vietnam School of Public Health, Fudan University, Shanghai 200032, P.R. China Public Systems Group, Centre for Management of Health Services, Indian Institute of Management, Ahmedabad 380 015, Gujarat, India and China Centre for Health Development Studies, Peking University, Beijing 100191, P.R. China.
authors.forename: Bui Thi Thu
authors.initials: BT
authors.lastname: Ha
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, UK Nuffield Centre for International Health and Development, University of Leeds, LS2 9LJ, UK Hanoi School of Public Health, 138 Giang vo - Ba Dinh,Vietnam School of Public Health, Fudan University, Shanghai 200032, P.R. China Public Systems Group, Centre for Management of Health Services, Indian Institute of Management, Ahmedabad 380 015, Gujarat, India and China Centre for Health Development Studies, Peking University, Beijing 100191, P.R. China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, UK Nuffield Centre for International Health and Development, University of Leeds, LS2 9LJ, UK Hanoi School of Public Health, 138 Giang vo - Ba Dinh,Vietnam School of Public Health, Fudan University, Shanghai 200032, P.R. China Public Systems Group, Centre for Management of Health Services, Indian Institute of Management, Ahmedabad 380 015, Gujarat, India and China Centre for Health Development Studies, Peking University, Beijing 100191, P.R. China.
authors.forename: K V
authors.initials: KV
authors.lastname: Ramani
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, UK Nuffield Centre for International Health and Development, University of Leeds, LS2 9LJ, UK Hanoi School of Public Health, 138 Giang vo - Ba Dinh,Vietnam School of Public Health, Fudan University, Shanghai 200032, P.R. China Public Systems Group, Centre for Management of Health Services, Indian Institute of Management, Ahmedabad 380 015, Gujarat, India and China Centre for Health Development Studies, Peking University, Beijing 100191, P.R. China xliu@bjmu.edu.cn.
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Liu
mesh_terms: D000288:Administrative Personnel; D002681:China; D005260:Female; D006285:Health Planning / Q000458:organization & administration; D006291:Health Policy; D006280:Health Workforce / Q000458:organization & administration* / Q000706:statistics & numerical data; D040361:Healthy People Programs / Q000458:organization & administration; D006801:Humans; D007194:India; D000068097:Maternal Health / Q000592:standards / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000458:organization & administration; D020380:Needs Assessment; D011247:Pregnancy; D014744:Vietnam
keywords: Health policy; human resources; maternal health; policy analysis