title: Implementing large-scale programmes to optimise the health workforce in low- and middle-income settings: a multicountry case study synthesis.
abstract: OBJECTIVE
  To identify factors affecting the implementation of large-scale programmes to optimise the health workforce in low- and middle-income countries.
  
  
  METHODS
  We conducted a multicountry case study synthesis. Eligible programmes were identified through consultation with experts and using Internet searches. Programmes were selected purposively to match the inclusion criteria. Programme documents were gathered via Google Scholar and PubMed and from key informants. The SURE Framework - a comprehensive list of factors that may influence the implementation of health system interventions - was used to organise the data. Thematic analysis was used to identify the key issues that emerged from the case studies.
  
  
  RESULTS
  Programmes from Brazil, Ethiopia, India, Iran, Malawi, Venezuela and Zimbabwe were selected. Key system-level factors affecting the implementation of the programmes were related to health worker training and continuing education, management and programme support structures, the organisation and delivery of services, community participation, and the sociopolitical environment.
  
  
  CONCLUSIONS
  Existing weaknesses in health systems may undermine the implementation of large-scale programmes to optimise the health workforce. Changes in the roles and responsibilities of cadres may also, in turn, impact the health system throughout.
authors.affiliation: Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Unni
authors.initials: U
authors.lastname: Gopinathan
authors.forename: Simon
authors.initials: S
authors.lastname: Lewin
authors.forename: Claire
authors.initials: C
authors.lastname: Glenton
mesh_terms: D003695:Delivery of Health Care; D003906:Developing Countries; D006282:Health Personnel; D006284:Health Plan Implementation; D006801:Humans; D007182:Income
keywords: ampliación de tareas; délégation des tâches; entrega de servicios; gobernanza; gouvernance; governance; health systems; human resources for health; implementación; implementation; implémentation; prestation de services; recursos humanos en salud; ressources humaines pour la santé; service delivery; sistemas sanitarios; systèmes de santé; task shifting