title: Realizing universal health coverage for maternal health services in the Republic of Guinea: the use of workforce projections to design health labor market interventions.
abstract: BACKGROUND
  Universal health coverage requires a health workforce that is available, accessible, and well-performing. This article presents a critical analysis of the health workforce needs for the delivery of maternal and neonatal health services in Guinea, and of feasible and relevant interventions to improve the availability, accessibility, and performance of the health workforce in the country.
  
  
  METHODS
  A needs-based approach was used to project human resources for health (HRH) requirements. This was combined with modeling of future health sector demand and supply. A baseline scenario with disaggregated need and supply data for the targeted health professionals per region and setting (urban or rural) informed the identification of challenges related to the availability and distribution of the workforce between 2014 and 2024. Subsequently, the health labor market framework was used to identify interventions to improve the availability and distribution of the health workforce. These interventions were included in the supply side modeling, in order to create a "policy rich" scenario B which allowed for analysis of their potential impact.
  
  
  RESULTS
  In the Republic of Guinea, only 44% of the nurses and 18% of the midwives required for maternal and neonatal health services are currently available. If Guinea continues on its current path without scaling up recruitment efforts, the total stock of HRH employed by the public sector will decline by 15% between 2014 and 2024, while HRH needs will grow by 22% due to demographic trends. The high density of HRH in urban areas and the high number of auxiliary nurses who are currently employed pose an opportunity for improving the availability, accessibility, and performance of the health workforce for maternal and neonatal health in Guinea, especially in rural areas.
  
  
  CONCLUSIONS
  Guinea will need to scale up its recruitment efforts in order to improve health workforce availability. Targeted labor market interventions need to be planned and executed over several decades to correct entrenched distortions and mismatches between workforce need, supply, and demand. The case of Guinea illustrates how to design and operationalize HRH interventions based on workforce projections to accompany and facilitate universal health coverage reforms.
authors.affiliation: Health Unit, Royal Tropical Institute, Amsterdam, the Netherlands.
authors.forename: Christel
authors.initials: C
authors.lastname: Jansen
authors.affiliation: Health Workforce, World Health Organization, Geneva, Switzerland.
authors.forename: Laurence
authors.initials: L
authors.lastname: Codjia
authors.affiliation: Global Health Workforce Alliance, World Health Organization, Geneva, Switzerland.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cometto
authors.affiliation: Health Focus GmbH, Conakry, Guinea.
authors.forename: Mohamed Lamine
authors.initials: ML
authors.lastname: Yansané
authors.affiliation: Health Unit, Royal Tropical Institute, Amsterdam, the Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Dieleman
keywords: human resources for health; workforce projections