MANAGEMENT AND ADMINISTRATION PLAY A PIVOTAL ROLE OF HUMAN RESOURCE DEVELOPMENT

Abstract

Decentralization of political and administrative power, combined with a civil service reform, are increasingly prevalent components of health sector reform. The wider implications of decentralization for human resources development are, however, poorly researched and inadequately understood. This paper analyzes these implications from the experience of the author, her colleagues at Management Sciences for Health, and published literature. Four important human resource issues are found to emerge as a part of the process of transferring power to lower management levels. They are the adequacy of available information on human resources, the complexity of transferring staff, the impact of professional associations, Unions and registration bodies on the design and implementation of management structures and jobs, and the morale and motivation of health workers. The key human resource domains where problems arise as a result of the way in which Decentralized management systems are structured, are identified next. Organizational structures, roles, and responsibilities may become inappropriate, conflict with each other, be disputed or poorly communicated. The viability of developing health services and human resources in a coordinated manner may be in jeopardy because of deteriorating databases, reduced planning capacity, inequitable or inappropriate staff allocation, or decentralization-induced difficulties in career development. The retention of an appropriate training capacity may be threatened, if mistakes are made in allocating training responsibility. Technical and managerial competence may be reduced by a shortage of skilled staff or the deterioration of supervision systems. Finally, performance conditions may be impaired if decentralization impacts on the timely payment of wages and benefits and the availability of essential resources. Recommendations for other health leaders include becoming an advocate for human resources, anticipating and preparing for the cost and complexity of decentralization, developing a strategic human resources development capability, investing in developing staff, and monitoring the impact of decentralization.