Human Resources for Health Thesis


Amorim Lopes et al. Human Resources for Health (2015) 13:38 DOI 10.1186/s12960-015-0028-0

REVIEW Open Access

Handling healthcare workforce planning with care: where do we stand? Mário Amorim Lopes1*, Álvaro Santos Almeida2 and Bernardo Almada-Lobo1


Background: Planning the health-care workforce required to meet the health needs of the population, while providing service levels that maximize the outcome and minimize the financial costs, is a complex task. The problem can be described as assessing the right number of people with the right skills in the right place at the right time, to provide the right services to the right people. The literature available on the subject is vast but sparse, with no consensus established on a definite methodology and technique, making it difficult for the analyst or policy maker to adopt the recent developments or for the academic researcher to improve such a critical field.

Methods: We revisited more than 60 years of documented research to better understand the chronological and historical evolution of the area and the methodologies that have stood the test of time. The literature review was conducted in electronic publication databases and focuses on conceptual methodologies rather than techniques.

Results: Four different and widely used approaches were found within the scope of supply and three within demand. We elaborated a map systematizing advantages, limitations and assumptions. Moreover, we provide a list of the data requirements necessary to implement each of the methodologies. We have also identified past and current trends in the field and elaborated a proposal on how to integrate the different methodologies.

Conclusion: Methodologies abound, but there is still no definite approach to address HHR planning. Recent literature suggests that an integrated approach is the way to solve such a complex problem, as it combines elements both from supply and demand, and more effort should be put in improving that proposal.

Keywords: Review, Health-care workforce planning, Supply, Demand, Needs, Health policy

Introduction Health-care human resources (HHR) planning has been identified as the most critical constraint in achieving the well-being targets set forth in the United Nations’ Mil- lennium Development Goals [1]. Moreover, the effective use and deployment of personnel is paramount to ensure an efficient service delivery in terms of cost, quality and quantity [2]. Failure to do so may result in an oversupply or shortage of clinical staff. While the former may lead to economic inefficiencies and misallocated resources under the guise of unemployment [3] or inflated costs through supplier-induced demand [4], the latter is linked to a more extensive list of negative effects, including but not limited to the following: lower quantity and quality of medi- cal care as few resources exist to provide the necessary

*Correspondence: 1INESC TEC, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal Full list of author information is available at the end of the article

services and the visits are shorter [5]; work overload of the available physicians and nurses, resulting in sleep- deprivation, ultimately compromising patient safety [6]; and queues and waiting lists resulting from insufficient medical staff, causing avoidable patient deaths [7]. Another argument supporting HHR planning is the

recent rise in health-care expenditure, both in per capita spending on health and as a proportion of per capita domestic product in real terms [8]. The average annual growth rate of health-care expenditure in a selection of 18 countries that are part of the Organisation for Eco- nomic Co-operation and Development (OECD) was 3.0 % between 1980 and 1990 and 3.3 % in the decade after [8]. Recent studies confirm the rising trend, with health spending growing at an average of 3.8 % in 2008 and 3.5 % in 2009 [9], well above the growth rate of the gross domestic product. Health worker wages account for

© 2015 Amorim Lopes et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http:// applies to the data made available in this article, unless otherwise stated.

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