Human Resources for Health最新文献

{"title":"Addressing geographical disparities in the allocation of hospital human resources: an examination of health inequalities in Iran.","authors":"Hakimeh Mostafavi, Efat Mohamadi, Amirhossein Takian, Ahad Bakhtiari, Jawad Jafarzadeh, Alireza Olyaeemanesh","doi":"10.1186/s12960-026-01073-z","DOIUrl":"10.1186/s12960-026-01073-z","url":null,"abstract":"<p><strong>Background: </strong>Human resources are fundamental to improving both service quality and patient outcomes. Given the critical role of accurate data on workforce distribution as a key hospital resource in planning and policymaking, this study aims to assess inequalities in the distribution of hospital human resources and their association with hospital mortality rates across the provinces of Iran.</p><p><strong>Data and methods: </strong>This cross-sectional quantitative study covered 31 provinces across Iran, analyzing data from 383 districts, which represent a comprehensive national-level examination of human resource distribution in the healthcare sector. The Gini coefficient was calculated at both national and sub-national levels. Additionally, stratified analyses were conducted by region to determine whether inequalities were more pronounced in specific geographic areas.</p><p><strong>Results: </strong>The analysis of hospital human resources revealed mean physician and nurse densities of 0.34 and 1.28 per bed, respectively, with relative ratios (RR) of 0.67 and 0.80. The Gini coefficients indicated moderate inequality for physicians (0.19) and low inequality for nurses (0.10), while other staff showed intermediate values (mean 0.44, Gini 0.15). Variability across provinces was reflected in standard deviations, with the highest inequality observed in physician distribution (max Gini 0.59). These findings highlight uneven distribution patterns of hospital workforce components.</p><p><strong>Conclusions: </strong>The Gini coefficients indicate notable disparities, particularly among physicians, where some provinces experience far worse staffing levels compared to others. Targeted interventions, including incentivizing healthcare professionals to work in underserved areas and improving resource allocation models, are essential to enhance the fairness and efficiency of Iran's healthcare system.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13418774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Field Epidemiology Training Program global evaluation: application of graduates' skills.","authors":"Emily Moore, Whitney L Rémy, Lauren Courtney, Briana Lucido, Meredith Pinto, Sara Albanna, Lise Martel","doi":"10.1186/s12960-026-01055-1","DOIUrl":"10.1186/s12960-026-01055-1","url":null,"abstract":"<p><strong>Background: </strong>The Field Epidemiology Training Program (FETP) is a three-tier (Frontline, Intermediate, and Advanced) practical training that strengthens the capacity of the global public health workforce to detect and respond to epidemics. The U.S. Centers for Disease Control and Prevention (CDC) has supported the development of FETPs worldwide for over 40 years. A global cross-sectional evaluation was conducted with graduates from CDC-supported FETP Intermediate and Advanced programs to understand the application of FETP in their current job and its impact on their career progression.</p><p><strong>Methods: </strong>An online survey with Intermediate and Advanced FETP graduates was conducted from March to May 2022. Purposive and snowball sampling was used to recruit survey participants. Each participant received the survey link via email. The survey included questions on demographics, FETP competencies and functional areas, and the impact of training on career. Poststratification weights were applied based on the known proportions of the study population, and univariate and bivariate frequency distributions were calculated. Bivariate cross-tabulations for association were tested using the Rao-Schott Chi-square test of independence.</p><p><strong>Results: </strong>The sample included 1493 graduates representing CDC-supported FETP programs from 49 countries. Three-quarters graduated from the advanced program (wt. n = 1108); 82% worked on the COVID-19 response (wt. n = 1206); and 83% serve as supervisors in their current role (wt. n = 1172). Most graduates felt confident performing FETP competencies independently or as experts (87%), 71% found the competencies very or extremely relevant to their work, and 82% of those who worked on the COVID-19 response found the competencies very or extremely helpful for their response work. Most graduates reported that FETP helped them achieve their current job (87%) and career aspirations (90%) and has been helpful to the organizations for which they worked (95%).</p><p><strong>Conclusions: </strong>The FETP competencies are relevant and helpful to graduates' professional work. FETP advanced and intermediate graduates are confident performing FETP competencies, with advanced graduates and supervisors feeling more confident. Graduates see FETP as helpful for achieving their career goals and beneficial to the organizations for which they work.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study of healthcare workers' living and working conditions in rural and urban areas of Senegal in the context of Universal Health Coverage: the ANRS-12399 Soignants Senegal study.","authors":"Ousmane Diop, Clément Boutet, Kanuya Coulibaly, El Hadji Ba, Gwenaëlle Maradan, Marion Mora, Bruno Spire, Cheikh Sokhna, Luis Sagaon-Teyssier","doi":"10.1186/s12960-026-01071-1","DOIUrl":"10.1186/s12960-026-01071-1","url":null,"abstract":"<p><strong>Background: </strong>Healthcare delivery in Senegal is hindered by a limited, unequally distributed healthcare workforce, and by inadequate infrastructure which negatively impacts access to quality care and good health outcomes. Despite efforts to improve healthcare delivery through Universal Health Coverage (UHC), progress remains insufficient. We investigated the living and working conditions of Senegalese healthcare workers (HWs), specifically their representations and experiences of the implementation of UHC programs.</p><p><strong>Methods: </strong>The ANRS-12399 Soignants Senegal study focused on HWs, including community HWs, working in health posts, health centers, regional and national hospitals, located in urban and rural areas. Individual semi-structured interviews were conducted with doctors and with new (preceding 12 months) arrivals (any HR type). Instead, separate semi-structured focus groups were conducted for non-doctor HWs who had graduated in a chosen technical field (e.g., nurses) and non-graduate HWs (e.g., community HWs).</p><p><strong>Results: </strong>The sample comprised 60 HWs; median age was 34 years (IQR [29.5-37.5]). Those with administrative responsibility were more likely to have an understanding of the UHC's various programs. UHC implementation had led to debt for care structures, poorer working conditions because of a deterioration of the patient-HW relationship through unexpected out-of-pocket costs for supposedly free services, delayed salary payment, and drug stock-outs. Moreover, job tenure was shorter in rural areas and for doctors, indicating the attractiveness of urban workplaces and greater doctor mobility, respectively. Reasons for leaving rural positions included dissatisfaction because of poor recognition, limited opportunities for career development, equipment and training infrastructure shortages, distance from one's family, and the absence of financial incentives. HWs working in urban settings faced more equipment maintenance issues, but were less likely to leave their position. Different knowledge acquisition desires drove mobility to and from rural areas; seeking stable contracts motivated HWs to work in rural areas.</p><p><strong>Conclusion: </strong>HWs working in rural Senegal face greater challenges. Deciding whether to work there entails more than financial considerations. Although UHC is not the origin of HWs' poor working conditions in the country, it exacerbates them. Addressing the difficulties HWs face in rural Senegal is essential to ensure retention and better implementation of UHC's various programs.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel approaches to empowering health workforce: a scoping review.","authors":"Azam Choopani, Jalal Arabloo, Soudabeh Vatankhah, Seyed Hasan Arkian","doi":"10.1186/s12960-026-01079-7","DOIUrl":"10.1186/s12960-026-01079-7","url":null,"abstract":"<p><strong>Background: </strong>The development of health workers is crucial for achieving national and global health objectives. This study aims to identify novel methods and approaches for empowering the health workforce through in-service training.</p><p><strong>Methods: </strong>A scoping review was conducted following the Arksey and O'Malley framework in five steps. A comprehensive search was performed in three databases-PubMed, Web of Science, and Scopus-using MeSH terms and keywords until December 4, 2022. The study utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to carry out the investigation and present the results.</p><p><strong>Results: </strong>A total of 3257 articles were retrieved, of which 34 articles were included in the scoping review. The majority of the articles (n = 23, 68%) were published between 2018 and 2022, with physicians being the primary target group (n = 16, 47%). Most studies employed a combination of several methods, with simulation methods, virtual training, practical and field training, coaching, group interaction, flipped classrooms, case studies, peer experiences, teaching through surveys and research, small group training, and problem-solving approaches being the most commonly used strategies.</p><p><strong>Conclusion: </strong>Implementing innovative training methods to empower healthcare personnel enhances skills, improves training effectiveness, and ultimately leads to better performance and the delivery of higher-quality healthcare services.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13348792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health workforce planning models for older adults in the WHO Eastern Mediterranean Region: a mixed methods systematic review.","authors":"Salim Ahmed Alshehri, Lucy Simmonds, Angie Shafei, Fany Indriyani, Mohammed Khaled Al-Hanawi, Madhan Balasubramanian","doi":"10.1186/s12960-026-01077-9","DOIUrl":"10.1186/s12960-026-01077-9","url":null,"abstract":"<p><strong>Background/objective: </strong>As the population across the World Health Organization Eastern Mediterranean Region (EMR) ages, healthcare systems are increasingly strained by the rising burden of non-communicable diseases and the growing demand for chronic geriatric care. Effective health workforce planning is essential to address these evolving needs. However, limited evidence exists on the applicability of workforce planning models tailored specifically to older adults in the EMR. The purpose of this review is to examine current models and strategies in health workforce planning for older adult care in the EMR, with a focus on regionally tailored, financially sustainable, and policy-relevant solutions.</p><p><strong>Methods: </strong>A mixed methods systematic review following JBI methodology was conducted. Five databases (MEDLINE, Embase, Scopus, CINAHL, and Web of Science) were searched for English-language qualitative, quantitative, and mixed-methods studies examining workforce planning models relevant to older adults' care in the EMR. The review focused on identifying approaches to workforce supply, demand and needs forecasting, competency development, retention, and financial sustainability in healthcare systems. The data were synthesized using a convergent integrated approach and the included studies were assessed for quality using the QuADS tool.</p><p><strong>Results: </strong>Among the total 1152 records identified, 11 studies met the inclusion criteria, covering four EMR countries (Iran, Lebanon, Jordan, and Saudi Arabia) across three healthcare settings. The key findings highlighted persistent shortages in geriatric, rehabilitation, and chronic disease specialists; limited use of forecasting models; and insufficient professional development opportunities. Major barriers included health professional migration, poor working conditions, and financial instability. Critical enablers included integrated supply-and-demand forecasting, competency-based training, and retention strategies such as improved remuneration, career progression, and supportive work environments. Financial sustainability was highlighted as a cross-cutting concern.</p><p><strong>Conclusion: </strong>This review highlights the urgent need for regionally adapted data-driven workforce planning models that integrate forecasting, competency development, and retention strategies to meet the care demands of aging populations in the EMR.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13348860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with health care provider performance: a systematic review and meta-analysis.","authors":"Khalid Alkhurayji, Farah Kalagi, Hessah Alsuwaidan, Saja A Alrayes, Arwa Alumran, Sulaiman Bah","doi":"10.1186/s12960-026-01076-w","DOIUrl":"10.1186/s12960-026-01076-w","url":null,"abstract":"<p><strong>Background: </strong>Workers' health in business operations and healthcare delivery is paramount with various factors, significantly impacting performance and quality of care. Therefore, this systematic review and meta-analysis aimed to explore the intricate factors influencing the performance of healthcare providers.</p><p><strong>Methods: </strong>Searches were conducted in the PubMed, Web of Science, and Google Scholar databases from 1 January 2000 to 1 January 2024. A standardized form was used for data extraction of the characteristics of the studies, outcomes, and risk of bias. The identification and selection process is reported according to PRISMA guidelines. The meta-analysis was performed using Jamovi software (with major meta-analysis packages, version 2.4.14). The analysis was carried out using the Fisher r-to-z-transformed correlation coefficient as the outcome measure with a random-effects model fitted to the data.</p><p><strong>Results: </strong>The search strategy yielded 6136 studies from multiple databases, and according to the exclusion and inclusion criteria, only 61 studies were eligible for qualitative synthesis and 37 for meta-analysis. Among these studies, there was a predominant focus on hospital settings, with 43 studies, and Asia had the most studies. A meta-analysis investigated the relationship of the associated factors that influence healthcare professionals' performance in a total sample size of 24,419. The estimated average correlation coefficient based on the random effects model was 0.2370 (95% CI 0.0745-0.3995). Training, stress, workload, and organizational culture were the most commonly mentioned factors influencing healthcare providers' performance.</p><p><strong>Conclusion: </strong>The relentless demands of healthcare can take a toll on providers' physical and mental health. Actionable intervention through organizational policies and procedures, continuous development programs, and supportive workplace environments can improve healthcare provider performance and ultimately improve the healthcare services. Performance can be preserved, improved, or optimized by improving these aspects that can positively impact the entire healthcare system.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming healthcare: evaluating a decade of postgraduate training at the Liberia College of Physicians and Surgeons.","authors":"Juul Marlies Bakker, Douglas Weru Nyaguthii, Benetta Collins Andrews, Philderald Pratt, John Mulbah, Alex J van Duinen, Hakon Angell Bolkan","doi":"10.1186/s12960-026-01081-z","DOIUrl":"10.1186/s12960-026-01081-z","url":null,"abstract":"<p><strong>Background: </strong>Postgraduate training in Liberia was commenced in 2013 under the Liberia College of Physicians and Surgeons (LCPS). Since its inception, 125 medical doctors have specialized in seven disciplines: internal medicine, pediatrics, surgery, obstetrics and gynecology, family medicine, ophthalmology and psychiatry. This study evaluates the outcomes of a decade of postgraduate training in Liberia.</p><p><strong>Methods: </strong>An online questionnaire was distributed to all graduates, collecting data on demographics, work history, motivation, self-assessed competencies, and training experiences, including examinations, research and feedback. Descriptive analysis was used to calculate response frequency distributions for quantitative outcomes, and thematic analysis was used for open answer responses.</p><p><strong>Results: </strong>Ninety graduates (72.0%) responded to the questionnaire. All respondents worked in Liberia, with 56.3% in Montserrado County. Most (94.4%) were primarily employed in the public sector, whereas 21.1% held additional roles in the private sector or academia. After 3 years of membership-level postgraduate training to become a specialist, 30.0% pursued additional education, including 18.9% fellowship training. Overall, graduates expressed strong confidence in competencies gained during the postgraduate training, particularly medical knowledge, professionalism and teaching, with over 95% of graduates considering themselves competent in these areas. In contrast, only 44.3% felt competent in research. Nearly all graduates reported that the training supported their career growth and would recommend it to colleagues. Suggestions for improvements included increasing faculty numbers and diversity, enhancing training resources, and expanding research opportunities.</p><p><strong>Conclusions: </strong>The LCPS has contributed substantially to developing a competent specialist health workforce in Liberia. Graduates had a high retention rate and were primarily employed in clinical roles in the public sector. Challenges remain, such as too few specialists and limited healthcare coverage in rural areas. To train well-equipped specialists, it is crucial to strengthen faculty, institutional capacity and training resources, and to build research capacity. Sustained investment and continued collaborations between the government and partners are needed to implement strategies to maintain retention and improve equitable distribution of specialists and to support their career growth. These efforts will ensure the program's impact to meet Liberia's evolving healthcare demands effectively.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the gap: disparities in perceptions of the \"second victim\" phenomenon between Israeli policymakers and frontline nurses.","authors":"Rinat Cohen, Rachel Nissanholtz-Gannot, Yael Sela","doi":"10.1186/s12960-026-01078-8","DOIUrl":"10.1186/s12960-026-01078-8","url":null,"abstract":"<p><strong>Background: </strong>The \"second victim\" phenomenon (SVP) refers to healthcare providers who experience profound emotional and physical distress following adverse patient events. This phenomenon is a significant driver of burnout and can severely compromise both professional functioning and patient safety.</p><p><strong>Objective: </strong>This study aims to investigate the specific disparities in perceptions between policymakers and frontline nurses regarding the SVP within the Israeli healthcare system.</p><p><strong>Methods: </strong>Thirty in-depth interviews were conducted: 15 with policymakers and 15 with nurses who had firsthand experience as second victims. A convenience sampling method was used for both groups. Data were synthesized and analyzed using comparative thematic synthesis.</p><p><strong>Results: </strong>The findings revealed profound and pervasive perceptual gaps across several key domains. First, policymakers often restricted the definition of SVP to critical medical errors, whereas nurses perceived it broadly, irrespective of actual outcomes. Second, while policymakers viewed the phenomenon as rare and transient, nurses consistently reported it as an enduring occupational challenge with deep personal impact. Third, organizations predominantly offered reactive support, which stood in stark contrast to the nurses' preference for proactive and routine assistance.</p><p><strong>Conclusion: </strong>Significant perceptual gaps exist between Israeli policymakers and nurses regarding SVP. Addressing these disparities is crucial for developing proactive support policies, ultimately fostering provider well-being and enhancing the overall quality of patient care.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can financial retention incentives slow health worker migration? PPP-adjusted salary differentials in Zimbabwe's donor-dependent health system.","authors":"Gavin George","doi":"10.1186/s12960-026-01074-y","DOIUrl":"10.1186/s12960-026-01074-y","url":null,"abstract":"<p><strong>Background: </strong>Large-scale migration of health workers from low-income countries continues to undermine health system capacity, particularly in contexts characterised by fiscal constraint and donor dependence. While retention incentives are widely used to mitigate attrition, their ability to offset international wage differentials remains contested. Zimbabwe provides a salient case, having implemented a long-standing Health Worker Retention Scheme (HWRS), largely financed by external partners, to stabilise critical cadres within the public health sector. This study aimed to quantify PPP-adjusted international salary differentials for selected Zimbabwean health worker cadres and to assess the extent to which donor-financed retention incentives narrow these gaps.</p><p><strong>Methods: </strong>This was a cross-country comparison of annual remuneration for three cadres: professional nurses, medical officers, and medical specialists, using a purchasing power parity (PPP) framework. Salaries in Zimbabwe, South Africa, the United Kingdom, and the United States were compiled from official public-sector pay schedules and adjusted using International Comparison Program (ICP) 2021 PPP conversion factors. Zimbabwean salaries were analysed under three scenarios: base salary; base salary plus USD-denominated Government of Zimbabwe (GOZ) allowances; and total remuneration including GOZ allowances and Global Fund-financed HWRS top-ups. PPP-adjusted salary gaps were calculated relative to Zimbabwean health workers' base salary.</p><p><strong>Results: </strong>Combined USD-denominated Government of Zimbabwe allowances and Global Fund-financed HWRS top-ups substantially increased PPP-adjusted salaries across all cadres, more than doubling remuneration for medical officers and specialists and nearly tripling earnings for nurses. Despite these increases, PPP-adjusted salaries in South Africa, the United Kingdom, and the United States remained several multiples higher than those in Zimbabwe.</p><p><strong>Conclusion: </strong>Combined domestic and donor-financed retention incentives meaningfully improve Zimbabwe's relative salary position but do not fundamentally alter the international remuneration gradient that underpins health worker migration. In donor-dependent health systems, such schemes function as stabilising mechanisms rather than long-term solutions. Sustainable retention will require complementary strategies addressing career progression, working conditions, and the global governance of health worker mobility.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From implementation to learning: a process-oriented framework to evaluate innovative global health capacity building in fragile and conflict-affected settings.","authors":"Shadi Saleh, Rim Alaeddine, Tracy Daou, Nisrine El-Hadi, Rania Mansour, Hady Naal","doi":"10.1186/s12960-026-01075-x","DOIUrl":"10.1186/s12960-026-01075-x","url":null,"abstract":"<p><strong>Background: </strong>Global Health Capacity Building (GHCB) initiatives are central to strengthening health systems and workforce readiness in Fragile and Conflict-Affected Settings (FCAS). While many evaluation frameworks exist, most were developed for stable contexts and offer limited guidance on how to adapt evaluation processes to environments rife with political instability, limited infrastructure, population mobility, and rapidly shifting conditions. As innovative learning modalities, such as online and blended learning modalities expand in FCAS, there is a critical need for evaluation approaches that are context-responsive, process-oriented, and tailored to fragile settings.</p><p><strong>Method: </strong>This paper presents the Evaluation of Capacity Building (eCAP) framework, an evidence-informed framework for evaluating GHCB in FCAS. The eCAP framework was developed through a 5-year iterative process by the Global Health Institute at the American University of Beirut, as informed by 3 sequential phases: (1) 3 systematic reviews exploring evaluation methods for GHCB in low- and middle-income countries and in the MENA region; (2) evaluation of 5 case studies implemented in the region; and (3) a synthesis of outcomes and process-related results between 2019 and 2024.</p><p><strong>Results: </strong>The eCAP framework conceptualizes the evaluation lifecycle in FCAS as a dynamic and adaptive process across three interconnected phases: (1) understanding the program (modality, population, context, level of evaluation, and program logic); (2) implementation (logistics, recruitment, engagement, tool selection, and timing of data collection), and (3) analysis, feedback, and learning. Without prescribing standardized indicators, the framework emphasizes decision-making principles for evaluation that enable adaptation to contextual constraints and other field-based realities. The framework is useful for diverse FCAS, and it has demonstrated feasibility and utility in capturing short-to-medium term outcomes while preserving methodological rigor under challenging and unstable conditions.</p><p><strong>Conclusion: </strong>The eCAP framework addresses a key gap in the evaluation of GHCB initiatives in FCAS by offering a structured yet adaptable approach grounded in ample field-based evidence. The framework provides practical guidance for researchers, implementers, and funders seeking to design and evaluate capacity building initiatives in complex humanitarian environments. Ultimately, this framework has implications for strengthening evaluation practices, improving programmatic learnings, and guiding policy and funding decisions related to capacity building in FCAS.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}