Identification of priority research questions in three thematic areas: human resources for health, health financing and the role of the non-state sector

Identification of Priority Research Questions Related to Health Financing, Human Resources for Health, and the Role of the Non-State Sector in Low- and Middle-Income Countries of the MENA Region

This paper presents the results from a recent research priority exercise that identified regional policy concerns and research priorities related to three themes that encompass a wide range of health system issues in the region. Specifically, the objective of this exercise was to identify policy concerns and rank research priorities related to health financing, human resources and the non-state sector as perceived by policy-makers, researchers and academics, health professional groups, non-governmental organizations, and civil society representatives in nine low- and middle-income countries (LMICs) of the Middle East and North Africa (MENA) region. The eight countries included in this study are: Algeria, Egypt, Jordan, Lebanon, Morocco, Syrian Arab Republic, Tunisia and Yemen. West Bank and Gaza Strip is also included.

Health financing
Health financing and delivery mechanisms have serious consequences on the health of populations. The way health systems are financed has important implications on access to health care services, equity, efficiency, quality of care and on health outcomes. Most LMIC countries in the MENA region have mixed systems of health care financing, including tax-based through government budget, contributory systems and private spending. Health care coverage by social health protection in these LMICs remains limited. Financial barriers to access and the rise in out-of-pocket spending, accompanied by the slow growth of pre-payment schemes in the form of social and private health insurance, have increased inequities in health care financing, exposing large segments of the population to catastrophic health care expenditures.

Human Resources for Health
The lack of explicit strengthening of human resources for health (HRH) policy, planning and management has been identified as an important reason for the failure of past attempts to reform health systems. The nine LMICs in the region lack sound HRH policies, have poor planning, limited capacity of educational and training programs and inefficient management of HRH. The region has the second lowest HRH density (with sub-Saharan Africa the lowest) among the six administrative regions of the WHO (WHO 2006). A recent study found that while HRH can improve population health indicators, it cannot be considered in isolation of socio-economic factors (such as education, poverty, income etc.), which also exert an effect on the health of the population (El-Jardali et al., 2007 (a)). In fact, the HRH shortage is more complex than a simple imbalance in supply and demand. Some issues hindering HRH development in the MENA region include outright worker shortage, an inappropriate skills mix, underemployment, geographic maldistribution, and poor work environments.

The role of the non-state sector
In several MENA countries, there has been a significant increase in the number and scope of operations of non-state providers. This is primarily due to the weak capacity of the state to provide comprehensive health care services that are responsive to population needs. The blurry boundaries and lack of clarity on role, responsibilities and accountabilities between the state and non-state sector have created critical challenges to LMICs in the region.


Project description

Programme: Identification of priority research questions in three thematic areas: human resources for health, health financing and the role of the non-state sector

Research title: Identification of Priority Research Questions Related to Health Financing, Human Resources for Health, and the Role of the Non-State Sector in Low- and Middle-Income Countries of the MENA Region

Thematic Research Area: Cross-cutting

Grantee Country: Lebanon

Grantee Institution: Middle East and North Africa Health Policy Forum

Program Coordinator/Principle Investigator: Dr. Fadi El-Jardali

Start date: May 2007

Status of grant: Completed in March 2008

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