Table 2.
Level | Constraint | Estimated size of the constraints in the context of scaling-up in low- and middle-income countries |
Individual characteristics | ||
Gender | ++ | |
Social class and ethnicity of staff | +++ | |
Demand for medical training | + | |
Disease* | ++ | |
Health service level | ||
Team building and interaction | ++ | |
Surpluses, shortages and skill mix at health service level | ++ | |
Physical working environment | + | |
Health sector level | ||
Salary level and monetary incentives | ++ | |
Performance management and productivity | +++ | |
Composition of workforce and skill mix | ++ | |
Geographical imbalances | +++ | |
Retention policy | ++ | |
Health sector reform | ++ | |
HRH policy | +++ | |
Training capacities | ||
Initial training | +++ | |
Re-training | +++ | |
Sociopolitical and economic context of a country | ||
Multisectoral approaches | ++ | |
Migration | ++ | |
Governance and overall policy framework | +++ |
* Heavily influenced by the epidemiological situation of HIV/AIDS for a given country +++ = very important; ++ = important; + = moderate