Decentralising health workforce management in China and South Africa

Decentralising health workforce management may help local services to coordinate and plan their human resources more effectively to meet health care needs.

Health sector decentralisation in China and South Africa is complex, with different forms being implemented within varying timescales and for different purposes. In China decentralisation has taken place alongside the transition to a market economy, whilst post-apartheid South Africa is attempting to establish a new district health system.

In the Xinlou and Liancheng counties of China’s Fujian Province human resource planning, recruitment and selection, staff performance management and training are all decentralised, though in some cases control has been regained by higher levels of governance. Human resource planning is influenced by the need for health institutions to generate income, and in some cases this may be detrimental to wider health service objectives.

In the Alfred Nzo District of South Africa’s Eastern Province, the performance management and training functions are partially decentralised. However, local decision-making regarding human resource planning has been overtaken by higher level staffing initiatives.

In both countries decentralisation allows managers to manage their workforce better, though in some cases – particularly in China – this is to meet organisational objectives as opposed to broader health service objectives. In some cases managers are frustrated as authority is either not fully decentralised or sometimes withdrawn.

The complexity of several forms of decentralisation happening simultaneously means managers, particularly in China, are not prepared or supported in their new roles. There is a need for better planning, capacity development, and monitoring of the process of decentralising human resource management and the impact of decisions made by newly empowered managers. Recommendations include:

• Putting human resources management clearly on the agenda of decentralisation reforms at an early stage.
• Developing clear strategies for decentralising human resources management, including deciding what, how and when functions should be decentralised.
• Developing a system to monitor both processes of decentralisation – to ensure that adequate preparation and support is provided – as well as the impact on both human resources and the achievement of wider health system objectives.

Tim Martineau
Liverpool School of Tropical Medicine
Pembroke Place
Liverpool L3 5QA
UK
T +44 (0) 151 705 3194
F +44 (0) 151 705 3364
T.Martineau@liv.ac.uk

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