Health leaders and managers report that they are mired in
layers of civil service rules, highly centralized and fragmented
HR management systems, poor incentives, underuse
or misuse of existing staff, and external pressure to
diminish social-sector expenditure. Managers in many
countries say that the leadership to address these issues is
lacking. There are pilot projects and examples of effective
HR solutions at the country level, but HR directors and
policymakers need a new way of thinking about leading
and managing to sustain these positive results and scale
them up. Health managers at a recent HR leadership meeting
in Southern Africa described their problems as follows:
"We are certainly weakest at implementing. We
agree on weekly, monthly, and quarterly activities – but at
the end of the day almost nothing gets done....