This book was produced to support the policy dialogue on Human Resources for Health (HRH) in Ghana. Despite some recent successes, further improvements in health outcomes are in part hampered by the lack of skilled service providers, or human resources for health (HRH), particularly in rural areas, that prevent critical health services from being accessed and adequately delivered to those that need them most. To address the lack of information to guide the development of policies and programs on HRH, the book aims to paint a comprehensive picture on HRH, consolidating new and existing evidence on stock, distribution and performance of health workers to focus on the "what", as in "What is the situation on HRH?" and the "how", as in "How is this situation explained?" . The book highlights in particular new evidence on some of the underlying determinants impacting stock, distribution and performance of health workers in Ghana, including health worker production and attrition, management and accountability structures, the capacity of health training institutions, and health worker compensation. As is made clear, any potential policies to improve the situation on HRH need to be well targeted, and take into account some of the fiscal and political challenges that are specific to the health labor market in Ghana. The data and findings presented in this book are the result of extended and close collaboration between the Ghana Ministry of Health, and the World Bank's Africa Region Technical Team on HRH and will provide a better basis for Ghanaian decision makers and external partners to dialogue on HRH and related policies, resulting in concrete HRH actions. More broadly, it will be of interest to all those working to improve Human Resources for Health in Africa and beyond.

The human resources crisis in the health sector has been gathering attention on the global stage. To date, however, most of this attention has focused on shortages of health human resources (HRH) at the national level. At least as important are problems at the sub-national level. Massive geographic and skill mix imbalances are reflected in the perilous undersupply of HRH in most rural areas. Virtually all Sub-Saharan African countries suffer from significant geographic imbalances. Very little substantive information or documentation exists on the problem. Even less is known about the lessons from policies aimed at addressing urban-rural human resource imbalances, let alone experiences of Sub-Saharan Africa countries, with such policies. There also appears to be a disconnect between the objectives and efforts of policymakers on the one hand and the functioning of national health labor markets and labor market behavior on the other hand. This disconnect hinders policy effectiveness and the efficient utilization of resources intended to narrow urban-rural inequities. In Sub-Saharan Africa government policies, often limited to the management of public sector vacancies, appear to be elaborated, prescribed, and implemented independently of labor market considerations. Partly as a result, they are unable to effectively address urban-rural imbalances, which are an outcome of labor market dynamics. This report discusses and analyzes labor market dynamics and outcomes (including unemployment, worker shortages, and urban-rural imbalances of categories of health workers) from a labor economics perspective. It then use insights from this perspective as a basis for elaborating policy options that incorporate the underlying labor market forces. The goal of the study is to address undesirable outcomes (including urban-rural HRH imbalances) more effectively. The book is thus suitable for researchers, policy analysts and policy makers with an interest in understanding and improving the allocation of human resources for health in the developing world.