Human Resources for Health and Universal Health Coverage: Fostering Equity and Effective coverage/Ressources Humaines Pour la Sante et la Couverture Sanitaire Universelle: Promouvoir L'equite et Une Couverture efficace/Los Recursos Humanos Para la Salud Y la Cobertura Sanitaria Universal: Como Fomentar Una Cobertura Eficaz Y Justa

Introduction In December 2012, the United Nations General Assembly called upon all governments to "urgently and significantly scale up efforts to accelerate the transition towards universal access to affordable and quality healthcare services". (1) The evolving momentum for universal health coverage (UHC), with its principles of equity and social justice, aims to ensure that all members of a society can access the health-care services they need without incurring financial hardship. (2,3) UHC encompasses the three dimensions of who is covered (population coverage), what is covered (health-care benefits) and how much of the cost is covered (financial protection), all of which may expand over time. (4) Addressing these three dimensions of UHC (5-7) within the boundaries of fiscal space (8) challenging for all countries. It requires continuing political commitment and leadership to distribute available resources, especially human resources for health (HRH), (9) in an efficient, equitable and sustainable manner to match population needs. Overcoming the inequitable distribution of services is particularly critical. (10) High-, middle--and low-income countries alike are facing fundamental health challenges stemming from demographic changes, ageing populations, the growing burden of non-communicable diseases and emerging public health threats such as drug-resistant malaria, tuberculosis and pandemics. Several countries of the Organisation for Economic Co-operation and Development (OECD), hit by the global financial crisis, are revisiting health benefits, coverage and protection--either to reaffirm commitments or cut services. (11) In low--and middle-income countries, other evolving dynamics will shape efforts to achieve UHC, including epidemiological transitions, (12) economic growth, increased health expenditure and diminishing international health aid--or its reprioritization. (13-15) In the next decade, an increasing number of African and Asian countries will become able to finance essential health services from domestic resources and will then face critical decisions on how to invest these funds most effectively to accelerate progress towards UHC. (16) The health workforce is central to a country's response to these challenges. Reaching a greater percentage of the population, extending the benefit package and improving the quality of the care provided requires commensurate attention to the governance and management of the health-care workforce, including its stock, skill mix, distribution, productivity and quality. Matching population health needs with a supply of competent and motivated health workers that are both fit for purpose and fit to practise in the country context is therefore the foundation for accelerating the attainment of UHC. Case studies: methods and findings This paper explores the HRH policy lessons from four countries--Brazil, Ghana, Mexico and Thailand (Table 1) --purposefully selected for having achieved sustained improvements in accelerating progress towards UHC since 1990. (7) Part of their success lies in the policy focus on the health workforce to expand population coverage and the health benefits package. The paper reviews the available literature on the impact of HRH policy to identify the key actions and lessons that support accelerated progress towards UHC, with special attention to "effective coverage" and equity. By effective coverage we mean the proportion of people who have received satisfactory health services relative to the number needing such services. (19.20) We focus on maternal and neonatal health--areas in which comparative data are widely available, given that measuring effective coverage of UHC within and across countries is feasible by establishing "tracers" or a subset of activities indicative of overall service quality and quantity. (21) We use an analytical framework (Fig. 1) specifically adapted from the UHC "cube" (4)--integrating Tanahashi's health coverage model and the right to health (2,19,22)--to characterize the dimensions of effective coverage: availability, accessibility, acceptability, utilization and quality. …