Strengthening systems of emergency healthcare is crucial to achieving global and national health goals. One of the key challenges in improving emergency care systems is the insufficient attention given to human resources for health (HRH) tasked with delivering this care. The intersection of emergency care policy and systems, human resources and health equity is an underdeveloped area of research and practice. In this project, we used HRH frameworks to conduct an exploratory and comparative mapping of emergency healthcare workforce policy and systems in four countries—Canada, Australia, Rwanda and South Africa—and to explore its intersection with health equity. We conducted a mapping exercise drawing on published peer-reviewed and grey literature (n=209), supplemented by expert consultations (n=8) in Rwanda given limited published literature in that context. We analysed these data using conceptual frameworks on HRH, particularly one framework that focused on HRH and health equity. Our findings suggest persistent limitations in the translation of equity principles into actionable HRH strategies for emergency care across all four contexts. Governance fragmentation for emergency care workforces was common, with responsibilities for workforce training, distribution, regulation and retention split among multiple governmental and non-governmental actors, typically without any high-level oversight of equity-related outcomes. The comparative nature of this project facilitated an exploration of labour market interdependencies across the countries, such as the impact of burnout and attrition in fuelling international migration of emergency care workers. Further research, analysis and policy attention is needed to understand the intersection of emergency care, workforce policy and systems, and health equity, and that comparative research has an important role to play in surfacing key learnings at the national and global level.
Sriram et al. (Thu,) studied this question.