Human resources: the Cinderella of health sector reform in Latin America

Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside

Using the TUNGSTEN approach to co-design DataDay: a self-management app for dementia

This chapter briefly describes a co-design project with people living with dementia, family care partners and clinical teams to create DataDay—a self-management app with an accompanying memory services portal. The project utilised the Tools for User Needs Gathering to Sustain Technology ENgagement (TUNGSTEN) approach of working with the users of technology as experts. Over seven months, four interactive sessions took place examining interactions with smart devices, current device and app use, and prototyping the DataDay interface and portal. This chapter focuses on the co-design sessions with people living with dementia and family caregivers and illustrates the benefits of the TUNGSTEN approach for co-designing with this population