| BackgroundHealth workforce is an important part of the health system, plays an active role in promoting the sustainable development of health services and improving the healthy level of people. At present, the world is facing a severe health workforce crisis, mainly manifested in the aspect of quantity, distribution and quality. Every country has taken a variety of policy measures in response to the crisis, related studies were carried out widely. On this basis, and with the development of evidence-based medicine, systematic reviews of different kinds of HRH(Human Resources for Health) policies have also been carrying out, providing a scientific method to synthesize the evidence of original researches. The content and the quality of these systematic reviews are related to the integrity and reliability of the evidence they provide. Therefore, along with the rising number of such systematic reviews, using the method of "overview" to integrate the content and to evaluate the quality of them can make the evidence more concentrated and reliable. So, health managers and decision makers can use the evidence more convenient.Currently, with the health care reform deepening in our country, the people’s health demand also improving constantly. Then, it is becoming more and more important to further improve the quantity and quality, and to promote the comprehensive, coordinated and sustainable development of health workforce. Therefore, using the method of "overview" to integrate the content and to evaluate the quality of the systematic reviews of HRH policies has a vital significance for the development or improvement of relevant policies.ObjectivesThe aim of this study is to carry out an overview of the systematic reviews of HRH policies, and to assess the methodological quality of these systematic reviews, thus to provide a comprehensive and reliable decision basis. The specific objectives include: to learn about the research status and characteristics of the systematic reviews of HRH policies; to assess the methodological quality of these systematic reviews, and to detect problems in each aspect; to summarize the HRH problems and policies and their effects; to provide implications for decision makers for the development or improvement of relevant policies.MethodsAccording to the study purpose, we made a criteria of inclusion and a searching strategy, then a literature search was conducted in both English and Chinese databases and relevant websites such as PubMed, the Cochrane Library, CNKI, WHO. The searching time is from the earliest collecting date to October2013; In addition, relevant journals and references were also searched for supplementation. The criteria were applied at the selection of studies, and only systematic reviews of HRH policies were included. Using the adjusted AMSTAR to assess the methodological quality of these included reviews, and analyze the appropriateness of the methodology. Using a data extraction table to extract key information of these systematic reviews, and summarize the HRH policies and their effects. In order to guarantee the objectivity and scientificity of the entire process, every step above were operated by at least two researchers independently. If there were some disagreements, they reached consensus through discussion.ResultsThere are80systematic reviews included in this overview. Although there is no restriction in study setting in most reviews, but the original studies included in them are from the developed countries.The overall methodological quality score of these systematic reviews is ranging from3to10.5points and the average score is7.169±1.779points. In each item, it is better in the databases searching, characteristics describing, and outcomes combining, But worse in the protocol designing, status of publication considering, and publication bias assessing.The HRH policies included in these systematic reviews can be divided into3categories:education and training, organization and management, and personnel supporting. Many different strategies are also included in each kind of policy. All kinds of these policies brought about positive effects in relieving the problems of quantity, distribution and quality. Among them, task shifting, in-service training, and directed education are used more often and their effects are clearer and better.ConclusionsThe overall methodological quality of these systematic reviews is better, but there are still some limitations in the aspects of designing protocol, considering the status or language of publication, and assessing the publication bias. These weaknesses may lower the scientificity, objectivity, and reliability of the process and outcomes. The content of these systematic reviews is extensive, including policies of education and training, organization and management, and personnel supporting. These HRH policies may have positive impact on some aspects of the quantity, distribution and quality problems of health workforce. However, because of the original studies in most systematic reviews are from the developed countries, so in developing countries, when using the same policy, they must take into account their social background and other factors, and make a cautious decision.ImplicationsStrengthen the coordinated development of the scale and quality in the education of medical students. Formulate a series of related supportive policies to supplement the policy of directed education.Try to use the combination of task shifting and in-service training strategies in primary health institutions.Take a full consideration of the applicability and the implementation environment before adopting some policies. |
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