Costing the Scaling-Up of Human Resources for Health : Lessons from Mozambique and Guinea Bissau

In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce Sub Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of advice and examples on how to conduct HRDP costing that can be found in the literature. Also, global initiatives have been launched recently to standardise costing methodologies and respective tools. The present paper reports the experience on HRDP costing in Mozambique and Guinea Bissau, with the objective to provide empirical examples and to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their context, policy process and actors involved. From the analysis of the two cases, it emerged that the costing exercise represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. Bottom-up and country-specific methods were designed to overcome the countries’ lack of cost and financing data, as well as to interpret their financial systems. Such approach also allowed the costing exercise to feed directly into the national planning and budgeting process. The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments’ dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the exercise, and reduce the benefits of the costing exercise for policy negotiation within the HRDP elaboration process