Human resource for health policy interventions towards health sector reform in a Zimbabwean peri-urban community: A Decision Space Approach

Background: Human Resources for Health (HRH) are important towards attainment of the health sector reform goal of universal health coverage in resource-constrained health systems. We used the Decision Space Approach to analyse decision space, innovation, and change in HRH reform policy interventions in Epworth, a peri-urban community in Zimbabwe. Methods: The study design was exploratory and cross-sectional. In this, we firstly explored the healthcare worker reform policy at the principal level to determine the main policy result areas. Findings enabled us to develop an HRH Decision Space Mapping Analysis Conceptual Tool consisting of six main policy result areas. We then used it to analyse decision space, innovation, and outcomes towards healthcare worker reform at the agent level in Epworth. Interpretive thematic analysis and descriptive statistics were used to facilitate analysis. Findings: Narrow decision space and functional innovation in the context of moderate decision space helps not only initiate healthcare worker reform interventions but also mitigate local incapacities to sustain the process. Future research may adopt the Conceptual Tool developed to facilitate analysis of decision space, innovation, and outcomes in local health systems focusing on the six policy result areas towards the health system reform goal of universal health coverage.