The World Health Report important part of such a balance is to ensure that there are individual incentives to invest in human capital in the form of improved earnings, career opportunities and working condi- ions. Indeed, many low and middle income countries have increased pay or benefits as a key strategy for developing human resources and improving delivery of services to meet health needs and priorities(7). Public sector pay in Uganda rose by 900%(in nominal terms)between 1990 and 1999, which represents a doubling in real terms(8) In general there are no easy answers in the area of human resources development. Left unmanaged, human skills markets take years, even decades, to respond to market signals And, unlike physical capital, human resources cannot be scrapped when their skills no longer needed or obsolete; even laying off public sector health workers is often so diffi- cult that it can only be achieved as part of a broader policy to reform the civil service Public intervention to produce the required balance is thus essential to reduce waste and accelerate adjustment. Some successful experiences are summarized below but many problems remain(7) utilization levels, mix and distribution. The relative prices of different skill categories should guide decisions about their most efficient mix, where labour markets are function ing. There are no absolute norms regarding the right ratio of physicians or nurses to popu lation; rules of thumb are often used. Generally, shortages or ov the basis of need and priorities combined with comparisons with neighbouring countries or those at a similar level of development. Such assessment requires sou available human resources and their geographical and professional distribution: such in- formation is often lacking In Guinea-Bissau, 700"ghost "workers were removed from the payroll of the Ministry of Finance, following an inventory of the health care workforce. Cambodia's 1993 survey of health workers revealed a poorly distributed and largely unreg- istered workforce, with widely differing competencies(2) Three types of human resource strategy have been pursued with some success making more efficient use of available personnel through better geographical greater use of multiskilled personnel where appropriate; ensuring a closer match between skills and functions The latter strategy responds to a widespread problem. Formal training of health work ers, particularly for more highly skilled staff, too seldom reflects the actual tasks being per- formed. This is both wasteful and demoralizing ome success has been recorded with mandatory service and multiple incentives(fi nancial, professional, educational, etc. )to make otherwise unattractive technical or geo- graphical areas more appealing, as has been done in Canada and the Scandinavian countries to deploy staff in their northern regions. Countries such as Fiji, Oman and Saudi arabia have successfully recruited foreign workers to fill critical gaps, as an interim strategy. This strategy can, however, create other difficulties and tensions. Oman at present has a policy to recruit primarily a domestic workforce, as the pool of potential medical students has Intake training and continuing education. a clear case can be made for strong public sector involvement in training and in monitoring the quality of continuing education to stimulate the development of human resources in targeted areas. New public health schools have recently been established in Hungary and Jamaica to meet needs for professionals with skills in epidemiology, statistics, management and health education. They aim to inte- grate initial formal training, subsequent continuing education, and actual service provision80 The World Health Report 2000 important part of such a balance is to ensure that there are individual incentives to invest in human capital in the form of improved earnings, career opportunities and working condi￾tions. Indeed, many low and middle income countries have increased pay or benefits as a key strategy for developing human resources and improving delivery of services to meet health needs and priorities (7). Public sector pay in Uganda rose by 900% (in nominal terms) between 1990 and 1999, which represents a doubling in real terms (8). In general there are no easy answers in the area of human resources development. Left unmanaged, human skills markets take years, even decades, to respond to market signals. And, unlike physical capital, human resources cannot be scrapped when their skills are no longer needed or obsolete; even laying off public sector health workers is often so diffi￾cult that it can only be achieved as part of a broader policy to reform the civil service. Public intervention to produce the required balance is thus essential to reduce waste and accelerate adjustment. Some successful experiences are summarized below but many problems remain (7). Utilization levels, mix and distribution. The relative prices of different skill categories should guide decisions about their most efficient mix, where labour markets are function￾ing. There are no absolute norms regarding the right ratio of physicians or nurses to popu￾lation; rules of thumb are often used. Generally, shortages or oversupply are assessed on the basis of need and priorities combined with comparisons with neighbouring countries or those at a similar level of development. Such assessment requires sound data about available human resources and their geographical and professional distribution: such in￾formation is often lacking. In Guinea-Bissau, 700 “ghost” workers were removed from the payroll of the Ministry of Finance, following an inventory of the health care workforce. Cambodia’s 1993 survey of health workers revealed a poorly distributed and largely unreg￾istered workforce, with widely differing competencies (2). Three types of human resource strategy have been pursued with some success: • making more efficient use of available personnel through better geographical distribution; • greater use of multiskilled personnel where appropriate; • ensuring a closer match between skills and functions. The latter strategy responds to a widespread problem. Formal training of health work￾ers, particularly for more highly skilled staff, too seldom reflects the actual tasks being per￾formed. This is both wasteful and demoralizing. Some success has been recorded with mandatory service and multiple incentives (fi￾nancial, professional, educational, etc.) to make otherwise unattractive technical or geo￾graphical areas more appealing, as has been done in Canada and the Scandinavian countries to deploy staff in their northern regions. Countries such as Fiji, Oman and Saudi Arabia have successfully recruited foreign workers to fill critical gaps, as an interim strategy. This strategy can, however, create other difficulties and tensions. Oman at present has a policy to recruit primarily a domestic workforce, as the pool of potential medical students has increased. Intake training and continuing education. A clear case can be made for strong public sector involvement in training and in monitoring the quality of continuing education to stimulate the development of human resources in targeted areas. New public health schools have recently been established in Hungary and Jamaica to meet needs for professionals with skills in epidemiology, statistics, management and health education. They aim to inte￾grate initial formal training, subsequent continuing education, and actual service provision