Can we halt health workforce deterioration in failed states? Insights from Guinea-Bissau on the nature, persistence and evolution of its HRH crisis.

Guinea-Bissau's case study suggests that any policy that does not factor in the limited clout of health authorities over a effectively privatised healthcare arena is doomed from the start. Improving health system governance and quality of training should take precedence over expanding HRH. A bloated and ineffective workforce must be managed through incentives rather than administrative orders, in order to improve skills and productivity against higher remuneration and better working conditions. Donor support might be crucial to trigger positive changes, through realistic and sustained investments.