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Governing the mixed health workforce: learning from Asian experiences
  1. Kabir Sheikh1,
  2. Lakshmi K Josyula2,
  3. Xiulan Zhang3,
  4. Maryam Bigdeli4,
  5. Syed Masud Ahmed5
  1. 1Public Health Foundation of India, New Delhi, India
  2. 2Previous affiliation: Indian Institute of Public Health, Hyderabad, Public Health Foundation of India; Present affiliation: The George Institute for Global Health, Hyderabad, India
  3. 3China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, Beijing, China
  4. 4Past: Alliance for Health Policy and Systems Research, WHO; Present: Department of Health Systems Governance, Policy and Aid Effectiveness, World Health Organization (WHO), Geneva, Switzerland
  5. 5Centre of Excellence for UHC, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  1. Correspondence to Dr Josyula K Lakshmi; jklakshmiiiph{at}


Examination of the composition of the health workforce in many low and middle-income countries (LMICs) reveals deep-seated heterogeneity that manifests in multiple ways: varying levels of official legitimacy and informality of practice; wide gradation in type of employment and behaviour (public to private) and diverse, sometimes overlapping, systems of knowledge and variably specialised cadres of providers. Coordinating this mixed workforce necessitates an approach to governance that is responsive to the opportunities and challenges presented by this diversity. This article discusses some of these opportunities and challenges for LMICs in general, and illustrates them through three case studies from different Asian country settings.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Handling editor Seye Abimbola.

  • Contributors KS conceptualised the paper, developed the framework presented in it and led the manuscript writing. LKJ wrote a case study and reworked successive drafts of the manuscript. XZ and MB wrote case studies, and SMA contributed to the literature review and discussion. All the authors critically revised the content of the paper, approved the final version and agree to be accountable for all aspects of the work.

  • Funding Wellcome Trust, Capacity Strengthening Strategic Award.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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