Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Dr. Andrea Baumann


Health human resource development (HHRD), including nursing human resource development (NHRD) is essential for any country, HHRD is an unexplored area of study in Pakistan. In this exploratory study, qualitative methodology was used to obtain the perceptions of key stakeholders on the current situation of nursing human resource development in the Province of Sindh in Pakistan. A conceptual framework organized around the three components of planning, production, and management guided data collection, coding, and analysis. Five year plans (FYPs) (1978-1998) containing national health policies were reviewed to identify issues relating to NHRD. Semi-structured interviews were conducted to elicit key stakeholders' perceptions regarding the current NHRD situation in Pakistan. Individual interviews were held with 34 stakeholders, the majority of whom were from the public sector at the federal, provincial, and local levels. Data were analyzed by generating codes. Nineteen categories emerged from the codes which were clustered under each of the following components: planning, production, and management. Emerging patterns were noted amongst categories and 22 issues within components were identified. The 22 issues were further collapsed into five themes: formulation of policies; planning-implementation gap; supply-requirement imbalance; quality of education; and working environment of nursing personnel. The findings indicated similarities as well as differences in the perceptions of nursing personnel and government officials with respect to the components of HHRD. Homogeneity was found in the perspectives of nursing personnel across levels, with a focus on operational issues. In contrast, divergence was found in perceptions of government officials; the officials at the federal level viewed NHRD from a broad societal perspective, while officials at the local level demonstrated more knowledge and understanding of issues related to NHRD. Findings of this study demonstrated that key stakeholders varied in their understanding of the issues, at both macro and micro levels. The policy review of five year plans indicated clear objectives, but stakeholders identified a policy-implementation gap. This research has implications for studying HHRD in general and for Pakistan in particular. The study confirmed the value of determining the perceptions of key stakeholders as a firs step in HHRD. When selecting key stakeholders, policy makers need to be aware that perceptions differ by level and affiliation of the stakeholder. At the time of policy formulation, input from key stakeholders should be obtained as a means of facilitating implementation of policies. Recommendations for further research were generated from the findings.

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Nursing Commons