Literature Review of the Integration of the Social Determinants of Health in Human Resources for Health Approaches

The project works with partner countries and local stakeholders to reduce financial barriers to care and treatment, ensure equitable access to essential health services for all people, and improve the quality of health services. Led by Abt Associates, the five-year, $209 million project will build local capacity to sustain strong health system performance, supporting countries on their journey to self-reliance and prosperity. A significant body of evidence has emerged on how the circumstances in which people are born, grow, live, work, and age impact health. The distribution of money, power, and resources—influenced by a range of global, national, and local policy choices—shapes the social determinants of health (SDoH). Socially stratifying forces, such as place of residence, race, ethnicity, culture, language, occupation, gender, religion, education, and socioeconomic status further drive inequities across populations. Social factors and other structural determinants of health inequities—including the socioeconomic and political context and the social status of individuals and groups—affect access to, and delivery and outcomes of health care. To deliver relevant, quality care effectively and equitably, the health care workforce—including health professionals, planners, health managers, and community health workers—must understand the complex factors that impact patients and communities and must possess competencies to mitigate the negative effects of these factors. This literature review seeks to identify, analyze, and document successful efforts to integrate SDoH into health workforce education, training, and service delivery in low- and middle-income countries (LMIC). The review aims to determine the range of evidence describing education approaches and tools for integrating SDoH in pre- and in-service health workforce education, clinical training, and service delivery, and the impact of those approaches and tools on quality of care and health equity for underserved or marginalized communities. The literature review had two objectives: to determine the range of evidence describing education approaches and tools for integrating SDoH in pre- and in-service health workforce education, clinical training, and service delivery, and the impact of those approaches and tools on quality of care and health equity for underserved or marginalized communities; and to determine what SDoH competencies are reflected in accreditation and/or quality assurance standards for health workforce education and training programs. The review analyzed studies on the integration of SDoH in health workforce education, training, and service delivery, and identified successful approaches and tools for mitigating the negative effects of SDoH on health outcomes. The review found that education approaches and tools for integrating SDoH in pre- and in-service health workforce education, clinical training, and service delivery varied widely across studies. However, common themes emerged, including the importance of community-based education and training, the need for health workforce education programs to address the social and economic determinants of health, and the importance of accreditation and quality assurance standards that reflect SDoH competencies. The review also identified barriers and enablers to integrating SDoH in service delivery contexts, including the need for health care providers to possess competencies to address the social and economic determinants of health, and the importance of policy and institutional support for integrating SDoH into health workforce education and training programs.