This includes non-EU migrant nurses and midwives [ 16] as well as Irish-trained nurses/midwives and suggests a potentially significant outflow from the Irish health system, albeit a flow that appears to be stabilising.
A strong health system provides both a downward flow of data, requisite policies, personnel, and materials, and an upward flow of data and management feedback on what is working and what is not.
An urgent next step in this complex inter-connected research agenda is to develop a standardized method for reporting the flow of health system benefits from developing to developed countries.
For example, the existence of parallel or hierarchical communication structures can limit the integration process of national CBHWs into the functions of the health system, by affecting the smooth flow of information.
Specifically, the NHA tracks the flow of health system resources from financing sources (i.e. entities that provide the funds), financing agents (entities that receive and use funds to pay for health activities), providers (entities that receive money to produce health activities), functions (types of goods and services provided) and health system inputs to beneficiaries [ 7].
A decentralized health system may promote more dynamic flows of health workers in the labour market, in which case the rural areas are in a disadvantaged position to attract and retain their health workers due to their disadvantages in working and living conditions [ 56].
Health system stewards could consider strengthening information flows by designing interventions aimed at increasing health worker training on user fee policies followed by reminder messages using mobile phones.
The CSC, if executed through the ongoing mechanisms of community based healthcare, can prove to be a valuable tool, toward instituting accountability measures for health system performance as it facilitates the flow of information between citizens and service providers, as evidenced in Vietnam and other African countries [ 16, 17, 19].
A national health account (NHA) provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period.
To that end, this paper presents a computable, dynamic model of personnel flows within a health system.
The lack of institutionalization of NHA makes it difficult to track changes in funding from all sources as well as flows to various health system inputs, service providers and beneficiaries.
