This article, from Human Resources for Health, considers the effect of fiscal reform and the introduction of decentralisation and market mechanisms on human resources in the health sector. Findings show that these reforms often result in 'corporatised' institutions, with reductions in the workforce as health services are contracted out, or increased short-term and temporary employment contracts. Increased private sector provision leads health workers to move to the private sector. This often leaves worsening working conditions, lack of employment security and dismantling of collective bargaining agreements for those who remain in the public sector.
Human Resources
Public sector reform and demand for human resources for health
Public-private options for expanding access to human resources for HIV/AIDS in Botswana
Dreesch N, Nyoni J, Mokopakgosi O, Seipone K, Kalilani JA, Kaluwa O and Musowe V: Human Resources for Health 5(25), 19 October 2007
In responding to the goal of rapidly increasing access to antiretroviral treatment (ART), the government of Botswana undertook a major review of its health systems options to increase access to human resources, one of the major bottlenecks preventing people from receiving treatment. In mid-2004, a team of government and World Health Organization (WHO) staff reviewed the situation and identified a number of public sector scale up options. The team also reviewed the capacity of private practitioners to participate in the provision of ART. Subsequently, the government created a mechanism to include private practitioners in rolling out ART. At the end of 2006, more than 4500 patients had been transferred to the private sector for routine follow up. It is estimated that the cooperation reduced the immediate need for recruiting up to 40 medically qualified staff into the public sector over the coming years, depending on the development of the national standard for the number and duration of patient visits to a doctor per year. Thus welcome relief was brought, while at the same time not exercising a pull factor on human resources for health in the sub-Saharan region.
Putting faith in mid-level workers paying off
Thom A: Health-e, 5 October 2009
African countries, much poorer and less resourced than South Africa, are using trained mid-level health workers to perform tasks traditionally reserved for doctors, including surgery, and, in the process, are saving the lives. Presenters from Mozambique, Tanzania and Malawi at the 14th FIGO (International Federation of Gynecology & Obstetrics) World Congress of Gynecology and Obstetrics on 4 October shared details of how mid-level health workers are performing caesareans and other emergency surgical procedures in hospitals where there are simply no doctors and often no professional nurses. In Mozambique, 92% of all Caesarean sections at the district hospital level are carried out my mid-level providers – tecnicos de cirugia. In Tanzania the percentage is 84%. Studies in all three countries have shown that with the right training these mid-level providers – some trained straight after school while other have some experience of working in the health sector – have similar outcomes to doctors when providing life-saving emergency obstetric surgical care. Compared to doctors, their retention rates, especially in rural and district areas where the need is desperate, are excellent.
Quest for quality: Guide for in-country discussions on human resources for health
Cordaid: February 2010
This paper presents and discusses a variety of experiences of faith-based organisations (FBOs) working in rural and remote areas of Anglophone Africa in dealing with human resources for health (HRH). The paper is intended to be used in discussions among people working in the field of HRH or who have tasks related to the management of health staff. It covers a number of case studies, including those in sub-Saharan Africa. It can be used for HRH discussions at different levels - at the level of umbrella organizations of FBOs, at district level, or at health facility level - and in different settings such as decentralised or centralised settings.
Questionnaire for educational needs assessment for ECSACON in member countries
Commonwealth Regional Health Community for east, central and southern Africa
The East, Central and Southern Africa College of Nursing (ECSACON) is an institution invested with the responsibility of improving the quality of health of the communities in the ECSA region through strengthening the contribution of nursing and midwifery services. ECSACON is conducting a needs assessment for its work and has disseminated a questionnaire for those in Authority at the Ministry of Health (MOH) or those in Nursing Regulatory bodies to complete. They ask that the questionniare found at the url given be completed and returned to ECSACON.
Radical changes in medical education needed globally
Ebrahim S, Squires N, di Fabio J, Reed G, Bourne P, Keck W, Neusy AJ, Chalkidou K: The Lancet 3(3), 2015
New medical schools in Africa have developed curricula that include community and rural health components, long-term family attachments, and admission processes that are more equitable for disadvantaged students. These worthwhile innovations have been incorporated in previous reforms of medical education, but the authors ask in this paper if they are sufficient to meet the challenges of achieving universal health care.
Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique
Mocumbi S; McKee K; Munguambe K; Chiau R; et al: Global Health Action, 11(1) 1-13, 2018
In this paper, the authors investigated the comprehensibility and the internal reliability of Context Assessment for Community Health and its use to describe the healthcare context as perceived by health providers involved in maternal care in Mozambique. The cross-sectional survey using Context Assessment for Community Health, which contains 49 items assessing eight dimensions, was administered to 175 health providers in 38 health facilities within six districts in Mozambique. Analysis of the survey data indicated that items on all dimensions were rated highly, revealing positive perception of context. Significant differences between districts were found for the work culture, leadership, and Informal payment dimensions.
Realities and experiences of community health volunteers as agents for behaviour change: evidence from an informal urban settlement in Kisumu, Kenya
Aseyo R; Mumma J; Scott K; et al: Human Resources for Health 16(53) 1-12, 2018
This study examines the behaviour change-related activities of community health volunteers (CHVs) community health workers affiliated with the Kenyan Ministry of Health in a peri-urban settlement in Kenya, in order to assess their capabilities, opportunities to work effectively, and sources of motivation. This mixed-methods study included a census of 16 CHVs who work in the study area. All CHVs participated in structured observations of their daily duties, structured questionnaires, in-depth interviews, and two focus group discussions. In addition to their responsibilities with the Ministry of Health, CHVs partnered with a range of non-governmental organizations engaged in health and development programming, often receiving small stipends from these organizations. CHVs reported employing a limited number of behaviour change techniques when interacting with community members at the household level. While supervision and support from the MOH was robust, CHV training was inconsistent and inadequate with regard to behaviour change and CHVs often lacked material resources necessary for their work. CHVs spent very little time with the households in their allocated catchment area. The number of households contacted per day was insufficient to reach all assigned households within a given month as required and the brief time spent with households limited the quality of engagement. Lack of compensation was noted as a demotivating factor for CHVs. This was compounded by the challenging social environment and CHVs’ low motivation to encourage behaviour change in local communities. In a complex urban environment, CHVs faced challenges that limited their capacity to be involved in behaviour change interventions. The authors argue that more resources, better coordination, and additional training in modern behaviour change approaches are needed to ensure their optimal performance in implementing health programmes.
Recall of lost-to-follow-up pre-antiretroviral therapy patients in the Eastern Cape: Effect of mentoring on patient care
Jones M, Stander M, van Zyl M and Cameron D: South African Medical Journal 102(9):768-769, September 2012
In 2011 an experienced HIV nurse from the UK was deployed for three months to act as a mentor to nurses learning to initiate antiretroviral therapy (ART) in primary care clinics in a small town in the Eastern Cape, South Africa. In this study, researchers assessed effectiveness of the mentoring process. A review of 286 existing pre-ART patient files was carried out and lost-to-follow-up HIV patients were recalled. Results showed that only 24% of patients had attended the clinics within the preceding six months and 20% had not attended for longer than two years. Two lay counsellors visited 222 patients to encourage them to return to care: of these 23% were untraceable, 4% had relocated, 10% declined and 3% had died. In the six weeks following recall, 18% of patients returned to the clinics. CD4 count testing was repeated and screening for tuberculosis (TB) and other opportunistic infections was performed for all patients. ART was initiated in 25% of patients, while isionazid prophylaxis was initiated in 45%. The cost of recall was R130 (US$16) per patient. Within six months, all clinics began providing full ART services, 17 professional nurses were mentored and they initiated ART in 55 patients. The authors conclude that mentoring played an important role in professional nurse training and support. Recall of lost-to-follow-up patients was shown to be feasible and effective in improving ART services in rural settings.
Recommendations on the World Health Organisation Draft Code of Practice on the International Recruitment of Health Personnel
Health Worker Migration Initiative: 2008
Global Policy Advisory Council members have reviewed and responded to the WHO Draft Code of Practice and had a number of recommendations to make. They believe the Code needs to reflect further on World Health Assembly Resolutions 57.19 and 58.17 and to focus more strongly on mitigating the adverse effects of health personnel migration and its negative impact on health systems in developing countries. A strong preamble is needed to appropriately inform the rationale, context and vision underlying the accompanying articles. The current Code pays much attention to the role of member states generally, but the specific roles of source and destination countries, health workers, recruiters/ employers and other relevant stakeholders require further elaboration. There was wide, though not unanimous, agreement that the principle of shared responsibility is paramount: states that are global employers must help support their source countries’ local health workforce. Clear implementation guidelines are lacking, specifically about how and what information must be collected. Developing countries will need technical and capacity-related assistance, otherwise they will not be able to pay the costs of implementing the Code.