With the United Kingdom needing 10 000 more doctors, and with more than 7000 nurses from the Philippines alone currently registered in the United Kingdom, compared with just 52 in 1999, a new report says that the countries providing the workers, as well as those that hire them, need to look for solutions. The report says that many African doctors also migrate within the continent, mostly to southern African states where salaries are often higher: for instance, $1242 a month in South Africa, compared with $50 in Sierra Leone.
Human Resources
Poor countries need to tackle the health brain drain
Poor MDR-TB knowledge among South African nurses
Plus News: 15 June 2010
South Africa has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB), but a new study has found that many nurses have not been trained to handle this deadly, difficult-to-treat strain of the disease. The research, presented at the South African TB Conference, which was held from 1–4 June 2010 in Durban, found that only about 19% of the 16 health facilities surveyed in rural and urban areas of Limpopo and KwaZulu-Natal provinces had nurses with formal training in MDR-TB management. Dr Tsholofelo Mhlaba, of Health Systems Trust, a health research non-governmental organisation, said some nurses who had been trained to handle MDR-TB demonstrated similar levels of knowledge as those who were untrained. Some nurses tried to fill this knowledge gap with reading and internet research, but many considered MDR-TB a rare problem, even in KwaZulu-Natal, which has the highest incidence of drug-resistant TB in the country. Inadequate understanding of the disease led to poorly recorded patient histories and failure to follow up on people who had been in close contact with MDR-TB patients, such as household members.
Position paper on human resource for health fee hike
National Organisation of Nurses and Midwives of Malawi (NONM): 6 November 2009
The National Organisation of Nurses and Midwives of Malawi’s position paper is a response to the proposed introduction of fees for student nurses and midwives. It has been submitted to top leadership in government, parliament, civil society organisations, media, community and religious leaders, professional organisations, trade unions and other opinion leaders. The organisation asks for ‘revision of government decision on payment of fees by students and parents towards training in nursing and midwifery. Specifically, the fees are very high costing over K1 million per student for a three-year course of study. This is prohibitive to selected candidates who aspire to study nursing/midwifery… [ ] … Existing and alternative funding options can be maximised to address funding for nurses and midwives’ training.’ It notes that civil society has a critical role in ‘complementing government efforts to develop the country socio-economically, taking it from “Poverty to Prosperity”’ and hopes to build on the economic prosperity achieved by Malawi in the past six years, referring to ‘meaningful and sustainable funding… [ ] … for the training of nurses and midwives.’
Further details: /newsletter/id/34456
Postgraduate training for trauma prevention, injury surveillance and research, Uganda
Bachani A; Paichadze N; Bentley J; et al: Bulletin of the World Health Organisation; 96(6):423–427, 2018
This paper addressed the gaps in shortage of trained people and lack of national data on non-communicable diseases and their risk factors in Uganda. The authors developed and implemented a new track within an existing master of public health programme, aimed at developing graduate-level capacity and promoting research on key national priorities for trauma and injuries. They also offered training opportunities to a wider audience and set up a high-level national injury forum to foster national dialogue on addressing the burden of trauma, injuries and disability. Over the years 2012 to 2017 there were four cohorts of master’s students, with a total of 14 students. Over 1300 individuals participated in workshops and seminars of the short-term training component of the programme. The forum hosted three research symposia and two national injury forums. The authors note that institutional support and collaborative engagement is important for developing and implementing successful capacity development programmes, and that integration of training components within existing academic structures is key to sustainability and appropriate mentorship for motivated and talented students.
Posting policies don’t change because there is peace or war”: the staff deployment challenges for two large health employers during and after conflict in Northern Uganda
Ayiasi R; Rutebemberwa E; Martineau T: Human Resources for Health 17(27)1-10, 2019
In this paper, the authors examine how deployment policies and practices were adapted during the conflict and post-conflict periods with the aim of drawing lessons for future responses to similar conflicts. Qualitative data was collected in a cross-sectional survey to investigate deployment policy and practice during the conflict and post-conflict period in Amuru, Gulu and Kitgum districts in Northern Uganda in 2013. Two large health employers from Acholi were selected, the district local government and Lacor hospital, a private provider. Twenty-three key informants’ interviews were conducted at the national and district level, and in-depth interviews with 10 district managers and 25 health workers. There was no evidence of change in deployment policy due to conflict, but decentralisation from 1997 had a major effect for the local government employer. Health managers in government and those working for Lacor hospital both implemented deployment policies pragmatically, especially because of the danger to staff in remote facilities. Lacor hospital introduced bonding agreements to recruit and staff their facilities. While managers in both organisations implemented the deployment policies as best as they could, some deployment-related decisions were noted as possibly leading to longer-term problems. While it may not be possible to change deployment policies during or after conflict, the authors observe that if given sufficient autonomy, local managers can adapt deployment policies appropriately to need, but that they should also be supported with the necessary management skills to enable this.
Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi
Chilopora G, Pereira C, Kamwendo F, Chimbiri A, Malunga E, Bergstrom S: Human Resources for Health 5:17, 14 June 2007
Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.
Practitioner Expertise to Optimize Community Health Systems: Harnessing Operational Insight
Ballard M; Schwarz R; Johnson A; et al: Community Health Worker Impact, USA, 2017
To harness the potential of community health workers (CHWs) to extend health services to poor and marginalized populations the authors argue that there is a need to better understand how CHW programs can be optimized. This paper presents the experience of and insights from application by selected organizations that have developed high-impact CHW programs with governments and communities in different countries globally. They present a series of design principles that, in their experience, drive programmatic quality and are debated or not commonly found in programs across the globe: CHWs must meet minimum standards before working; point of care fees should be avoided when possible; CHWs should go door to door and provide training on when to seek help; continuing training should be a requirement; CHWs should benefit from a dedicated supervisor and be paid and should be part of a strong local health system and data feedback loops.
Predictors of nurses’ and midwives’ intentions to provide maternal and child healthcare services to adolescents in South Africa
Jonas K; Reddy P; van den Borne B; Sewpaul R; Nyembezi A; Naidoo P; Crutzen R: BMC Health Services Research 16(658) 2016
This study was conducted to gain an understanding of nurses’ and midwives’ intentions to provide maternal and child healthcare and family planning services to adolescents in South Africa. A total of 190 nurses and midwives completed a cross-sectional survey. The survey included components on demographics, knowledge of maternal and child healthcare (MCH) and family planning (FP) services, attitude towards family planning services, subjective norms regarding maternal and child healthcare and family planning services, self-efficacy with maternal and child healthcare and family planning services, and intentions to provide maternal and child healthcare and family planning services to adolescents. Self-efficacy to conduct MCH and FP services and years of experience as a nurse- midwife were associated with stronger intentions to provide the services. Self-efficacy had a strong and positive association with the intentions to provide both MCH and FP services, while there is a moderate association with attitude and norms. The authors argue that there is a need to improve and strengthen nurses’ and midwives’ self-efficacy in conducting both MCH and FP services in order to improve the quality and utilisation of the services by adolescents in South Africa.
Preparing a Health Care Workforce for the 21st Century
This publication from the WHO calls for the transformation of healthcare workforce training to better meet the needs of caring for patients with chronic conditions, predicated upon the rapid escalation in chronic health problems around the world. To provide effective care for chronic conditions, the skills of health professionals must be expanded to meet these new complexities. The report presents a new, expanded training model, based on a set of core competencies that apply to all members of the workforce. This model has been endorsed by the World Medical Association (WMA), International Council of Nurses (ICN), International Pharmaceutical Federation (FIP), European Respiratory Society (ERS), International Alliance of Patients' Organizations (IAPO) and others.
Prevalence of HIV infection and median CD4 counts among health care workers in South Africa
Connelly D, Veriava Y, Roberts S, Tsotetsi J, Jordan A, DeSilva E, Rosen S, DeSilva MB: South African Medical Journal 97(2):115-120, 2007
A cross-sectional voluntary, anonymous, unlinked survey including an oral fluid or blood sample and a brief demographic questionnaire where undertaken in two public hospitals in Gauteng, South Africa to determine the prevalence of HIV infection and the extent of disease progression based on CD4 count in a public health system workforce in southern Africa. The overall prevalence of HIV was 11.5%. By occupation, prevalence was highest among student nurses (13.8%) and nurses (13.7%). The highest prevalence by age was in the 25-34-year group (15.9%). Nineteen per cent of HIV-positive participants who provided blood samples had CD4 counts less than or equal to 200 cells/μl, 28% had counts 201-350 cells/μl, 18% had counts 351-500 cells/μl, and 35% had counts above 500 cells/μl. One out of 7 nurses and nursing students in this public sector workforce was HIV-positive. A high proportion of health care workers had CD4 counts below 350 cells/μl, and many were already eligible for antiretroviral therapy under South African treatment guidelines. Given the short supply of nurses in South Africa, knowledge of prevalence in this workforce and provision of effective AIDS treatment are crucial for meeting future staffing needs.