This paper discusses gender issues manifested within health occupations and across them. It examines gender dynamics in medicine, nursing, community health workers and home carers and explores from a gender perspective issues concerning delegation, migration and violence, which cut across these categories of health workers. Gender plays a critical role in determining the structural location of women and men in the health labour force and their subjective experience of that location. The paper shows that woman are overrepresented in caring, informal, part-time, unskilled and unpaid work and within occupations there are significant gender differences in terms of employment security, promotion, remuneration.
Human Resources
Literature review on gender issues amongst health care workers
George A: Women and Gender Equity Knowledge Network, 2007
Long-term outcomes of a pediatric HIV treatment program in Maputo, Mozambique: a cohort study
Walter J; Molfino L; Moreno V; Edwards CG; Chissano M; Prieto A; Bocharnikova T; Antierens A; Lujan J: Glob Health Action 8 (26652), 2015
This paper describes long-term treatment outcomes of a paediatric HIV cohort in Mozambique, in the Chamanculo Health District of Maputo. The subjects involved a total of 1,335 antiretroviral treatment (ART) naïve children <15 years of age enrolled in HIV care between 2002 and 2010. The interventions included HIV care, ART (since 2003), task shifting to lower cadre nurses, counseling by lay counselors, active patient tracing, nutritional support, support by a psychologist, targeted viral load testing, and switch to second-line treatment. The main outcome measures included Kaplan–Meier estimates for retention in care (RIC), CD4 cell percentage, body mass index for age z-score, and adjusted incidence rate ratios for attrition (death or loss to follow-up) as calculated by Poisson regression. The RIC at 6 years in the pre-ART cohort was 44% and the one at 8 years in the ART cohort was 70%. Risk factors for attrition included young age, low CD4 percentage, underweight, active tuberculosis, and enrollment/treatment initiation after 2006. The mean CD4 percentage increased strongly at 1 year on treatment and remained high thereafter. The body mass index for age sharply increased at 1 year after treatment initiation before stabilizing at pre-ART levels thereafter. The study concludes that good clinical and immunological treatment outcomes up to 8 years of follow-up on ART can be achieved in a context of shortage of health workers and a high level of task-shifting approach.
Longitudinal analysis of community health workers’ adherence to treatment guidelines, Siaya, Kenya, 1997–2002
Rowe SY, Olewe MA, Kleinbaum DG, McGowan Jr JE, McFarland DA, Rochat R, Deming MS: Tropical Medicine & International Health 12(5): 651-663, May 2007
This report investigated community health workers’ (CHW) adherence over time to guidelines for treating ill children and to assess the effect of refresher training on adherence. The average adherence score was 79.4%. Multivariable analyses indicate that immediately after the first refresher training, the mean adherence level improved for patients with a severe illness, but worsened for patients without severe illness. Adherence scores declined rapidly during the 6 months after the second refresher training.
Maintaining health worker performance in resource-poor settings
The Lancet 2005
"In low and middle income countries, health workers are essential for the delivery of health interventions. However, inadequate health-worker performance is a very widespread problem. We present an overview of issues and evidence about the determinants of performance and strategies for improving it. Health-worker practices are complex behaviours that have many potential influences. Reviews of intervention studies in low and middle income countries suggest that the simple dissemination of written guidelines is often ineffective, that supervision and audit with feedback is generally effective, and that multifaceted interventions might be more effective than single interventions." (Requires registration)
Major surgery delegation to mid-level health practitioners in Mozambique: health professionals' perceptions
Cumbi A, Pereira C, Malalane R, Vaz F, McCord C, Bacci A and Bergstrom S: Human Resources for Health 5:27, 6 December 2007
This study examines the opinions of health professionals about the capacity and performance of the 'tecnico de cirurgia', a surgically trained assistant medical officer in the Mozambican health system. Particular attention is paid to the views of medical doctors and maternal and child health nurses. Health workers at all levels voiced satisfaction with the work of the "tecnicos de cirurgia". They stressed the life-saving skills of these cadres, the advantages resulting from a reduction in the need for patient referrals and the considerable cost reduction for patients and their families. Important problems in the professional status and remuneration of "tecnicos de cirurgia" were identified. This study, the first one to scrutinize the judgements and attitudes of health workers towards the "tecnico de cirurgia", showed that, despite some shortcomings, this cadre is highly appreciated and that the health delivery system does not recognize and motivate them enough. The findings of this study can be used to direct efforts to improve motivation of health workers in general and of tecnicos de cirurgia in particular.
Major surgery delegation to mid-level health practitioners in Mozambique: health professionals' perceptions
Cumbi A, Pereira C, Malalane R, et al: Human Resources for Health 5(27), 2007
This study examines the opinions of health professionals about the capacity and performance of the 'tecnico de cirurgia', a surgically trained assistant medical officer in the Mozambican health system. Particular attention is paid to the views of medical doctors and maternal and child health nurses. Health workers at all levels voiced satisfaction with the work of the "tecnicos de cirurgia". They stressed the life saving skills of these cadres, the advantages resulting from a reduction in the need for patient referrals and the considerable cost reduction for patients and their families. Important problems in the professional status and remuneration of "tecnicos de cirurgia" were identified. This study, the first one to scrutinise the judgements and attitudes of health workers towards the "tecnico de cirurgia", showed that this cadre is highly appreciated and that the health delivery system does not recognise and motivate them enough. The findings of this study can be used to direct efforts to improve motivation of health workers in general and of tecnicos de cirurgia in particular.
Making migration work for development: Key findings in migration research
Development Research Centre on Migration, Globalisation and Poverty, University of Sussex: 2009
This report is a summary of six years of investigation into migration policy and practice. Its findings indicate that, for migration to have its full developmental impact, the most beneficial policy change would be to reduce barriers to migration, at all levels and particularly for the poorest. This paper examines the changing dynamics of migration, impacts of migration on poverty and livelihoods, new initiatives in international migration, and how the findings in relation to the development of policy on migration. It found that poor people are more likely to move over shorter distances, either within or between poor countries, and where poor people have a greater choice in terms of migration destinations, the net effect on inequality is more likely to be positive. In addition, skilled migration is largely a symptom, not a cause, of underdevelopment. Diaspora engagement can contribute to the development of countries of origin, but this is a highly politicised arena.
Malawi: Health worker shortage a challenge to AIDS treatment
IRIN News, 17 November 2006
The shortage of healthcare workers is a global crisis, but developed countries can afford to throw money at the problem, attracting nurses and doctors from developing countries with vastly better salaries and working conditions. In Malawi, the fourth poorest country in the world, where UNAIDS has put HIV prevalence at 14 percent, the health worker shortage is so acute that the ministry of health and international donors are now treating it as an emergency.
Malawi: Pfizer to Offer Diflucan Free of Charge
Pfizer Inc. has announced that it will provide its antifungal drug Diflucan at no cost to people with AIDS in Malawi, Reuters reports. The drug maker stated that Diflucan will be provided free of charge for Malawians being treated in hospitals operated by either the government or by the Christian Health Association of Malawi. The drug will be provided "for as long as it is required" for these patients, and there is "no dollar or time limit" on the offer, Pfizer stated. Diflucan treats two opportunistic infections: cryptococcal meningitis, a brain infection which affects 10% of people with AIDS, and oral thrush, which affects between 20% and 40% of people with AIDS. Malawi is the seventh African nation to participate in the program, which also helps train health workers. South Africa, Uganda, Botswana, Namibia, Swaziland and Lesotho have already signed on to the program. Tanya Elston, communications manager at Pfizer, said that the company plans to offer the program soon in Mozambique and Zambia. Pfizer hopes eventually to expand the program to 50 of the world's poorest nations, Elston said.
Management of expatriate medical assistance in Mozambique
Vio F: Human Resources for Health 4:26, 2 December 2006
This paper discusses how Mozambique coped with the health system needs in terms of specialised doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. Different scenarios, partnerships and contract schemes that have evolved since independence are briefly described, as well as self-reliance option possibility and implications. Lessons learned about donor initiatives aimed at contracting specialists from other developing countries are singled out. The issue of obtaining expertise and knowledge in the global market as cheap as possible is stressed, and realistic figures of cost planning are highlighted, as determined by the overall health system necessities and budget limitations.