Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries; and (iii) to describe other losses from brain drain. Results showed that Developed countries continue to deprive Kenya of millions of dollars worth of investments embodied in her human resources for health. If the current trend of poaching of scarce human resources for health (and other professionals) from Kenya is not curtailed, the chances of achieving the Millennium Development Goals would remain bleak.
Human Resources
The human resource crisis in health care is an important obstacle to attainment of the health-related targets for the Millennium Development Goals. One suggested strategy to alleviate the strain upon government services is to encourage new forms of non-government provision. Detail on implementation and consequences is often lacking, however. This article examines one new element of non-government provision in Tanzania: small-scale independent midwifery practices. A multiple case study analysis over nine districts explored their characteristics, and the drivers and inhibitors acting upon their development since permitted by legislative change. Because of their location and emphasis on personalized care, small-scale independent practices run by retired midwives could potentially increase rates of skilled attendance at delivery at peripheral level. The model also extends the working life of members of a professional group at a time of shortage. However, the potential remains unrealized. Successful multiplication of this model in resource-poor communities requires more than just deregulation of private ownership. Prohibitive start-up expenses need to be reduced by less emphasis on facility-based provision. On-going financing arrangements such as micro-credit, contracting, vouchers and franchising models require consideration.
This paper reports on a survey of 415 South African doctors in Canada conducted in 2009-2010, representing almost 20% of the total number working in Canada. The researchers found that, while this group of South African professionals are proud to think of themselves as South African and take a relatively keen interest in events in that country, they are largely disengaged from any serious diasporic interest in and commitment (beyond contact with and some limited support for family members who remain). Amounts remitted by South African physicians are small in comparison to their incomes and remitting is infrequent, differing markedly in their remitting behaviour from physicians from other African countries and from African diasporas in general, where remittances are significant. More than half expressed no interest in returning to South Africa to help with nation building. Only 7% said they are likely to return within the next two years and another 10% within the next five years. Almost without exception, the respondents painted a very negative picture of life in South Africa and they do not see any role for themselves in helping address the country’s deep social and economic inequalities and needs. The findings of this study challenge assertions by neo-liberal economists that the negative impacts of the ‘medical brain drain’ in Africa are highly exaggerated and there is adequate compensation in the form of remittances, direct investment, knowledge and skills transfer, return migration and involvement in diaspora associations.
Two crises dominate the health sectors of sub-Saharan African countries: those of human resources and of HIV. Nevertheless, there is considerable variation in the extent to which these two phenomena affect sub-Saharan countries, with a few facing extreme levels of both: Lesotho, Zimbabwe, Zambia, Mozambique, the Central African Republic and Malawi. This paper reviews the continent-wide situation with respect to this double burden before considering the case of Malawi in more detail. In Malawi, there has been significant concurrent investment in both an Emergency Human Resource Programme and an antiretroviral therapy programme which was treating 60,000 people by the end of 2006. Both synergy and conflict have arisen as the two programmes have been implemented. These highlight important issues for programme planners and managers, particularly that planning for the scale-up of antiretroviral therapy while simultaneously strengthening health systems and human resources requires prioritisation of support and time, and not just resources.
In this paper the authors present a systematic review of empirical studies investigating the relationship between human resource management and performance in Sub-Saharan Africa hospitals, based on a total of 111 included studies that represent 19 out of 48 Sub-Saharan Africa countries. From a human resource management perspective, most studies researched human practices from motivation-enhancing, skills-enhancing, and empowerment-enhancing domains. Motivation-enhancing practices were most frequently researched, followed by skills-enhancing practices and empowerment-enhancing practices. Few studies focused on single human resource management practices. Training and education were the most researched single practices, followed by task shifting. Most studies report human resource management interventions to have positively impacted performance in one way or another. The authors found that specific outcome improvements can be accomplished by different human resource management interventions and conversely that similar human resource management interventions are reported to affect different outcome measures. The review also identified little evidence on the relationship between human resource management and patient outcomes and the evidence often fails to provide contextual characteristics which can affect the impact of human resource management interventions. The authors call for more coordinated research efforts.
In this study, researchers assessed whether text-message reminders sent to health workers' mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya. From March 6, 2009, to May 31, 2010, they conducted a cluster-randomised controlled trial at 107 rural health facilities in 11 districts in coastal and western Kenya. Health facilities were randomly allocated to either the intervention group, in which all health workers received text messages on their personal mobile phones on malaria case-management for six months, or the control group, in which health workers did not receive any text messages. They found that 119 health workers received the intervention. Case-management practices were assessed for 2,269 children who needed treatment, indicating that correct artemether-lumefantrine management improved by 23.7% immediately after intervention and by 24.5% six months later. The authors conclude that in resource-limited settings, malaria control programmes should consider use of text messaging to improve health workers' case-management practices.
Motivation and job satisfaction have been identified as key factors for health worker retention and turnover in low- and middle-income countries. District health managers in decentralised health systems usually have a broadened 'decision space' that enables them to positively influence health worker motivation and job satisfaction, which in turn impacts on retention and performance at district-level. The study explored the effects of motivation and job satisfaction on turnover intention and how motivation and satisfaction can be improved by district health managers in order to increase retention of health workers. The authors conducted a cross-sectional survey in three districts of the Eastern Region in Ghana and interviewed 256 health workers from several staff categories (doctors, nursing professionals, allied health workers and pharmacists) on their intentions to leave their current health facilities as well as their perceptions on various aspects of motivation and job satisfaction. The effects of motivation and job satisfaction on turnover intention were explored through logistic regression analysis. Overall, 69% of the respondents reported to have turnover intentions. Motivation and job satisfaction were significantly associated with turnover intention and higher levels of both reduced the risk of health workers having this intention. The dimensions of motivation and job satisfaction significantly associated with turnover intention included career development, workload, management, organisational commitment and burnout. The authors’ findings indicate that effective human resource management practices at district level influence health worker motivation and job satisfaction, thereby reducing the likelihood for turnover. Therefore, they argue that it is worth strengthening human resource management skills at district level and supporting district health managers to implement retention strategies.
A recent conference entitled "Immigration Futures", organised by the Monash Institute for the Study of Global Movements. One panel focused on outward migration which looks at the “brain drain” problem facing many predominantly poor countries since some of their most skilled citizens choose to live and work in predominantly rich countries. Manchester in England, UK for example, has more Malawian doctors than the entire Malawian health system!
Undergraduate teaching on global health has seen a marked growth over the past ten years, partly as a response to student demand and partly due to increasing globalisation, cross-border movement of pathogens and international migration of health care workers. In this study, researchers carried out a survey of medical schools across the world in an effort to analyse their teaching of global health. Results indicate that global health teaching is moving away from its previous focus on tropical medicine towards issues of more global relevance. The authors suggest that there are three types of doctor who may wish to work in global health - the 'globalised doctor', 'humanitarian doctor' and 'policy doctor' - and that each of these three types will require different teaching in order to meet the required competencies. This teaching needs to be inserted into medical curricula in different ways, notably into core curricula, a special developing countries track, optional student selected components, elective programmes, optional intercalated degrees and postgraduate study. The authors argue that teaching of global health in undergraduate medical curricula must reflect the social, political and economic causes of ill health.
Undergraduate global health teaching has seen a marked growth over the past ten years, partly as a response to student demand and partly due to increasing globalisation, cross-border movement of pathogens and international migration of health care workers. In this study, researchers carried out a survey of medical schools across the world in an effort to analyse their teaching of global health. Results indicate that global health teaching is moving away from its previous focus on tropical medicine towards issues of more global relevance. The authors suggest that there are three types of doctor who may wish to work in global health - the 'globalised doctor', 'humanitarian doctor' and 'policy doctor' - and that each of these three types will require different teaching in order to meet the required competencies. This teaching needs to be inserted into medical curricula in different ways, notably into core curricula, a special developing countries track, optional student selected components, elective programmes, optional intercalated degrees and postgraduate study. The authors argue that teaching of global health in undergraduate medical curricula must reflect the social, political and economic causes of ill health.