This article profiles three leaders who have made a significance difference in the HR situation in their countries. By taking a comprehensive approach and working in partnership with stakeholders, these leaders demonstrate that strengthening health workforce planning, management, and training can have a positive effect on the performance of the health sector. Three profiles are presented, from Afghanistan, South Africa and southern Sudan, revealing common approaches and leadership traits while demonstrating the specificity of local contexts. In the South African profile, Dr. Mahlathi, Deputy Director General of Human Resources for South Africa's national Department of Health (DOH) is discussed. South Africa will need a multisectoral approach, with strong health management and leadership and additional human and financial resources to help meet the needs of its citizens.
Human Resources
Neglected tropical diseases produce an enormous burden on many of the poorest and most disenfranchised populations in sub-Saharan Africa, where a dearth of skilled health providers limits primary care efforts to address such diseases. Consequently, many countries rely on nurses and community health workers to engage with under-served and hard-to-reach populations. This review of the literature was conducted to assess the role nurses and community health workers play in the primary, secondary, and tertiary prevention of neglected tropical diseases in sub-Saharan Africa. Articles published between January 2005 and December 2015 were reviewed in order to capture the full scope of nurses’ and community health workers’ responsibilities for neglected tropical disease control within their respective countries’ health systems. A total of 59 articles were identified that fit all inclusion criteria. It reports that successful disease control requires deep and meaningful engagement with local communities and that horizontal or multidisease control programs can create complimentary interactions between their different control activities as well as reduce costs through improved program efficiencies.
This survey was conducted among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes. Nurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunisation campaigns for polio and measles. The survey shows that nurses and midwives play an important role in implementing immunisation activities at the district level and that their roles can be maximised by creating opportunities that lead to their having more responsibilities in their work and in particular, their involvement in early phases of planning of priority health activities. This should be accompanied by written job descriptions, tasks and clear lines of authority as well as good supportive supervision. The lessons from supplementary immunisation activities, where the roles of nurses and midwives are maximised, can be easily adopted to benefit the rest of the health services provided at district level.
The authors of this study conducted a survey among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes. Nurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunisation campaigns for polio and measles. This study shows that nurses and midwives play an important role in implementing immunisation activities at the district level and that their roles can be maximised by creating opportunities that lead to their having more responsibilities in their work and in particular, their involvement in early phases of planning of priority health activities. This should be accompanied by written job descriptions, tasks and clear lines of authority as well as good supportive supervision. The lessons from supplementary immunisation activities, where the roles of nurses and midwives are maximised, can be easily adopted to benefit the rest of the health services provided at district level.
The already inadequate health systems of sub-Saharan Africa have been badly damaged by the emigration of their health professionals, a process in which the UK has played a prominent part. In 2005, there are special opportunities for the UK to take the lead in addressing that damage, and in focusing the attention of the G8 on the wider problems of health-professional migration from poor to rich countries. This article from The Lancet suggests some practical measures to these ends. (requires registration)
Several countries are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals. This trend has led to concerns that in many of the source countries - especially within Africa - the outflow of health care professionals is adversely affecting the health care system. This paper examines the role of wages in the migration decision and discusses the likely effect of wage increases in source countries in slowing migration flows.
Social accountability is defined as the responsibility of institutions to respond to the health priorities of a community. There is an international movement towards the education of health professionals who are accountable to communities. There is little evidence of how communities experience or articulate this accountability. In this grounded theory study eight community based focus group discussions were conducted in rural and urban South Africa to explore community members’ perceptions of the social accountability of doctors. The discussions were conducted across one urban and two rural provinces. Group discussions were recorded and transcribed verbatim. Initial coding was done and three main themes emerged following data analysis: the consultation as a place of respect (participants have an expectation of care yet are often engaged with disregard); relationships of people and systems (participants reflect on their health priorities and the links with the social determinants of health) and Ubuntu as engagement of the community (reflected in their expectation of Ubuntu based relationships as well as part of the education system). These themes were related through a framework which integrates three levels of relationship: a central community of reciprocal relationships with the doctor-patient relationship as core, a level in which the systems of health and education interact and together with social determinants of health mediate the insertion of communities into a broader discourse. The paper outlines an ubuntu framing in which the tensions between vulnerability and power interact and reflect rights and responsibility as important for social accountability. Communities are argued to bring a richer dimension to social accountability through their understanding of being human and caring.
Most of the 58 countries covered in this report have been identified as suffering from a crisis in human resources for health. Collectively, across these countries women gave birth to 81 million babies in 2009, accounting for 58% of the world’s total births. The inequitable ‘state of the world’ is most evident in the disproportionate number of deaths in these countries: 91% of the global burden of maternal mortality, 80% of stillbirths and 82% of newborn mortality. These figures partly reflect the distribution of the global workforce: less than 17% of the world’s skilled birth attendants are available to care for women in the 58 countries. There is a triple gap, consisting of competencies, coverage and access. The triad of education, regulation and association has insufficient focus on quality of care, the authors argue. Policy coherence is disjointed and access to the necessary strategic intelligence or evidence for action weak. They urge governments to recognise midwifery as a distinct profession, core to the provision of maternal and newborn health services, and promote it as a career with posts at the national policy level. They also make a number of recommendations for governments, regulatory bodies, schools and training institutions, professional midwifery organisations, international organisations and global partnerships, external funders and civil society organisations.
The delivery of an appropriate quantity and quality of health care in an efficient way requires, among other things, matching the supply with the demand for the services of physicians, over time. Such matching has led to very different levels of physicians per million population across OECD countries ; because of variations, among other things, in: morbidity and mortality, health expenditure as a share of GDP and the design of health systems. Most OECD countries experience inequities in the geographical distribution of their physician workforce. This article discusses how, to tackle this difficulty, a mix of educational policies, regulatory policies and financial policies has been used with some success in a number of countries.
The Tanzania Connect Project is a randomised cluster trial located in three rural districts with a population of roughly 360,000 ( Kilombero, Rufiji, and Ulanga). Connect aims to test whether introducing a community health worker into a general programme of health systems strengthening and referral improvement will reduce child mortality, improve access to services, expand utilisation, and alter reproductive, maternal, newborn and child health seeking behaviour; thereby accelerating progress towards Millennium Development Goals 4 and 5. Connect has introduced a new cadre — Community Health Agents (CHA) — who were recruited from and work in their communities. To support the CHAs, Connect developed supervisory systems, launched information and monitoring operations, and implemented logistics support for integration with existing district and village operations. Connect will not only address Tanzania’s need for policy and operational research, it will bridge a critical international knowledge gap concerning the added value of salaried professional community health workers in the context of a high density of fixed facilities.