Private hospitals are pulling out all the stops to keep nurses from taking up lucrative offers overseas. Salary incentives and training programmes are just some of the carrots being dangled before staff to keep them loyal. Nursing Update, the journal of the Democratic Nursing Organisation of South Africa (Denosa), is overflowing with adverts for nursing positions in the UK (where the training background is similar), Canada, the US, Australia and New Zealand. Saudi Arabia also pays big money.
Human Resources
Hospitals offer incentives in a bid to keep their staff
How are African hospitals coping with the rising burden of HIV?
How is the HIV/AIDS epidemic affecting healthcare systems in developing countries? Can existing services cope? Two-thirds of people infected with HIV live in sub-Saharan Africa. Research by the UK Liverpool School of Tropical Medicine has examined the effect of high HIV prevalence on healthcare services in Kenya and South Africa.
How are health professionals earning their living in Malawi?
Muula AS, Maseko FC: BMC Health Services Research 6:97, 9 August 2006
Many health professionals in Malawi experience overly challenging environments. In order to survive some are involved in ethically and legally questionable activities such as receiving gifts from patients and pilfering drugs. The efforts by the Malawi government and the international community to retain health workers in Malawi are recognised. There is however need to evaluate of these human resources-retaining measures are having the desired effects.
How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework
Steege R; Taegtmeyer M; McCollum R; et al: Social Science & Medicine 209 (2018) 1–13, 2018
This paper synthesises current evidence on gender and close-to-community (CTC) providers and the services they deliver. The review included 58 papers from literature to inform the development of a conceptual framework. The authors present a holistic conceptual framework to show how gender roles and relations shape CTC provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. The authors present suggestions for how the role of a CTC provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities.
How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework
Steege R; Taegtmeyer M; McCollum R; et al.: Social Science & Medicine, (209) 1-13, 2018
This paper synthesises current evidence on gender and close-to-community providers and the services they deliver. The authors used a two-stage exploratory approach drawing upon qualitative research from six countries in the REACHOUT consortium in 2013 to 2014. This was followed by systematic review that took place in 2017, using critical interpretive synthesis methodology. This review included 58 papers. From this, the authors present the holistic conceptual framework to show how gender roles and relations shape close to community provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, influence of family and intra- household dynamics are of importance. Important at the health systems level, are career progression and remuneration. The authors present suggestions for how the role of a close to community provider can, with the right support, be an empowering experience. They argue for policymakers to promote gender equity in this cadre through safety and well-being, remuneration, and career progression opportunities.
How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda, Sierra Leone, Zimbabwe and Cambodia
Witter S; Wurie H; Chandiwana P; et al.: Health Policy and Planning 32(Suppl 3) iii3–iii13, 2017
This article is grounded in a research programme which set out to understand how to rebuild health systems post-conflict. Four countries were studied—Uganda, Sierra Leone, Zimbabwe and Cambodia—which were at different distances from conflict and crisis, as well as having unique conflict stories. The authors captured insights from 128 life histories and in-depth interviews with a variety of staff that had remained in service. This article aims to draw together lessons from these contexts which can provide lessons for enhancing staff and therefore health system resilience in future, especially in similarly fragile and conflict-affected contexts. The authors examine the reported effects, both personal and professional, of the three different types of shock (conflicts, epidemics and prolonged political-economic crises), and how staff coped. They find that the impact of shocks and coping strategies are similar between conflict/post-conflict and epidemic contexts—particularly in relation to physical threats and psychosocial threats—while all three contexts create challenges and staff responses for working conditions and remuneration. Health staff showed considerable inventiveness and resilience, and also benefited from external assistance of various kinds, but important gaps were found which point to ways in which they should be better protected and supported in the future.
How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review
McCollum R; Gomez W; Theobald S; Taegtmeyer M: BMC Public Health 16(419) 2016 doi: 10.1186/s12889-016-3043-8
Community health workers (CHWs) are uniquely placed to link communities with the health system, playing a role in improving the reach of health systems and bringing health services closer to hard-to-reach and marginalised groups. A systematic review was conducted to determine the extent of equity of CHW programmes and to identify intervention design factors which influence equity of health outcomes. In accordance with published protocol, the authors systematically searched eight databases from 2004 to 2014 for quantitative and qualitative studies which assessed access, utilisation, quality or community empowerment following introduction of a CHW programme according to equity stratifiers (place of residence, gender, socio-economic position and disability). Thirty four papers met inclusion criteria. A thematic framework was applied and data extracted and managed, prior to charting and thematic analysis. The authors believe this to be the first systematic review that describes the extent of equity within CHW programmes and identifies CHW intervention design features which influence equity. CHW programmes were found to promote equity of access and utilisation for community health by reducing inequities relating to place of residence, gender, education and socio-economic position. CHWs can also contribute towards more equitable uptake of referrals at health facility level. There was no clear evidence for equitable quality of services provided by CHWs and limited information regarding the role of the CHW in generating community empowerment to respond to social determinants of health. Factors promoting greater equity of CHW services include recruitment of most poor community members as CHWs, close proximity of services to households, pre-existing social relationship with CHW, provision of home-based services, free service delivery, targeting of poor households, strengthened referral to facility, sensitisation and mobilisation of community. However, if CHW programmes are not well planned some of the barriers faced by clients at health facility level can replicate at community level. CHWs promote equitable access to health promotion, disease prevention and use of curative services at household level. However, care must be taken by policymakers and implementers to take into account factors which can influence the equity of services during planning and implementation of CHW programmes.
How should community health workers in fragile contexts be supported: qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo
Raven J; Wurie H; Idriss A; Bah A; et al: Human Resources for Health 18(58), 1—14, doi: https://doi.org/10.1186/s12960-020-00494-8, 2020
This paper presents evidence from Sierra Leone, Liberia and Democratic Republic of Congo on how community health workers (CHWs) are .managed, the challenges they face and potential solutions. According to the findings: fragility disrupts education of community members so that they may not have the literacy levels required for the CHW role; with implications for the selection, role, training and performance of CHWs. Policy preferences about selection need discussion at the community level, so that they reflect community realities. CHWs’ scope of work is varied and may change over time, requiring ongoing training. The modular, local and mix of practical and classroom training approach worked well, helping to address gender and literacy challenges and developing a supportive cohort of CHWs. A package of supervision, community support, regular provision of supplies, performance rewards and regular remuneration is argued to be vital to the retention and performance of CHWs, as are predictable supervision, supplies, community recognition and allowances.
How to do (or not to do)… Measuring health worker motivation in surveys in low- and middle-income countries
Borghi J; Lohmann J; Dale E; et al: Health Policy and Planning 33(2) doi: https://doi.org/10.1093/heapol/czx153, 2018
A health system’s ability to deliver quality health care depends on the availability of motivated health workers, which are insufficient in many low income settings. Increasing policy and researcher attention is directed towards understanding what drives health worker motivation and how different policy interventions affect motivation, as motivation is key to performance and quality of care outcomes. As a result, there is growing interest among researchers in measuring motivation within health worker surveys. However, there is currently limited guidance on how to conceptualize and approach measurement and how to validate or analyse motivation data collected from health worker surveys, resulting in inconsistent and sometimes poor quality measures. This paper begins by discussing how motivation can be conceptualized, then sets out the steps in developing questions to measure motivation within health worker surveys and in ensuring data quality through validity and reliability tests. The paper also discusses analysis of the resulting motivation measure/s.
Human capacity-building plan for scaling up HIV/AIDS treatment
In order to meet the target of delivering simplified, standardised antiretroviral treatment services to 3 million people by the end of 2005, it is estimated that up to 100,000 people need to be trained. These figures include those involved in managing and delivering antiretroviral treatment services; those working on testing and counselling and other entry points to antiretroviral treatment; and community treatment supporters assisting people who are receiving medication. This document from the World Health Organization (WHO) outlines their strategic plan to support the development, strengthening and sustaining of the workforce.