This paper presents some initial findings from a survey of public sector workers, in a number of countries in Europe, Africa, North America, Latin America and Asia, and how they have been affected by policies of liberalisation in relation to wages, working conditions and other forms of socio-economic security. This survey was a joint initiative between the International Labour Organization (ILO) and Public Services International (PSI), an international trade union. The aim of the survey was to explore three themes: workers’ socio-economic security; quality and accessibility of public services; and relations between government, foreign and domestic capital, trade unions and civil society.
Human Resources
The impact of Public Sector Reforms on Public Sector Workers
Lethbridge J: Public Services International Research Unit, 2006
The impact of the National HIV Health Care Worker Hotline on patient care in South Africa
Chisholm BS, Cohen K, Blockman M, Kinkel H, Kredo TJ and Swart AM: AIDS Research and Therapy 8(4), 26 January 2011
In South Africa, many health care workers managing HIV-infected patients - particularly those in rural areas and primary care health facilities - have minimal access to information resources and to advice and support from experienced clinicians. The Medicines Information Centre, based in the Division of Clinical Pharmacology at the University of Cape Town, has been running the National HIV Health Care Worker (HCW) Hotline since 2008, providing free information for HIV treatment-related queries via telephone, fax and e-mail. This questionnaire-based study showed that 224 (44%) of the 511 calls that were received by the hotline during the two-month study period were patient-specific. Ninety-four completed questionnaires were included in the analysis. Of these, 72 (77%) were from doctors, 13 (14%) from pharmacists and 9 (10%) from nurses. Ninety-six percent of the callers surveyed took an action based on the advice they received from the National HIV HCW Hotline. Most of the queries concerned the start, dose adaptation, change or discontinuation of medicines. Less frequent actions taken were adherence and lifestyle counselling, further investigations, referring or admission of patients. The authors of this study conclude that the information provided by the National HIV HCW Hotline on patient-specific requests has a direct positive impact on the management of patients.
The impact on nurses and nurse managers of introducing PEPFAR clinical services in urban government clinics in Uganda
Nankumbi J, Groves S, Leontsini E, Kyegombe N, Coutinho A, Manabe Y: BMC International Health and Human Rights 11(Suppl 1):S8, 9 March 2011
In an effort to expand much-needed HIV services in the Ugandan capital of Kampala, the Infectious Disease Institute, an affiliate of Makerere University College of Health Science, has established a community-university partnership with the Ministry of Health to implement an innovative model to build capacity in HIV service delivery. In this paper, the authors evaluate the impact on the nurses from this programme to provide more health care in six nurse-managed Kampala City Council (KCC) Clinics. A mixed method approach was used. The descriptive study collected key informant interviews from the clinics’ six nurse managers, and administered a questionnaire to 20 staff nurses between September and December 2009. Results showed that introducing new HIV services into the KCC clinics was positive for the nurses. They identified the project as successful because of perceived improved work environment, increase in useful in-service training, new competence to manage patients and staff, improved physical infrastructure, provision of more direct patient care, motivation to improve the clinic because the project acted on their suggestions, and involvement in role expansion. All of these helped empower the nurses, improving quality of care and increasing job satisfaction.
The importance of human resources management in health care: A global context
Kabene SM, Orchard C, Howard JM, et al: Human Resources for Health 4 (20), July 2006
This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models.
The importance of human resources management in health care: A global context
Kabene SM, Orchard C, Howard JM , Soriano MA, Leduc R: Human Resources for Health 4:20, 20 July 2006
This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services.
The Impossible Dream? Codes of Practice and the International Migration of Skilled Health Workers
Connell J and Buchan J: World Medical and Health Policy 3(3): Article 3, 17 August 2012
To stem the loss of skilled health workers from developing countries, there has recently been an increase in the number of regional Codes of Practice and bilateral Memoranda of Understanding to achieve more effective, equitable and ethical international migration of workers, culminating in the finalisation of the World Health Organisation’s Global Code for Health Worker Recruitment in 2010. Despite this, the authors of this paper point out that there is no agreed definition of ethical international recruitment, and no consensus on the significance and location of harmful recruitment practices. Most codes they analysed covered relatively few regions and exhibited a high degree of generality. Migration, they found, occurs in contexts that do not necessarily involve health issues. Limitations were identified: there are no incentives for recipient countries and agencies to be involved in ethical international recruitment and all codes are voluntary, which has restricted their impact. At the same time, the private sector is effectively excluded from codes. Bilateral agreements and memoranda have a greater chance of success, the authors note, enabling managed migration and return migration, but are more geographically limiting. The most effective constraints to the unregulated flow of skilled health workers are the production of adequate numbers in present recipient countries and provision of improved employment conditions in source countries.
The integration of occupational- and household-based chronic stress among South African women employed as public hospital nurses
Cohen J; Venter W: PLOS One 15(5), e0231693, 2020
This study explored the lived experience of public hospital-employed, black women nurses’ to better understand their stressors and what may help to reduce it. Through semi-structured life history interviews with 71 nurses in Johannesburg, nurses described daily lives of chronic distress, with extreme pressures on their incomes, time, and resources. Much of this pressure was said to come from the number and intensity of family dependents, related financial obligations and debt. This revised from social norms which assign women primary responsibility for unpaid household work, which nurses struggle with as unsustainable, anxiety-inducing and with pay and paid work schedules that make meeting that responsibility virtually impossible. The structure of the nursing occupation contributes to stress outside the workplace, while the structure of nurses’ households contributes to stress and emotional exhaustion. This implies that workplace-oriented interventions may assist but alone are unlikely to adequately address the overall level of stress.
The interface between health sector reform and human resources in health
Human Resources for Health 2003
The relationship between health sector reform and the human resources issues raised in that process has been highlighted in several studies. These studies have focused on how the new processes have modified the ways in which health workers interact with their workplace, but few of them have paid enough attention to the ways in which the workers have influenced the reforms. The impact of health sector reform has modified critical aspects of the health workforce, including labour conditions, degree of decentralization of management, required skills and the entire system of wages and incentives.
The Labour Market for Health Workers in Africa : New Look at the Crisis
Soucat A, Scheffler R: Journal of the World Bank, April 2013
Health systems in Sub-Saharan Africa have changed profoundly over the last 20 years. The economic crisis of the 1980s and 1990s rattled public health care systems, which were largely holdovers from the colonial and postcolonial eras. The later wave of structural adjustments and public sector reforms wrought further change. As African economies opened to market based approaches, the private sector became a sizable source of health care service. This paper presents data from the World Bank's Africa Region Human Resources for Health Program.
The mental health workforce gap in low- and middle-income countries: A needs-based approach
Bruckner TA, Scheffler RM, Shen G, Yoon J, Chisholm D, Morris J et al: Bulletin of the World Health Organisation 89(3): 184–194, March 2011
The objective of this study was to estimate the shortage of mental health professionals in low- and middle-income countries (LMICs). The researchers used data from the World Health Organisation’s Assessment Instrument for Mental Health Systems (WHO-AIMS) from 58 LMICs, as well as country-specific information on the burden of various mental disorders, focusing on eight mental health issues: depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs, and paediatric mental disorders. The researchers found that all low-income countries and 59% of the middle-income countries in the sample had far fewer professionals than needed to deliver a core set of mental health interventions. According to their calculations, the 58 LMICs sampled would need to increase their total mental health workforce by 239,000 full-time equivalent professionals to address the current shortage. The authors of the study call for country-specific policies to overcome the large shortage of mental health-care staff and services in LMICs.