A key component of the proposed primary health care (PHC) re-engineering model in South Africa is creating ward-based outreach teams linked to primary health care clinics. Each team consists of a professional nurse team leader, three staff nurses and six community health workers (CHWs), with each team serving a population of approximately 6,000 people in a demarcated area. The model envisages the professional nurse team leader and two of the three staff nurses being based at the clinic, while the rest of the team is based in the community. Team leaders will spend 20-30% of their time in the community supporting the work of the team and visiting high risk households. The managers of the clinics to which these teams are linked are expected to lead, manage and oversee the outreach teams’ work in the community and their interactions with other stakeholders working in the same communities. The model requires clinic managers to promote an understanding of the facility catchment area’s epidemiology and burden of disease using health information and data collected during community activities, and to identify strategies to address the local health issues. The addition of these responsibilities will expand the clinic managers’ scope of work.
Human Resources
Nurses in South Africa - as in the rest of the continent - are the backbone and oxygen of public health care though not adequately acknowledged. This article traces the pattern of public health care spending and its impact on nurses since 1994. Given the nature and quantity of demand for public health care in South Africa, deemed the most unhealthy nation in the world in the 2019 Indigo Wellness Index, the article shows that the 25 year record of democratic South Africa registers low public health care expenditure and nurses are at the coal face of this contradiction.
Nurses have long been identified as key contributors to strategies to reduce health inequalities. This raises questions about: convergence between policy makers’ and nurses’ understanding of how inequalities in health are created and sustained and educational preparation for the role as contributors in reducing health inequalities. This qualitative research project determined public health nurse educators’ understanding of public health as a strategy to reduce health inequalities, through semi-structured interviews. Public health nurse educators described health inequalities as the foundation on which a public health framework should be built. Two distinct views emerged of how health inequalities should be tackled: some proposed a population approach focusing on upstream preventive strategies, whilst others proposed behavioural approaches focusing on empowering vulnerable individuals to improve their own health. Despite upstream interventions to reduce inequalities in health being proved to have more leverage than individual behavioural interventions in tackling the fundamental causes of health inequalities, some nurses have a better understanding of individual interventions than population approaches.
Nurses have long been identified as key contributors to strategies to reduce health inequalities. This qualitative research project explored public health nurse educators’ understanding of public health as a strategy to reduce health inequalities. 26 semi-structured interviews were conducted with higher education institution-based public health nurse educators. Public health nurse educators described health inequalities as the foundation on which a public health framework should be built. Two distinct views emerged of how health inequalities should be tackled: some proposed a population approach focusing on upstream preventive strategies, whilst others proposed behavioural approaches focusing on empowering vulnerable individuals to improve their own health. Despite upstream interventions to reduce inequalities in health being proved to have more leverage than individual behavioural interventions in tackling the fundamental causes of health inequalities, some nurses have a better understanding of individual interventions than population approaches.
This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that need to be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about the composition, training or performance of the workforce. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems?
This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that need to be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organisational base. Although the public health workforce is central to the performance of health systems, very little is known about the composition, training or performance of the workforce. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems.
PUBLIC sector management should brace itself to face a much stronger union if the merger plans by affiliates of the Congress of SA Trade Unions organising in this sector succeed. All Cosatu public service unions will meet in the middle of June to discuss forming a single public sector union. This development is in line with Cosatu's resolution, adopted by the federation's 1991 and 1997 congresses, which called for the establishment of super unions or cartels by way of mergers. Two other Cosatu affiliates, the National Education, Health and Allied Workers' Union (Nehawu) and the SA Municipal Workers' Union (Samwu), are already involved in a merger plan.
This paper describes the current situation of the health workforce in the public sector in Swaziland. Swaziland, like most other countries in southern Africa, is facing a human resources crisis that is exacerbated by the impact of HIV and AIDS. The paper identifies the major factors that contribute to losses in the health workforce as emigration and attrition due to AIDS. It describes the initiatives that the government has undertaken to tackle the crisis. These include retention strategies such as increased salaries to retain staff, and scaling up anti retroviral therapy (ART) for health-care workers to reduce attrition.
The lack of Human Resources for Health (HRH) is increasingly being recognised as a major bottleneck for scaling-up anti-retroviral treatment (ART), particularly in sub-Saharan Africa whose societies and health systems are hardest hit by HIV/AIDS. This country case study of Swaziland describes the current HRH situation in the public sector and identifies major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. It also suggests some areas for further research that may contribute to tackling the HRH crisis in Swaziland.
This article from the journal Human Resources for Health considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. The introduction of market mechanisms often involves the formation of an internal market within the health sector and market testing of different functions with the private sector. This has immediate implications for the employment of health workers in the public sector, because the public sector may reduce its workforce if services are purchased from other sectors or may introduce more short-term and temporary employment contracts.