The impact of intermittent preventive treatment (IPTp) on malaria in pregnancy is well known. However, in countries where this policy is implemented, poor access and low compliance have been widely reported. Novel approaches are needed to deliver this intervention. This paper assesses whether or not traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilisers can administer IPTp with sulphadoxine–pyrimethamine (SP) to pregnant women, reach those at greatest risk of malaria, and increase access and compliance with IPTp. The report found that the community approach was effective for the delivery of IPTp, although women still accessed and benefited from malaria treatment and other services at health units. However, the costs for accessing malaria treatment and other services are high and could be a limiting factor.
Human Resources
At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers’ work environment and perceived quality of HIV-related care were assessed to complement data on provider performance. The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. The intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale. The performance and quality improvement intervention implemented at Zambian Defence Forces’ health facilities was associated with improvements in providers’ perceptions of work environments consistent with the intervention’s focus on commodities, skills acquisition, and receipt of constructive feedback.
Communication between non-language-concordant health care workers (HCWs) and patients has been shown by international studies to adversely affect patient and staff satisfaction, yet the authors of this study note that, to the best of their knowledge, no such intervention studies have been conducted in Africa. They conducted research in South Africa to determine whether teaching Xhosa language skills and cultural understanding to HCWs affects patient satisfaction, HCWs’ ability to communicate effectively with Xhosa-speaking patients and HCWs’ job satisfaction levels. A before-and-after interventional study was performed at two community health centres and a district hospital in the Western Cape Province. Fifty-four randomly selected patients (27 pre- and 27 post-intervention) assessed communication with HCWs and rated their satisfaction. Six non-Xhosa-speaking HCW participants completed pre- and post-intervention questionnaires. HCWs completed a ten-week basic language course consisting of ten 120-minute interactive contact sessions developing basic Xhosa speaking and listening skills and cultural competence. Results showed that patient satisfaction showed significant improvements after the intervention. Patients perceived HCWs to be more understanding, respectful and concerned, and to show better listening skills, after the intervention. They were also better able to understand HCWs and their instructions. HCWs’ ability to communicate improved and HCWs experienced decreased frustration levels.
The active recruitment of health workers from developing countries to developed countries has become a major threat to global health. In an effort to manage this migration, the 63rd World Health Assembly adopted the World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel in May 2010. While the Code has been lauded as the first globally-applicable regulatory framework for health worker recruitment, its impact has yet to be evaluated. The authors offer the first empirical evaluation of the Code’s impact on national and sub-national actors in Australia, Canada, United Kingdom and United States of America, which are the English-speaking high income countries with the greatest number of migrant health workers. Forty two key informants from across government, civil society and private sectors were surveyed. Sixty percent of respondents believed their colleagues were not aware of the Code, and 93% reported that no specific changes had been observed in their work as a result of the Code. 86% reported that the Code has not had any meaningful impact on policies, practices or regulations in their countries. This suggests a gap between awareness of the Code among stakeholders at global forums and the awareness and behaviour of national and sub-national actors. Advocacy and technical guidance for implementing the Code are needed to improve its impact on national decision- makers.
This article is the third in the Human Resources for Health journal's feature on the theme of leadership and management in public health leadership. It presents a successful application in Mozambique of a leadership development programme created by MSH, in which managers from 40 countries have learned to work in teams to identify their priority challenges and act to implement effective responses. From 2003 to 2004, 11 health units in Nampula Province participated in a leadership and management development programme called the Challenges Programme. The programme used several strategies that contributed to successful outcomes. It integrated leadership strengthening into the day-to-day challenges that staff were facing in the health units. Participatory teams were also created. After the programme, people no longer waited passively to be trained but instead proactively requested training in needed areas. Ministry of Health workers in Nampula reported that the programme's approach to improving management and leadership capacity at all levels promoted the efficient use of resources and empowered staff to make a difference.
With much smaller numbers relative to their counterparts in developed countries, pharmacists in developing countries tend to keep to the confines of dispensing roles mainly in community pharmacies. In this article the authors challenge these pharmacists to move away from the dispensing window and to demonstrate the value of the years invested in pharmacy schools to improve the well-being of communities. In Africa, another reason why pharmacy must be proactive in assuming service- and systems-based roles is the fact that physicians are often overloaded with clinical duties. By demonstrating that they can competently assume these roles and complement physicians in providing quality healthcare services, pharmacists have ready-made opportunities to enhance their role in the community. To arrest the waning image of the profession in Africa, there is need to identify service opportunities that would perpetuate the continued relevance of the profession to health systems and communities. Even though new opportunities in the areas of public health, pharmaceutical supply chain management, pharmacovigilance, regulation, management, rational drug use and others are emerging in different forms and designs, pharmacists appear slow to seize these opportunities. Changes in mind sets, perceptions, curricula and teaching methodologies are required, the article concludes.
In recognition of the microbial and societal complexities underlying infectious disease control, this report emphasizes that mounting an effective response to infectious disease threats will require multidisciplinary efforts involving all sectors of the clinical medicine, public health, and veterinary medicine communities. Such a multidisciplinary approach must rest squarely on a well-prepared work-force within each of these communities. However, "the number of qualified individuals in the workforce required for microbial threat preparedness is dangerously low....".
Over the past decade, governments and international partners have responded to calls for health workforce data with ambitious investments in human resources information systems (HRIS). However, documentation of country experiences in the use of HRIS to improve strategic planning and management has been lacking. This case presentation documents for the first time Mozambique’s novel approach to HRIS, sharing key success factors and contributing to the scant global knowledge base on HRIS. Core components of the system are a Government of Mozambique (GOM) registry covering all workers in the GOM payroll and a “health extension” which adds health-sector-specific data to the GOM registry. Separate databases for pre-service and in-service training are integrated through a business intelligence tool. The first aim of the HRIS was to identify the following: who and where are Mozambique’s health workers? As of July 2015, 95 % of countrywide health workforce deployment information was populated in the HRIS, allowing the identification of health professionals’ physical working location and their pay point. HRIS data are also used to quantify chronic issues affecting the Ministry of Health (MOH) health workforce. Examples include the following: HRIS information was used to examine the deployment of nurses trained in antiretroviral therapy (ART) vis-à-vis the health facilities where ART is being provided. Such results help the MOH align specialized skill sets with service provision. Twenty-five percent of the MOH health workforce had passed the 2-year probation period but had not been updated in the MOH information systems. For future monitoring of employee status, the MOH established a system of alerts in semi-monthly reports. As of August 2014, 1046 health workers were receiving their full salary but no longer working at the facilities. The MOH is now analysing this situation to improve the retirement process and coordination with Social Security. The Mozambican system is an important example of an HRIS built on a local platform with local staff. Notable models of strategic data use demonstrate that the system is empowering the MOH to improve health services delivery, health workforce allocation, and management. Combined with committed country leadership and ownership of the program, this suggests strong chances of sustainability and real impact on public health equity and quality.
This paper outlines the Human Resources for Health (HRH) issues during the period of reconstruction in post-conflict countries, drawing examples from Afghanistan and Cambodia. It explores issues of restoring a health workforce and outlines key HRH actions for workforce reconstruction, including: identifying available staff; developing HRH management structures, systems and capacity; clarifying HRH roles and responsibilities; establishing health worker equivalencies and upgrading skills; supporting civil service reconstruction; and widely disseminating HRH information.
This paper uses a forecasting model to estimate the need for, supply of, and shortage of doctors, nurses, and midwives in thirty-nine African countries for 2015, the target date of the United Nations Millennium Development Goals. It forecasts that thirty-one countries will experience needs-based shortages of doctors, nurses, and midwives, totalling approximately 800,000 health professionals. It further estimates the additional annual wage bill required to eliminate the shortage at about US$2.6 billion, more than 2.5 times current wage-bill projections for 2015. Additional funds would be required to hire health care support staff, train and support staff, and pay for expenses. Raising the money required to eliminate the shortfall would be difficult for the countries involved, even under the most optimistic assumptions regarding economic growth and governmental commitments to the health sector. Global aid can help but will still not provide enough resources, the researchers say. They call for changes in the skills mix, worker incentives and improvements in training for health care workers.