The authors of this study estimated the shortage of mental health professionals in low- and middle-income countries (LMICs). They used data from the World Health Organisation’s Assessment Instrument for Mental Health Systems (WHO-AIMS) from 58 LMICs, country-specific information on the burden of various mental disorders and a hypothetical core service delivery package to estimate how many psychiatrists, nurses and psychosocial care providers would be needed to provide mental health care to the total population of the countries studied. All low-income countries and 59% of the middle-income countries in the sample were found to have far fewer professionals than they need to deliver a core set of mental health interventions. 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 conclude. Country-specific policies are needed to overcome the large shortage of mental health-care staff and services throughout LMICs.
Human Resources
Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration.
"There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries...International medical graduates constitute between 23 and 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia, and lower-income countries supply between 40 and 75 percent of these international medical graduates. The United Kingdom, Canada, and Australia draw a substantial number of physicians from South Africa, and the United States draws very heavily from the Philippines. Nine of the 20 countries with the highest emigration factors are in sub-Saharan Africa or the Caribbean."
This study was undertaken to assess the scope and nature of community-based education (CBE) for various health worker cadres in Uganda. Curricula and other materials on CBE programmes in Uganda were reviewed to assess nature, purpose, intended outcomes and evaluation methods used by CBE programmes. In-depth and key informant interviews were conducted with people involved in managing CBE in twenty-two selected training institutions, as well as stakeholders from the community, Ministry of Health, Ministry of Education, civil society organisations and local government. The researchers found that CBE curriculum is implemented in most health training institutions in Uganda and is a core course in most health disciplines at various levels. The CBE curriculum is systematically planned and implemented with major similarities among institutions. Organisation, delivery, managerial strategies, and evaluation methods are also largely similar. Strengths recognised included providing hands-on experience, knowledge and skills generation and the linking learners to the communities. Almost all CBE implementing institutions cited human resource, financial, and material constraints. It is still uncertain whether this approach is increasing the number graduates seeking careers in rural health service, one of the stated programme goals.
This time and motion study in Dar es Salaam, Tanzania estimated the potential of task-shifting in services for prevention of mother to child transmission (PMTCT) to reduce nurses’ workload and health system costs. The time used by nurses to accomplish PMTCT activities during antenatal care (ANC) and postnatal care (PNC) visits was measured. These data were then used to estimate the costs that could be saved by shifting tasks from nurses to community health workers in the Tanzanian public-sector health system. A total of 1121 PMTCT-related tasks carried out by nurses involving 179 patients at ANC and PNC visits were observed at 26 health facilities. The average time of the first ANC visit was the longest, 54 min, followed by the first PNC visit which took 29 minutes on average. ANC and PNC follow-up visits were substantially shorter, 15 and 13 minutes, respectively. During both the first and the follow-up ANC visits, 94% of nurses’ time could be shifted to community health workers, while 84% spent on the first PNC visit and 100% of the time spent on the follow-up PNC visit could be task-shifted. Depending on community health workers salary estimates, the cost savings due to task-shifting in PMTCT ranged from US$ 1.3 to 2.0 (first ANC visit), US$ 0.4 to 0.6 (ANC follow-up visit), US$ 0.7 to 1.0 (first PNC visit), and US$ 0.4 to 0.5 (PNC follow-up visit). Nurses working in PMTCT spend large proportions of their time on tasks that could be shifted to community health workers, giving them more time for specialised PMTCT tasks and reducing the average cost per PMTCT patient.
Competency-based education (CBE) is argued to provide a useful alternative to time-based models for preparing health professionals and constructing educational programmes. In this paper, the authors describe the concept of 'competence' and 'competencies' as well as the critical curricular implications that derive from a focus on 'competence' rather than 'time'. These implications include: defining educational outcomes, developing individualised learning pathways, setting standards, and the centrality of valid assessment so as to reflect stakeholder priorities. They also highlight four challenges to implementing CBE: identifying the health needs of the community, defining competencies, developing self-regulated and flexible learning options, and assessing learners for competence. While CBE has been a prominent focus of educational reform in resource-rich countries, the authors argue that it has even more potential to align educational programmes with health system priorities in more resource-limited settings. Because CBE begins with a careful consideration of the competencies desired in the health professional workforce to address health care priorities, it provides a vehicle for integrating the health needs of the country with the values of the profession.
By James D. Shelton
For more than 20 years, the family planning and reproductive health field has promoted the understanding of the "user perspective,"1 and rightly so. We've learned that in order to have successful programs that serve clients well, we need a better understanding of the people being served. But what of providers? Although providers are obviously essential partners in service programs, their perspectives have received remarkably little attention. That is a major gap. In the early 1990s, the International Planned Parenthood Federation (IPPF) put forward its seminal work on the "needs of the provider" to complement its "rights of the client."2 But to improve programs further, we need to see the world through the providers' eyes and understand them better. Who are they? How do they see their jobs, their roles and their programs? What are their needs and motivations? What aspects of their work environments challenge them? What is the human dimension of their overall lives, and how can we best enlist their help to improve access to services and the quality of programs?
The South African Department of Home Affairs (DHA) is responsible for the implementation and management of migration policy and legislation, as well as the registration of births, marriages and deaths and the issuing of identity documents and passports. It is often criticised in the media and in private conversation for being administratively inefficient, cumbersome and unwieldy. The Southern African Migration Project (SAMP) therefore proposed to test current perceptions of the Department through a study.
Tanzania suffers a severe shortage of pharmaceutical staff negatively affecting the provision of pharmaceutical services and access to medicines, particularly in rural areas. Task shifting has been proposed as a way to mitigate this. This study aimed to understand the context and extent of task shifting in pharmaceutical management in Dodoma Region, Tanzania. The authors explored 1) the number of trained pharmaceutical staff as compared to clinical cadres managing medicines, 2) the national establishment for staffing levels, 3) job descriptions, 4) supply management training conducted and 5) availability of medicines and adherence to Good Storage Practice in 270 public health facilities in 2011. In 95.5% of studied health facilities medicines management was done by non-pharmaceutically trained cadres, predominantly medical attendants. Task shifting was found to be a reality in the pharmaceutical sector in Tanzania occurring mainly as a coping mechanism rather than a formal response to the workforce crisis. Pharmacy-related tasks and supply management were informally shifted to clinical staff without policy guidance, explicit job descriptions, and without the necessary support through training. It was argued that implicit task shifting be recognised and formalised and job orientation, training and operational procedures be used to support non-pharmaceutical health workers to effectively manage medicine supply.
This paper from the Department of International Health at Boston School of Public Health is to summarizes what is known about the internal costs of HIV/AIDS, such as increasing absenteeism, higher pension payouts, and breakdowns in worker discipline and morale, to companies in Commonwealth countries in sub-Saharan Africa. The authors identify a dozen different types of workforce costs that HIV/AIDS will impose on African companies in the coming years. After briefly reviewing existing estimates of the costs of HIV/AIDS to business, they present a model for assessing these costs and describe some of the strategies companies are adopting to reduce the costs.