South Africa launched its National Strategic Plan for Nurse Education, Training and Practice for 2012/13 - 2016/17 in March 2013. The plan aims to revitalise the ailing public health sector. According to the plan, nursing colleges will be declared higher education institutions in compliance with the provisions of the Higher Education Act (as amended in 2008). This will help to address provincial inequalities, norms and standards, quality, decrease fragmentation, eliminate fly-by-night nursing education institutions (NEIs), improve clinical training and enhance social accountability. Nursing students will also have the status of full students (rather than employees) while undergoing training. They should receive funding support paid monthly for tuition books and study materials, as well as living costs, medical aid and indemnity insurance, while tuition fees should be paid directly to the NEIs. The plan also addresses the need to emphasise modules that focus on caring, and these should be compulsory at all levels of nursing and midwifery. This should help address the issue of compassion in the profession. The plan also significantly proposes that an office for the chief nursing officer be established, which will then take responsibility for the implementation of the strategy over the next five years.
Human Resources
Government is considering engaging countries where nurses have migrated to enter into a formal memorandum of understanding for fixed contracts. Health minister Brian Chituwo says government is working out modalities on how to retain and motivate nurses and other medical personnel that have left the country. The countries in question would be required to pay the Zambian government a certain amount of money which will be re - invested in training.
This presentation was given at the First Forum on Human Resources for Health in Kampala. It defines health leadership and management, why strengthening it is important, the lessons learned so far, and the main components and uses of the WHO framework.
This World Health Organization background paper reviews and summarises service delivery management at the district level in Uganda. Specifically, it looks at health sector management development approaches that have been recently implemented, changes in the management capacity and performance and links between management development and health service delivery outputs. The paper finds that significant effort has gone into developing managers using long and short courses and placing "technical advisers" with District Health Management Teams. The paper concludes that whilst opportunities exist for managers to develop skills, courses need to be better designed to produce the essential competencies needed. A health sector competency framework for managers will provide common performance objectives and standards in the sector.
In this article, the authors describe health care workers (HCWs') experiences and perceptions of meeting clients exposed to intimate partner violence. Qualitative content analysis of in-depth interviews from 16 informants resulted in four main themes. The first, Internalising women's suffering and powerlessness’, describes HCWs' perceptions of violence, relating it to gender relations. The second, ’Caught between encouraging disclosure and lack of support tools, refers to views on possibilities for transparency and openness. The third, ’Why bother? A struggle to manage with limited resources’, illustrates the consequences of a heavy workload. Last, ‘Striving to make a difference’, emphasises a desire to improve abilities to support clients and advocate for prevention.
This study was conducted to determine the prevalence of substance use and identify factors that influenced the behaviour among undergraduate medical students of Addis Ababa University in Ethiopia. A cross-sectional study using a pre-tested structured self-administered quantitative questionnaire was conducted in June 2009 among 622 medical students (Year I to Internship programme) at the School of Medicine. Results showed that in the 12 months prior to the study, alcohol was consumed by 22% of students and khat use was reported by 7%. Being male was strongly associated with alcohol use in the last 12 months. Khat use and use of tobacco was strongly and positively associated with alcohol consumption. In conclusion, concordant use of alcohol, khat and tobacco was observed and exposure to friends' use of substances was often implicated. While the findings of this study suggest that substance use among the medical students was not alarming, but its trend increased among students from Year I to Internship programme. The authors caution the university to be vigilant in monitoring and educating the students about the consequences of substance use.
The WHO Secretariat held a global, web-based public hearing between 1 September and 3 October 2008 to obtain inputs on the first draft of the WHO code of practice from as wide a group of stakeholders as possible. Member States, national institutions, health professional organisations, nongovernmental organisations, academic institutions, international organisations and other stakeholders submitted more than 90 contributions to the public hearings. Some expressed the view that Article 4 should be revised to provide greater emphasis on the legal responsibilities of health personnel to source and destination countries, such as those to protect the public health interest. Others felt that Article 4 should recommend that states prohibit all active recruitment of health personnel from countries experiencing a health workforce crisis.
This qualitative paper reports on the experience of three community health worker (CHW) supervisors who were responsible for supporting infant feeding peer counsellors. The intervention took place in three diverse settings in South Africa. Each setting employed one CHW supervisor, each of whom was individually interviewed for this study. The study forms part of the process evaluation of a large-scale randomised controlled trial of infant feeding peer counselling support. The findings highlight the complexities of supervising and supporting CHWs. In order to facilitate effective infant feeding peer counselling, supervisors in this study had to move beyond mere technical management of the intervention to broader people management. While their capacity to achieve this was based on their own prior experience, it was enhanced through being supported themselves. In turn, resource limitations and concerns over safety and being in a rural setting were raised as some of the challenges to supervision. Adding to the complexity was the issue of HIV. Supervisors not only had to support CHWs in their attempts to offer peer counselling to mothers who were potentially HIV positive, but they also had to deal with supporting HIV-positive peer counsellors. This study highlights the need to pay attention to the experiences of supervisors so as to better understand the components of supervision in the field.
Uganda’s national community health worker program involves volunteer Village Health Teams (VHTs) delivering basic health services and education. Evidence demonstrates their positive impact on health outcomes, particularly for Ugandans who would otherwise lack access to health services. Despite their impact, VHTs are not optimally supported and attrition is a growing problem. In this study, the authors examined the support needs and existing challenges of VHTs in two Ugandan districts and evaluated specific factors associated with long-term retention. The authors reported on findings from a standardised survey of VHTs and exploratory interviews with key stakeholders and draw conclusions that inform efforts to strengthen and sustain community health care delivery in Uganda. A mixed-methods approach was employed through a survey of 134 individual VHT members and semi-structured interviews with six key stakeholders. Descriptive and bivariate regression analysis of quantitative survey data was performed along with thematic analysis of qualitative data from surveys and interviews. In the regression analysis, the dependent variable is 10-year anticipated longevity among VHTs, which asked respondents if they anticipate continuing to volunteer as VHTs for at least 10 more years if their current situation remains unchanged. VHTs desire additional support primarily in the forms of money (for example transportation allowance) and material supplies (for example rubber boots). VHTs commonly report difficult working conditions and describe a lack of respect from their communities and other health workers. If their current situation remains unchanged, 57% of VHTs anticipate remaining in their posts for at least 10 years. Anticipated 10-year longevity was positively associated with stronger partnerships with local health centre staff and greater ease in home visiting. The authors note that supporting and retaining Uganda’s VHTs would be enhanced by building stronger partnerships between VHTs and other health workers and regularly providing supplies and transportation allowances. Pursuing such measures would likely improve equity in access to healthcare for all Ugandans.
The government of Malawi is committed to the rollout of antiretroviral treatment in Malawi in the public health sector; however one of the primary challenges has been the shortage of trained health care workers. The Practical Approach to Lung Health Plus HIV/AIDS in Malawi (PALM PLUS) package is an innovative guideline and training intervention that supports primary care middle-cadre health care workers to provide front-line integrated primary care. The purpose of this paper is to describe the lessons learned in implementing the PALM PLUS package. A clinical tool, based on algorithm- and symptom-based guidelines was adapted to the Malawian context. An accompanying training program based on educational outreach principles was developed and a cascade training approach was used for implementation of the PALM PLUS package in 30 health centres, targeting clinical officers, medical assistants, and nurses. Lessons learned were identified during program implementation through engagement with collaborating partners and program participants and review of program evaluation findings. Key lessons learned for successful program implementation of the PALM PLUS package include the importance of building networks for peer-based support, ensuring adequate training capacity, making linkages with continuing professional development accreditation and providing modest in-service training budgets. The main limiting factors to implementation were turnover of staff and desire for financial training allowances.