This presentation was given at the First Forum on Human Resources for Health in Kampala. It details a study done to assess the feasibility and interest among stakeholders in the Netherlands, UK and US in facilitating recruitment and placement of foreign health care professionals to work in public sector health care in South Africa.
Human Resources
Recruitment and Placement of Foreign Health Care Professionals to Work in the Public Sector Health Care in South Africa: Assessment
Matsuyama R: International Organization for Migration; Global Health Workforce Alliance
Recruitment and Retention of Mental Health Workers in Ghana
Jack H; Canavan M; Ofori-Atta A; Taylor L; Bradley E: PLOS One; 8, 2, February 2013
Despite the great need to recruit and retain mental health workers in low-income countries, little is known about how these workers perceive their jobs and what drives them to work in mental health care. Using qualitative interviews, the authors aimed to explore factors motivating mental health workers in order to inform interventions to increase recruitment and retention. The authors conducted 28 in-depth, open-ended interviews with staff in Ghana’s three public psychiatric hospitals and used the snowballing method to recruit participants and the constant comparative method for qualitative data analysis, with multiple members of the research team participating in data coding to enhance the validity and reliability of the analysis. The use of qualitative methods allowed the authors to understand the range and depth of motivating and demotivating factors. Respondents described many factors that influenced their choice to enter and remain in mental health care. Motivating factors included 1) desire to help patients who are vulnerable and in need, 2) positive day-to-day interactions with patients, 3) intellectual or academic interest in psychiatry or behavior, and 4) good relationships with colleagues. Demotivating factors included 1) lack of resources at the hospital, 2) a rigid supervisory hierarchy, 3) lack of positive or negative feedback on work performance, and 4) few opportunities for career advancement within mental health. Because many of the factors are related to relationships, these findings suggest that strengthening the interpersonal and team dynamics may be a critical and relatively low cost way to increase worker motivation. The data also allowed the authors to highlight key areas for resource allocation to improve both recruitment and retention, including risk pay, adequate tools for patient care, improved hospital work environment, and stigma reduction efforts.
Redressing the gender imbalance: a qualitative analysis of recruitment and retention in Mozambique’s community health workforce
Steege R; Taegtmeyer M; Ndima S; Give C; et al: Human Resources for Health 18(37) doi: https://doi.org/10.1186/s12960-020-00476-w, 2020
Mozambique’s community health programme has a disproportionate number of male community health workers (known as Agentes Polivalentes Elementares (APEs)). This paper seeks to explore the current recruitment imbalance processes for APEs and how these are shaped by gender norms, roles and relations, as well as how they influence the experience and retention of APEs in Maputo Province, Mozambique. The authors employed qualitative methods with APEs, APE supervisors, community leaders and a government official in two districts within Maputo Province. Women reported difficulty leaving family responsibilities behind, and men reported challenges in providing for their families during training as other income-generating opportunities were not available to them. These dynamics were particularly acute in the case of single mothers, serving both a provider and primary carer role. Differences in attrition by gender were reported: women are likely to leave the programme when they marry, whereas men tend to leave when offered another job with a higher salary. Age and geographic location were also important intersecting factors, younger male and female APEs seek employment opportunities in neighbouring South Africa, whereas older APEs are more content to remain. The authors suggest that responsive policies to support gender equity within APE recruitment processes are required to support and retain a gender-equitable APE cadre.
Reducing child deaths: the contribution of community health workers
Haines A et al: The Lancet 369 (9579): 2121-2131
Insufficient progress is being made towards the Millennium Development Goals, including those dealing with child and maternal mortality. At the current rate of progress in sub-Saharan Africa, the target of a two-thirds reduction in child mortality by 2015 will only be reached in 2165. Renewed interest in the potential contribution of community health workers may be timely. Evidence suggests that over sixty percent of deaths in children under-five years could be prevented by interventions already in existence. Studies show that 41–72 percent of deaths in newborns are preventable using available interventions if there is high coverage, and about half of this reduction may be possible using community-based interventions. This study reviews the literature for evidence of whether community health workers are capable of carrying out the tasks required of them as part of a sustainable workforce. It concluded that several factors influence programme impact and sustainability and determine whether child death reductions can be realised on a national scale: national socio-economic and political factors, community factors, health system factors and international factors. For instance, particularly if the political context is not a participatory democracy, support within the community for community health workers may be undermined by social class and caste divisions.
Reducing child deaths: the contribution of community health workers
Haines A: ID21 Health News,
Insufficient progress is being made towards the Millennium Development Goals, including those dealing with child and maternal mortality. At the current rate of progress in sub-Saharan Africa, the target of a two-thirds reduction in child mortality by 2015 will only be reached in 2165. Renewed interest in the potential contribution of community health workers may be timely. This study reviews the literature for evidence of whether community health workers are capable of carrying out the tasks required of them as part of a sustainable workforce. The study concluded that several factors influence programme impact and sustainability and determine whether child death reductions can be realised on a national scale: national socio-economic and political factors, community factors, health system factors and international factors. For instance, particularly if the political context is not a participatory democracy, support within the community for community health workers may be undermined by social class and caste divisions. Moreover, the success of a community health worker programme depends to a considerable extent on a successful interaction with the formal health services sector.
Reflecting strategic and conforming gendered experiences of community health workers using photovoice in rural Wakiso district, Uganda
Musoke D; Ssemugabo C; Ndejjo R; et al: Human Resources for Health 16(41) 1-9, 2018
This paper explores the differential roles of male and female Community health workers (CHWs)in rural Wakiso district, Uganda, using photovoice, a community-based participatory research approach. The authors trained ten CHWs on key concepts about gender and photovoice. The CHWs took photographs for 5 months on their gender-related roles which were discussed in monthly meetings. The discussions from the meetings were recorded, transcribed, and translated to English, and emerging data were analysed using content analysis. Although responsibilities were the same for both male and female CHWs, they reported that in practice, CHWs were predominantly involved in different types of work depending on their gender. Social norms led to men being more comfortable seeking care from male CHWs and females turning to female CHWs. Due to their privileged ownership and access to motorcycles, male CHWs were noted to be able to assist patients faster with referrals to facilities during health emergencies, cover larger geographic distances during community mobilization activities, and take up supervisory responsibilities. Due to the gendered division of labour in communities, male CHWs were also observed to be more involved in manual work such as cleaning wells. The gendered division of labour also reinforced female caregiving roles related to child care, and also made female CHWs more available to address local problems. CHWs reflected both strategic and conformist gendered implications of their community work. The authors argue that the differing roles and perspectives about the nature of male and female CHWs while performing their roles should be considered while designing and implementing CHW programmes, without further retrenching gender inequalities or norms.
Reflections on the ethics of recruiting foreign-trained human resources for health
Runnels V, Labonté R and Packer C: Human Resources for Health 9(2), 20 January 2011
Developed countries' gains in health human resources (HHR) from developing countries with significantly lower ratios of health workers have raised questions about the ethics or fairness of recruitment from such countries. Little is known, however, about actual recruitment practices. In this study, the researchers focus on Canada (a country with a long reliance on internationally trained HHR) and recruiters working for Canadian health authorities. They conducted interviews with health human resources recruiters employed by Canadian health authorities to describe their recruitment practices and perspectives and to determine whether and how they reflect ethical considerations. HHR recruiters' reflections on the global flow of health workers from poorer to richer countries mirror much of the content of global-level discourse with regard to HHR recruitment. A predominant market discourse related to shortages of HHR outweighed discussions of human rights and ethical approaches to recruitment policy and action that consider global health impacts. The researchers conclude by suggesting that the concept of corporate social responsibility may provide a useful approach at the local organisational level for developing policies on ethical recruitment. Such local policies and subsequent practices may inform public debate on the health equity implications of the HHR flows from poorer to richer countries inherent in the global health worker labour market, which in turn could influence political choices at all government and health system levels.
Reforming essential health competencies and training in Africa in light of the Sustainable Development Goals
Houeto D; Bambini N: Global Health Promotion 23(1), 2016, doi: 10.1177/1757975916629737
Many African countries were not able to meet their Millennium Development Goals (MDGs) by the 2015 deadline. While this poor performance can be attributed to several factors, many analyses have revealed the main cause to be the absence of systematic and coordinated action on the social determinants of health, which are in large part outside of the health sector. Today, in light of the Sustainable Development Goals (SDGs), it is absolutely necessary to address this shortcoming. The authors indicate that reaching the SDGs calls for action on the social determinants of health and reduction of social inequalities. However, the current way health systems in the region operate emphasise treatment of disease, as if health systems are waiting for people to fall ill before taking care of them. In light of the SDGs, they argue that it has grown urgent for the African region to accelerate training of professionals who are skilled in acting on the social determinants of health to help reorient health services and place health in all policies.
Relaunch of the official community health worker programme in Mozambique: is there a sustainable basis for iCCM policy?
Chilundo B; Cliff J; Mariano A; Rodríguez D; George A: Health Policy and Planning 30 (suppl 2): ii36-ii45, 2015
In Mozambique, integrated community case management (iCCM) of diarrhoea, malaria and pneumonia is embedded in the national community health worker (CHW) programme, mainstreaming it into government policy and service delivery. Since its inception in 1978, the CHW programme has functioned unevenly, was suspended in 1989, but relaunched in 2010. To assess the long-term success of iCCM in Mozambique, this article addresses whether the current CHW programme exhibits characteristics that facilitate or impede its sustainability. The authors undertook a qualitative case study based on document review (n = 54) and key informant interviews (n = 21) with respondents from the Ministry of Health (MOH), multilateral and bilateral agencies and non-governmental organizations (NGOs) in Maputo in 2012. Interviews were mostly undertaken in Portuguese and all were coded using NVivo. A sustainability framework guided thematic analysis according to nine domains: strategic planning, organizational capacity, programme adaptation, programme monitoring and evaluation, communications, funding stability, political support, partnerships and public health impact. Government commitment was high, with the MOH leading a consultative process in Maputo and facilitating successful technical coordination. The MOH made strategic decisions to pay CHWs, authorize their prescribing abilities, foster guidance development, support operational planning and incorporate previously excluded ‘old’ CHWs. Nonetheless, policy negotiations excluded certain key actors and uncertainty remains about CHW integration into the civil service and their long-term retention. In addition, reliance on NGOs and donor funding has led to geographic distortions in scaling up, alongside challenges in harmonization. Finally, dependence on external funding, when both external and government funding are declining, may hamper sustainability. The authors’ analysis represents a nuanced assessment of the various domains that influence CHW programme sustainability, highlighting strategic areas such as CHW payment and programme financing. These organizational and contextual determinants of sustainability are central to CHW programme strengthening and iCCM policy support.
Report back from Global Health Workforce Alliance board meeting: 24–25 November 2008
Sheikh M: 10 December 2008
Underlining the Alliance vision that 'All people everywhere will have access to a skilled, motivated and supported health worker, within a robust health system', the strategic directions and priorities 2009-2011 confirmed the two main objectives within which the Alliance operates: to enable country leadership in national planning and management to improve the human resources for health (HRH) situation and respond to shortages of skilled and motivated health workers; and to address global policy challenges through evidence-informed actions to tackle trans-national problems in areas such as insufficient and inefficient use of resources, fiscal restraints on health sector spending, migration, priority research and cooperation among all stakeholders.
Further details: /newsletter/id/33694