This study aimed to describe perceptions of medical students, recent medical graduates, faculty of the College of Medicine, University of Malawi and private medical practitioners (PMPs) towards an attachment of undergraduate medical students in private medical doctors' offices. A qualitative cross-sectional study was conducted in Blantyre, Malawi in 2004 using in-depth key informant interviews and content analysis. In general, private medical practitioners were favourable to the idea of having medical students within their consulting offices while the majority of students, recent graduates and faculty opposed, fearing compromising teaching standards. Private medical practitioners (PMPs) were seen as outdated in skills and knowledge. Faculty, medical students and recent graduates of the Malawi College of Medicine do not perceive PMPs as a resource to be tapped for the training of medical students.
Human Resources
This study aimed to document the kinds of leadership styles are practiced at primary health care (PHC) centres and how these styles can be explained by the contexts, characteristics of the health centre in charge (IC) and subordinate trained health staff (STHS). Self-administered questionnaires were distributed at 47 centres in three districts. A total of 347 STHSs (95%) and 46 ICs (98%) responded. Two leadership styles were revealed: ‘trans’ style contained all relation and the majority of task and change items, while ‘control’ style focused on health statistics, reporting and evaluation. The researchers found that frontline PHC leadership may be forced by situation and context to use a comprehensive style, which could lack the diversity and flexibility needed for effective leadership. The missing associations between staff characteristics and leadership styles might indicate that this group is not sufficiently considered and included in leadership processes in the PHC organisation. Leadership competency for the ICs seems not to be based on formal training, but substituted by young age and work experience. In conclusion, the authors call for a reassessment of PHC leadership and formal leadership training.
This study identified the level of knowledge and competencies related to quality of care during medical education in sub-Saharan African medical schools. A cross-sectional study design was utilised to examine the capacity of medical schools in sub-Saharan African countries to teach about the concepts of quality of care and the inclusion of these concepts in their curriculum. A purposeful convenience sampling technique was used to select participants from 25 medical schools in 5 sub-Saharan African countries. Respondents included medical school deans or senior academic personnel. While 45% of the schools surveyed are teaching on at least one of the six domains of the Institute of Medicine’s definition of quality of care, there are some schools who report not teaching about quality at all, or that they “do not know”. Despite these low numbers, when asked about topics related to quality of care, many schools are teaching applied management related topics and almost all schools teach about equity and patient-centred care. The results have implications for incorporating quality of care in medical education and for practitioners. The tool developed for this study could be used in future qualitative and quantitative studies to further understanding of how to improve the teaching and learning about quality of care in medical schools.
The objective of the study was to demonstrate the effectiveness of service-based human resources for health (HRH) planning through its adaptation in two rural Zambian districts, Gwembe and Chibombo. The health conditions causing the greatest mortality and morbidity in each district were identified using administrative data and consultations with community health committees and health workers. The number and type of health care services required to address these conditions were estimated based on their population sizes, incidence and prevalence of each condition, and desired levels of service. The capacity of each district’s health workers to provide these services was estimated using a survey of health workers (n=44) that assessed the availability of their specific competencies. The primary health conditions identified in the two districts were HIV/AIDS in Gwembe and malaria in Chibombo. Although the competencies of the existing health workforces in these two mostly aligned with these conditions, some substantial gaps were found between the services the workforce can provide and the services their populations need. The largest gaps identified in both districts were: performing laboratory testing and interpreting results, performing diagnostic imaging and interpreting results, taking and interpreting a patient’s medical history, performing a physical examination, identifying and diagnosing the illness in question, and assessing eligibility for antiretroviral treatment.
In South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development. Community service officers are required to contribute a year towards serving in a public health facility while receiving supervision and remuneration. Although the South African community service programme has been in effect since 1998, little is known about how placement and practical support occur, or how community service may impact future retention of health professionals. National, cross-sectional data were collected from community service officers who served during 2009 using a structured self-report questionnaire. A Supervision Satisfaction Scale (SSS) was created by summing scores of five questions rated on a three-point Likert scale (orientation, clinical advising, ongoing mentorship, accessibility of clinic leadership, and handling of community service officers’ concerns). Research endpoints were guided by community service programmatic goals and analysed as dichotomous outcomes. Bivariate and multivariate logistical regressions were conducted using Stata 12. The sample population comprised 685 doctors and dentists (response rate 44%). Although few participants planned to continue work in rural, underserved communities (n = 171 out of 657 responses, 25%), those serving in a rural facility during the community service year had higher intentions of continuing rural work. Those reporting professional development during the community service year were twice as likely to report intentions to remain in rural, underserved communities. Despite challenges in equitable distribution of practitioners, participant satisfaction with the compulsory community service programme appears to be high among those who responded to a 2009 questionnaire. An emphasis on professional development and supervision is crucial if South Africa is to build practitioner skills, equitably distribute health professionals, and retain the medical workforce in rural, underserved areas.
This brochure, published by the WHO Africa Regional Office, aims to raise awareness of human resources for health in Africa. It argues that health workers are central to making the best possible use of other resources and investments in the health sector, yet their importance has not been widely recognised. Declining staff salaries have contributed to a brain drain from the public to the private sector and from developing to more developed countries, and few countries have made systematic efforts to ensure that health professionals return home after training abroad. Training in Africa has tended to mimic developed countries, producing highly trained, expensive, elite and hospital-focused professionals.
This study aimed to assess the policy and programmatic implications of task shifting in Uganda. This was a qualitative, descriptive study through 34 key informant interviews and eight focus group discussions, with participants from various levels of the health system. Policy makers understood task shifting, but front-line health workers had misconceptions on the meaning and intention(s) of task shifting. There was apparently high acceptance of task shifting in HIV and AIDS service delivery, with involvement of community health workers (CHW) and people living with HIV and AIDS (PLWHAs) in care and support of AIDS patients. There was no written policy or guidelines on task shifting, but the policy environment was reportedly conducive with plans to develop a policy and guidelines on task shifting. The study identifies a number of factors favouring task shifting and barriers. There were widespread examples of task in Uganda, and task shifting was mainly attributed to HRH shortages coupled with the high demand for healthcare services. The authors emphasise a need for clear policy and guidelines to regulate task shifting and protect those who undertake delegated tasks.
In 2007, the South African government introduced the occupation-specific dispensation (OSD), a financial incentive strategy to attract, motivate, and retain health professionals in the public sector. Implementation commenced with the nursing sector. In this paper, researchers examine implementation of the OSD for nurses and highlight the conditions for the successful implementation of financial incentives. They conducted a qualitative case study design using a combination of a document review and in-depth interviews with 42 key informants, finding several implementation weaknesses. Only a few of the pre-conditions were met for OSD policy implementation. The information systems required for successful policy implementation, such as the public sector human resource data base and the South African Nursing Council register of specialised nurses, were incomplete and inaccurate, thus undermining the process. Insufficient attention was paid to time and resources, dependency relationships and task specification. In conclusion, the implementation of financial incentives requires careful planning and management in order to avoid loss of morale and staff grievances.
This study aimed to evaluate the relative effectiveness of different policies in attracting nurses to rural areas in Kenya, South Africa and Thailand using data from a discrete choice experiment (DCE). A labelled DCE was designed to model the relative effectiveness of both financial and non-financial strategies designed to attract nurses to rural areas. Data were collected from over 300 graduating nursing students in each country. Mixed logit models were used for analysis and to predict the uptake of rural posts under different incentive combinations. The study found that nurses’ preferences for different human resource policy interventions varied significantly between the three countries. In Kenya and South Africa, better educational opportunities or rural allowances would be most effective in increasing the uptake of rural posts, while in Thailand better health insurance coverage would have the greatest impact. In conclusion, it recommends that DCEs can be designed to help policy-makers choose more effective interventions to address staff shortages in rural areas. Intervention packages tailored to local conditions are more likely to be effective than standardised global approaches.
This paper looks at different possible policy responses to the emigration of highly skilled persons from developing countries (the brain drain) with the goal of minimising its adverse effects and promoting the sharing of gains between source and host countries. It focuses on three policy approaches: retention, return and circulation of skills. It argues that the best strategy to deal with the problem of loss of skilled labour is one based on the concept of circulation of skills, which yields mutual benefits for both sending and host countries.