This study describes the perspectives and engagement of key stakeholders in advancing critical regulatory and educational reform in east, central, and southern Africa (ECSA). Researchers surveyed 32 leading stakeholders from 13 ECSA countries with regard to task shifting and the challenges related to practice and education regulation reform. Most (72%) reported task shifting is practiced in their countries; however only 57% reported their national regulations had been revised to incorporate additional professional roles and responsibilities. They also reported different roles and levels of involvement with regard to nursing and midwifery regulation. The most frequently cited challenge impacting nursing and midwifery regulatory reform was the absence of capacity and resources needed to implement change. While guidelines on task shifting and recommendations on transforming health professional education exist, the authors argue that their study provides new evidence that countries in the ECSA region face obstacles to adapting their practice and education regulations accordingly. Stakeholders such as community nursing organisations, nursing associations, and academicians have varied and complementary roles with regard to reforming professional practice and education regulation.
Human Resources
Commissioned by the SADC (Southern African Development Community) AIDS Network of Nurses and Midwives (SANNAM) in collaboration with UNAIDS, this report summarises the results of a month of field research in five countries in Southern Africa – Botswana, Lesotho, Namibia, South Africa and Zambia. It highlights the fact that, among health professionals, nurses and midwives shoulder most of the care, treatment and support responsibilities for people living with HIV/AIDS (PLWHA) in Southern Africa. It also stresses the limited resources and constraints under which they deliver care.
Malawi is facing a health crisis as trained nurses leave to seek better wages abroad. More than half come to Britain to work for the NHS and private hospitals. Last year over 12,000 nurses from outside the European Union registered to work in the UK. In contrast Malawi, one of the world's poorest countries, trains around 60 nurses each year.
This integrative review examined literature on nursing education challenges and solutions in Sub Saharan Africa to inform development of a model for improving the quality, quantity and relevance of nursing education at local level through a search of online libraries. Twenty articles and five grey sources were included. The findings of the review generally support World Health Organisation framework for transformative and scale up of health professions education. Six themes emerged; curriculum reforms, profession regulation, transformative teaching strategies, collaboration and partnership, capacity building and infrastructure and resources. Challenges and solutions in nursing education are common within countries. The review shows that massive investment by development partners is resulting in positive development of nursing education in Sub Saharan Africa. However, strategic leadership, networking and partnership to share expertise and best practices are argued from the evidence to be critical. The authors propose that Sub Saharan Africa needs more reforms to increase capacity of educators and mentors, responsiveness of curricula, strongly regulatory frameworks, and availability of infrastructure and resources.
High rates of TB and HIV infection in sub-Saharan Africa increase the risk of healthworkers of catching TB from their patients. In mid-1998, Malawi’s National Tuberculosis Control Programme produced guidelines for hospitals on TB control. Are hospitals sticking to the guidelines? Are they having any effect?
This presentation was delivered at BioMed’s Open Access Conference, held from 24-26 October 2011, in Kumasi, Ghana. It documents work by the African Medical And Research Foundation (AMREF), an international African non-governmental organisation (NGO) that focuses on community health development, with programme offices in seven African countries and direct reach through training, partnerships and consultancy in 33 other African countries. With major information challenges facing African health workers and systems, the use of emerging information and innovations have a huge role to play in improving health and health systems in Africa, the presenter argues, but he warns that tools alone cannot do it – the content needs to be developed and made available. Therefore, publishing and making information available to Africa’s health workers and practitioners is an urgent issue for the improvement of health services delivery in Africa. AMREF focuses on three broad health system approaches: capacity building for community and health systems including development and support to community health workers; improving health information; and human resources for health, particularly regarding the issues of health worker numbers and skills, training approaches including task shifting, and deployment and retention. Challenges in accessing research were identified as: low investment in research within the continent; lack of infrastructure for accessing research online in appropriate platforms to share research; and the prohibitive cost of accessing research (in print or online).
The European Economic and Social Committee decided to draw up an opinion, under Rule 29(2) of its Rules of Procedure, on Migration and development: opportunities and challenges. It says the process of globalisation has led to the liberalised movement of capital, goods, and services. The movement of people, however, still remains globalisation's most restricted branch. In order to give less-developed economies a bigger share of the economic growth driven by globalisation, more attention should be given to the free movement of people. This opinion follows the school of thought that migration is a chance for developing countries to participate more equally in today's globalised economy and that migration has the potential to decrease inequality.
This qualitative comparative study aimed at understanding similarities and differences in how relationships between community health workers, communities and the health sector were shaped in different Sub-Saharan African settings. The study demonstrates a complex interplay of influences on trust and community health workers’ relationships with their communities and actors in the health sector. Mechanisms influencing relationships were feelings of (dis)connectedness, (un)familiarity and serving the same goals, and perceptions of received support, respect, competence, honesty, fairness and recognition. Sometimes, constrained relationships between community health workers and the health sector resulted in weaker relationships between community health workers and communities. The broader context and programme context in which these mechanisms took place were identified. Policy-makers and programme managers should take into account the broader context and could adjust community health worker programmes so that they trigger mechanisms that generate trusting relationships between CHWs, communities and other actors in the health system. This can contribute to enabling community health workers to perform well and responding to the opportunities offered by their unique intermediary position.
The findings in this report by the United Nations Development Programme (UNDP) cast new light on some common misconceptions about migration. Most migrants do not cross national borders, but instead move within their own country: 740 million people are internal migrants, almost four times the number of international migrants. Among international migrants, less than 30% move from developing to developed countries. For example, only 3% of Africans live outside their country of birth. Contrary to commonly held beliefs, migrants typically boost economic output and give more than they take. Detailed investigations show that immigration generally increases employment in host communities, does not crowd out locals from the job market and improves rates of investment in new businesses and initiatives. Overall, the impact of migrants on public finances is relatively small, while there is ample evidence of gains in other areas such as social diversity and the capacity for innovation. The gains to people who move can be enormous. Research found that migrants from the poorest countries, on average, experienced a 15-fold increase in income, a doubling of school enrolment rates and a 16-fold reduction in child mortality after moving to a developed country.
In this new piece, Remco van de Pas and Linda Mans, researchers in public health, draw attention to a key chapter, titled ‘The Global Health Workforce Crisis’, of the latest edition of the Alternative World Health Report, Global Health Watch 4. They argue that overcoming the health work force gap is one of the key lessons we should learn from the current Ebola outbreak.
The chapter of GHW4 discusses how 'ceilings’ in the public wage bill imposed by the International Monetary Fund in Africa have contributed to migration of health workforce from the continent towards northern countries. It provides shocking numbers on the cost of health workforce training to governments in the south, and corresponding subsidy to governments in the north. The chapter also highlights that concerns of ‘economic efficiency’ threaten reducing health workers' role to undertaking selective diagnosis and treatment. It concludes that a strong health workforce, supported by public funds, is a requirement for strong, universal health systems.