Pharmacists in hospitals and institutions have dismissed as inaccurate and lacking in detail measures proposed to improve working conditions and stop medical staff quitting SA.
Human Resources
Health workers sceptical of human resources plan
Radebe H, Business Day, 22 March 2006
Health workers' attitudes toward sexual and reproductive health services for unmarried adolescents in Ethiopia
Tilahun M, Mengistie B, Egata G and Reda AA: Reproductive Health 9(19), 3 September 2012
In this study, researchers examined health care workers' attitudes toward sexual and reproductive health services to unmarried adolescents in Ethiopia. The study took the form of a descriptive cross-sectional survey, which was conducted among 423 health care service providers working in eastern Ethiopia in 2010. A pre-tested structured questionnaire was used to collect data. The results showed that most health workers had a positive attitude towards providing reproductive health services to unmarried adolescents, with 30% having a negative attitude. Close to half (46.5%) of the respondents were opposed to providing family planning to unmarried adolescents, while about 13% of health workers felt penal rules and regulations should be implemented against adolescents who practice pre-marital sexual intercourse. Negative attitudes were associated with being married, lower education level, being a health extension worker and lack of training on reproductive health services. The authors call for a targeted effort toward alleviating negative attitudes toward adolescent-friendly reproductive health service and re-enforcing the positive ones.
Health workers’ experiences, barriers, preferences and motivating factors in using mHealth forms in Ethiopia
Medhanyie AA, Little Am Yebyo H, Spigt M, Tadesse K, Blanco R, Dinant GJ: Human Resources for Health 13(2), 2015
Mobile health (mHealth) applications, such as innovative electronic forms on smartphones, could potentially improve the performance of health care workers and health systems in developing countries. A pretested semistructured questionnaire was used to assess health workers’ experiences, barriers, preferences, and motivating factors in using mobile health forms on smartphones in the context of maternal health care in Ethiopia. Twenty-five health extension workers (HEWs) and midwives, working in 13 primary health care facilities in Tigray region, Ethiopia, participated in this study. Sixteen (69.6%) workers believed the forms were good reminders on what to do and what questions needed to be asked. Twelve (52.2%) workers said electronic forms were comprehensive and 9 (39.1%) workers saw electronic forms as learning tools. All workers preferred unrestricted use of the smartphones and believed it helped them adapt to the smartphones and electronic forms for work purposes. Identified barriers for not using electronic forms consistently included challenges related to electronic forms and smartphones and health system issues such as frequent movement of health workers. Both HEWs and midwives found the electronic forms on smartphones useful for their day-to-day maternal health care services delivery. However, tyhe authors found that sustainable use and implementation of such work tools at scale would be daunting without providing technical support to health workers, securing mobile network airtime and improving key functions of the larger health system.
Health workers’ perceptions on where and how to integrate tobacco use cessation services into tuberculosis treatment; a qualitative exploratory study in Uganda
Rutebemberwa E; Nyamurungi K; Joshi S; et al: BMC Public Health 21(1464), 1-9, 2021
The authors explored perceptions of health workers on where and how to integrate tobacco use cessation services into TB treatment programs in Uganda, using nine focus group discussions and eight key informant interviews in high volume health centres, general hospitals and referral hospitals. Respondents highlighted that just like TB prevention starts in the community and TB treatment goes beyond health facility stay, integration of tobacco cessation should be started when people are still healthy and extended to those who have been healed as they go back to communities. Tobacco cessation activities should be provided in a continuum with coordination of different organizations like peers, the media and TB treatment supporters. TB patients needed regular follow up and self-management support for both TB and tobacco cessation. Patients needed to be empowered to know their condition and their caretakers needed to be involved. Effective referral between primary health facilities and specialist facilities was needed. Clinical information systems should identify relevant people for proactive care and follow up. In order to achieve effective integration, the health system needed to be strengthened especially health worker training and provision of more space in some of the facilities.
Health workers’ strikes in low-income countries: the available evidence
Russo G; Xu L; McIsaac M; Matsika-Claquin M; et al: Bulletin of the World Health Organisation 97(7) 460–467H, 2019
In this paper, the authors analysed the characteristics, frequency, drivers, outcomes and stakeholders of health workers’ strikes in low-income countries, using published and grey online sources for 2009 to 2018. They identified 70 unique health workers’ strikes in 23 low-income countries during the period, accounting for 875 strike days. 2018 had the highest number of events, with 170 work days lost. Strikes involving more than one professional category were more frequent, followed by strikes by physicians only. The most commonly reported cause was complaints about pay, followed by protest against the sector’s governance or policies and safety of working conditions. Positive resolution was achieved more often when collective bargaining institutions and higher levels of government were involved in the negotiations.
Health workforce and governance: the crisis in Nigeria
Adeloye D; David R; Olaogun A; Auta A; Adesokan A; Gadanya M; Opele J; Owagbemi O; Iseolorunkanmi A: Human Resources for Health 15(32), doi: 10.1186/s12960-017-0205-4, 2017
In Nigeria, several challenges have been reported within the health sector, especially in training, funding, employment, and deployment of the health workforce. The authors reviewed the recent health workforce crises in the Nigerian health sector to identify key underlying causes and provide recommendations toward preventing and/or managing potential future crises in Nigeria. The authors observe that the Nigerian health system is relatively weak, and there is yet a coordinated response across the country. A number of health workforce crises have been reported in recent times due to several months’ salaries owed, poor welfare, lack of appropriate health facilities and emerging factions among health workers. Poor administration and response across different levels of government were found to have played contributory roles to further internal crises among health workers, with different factions engaged in protracted supremacy challenge. These crises have consequently prevented optimal healthcare delivery to the Nigerian population. The authors argue for various measures, including an inclusive stakeholders’ forum in the health sector; and a solid administrative policy foundation that allows coordination of priorities and partnerships in the health workforce and among various stakeholders.
Health workforce attrition in the public sector in Kenya: A look at the reasons
Chankova Slavea, Muchiri S and Kombe G: Human Resources for Health, 21 July 2009
This study analysed data from a human resources health facility survey conducted in 2005 in 52 health centres and 22 public hospitals (including all provincial hospitals) across all eight provinces in Kenya. The study looked into the status of attrition rates and the proportion of attrition due to retirement, resignation or death among doctors, clinical officers, nurses and laboratory and pharmacy specialists in surveyed facilities. Results showed that overall health workers attrition rates from 2004 to 2005 were similar across type of health facility: provincial hospitals lost on average 4% of their health workers, compared to 3% for district hospitals and 5% for health centres. The main reason for health worker attrition (all cadres combined) at each level of facility was retirement, followed by resignation and death. Appropriate policies to retain staff in the public health sector may need to be tailored for different cadres and level of health facility. Further studies, perhaps employing qualitative research, need to investigate the importance of different factors in the decision of health workers to resign.
Health Workforce Brain Drain: From Denouncing the Challenge to Solving the Problem
Cometto G, Tulenko K, Muula AS and Krech R: PLoS Med 10(9): 1-3, September 2013
Migration of health workers from low- and middle-income countries (LMICs) to high-income countries is one of the most controversial aspects of globalization, having attracted considerable attention in the health policy discourse at both the technical and political level. Some countries train health workers to export them overseas and reap the financial benefits of remittances; such investments should therefore be considered as driven primarily by economic—rather than population health—motives. In most cases, however, migration of health professionals is unplanned for and represents a “brain drain” for source countries, a result of enormous wage differences and poor working conditions, including lack of support, adequate infrastructure, and career development opportunities, in LMICs. The paper presents the policy options for both low income and OECD countries for addressing health worker migration.
Health workforce metrics pre- and post-2015: a stimulus to public policy and planning
Pozo-Martin F, Nove A, Castro Lopes S, et al.: Human Resources for Health 15(11), 3, 2017
In low- and middle-income countries, scaling essential health interventions to achieve health development targets is constrained by the lack of skilled health professionals to deliver services. The authors take a labour market approach to project the future health workforce demand using an economic model based on projected economic growth, demographics, and health coverage, and using health workforce data (1990–2013) for 165 countries from the WHO Global Health Observatory. The demand projections are compared with the projected growth in health worker supply and the health worker “needs” as estimated by WHO to achieve essential health coverage. The model predicts that, by 2030, global demand for health workers will rise to 80 million workers, double the current (2013) stock of health workers, while the supply of health workers is expected to reach 65 million over the same period, resulting in a worldwide net shortage of 15 million health workers. Growth in the demand for health workers will be highest among upper middle-income countries, driven by economic and population growth and ageing. This results in the largest predicted shortages which may fuel global competition for skilled health workers. Middle-income countries will face workforce shortages because their demand will exceed supply. By contrast, low-income countries will face low growth in both demand and supply, which are estimated to be far below what will be needed to achieve adequate coverage of essential health services. In many low-income countries, demand may stay below projected supply, leading to the paradoxical phenomenon of unemployed (“surplus”) health workers in those countries facing acute “needs-based” shortages. Opportunities exist to bend the trajectory of the number and types of health workers that are available to meet public health goals and the growing demand for health workers.
Health workforce responses to global health initiatives funding: A comparison of Malawi and Zambia
Brugha R, Kadzandira J, Simbaya J, Dicker P, Mwapasa V and Walsh A: Human Resources for Health 8(19), 11 August 2010
This paper reports and analyses health workforce responses in Malawi and Zambia during a period of large increases in global health initiative (GHI) funds. Health facility record reviews were conducted in 52 facilities in Malawi and 39 facilities in Zambia in 2006/07 and 2008, as well as interviews with staff. Facility data confirmed significant scale-up in HIV and AIDS service delivery in both countries. In Malawi, this was supported by a large increase in lower trained cadres and only a modest increase in clinical staff numbers. In Zambia, total staff and clinical staff numbers stagnated between 2004 and 2007. Key informants described the effects of increased workloads in both countries and attributed staff migration from public health facilities to non-government facilities in Zambia to PEPFAR. Malawi, which received large levels of GHI funding from only the Global Fund, managed to increase facility staff across all levels of the health system: urban, district and rural health facilities, supported by task-shifting to lower trained staff. The more complex GHI arena in Zambia, where both Global Fund and PEPFAR provided large levels of support, may have undermined a coordinated national workforce response to addressing health worker shortages, leading to a less effective response in rural areas.