"The nations of the world are setting ambitious health and development goals, including the World Health Organization (WHO) target of providing AIDS treatment to 3 million people by 2005 and health-related UN Millennium Development Goals. Unless greater attention by donors and governments is given to developing human resources, these goals almost certainly will not be met. Many of the countries in sub-Saharan Africa, the region that will be the focus of this report, are experiencing severe shortages of skilled health care workers. There are multiple causes, the significance of which varies by country, but one of the most important factors is brain drain. Brain drain is defined in this report as the exodus of health care workers from developing nations to the wealthier countries of the North."
Human Resources
This study aimed to identify the human resources for health (HRH) policy concerns and research priorities of key stakeholders in low- and middle-income countries; to assess the extent to which existing HRH research addresses these concerns and priorities; and to develop a prioritised list of core research questions requiring immediate attention to facilitate policy development and implementation. The study involved interviews with key informants, including health policy-makers, researchers and community and civil society representatives, in 24 low- and middle-income countries, and a literature search for relevant research reviews, from which research questions were prioritised. The questions ranked as most important at the consultative workshop were: To what extent do incentives work in attracting and retaining qualified health workers in underserviced areas? What is the impact of dual practice and multiple employment? How can incentives be used to optimise efficiency and the quality of health care? There was a clear consensus about the type of HRH policy problems faced by different countries and the nature of evidence needed to tackle them. The study concludes that co-ordinated action to support and implement research into the above questions could have a major impact on health worker policies and, ultimately, on the health of the poor.
Despite the clear prohibition against sexual relations with one’s patients, complaints of a sexual nature against practitioners registered with the Health Professions Council of South Africa (HPCSA) have been increasing. The authors of this paper set out to ascertain how a group of medical practitioners felt about the presence of chaperones during the consultation and intimate examination of patients. They distributed a self-administered, questionnaire-based survey to gynaecologists and medical practitioners. There was a 43% response rate with 72% of practitioners in favour of using a chaperone during an intimate examination, although only 27% always do so. Most practitioners felt that consensual sexual relationships with patients are unacceptable; 83% felt that ethical guidelines on this topic were needed. The authors recommend that the HPCSA should develop guidelines on the use of chaperones to assist practitioners. With medical litigation increasing, using chaperones will benefit patients and practitioners.
This paper compares the socioeconomic profile of medical students registered at the Faculty of Medicine of Universidade Eduardo Mondlane (FM-UEM), Maputo, for the years 1998/99 and 2007/08. Its objective is to describe the medical students' social and geographical origins, expectations and perceived difficulties regarding their education and professional future. Data was collected through questionnaires administered to all medical students. The response rate in 1998/99 was 51% and 50% in 2007/08. The main results reflect a doubling of the number of students enrolled for medical studies at the FM-UEM, associated with improved student performance (as reflected by failure rates). Nevertheless, satisfaction with the training received remains low and, now as before, students still identify lack of access to books or learning technology and inadequate teacher preparedness as major problems. Despite a high level of commitment to public sector service, students, as future doctors, have very high salary expectations that will not be met by current public sector salary scales, as reflected in an increasing degree of orientation to double sector employment after graduation.
This paper compares the socioeconomic profile of medical students registered at the Faculty of Medicine of Universidade Eduardo Mondlane (FM-UEM), Maputo, for the years 1998/99 and 2007/08. Its objective is to describe the medical students' social and geographical origins, expectations and perceived difficulties regarding their education and professional future. Data was collected through questionnaires administered to all medical students. The response rate in 1998/99 was 51% (227/441) and 50% in 2007/08 (484/968). The main results reflect a doubling of the number of students enrolled for medical studies at the FM-UEM, associated with improved student performance (as reflected by failure rates). Nevertheless, satisfaction with the training received remains low and, now as before, students still identify lack of access to books or learning technology and inadequate teacher preparedness as major problems. In conclusion, there is a high level of commitment to public sector service. However, students, as future doctors, have very high salary expectations that will not be met by current public sector salary scales. This is reflected in an increasing degree of orientation to double sector employment after graduation.
The authors explored the perceptions and experiences of frontline health managers and community members of the 2017 prolonged health workers’ strikes in Kenya, using informal observations, reflective meetings, individual and group interviews and document reviews, analysed using a thematic approach. In the face of major health facility and service closures and disruptions, frontline health managers enacted a range of strategies to keep key services open, but many were piecemeal, inconsistent and difficult to sustain. Interviewees reported huge negative health and financial impacts on local communities, and especially poor people. They found limited evidence of improved health system preparedness to cope with any future strikes. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the strike, but were not sufficient to confer resilience to the shock of prolonged strikes. To minimise the negative effects of strikes when they occur, the authors suggest that careful monitoring and advanced planning is needed. Planning should aim to ensure that emergency and other essential services are maintained, threats between staff are minimized, health worker demands are reasonable, and that governments respect and honour agreements.
This compendium of examples of promising practices for evidence-based planning and decision-making for dealing with the HIV pandemic is based on the premise that building national strategic information (SI) and monitoring and evaluation (M&E) capacity requires supportive policies for health workers, as well as organisational and leadership development and individual technical capacity development. The promising practices cover the core components of SI (M&E; surveys and surveillance; and health management information systems, including geographical information systems) and span six ‘action fields’ (policy, leadership, partnership, finance, human resource management systems and education) to provide a comprehensive lens through which to strategically plan for and implement M&E workforce strengthening initiatives. By examining the experiences in detail, reviewing available results and supporting materials as well as considering the implementation context, users of the compendium may be able to identify approaches worth testing in their own countries. While the list of practices is by no means exhaustive or representative, it does provide an important starting point upon which to build a more comprehensive learning resource for human resources capacity building for effective HIV M&E systems and strategic information.
Botswana has the highest rate of HIV prevalence in the world and AIDS has now reached crisis proportions in the country. Among the initiatives implemented as a response to promote sexual behaviour change, is the Peer Education HIV/AIDS Prevention Program (PEHAPP) at the workplace. This paper assesses the impact and outcome of the PEHAPP. It concludes that the PEHAPP is having a measurable positive impact in the key areas of improving knowledge, attitudes, and practices related to risky sexual behaviour which, in turn, should reduce the incidence of transmission of HIV/AIDS and other STDs over the long-term.
This study aimed to determine the prevalence and associated factors of psychological distress among attendees of traditional healing practices in two districts in Uganda. Face-to-face interviews with the Lusoga version of the self-reporting questionnaire (SRQ-20) were carried out with 400 patients over the age of 18 years attending traditional healing in Iganga and Jinja districts in Eastern Uganda. Three hundred and eighty-seven questionnaire responses were analysed. The study found that a substantial proportion of attendees (61%) of traditional healing practices suffered from psychological distress. Among the socioeconomic indicators, lack of food and having debts were significantly associated with psychological distress. These findings may be useful for policy makers and biomedical health workers for engagement with traditional healers.
Ensuring health workers’ psychological wellbeing is critical to sustaining their availability and productivity. This study investigated levels of and factors associated with psychological wellbeing of mid-level health workers in Malawi, using a cross-sectional sample of 174 health workers from 33 primary and secondary level health facilities in four districts of Malawi. Twenty-five percent of respondents had World Health Organsation-5 scores indicative of poor psychological wellbeing. Analyses of factors related to psychological wellbeing showed no association with sex, cadre, having dependents, supervision, perceived co-worker support, satisfaction with the physical work environment, satisfaction with remuneration, and motivation; a positive association with respondents’ satisfaction with interpersonal relationships at work; and a negative association with having received professional training recently. The high proportion of health workers with poor wellbeing scores is concerning in light of the general health workforce shortage in Malawi and strong links between wellbeing and work performance. While more research is needed to draw conclusions and provide recommendations as to how to enhance wellbeing, the results are argued to underline the importance of considering wellbeing as a key concern for human resources for health.