Sub-Saharan Africa faces a severe health worker shortage, which community health workers (CHWs) may fill. This study describes tasks shifted from clinicians to CHWs in Kenya, places monetary valuations on CHWs’ efforts, and models effects of further task shifting on time demands of clinicians and CHWs. Interviews were conducted with 28 CHWs and 19 clinicians in 17 health facilities throughout Kenya. Twenty CHWs completed task diaries over a 14-day period to examine current CHW tasks and the amount of time spent performing them. A modelling exercise was conducted examining a current task-shifting example and another scenario in which additional task shifting to CHWs has occurred. CHWs worked an average of 5.3 hours per day and spent 36% of their time performing tasks shifted from clinicians. The authors estimated a monthly valuation of US$ 117 per CHW. The modelling exercise demonstrated that further task shifting would reduce the number of clinicians needed while maintaining clinic productivity by significantly increasing the number of CHWs. The authors’ argue that this costing of CHW contributions raises evidence for discussion, research and planning regarding CHW compensation and programmes.
Human Resources
This paper analyses the relationship between physician migration from developing source countries to more developed host countries (brain drain) and the developmental and global health profiles of source countries. Source countries with better human resources for health, more economic and developmental progress, and better health status appear to lose proportionately more physicians than the more disadvantaged countries. Higher physician migration density is associated with higher current physician and public health workforce densities and more medical schools. Policymakers should realize that physician migration is positively related to better health systems and development in source countries. In view of the "train, retain, and sustain" perspective of public health workforce policies, physician retention should become even more important to countries growing richer, whereas poorer countries must invest more in training policies.
This book was produced to support the policy dialogue on Human Resources for Health (HRH) in Ghana. Despite some recent successes, further improvements in health outcomes are in part hampered by the lack of skilled service providers, or human resources for health (HRH), particularly in rural areas, that prevent critical health services from being accessed and adequately delivered to those that need them most. To address the lack of information to guide the development of policies and programmes on HRH, the book aims to paint a comprehensive picture on HRH, consolidating new and existing evidence on some of the underlying determinants impacting stock, distribution and performance of health workers in Ghana, including health worker production and attrition, management and accountability structures, the capacity of health training institutions, and health worker compensation. As is made clear, any potential policies to improve the situation on HRH need to be well targeted, and take into account some of the fiscal and political challenges that are specific to the health labour market in Ghana. The book is intended to provide a basis for Ghanaian decision makers and external partners to dialogue on HRH and related policies, resulting in concrete HRH actions. More broadly, it will be of interest to all those working to improve HRH in Africa and beyond.
The papers presented in the book cover the main dimensions of HRD in health: planning and managing the workforce, education and training, incentives and working conditions, managing the performance of personnel and policies needed to ensure that investments in human resources produce the benefits to which the investing populations are entitled. Authors write from diverse professional, regional and cultural perspectives, and yet there is a high degree of consistency in their diagnosis of problems and proposals for strategies to address them. They all agree on the multidimensionality of problems and on the need for solutions that take into account all dimensions. They also agree that if problems tend to be similar in nature, they take forms that are time and context-determined.
Phyllida Travis, Dominique Egger, Philip Davies, Abdelhay Mechbal. Evidence and Information for Policy, World Health Organization, 2002.
The paper proposes that stewards should have access to reliable, up-to-date information on: Current and future trends in health and health system performance? For example, on levels, trends and inequalities in key areas such as national health expenditures; human resources; health system outcomes; health risk factors; vulnerable groups; coverage; provider performance; organisational / institutional challenges in provision, financing, resource generation, stewardship Important contextual factors and actors the political, economic and institutional context; the roles and motivation of different actors; user / consumer preferences; opportunities and constraints for change. Events / reforms in other sectors with implications for the health sector Possible policy options, based on national and international evidence and experience? For example, intelligence on different policy tools and instruments for similar problems; on their effects in different settings, and on managing change. It includes information on relatively specific things such as cost-effective interventions; and on possible institutional arrangements for different functions.
The purpose of this article is twofold. First, the authors describe Uganda's transition from a paper filing system to an electronic Human Resource Information System (HRIS) capable of providing information about country-specific health workforce questions. They examine the ongoing five-step process to strengthen the HRIS to track health worker data at the Uganda Nurses and Midwives Council (UNMC). Second, they describe how HRIS data can be used to address workforce planning questions via an initial analysis of the UNMC training, licensure and registration records from 1970 through May 2009. The data indicated that, for the 25,482 nurses and midwives who entered training before 2006, 72% graduated, 66% obtained a council registration, and 28% obtained a licence to practice. Of the 17,405 nurses and midwives who obtained a council registration as of May 2009, 96% are of Ugandan nationality and just 3% received their training outside of the country. Thirteen percent obtained a registration for more than one type of training. Most (34%) trainings with a council registration are for the enrolled nurse training, followed by enrolled midwife (25%), registered (more advanced) nurse (21%), registered midwife (11%), and more specialised trainings (9%). The authors found the UNMC database was valuable in monitoring and reviewing information about nurses and midwives. However, they add that information obtained from this system is also important in improving strategic planning for the wider health care system in Uganda.
The purpose of this article is twofold. First, the authors describe Uganda's transition from a paper filing system to an electronic HRIS capable of providing information about country-specific health workforce questions. They then examine the ongoing five-step HRIS strengthening process used to implement an HRIS that tracks health worker data at the Uganda Nurses and Midwives Council (UNMC). Secondly, they describe how HRIS data can be used to address workforce planning questions via an initial analysis of the UNMC training, licensure and registration records from 1970 through May 2009. The data indicate that, for the 25 482 nurses and midwives who entered training before 2006, 72% graduated, 66% obtained a council registration, and 28% obtained a license to practice. Of the 17,405 nurses and midwives who obtained a council registration as of May 2009, 96% are of Ugandan nationality and just 3% received their training outside of the country. Thirteen per cent obtained a registration for more than one type of training. Most (34%) trainings with a council registration are for the enrolled nurse training, followed by enrolled midwife (25%), registered (more advanced) nurse (21%), registered midwife (11%), and more specialised trainings (9%). The authors conclude that the UNMC database is valuable in monitoring and reviewing information about nurses and midwives. However, information obtained from this system is also important in improving strategic planning for the greater health care system in Uganda.
This paper examined the training coverage and self-reported competence, knowledge, abilities, and attitudes, of health care workers caring for adolescents living with HIV in Kenya. Surveys were conducted with 24 managers and 142 health care workers. Health care workers had a median of 3 years of experience working with adolescents living with HIV, and 40% reported exposure to any adolescents living with HIV training. Median overall competence was 78%. More years caring for adolescents living with HIV and any prior training in adolescent HIV care were associated with significantly higher self-rated competence. Training coverage for adolescent HIV care remains sub-optimal. The authors suggest that targeting health care workers with less work experience and training exposure may be a useful and efficient approach to improve quality of youth-friendly HIV services.
Palliative care should be an integral part of every health care professional's role. A key aspect of palliative care training involves raising the awareness of health care professionals, service providers and users. Palliative care should not just be seen as the compassionate care of dying patients but as an active discipline including assessing and treating pain and other problems. Health care workers need specific training to be able to offer quality palliative care to their patients.
The quality of health care is hugely dependent on the skills of health professionals. Clinical skills centres are neutral and protected settings in which a variety of skills and techniques can be taught. In developing countries, resource constraints and pressure to direct skilled staff away from teaching to working in health service facilities can limit the opportunities for developing and implementing an effective training curriculum.