This report by the White Ribbon Alliance for Safe Motherhood in Tanzania, summarises the key points discussed at a forum exploring the issues impacting on the maternal health crisis in Tanzania. Specifically, the forum looked at the current role and feasibility of promoting the use of community midwives to provide support and guidance for women through all stages of pregnancy, to coordinate services between the facility and community, and to manage the basic health of a community.
Human Resources
Is it worth it for Tanzania to invest in community midwives?
White Ribbon Alliance for Safe Motherhood , August 2006
Is the attendance of paediatricians at all elective caesarean sections an effective use of resources?
Tooke LJ, Joolay Y, Horn AR and Harrison MC: South African Medical Journal 101(10): 749-750, October 2011
The aim of this study was to determine the need for resuscitation at the birth of babies delivered by elective caesarean section (CS) and to record the time spent by doctors attending such deliveries. Data were collected prospectively on all elective CSs performed at Groote Schuur Hospital in Cape Town, South Africa, over a three-month period. Data collected included: total time involved for paediatrician from call to leaving theatre, management of infant (requiring any form of resuscitation), Apgar scores and neonatal outcome (e.g. admission to nursery). The CSs were classified as low-risk or high-risk. Data were recorded for 138 deliveries. One-hundred-and-fifteen deliveries were classified as uncomplicated and 20 as high-risk. Only one of the babies born from the 115 low-risk CSs needed brief resuscitation, whereas nine of the 20 high-risk deliveries resulted in newborn resuscitation. The reasons for low-risk CS were: previous CS (81); infant of diabetic mother (IDM) and previous CS (16); IDM alone (6); estimated big baby (10); and other (2).The average time spent at each elective CS by the paediatrician was 37 minutes. The authors conclude that, for low-risk CS, the same medical attendance (i.e. a midwife) as for an uncomplicated normal vaginal delivery (NVD) would be appropriate. This would free up a doctor for other duties and assist in de-medicalising a low-risk procedure.
Is There any Solution to the "Brain Drain" of Health Professionals and Knowledge from Africa?
African public health care systems suffer from significant "brain drain" of its health care professionals and knowledge as health workers migrate to wealthier countries such as Australia, Canada, USA, and the United Kingdom. Knowledge generated on the continent is not readily accessible to potential users on the continent. Advocates are increasingly discussing not just the pull factors but also the "grab" factors emanating from the developed nations. In order to control or manage the outflow of vital human resources from the developing nations to the developed ones, various possible solutions have been discussed. The moral regard to this issue cannot be under-recognized. However, the dilemma is how to balance personal autonomy, right to economic prosperity, right to personal professional development, and the expectations of the public in relation to adequate public health care services in the developing nations.
Is There any Solution to the “Brain Drain” of Health Professionals and Knowledge from Africa?
Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
African public health care systems suffer from significant "brain drain" of its health care professionals and knowledge as health workers migrate to wealthier countries such as Australia, Canada, USA, and the United Kingdom. Knowledge generated on the continent is not readily accessible to potential users on the continent. In this paper, the brain drain is defined as both a loss of health workers (hard brain drain) and unavailability of research results to users in Africa (soft brain drain). The "pull" factors of "hard brain drain" include better remuneration and working conditions, possible job satisfaction, and prospects for further education, whereas the "push" factors include a lack of better working conditions including promotion opportunities and career advancement.
Is there really a pot of gold at the end of the rainbow? Has the Occupational Specific Dispensation, as a mechanism to attract and retain health workers in South Africa, levelled the playing field?
George GL and Rhodes B: BMC Public Health 12:613, 6 August 2012
Salaries and other benefits are an obvious pull factor towards foreign countries, given the often-extreme differences in wages internationally. The introduction of the Occupation Specific Dispensation (OSD) in 2007 sought to address the challenge of high levels of South African health workers migrating overseas. In this study, researchers evaluate the effectiveness of the OSD by comparing salaries of health workers in South Africa with their counterparts in developed countries. Using a representative basket of commonly bought goods (including food, entertainment, fuel and utilities), they used a purchasing power parity (PPP) ratio to adjust earnings in order measure real differences in salaries. Their results showed that salaries of most South African health workers, particularly registered nurses, are dwarfed by their international counterparts, notably in the United States, Canada and Saudi Arabia, although the OSD has gone some way to reduce that disparity. These countries generally offer higher salaries on a PPP-adjusted basis, while other foreign countries also show large salary advantages if health workers emigrated. Given that their findings suggest that the OSD has narrowed the gap between South African and overseas salaries, the authors call for further research into the push factors underlying high levels of worker out-migration in the country.
It is not all about salaries: Nurses in South Africa
Minnaar A, Selebi C: University of the Witwatersrand, August 2006
A study conducted by the Department of Nursing at the University of the Witwatersrand has revealed the top 10 reasons for dissatisfaction in the nursing profession. The study was administered over a period of two years (2003- 2005) in a public hospital in Johannesburg. Dr Ansie Minnaar, lead researcher in the study says “generally all the nurses interviewed experienced low satisfaction. Our findings show that it is not only salaries that are a factor in the nursing profession. Other factors are career prospects, policy implementation, the behaviour of supervisors, and relationships with other nurses and patient.”
It just won’t wash - why hygiene education for women fails
Hygiene education for women is a standard component of water supply projects. However, evaluations frequently reveal little change in hygiene and sanitation behaviour and so water-borne illnesses persist. Why is it so hard to convey water-related health messages? Researchers from UK University of Bradford tackle this issue in an assessment of Ghana’s Upper Region Water Supply Project (URWSP). They argue for a more rigorous analysis of the cultural and gender-related factors that influence women's acceptance and understanding of these messages.
It was hell in the community’: a qualitative study of maternal and child health care during health care worker strikes in Kenya
Scanlon M L; Maldonado L Y; Ikemeri J E; et al: International Journal for Equity in Health 20:210, 1-12, 2021
This paper investigated maternal and child health care and services during nationwide strikes by health care workers in 2017 from the perspective of pregnant women, community health volunteers, and health facility managers, using in-depth interviews and focus group discussions. Participants reported that strikes by health care workers significantly impacted the availability and quality of maternal and child health services in 2017 and had indirect economic effects due to households paying for services in the private sector. Participants felt poor households, particularly poor women, were most affected since they were more likely to rely on public services, while community health volunteers highlighted their own poor working conditions. Strikes strained relationships and trust between communities and the health system that were identified as essential to maternal and child health care and highlighted and exacerbated inequities in the health system.
Job satisfaction and morale in the Ugandan health workforce
Hagopian A, Zuyderduin A, Kyobutungi N, Yumkella F: Health Affairs 28(5): 863–875, 6 August 2009
Ugandan health workers are dissatisfied with their jobs, especially their compensation and working conditions, says this study. It found a shocking statistic – about one in four health workers, which includes half of all physicians, would like to leave the country. What can be done about this medical brain drain? The researchers urge that strategies for strengthening the health care workforce in Uganda should focus on salary and benefits, especially health coverage. Poor working conditions and excessive workloads should also be dealt with. Facility infrastructure needs to be upgraded to provide a decent work environment, including the supply of water and electricity. Management needs to be improved, as well as workforce camaraderie.
Job satisfaction and turnover intentions among health care staff providing services for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania
Helga N; Mujinja P; Kilewo C; et al.: Human Resources for Health 15(61)1-12, 2017
From March to April 2014, a questionnaire asking about job satisfaction and turnover intentions was administered to all nurses at 36 public-sector health facilities offering antenatal and prevention of mother-to-child transmission services in Dar es Salaam, Tanzania. Slightly over half of the providers were dissatisfied with their current job, and 35% intended to leave it. Most providers were dissatisfied with low salaries and high workload, but satisfied with workplace harmony and being able to follow their moral values. The following factors were associated with providers’ intention to leave their current job: dissatisfaction at not being recognized by one’s superior, and poor feedback on the overall unit performance. Providing reasonable salaries and working hours, clearer job descriptions, appropriate safety measures, job stability, and improved supervision and feedback are argued to be key to retaining satisfied health workers for prevention of mother-to-child transmission providers.