This paper provides a survey of the challenges and proposed interventions to protect healthcare workers on the continent, drawing on articles identified on Medline (Pubmed) in a search on 24 March 2020. Global jostling means that supplies of personal protective equipment are limited in Africa. Even low-cost interventions such as facemasks for patients with a cough and water supplies for handwashing may be challenging, as is ‘physical distancing’ in overcrowded primary health care clinics, raising the risk for healthcare workers and their families. The authors argue, however, that the continent has learnt invaluable lessons from Ebola and HIV control. HIV counselors and community healthcare workers are key and could promote social distancing and related interventions, dispel myths, support healthcare workers, perform symptom screening and trace contacts. Staff motivation and retention may be enhanced through carefully managed risk ‘allowances’ or compensation. International support with personnel and protective equipment, especially from China, could turn the pandemic’s trajectory in Africa around. Telemedicine holds promise as it rationalises personnel and reduces patient contact and thus infection risks. The authors argue that healthcare workers, using their authoritative voice, can promote effective COVID-19 policies and prioritization of their safety. Prioritizing healthcare workers for SARS-CoV-2 testing, hospital beds and targeted research, as well as ensuring that public figures and the population acknowledge the commitment of healthcare workers may help to maintain morale, while international support and national commitment could help safeguard healthcare workers in Africa, essential for limiting the pandemic’s impacts on the continent.
Human Resources
DIVISIONS within the African National Congress (ANC), and between the Congress of SA Trade Unions (Cosatu) and the SA Communist Party (SACP) over privatisation have been thrown into sharp relief at a top-level meeting called to iron out differences in the alliance on the issue. The meeting came as the ANC tries to head off next month's anti privatisation strike by Cosatu. At the same time it is seeking consensus on the restructuring of state assets in the run-up to a two-day alliance meeting scheduled for August 17- 18.
Primary health care (PHC) plays a vital role in maintaining population health, preventing suffering and providing coverage of essential services. In Kenya, primary health centres and dispensaries are often managed by the most senior clinical staff member at the facility who is responsible for performing both clinical and managerial duties. PHC managers, also known as in-charges, play a key role in the functioning of health services on a day-to-day basis. KEMRI-Wellcome Trust has conducted research in one of the 47 counties in Kenya to better understand the role and responsibilities of PHC managers and their coping strategies within the context of devolution and uncertainty. The key findings from the research are set out in this brief, as well as recommendations to support PHC managers. The research found that PHC managers carry out a variety of tasks to ensure facilities can function effectively. These include: developing annual work plans, ensuring coverage and delivery of services, providing leadership and management to frontline staff. Despite the challenges faced by PHC managers in the period since devolution, facilities remained open and functioning. A key support system for in-charges was the sub-county managers, some of whom had played the role of line managers to in- charges for decades.
Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload.
This paper draws on studies of financial incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial incentive programmes aimed at retaining staff in underserved areas: using innovative financing; promoting health as a career; introducing specific selection criteria to ensure programme success and achieve goals; ensuring correct placement of new employees; offering support by staying in close contact with participants throughout enrolment and assigning them mentors; enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and routine performance evaluation of programmes. To improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible.
This article analyses the work of community disability workers (CDWs) in three southern African countries to demonstrate the competencies that these workers acquired to make a contribution to social justice for persons with disabilities and their families. It points to some gaps and then argues that these competencies should be consolidated and strengthened in curricula, training and policy. Purposive sampling was used to select and interviews held with 16 CDWs who had at least 5 years experience of disability-related work in a rural area. Three main themes emerged, related to the integrated management of health conditions and impairments within a family focus; disability-inclusive community development and coordinated intersectoral management systems. The CDWs were found to facilitate change and manage the multiple transitions experienced by the families at different stages of the disabled person’s development. Disability-inclusive development is argued to require a workforce equipped with skills to work intersectorally and in a cross-disciplinary manner to operationalise the community-based rehabilitation guidelines that are designed to promote delivery of services in remote and rural areas. The author argues for their recognition as a CDWs as a cross-disciplinary profession.
Creating a national electronic nursing workforce database provides more reliable information on nurse demographics, migration patterns, and workforce capacity. Data analyses are most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who elect to out-migrate are among Kenya's most qualified.
This briefing paper explores different ways of addressing the health worker crisis in Africa. It addresses problems of poor training, motivation and retention of health workers, the lack of skilled health workers in remote and hard to reach areas, and poor community engagement with health systems. The authors argue that to tackle the immediate health worker crisis it is important to find models which can quickly deploy and retain workers and ensure they get appropriate training and support. Responses need to expand the cadres of workers with basic clinical and community health competencies, such as enrolled nurses, clinical officers and community health workers.
It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised.
It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised.