Human Resources

DOTS, the internationally-recommended control strategy for tuberculosis (TB), has been applied in South Africa since 1996. But TB cure rates remain at 65 percent - not high enough to control or reverse the epidemic. Could training clinic staff on patient-centred care, critical reflection on practice and quality enhancement improve treatment success? The rates of successful treatment and bacteriological cure for TB improved marginally in the clinics that received the training, compared with the controls. The differences were not statistically significant. The training was well accepted by staff who became more aware of the need to improve provider-patient relations and made some changes to the organisation of care. These changes in attitudes and practices often did not translate into improved provider-patient relations.

February's WHO Bulletin looks at the migration of skilled professionals to industrialized countries as one of the factors behind the chronic shortage of health workers in many developing countries. "….International recognition that the growing shortage of health workers poses a major threat to fighting diseases such as HIV/AIDS and tuberculosis has prompted a flurry of measures to stem the exodus of health professionals from developing countries."

Who should assist women in childbirth, what should these attendants do and not do under various circumstances, and where should births take place? Policies regarding these questions have been debated for hundreds of years. WHO’s position on where and with whom women should deliver has evolved from emphasis on training of traditional birth attendants (TBAs) in developing countries in the late 1950s and 1960s, to a recommendation that TBAs work with the health-care system, to a recommendation that they be integrated into the health system via training, supervision and technical support, to today’s position of promoting professionally skilled attendance at all births. The facts that a) this position was adopted in 1997 and that it took an additional two years to specify the criteria required to be a “skilled attendant”, and b) that the policy sidesteps the issue of where births should take place, suggests that substantial internal debate swirled around this stance, as well. Although the WHO skilled attendance at birth policy remains today, it has now been incorporated into a continuum of maternal and child health care policy, resulting from the formation of the Partnership for Maternal, Newborn and Child Health in 2005.

Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised. It is unlikely that migration will stop given the advances in global communications and the development of global labour markets in some fields, which now include nursing. The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration.