A growing "workforce crisis" is a serious obstacle to achieving targets for global tuberculosis control set for 2005 by the World Health Organisation (WHO). Faster and more effective recruitment and training of TB health workers is needed to ensure vacancies in developing countries are filled quickly, says a draft report written by TB experts. Of the 22 high burden countries (HBCs) which account for 80% of the world's TB cases, 17 reported that their efforts to reach the 2005 targets are being hampered by staffing problems.
Human Resources
TB WORKFORCE CRISIS A MAJOR OBSTACLE TO GLOBAL TREATMENT SUCCESS
Teachers' and Students' Perceptions of the Learning Environment in Clinical Departments at the School of Medicine, MuhimbilI University College of Health Sciences
Mkony C, Mbenbati N: Tanzania Medical Journal 22 (1): 9-11, 2007
The School of Medicine at Muhimbili is the main doctor-training institution in the country. It runs a five-year MD programme taking 200 students annually. As for many schools in low-income countries, the majority of teachers have no formal training in educational theory. The learning environment at the school has some strengths that should to be amplified, and numerous weaknesses that need to be corrected in order to make the environment more conducive to teaching and learning.
Ten best resources on health workers in developing countries
Grépin KA and Savedoff WD: Health Policy and Planning 24(6): 479–482, 2 September 2009
This paper found that, until recently, researchers and policymakers paid little attention to the role of health workers in developing countries but a new generation of studies are providing a fuller understanding of these issues using more sophisticated data and research tools. Recent research highlights the value of viewing health workers as active agents in dynamic labour markets who are faced with many competing incentives and constraints. Newer studies have provided greater insights into human resource requirements in health, the motivations and behaviours of health workers, and health worker migration. The authors note that they are encouraged by the progress but believe there is a need for even more, and higher-quality, research on this topic.
Ten best resources on health workers in developing countries
Grépin KA and Savedoff WD: Health Policy and Planning 24: 479–482, July 2009
According to this review, researchers and policymakers in the past have paid little attention to the role of health workers in developing countries but a new generation of studies are providing a fuller understanding of these issues using more sophisticated data and research tools. The review refers to recent research that views health workers as active agents in dynamic labour markets who are faced with many competing incentives and constraints. Studies using this approach appear to provide greater insights into human resource requirements in health, the motivations and behaviours of health workers and health worker migration. The review urges for more high-quality research on the role of health workers in developing countries.
Ten facts on health workforce crisis
World Health Organisation, 3 March 2008
WHO estimates the global health worker shortfall to be over 4.2 million. That shortage is impairing provision of essential, life-saving interventions such as childhood immunizations, safe pregnancy and childbirth services for mothers, and access to treatment for AIDS, tuberculosis and malaria. As a result, people are suffering and dying needlessly. Without prompt action, the shortage will worsen and health systems will be weakened further. As populations continue to grow in developing countries and grow older in the developed countries, health demand is on the rise virtually everywhere.
The African Union endorses new community health worker campaign and 2013 roll-out
Onemillionhealthworkers.org: 28 January 2013
The African Union has announced its strong support for the new One Million Community Health Workers Campaign that was launched by Rwanda’s President Paul Kagame, Professor Jeffrey Sachs and Novartis CEO Joseph Jimenez at the World Economic Forum early in January 2013. The new campaign will work closely with governments and aid agencies to finance and train the health workers, each of whom would serve an average of around 500 rural inhabitants. The incremental costs for full coverage might sum to around US$2.5 billion per year, or $5 per person per year covered by the expanded CHW programme. The campaign will work to mobilise these additional funds from existing and new external funders, as well as from the host countries consistent with their budgetary means. The campaign aims to boost the ongoing community health worker programmes and policies of many leading institutions.
The challenges of achieving high training coverage for IMCI: case studies from Kenya and Tanzania
Mushi HP, Mullei K, Macha J, Wafula F, Borghi J, Goodman C and Gilson L: Health Policy and Planning (Advance Access), 2 November 2010
Health worker training is a key component of the integrated management of childhood illness (IMCI). The researchers in this study conducted in-depth case studies in two east African countries to examine the factors underlying low training coverage ten years after IMCI had been adopted as policy. A document review and in-depth semi-structured interviews with stakeholders at facility, district, regional/provincial and national levels in two districts in Kenya (Homa Bay and Malindi) and Tanzania (Bunda and Tarime) were carried out in 2007 and 2008. The researchers found that Bunda and Malindi achieved higher levels of training coverage (44% and 25%) compared with Tarime and Homa Bay (5% and 13%). Key factors allowing the first two districts to perform better were: strong district leadership and personal commitment to IMCI, which facilitated access to external funding and encouraged local-level policy adaptation; sensitisation and training of district health managers; and lower staff turnover. However, IMCI training coverage remained well below target levels across all sites. The main barrier to expanding coverage was the cost of training due to its duration, the number of facilitators and its residential nature. Mechanisms for financing IMCI also restricted district capacity to raise funds. Critically, the low priority given to IMCI at national and international levels also limited the expansion of training. Levels of domestic and external funding for IMCI have diminished over time in favour of vertical programmes, partly due to the difficulty in monitoring and measuring the impact of an integrated intervention like IMCI. Alternative, lower cost methods of IMCI training need to be promoted, and greater advocacy for IMCI is needed both nationally and internationally, the authors conclude.
The complexity of rural contexts experienced by community disability workers in three southern African countries
Booyens M; van Pletzen E; Lorenzo T: African Journal of Disability 4(1) doi: 10.4102/ajod.v4i1.167, 2015
An understanding of rural communities is fundamental to effective community-based rehabilitation work with persons with disabilities. The authors argue that insufficient attention has been paid to the challenges that rural community disability workers face. This qualitative interpretive study, involving in-depth interviews with 16 community disability workers in Botswana, Malawi and South Africa, revealed the complex ways in which poverty, inappropriately used power and negative attitudes of service providers and communities combine to create formidable barriers to the inclusion of persons with disabilities in families and rural communities. The paper highlights the importance of understanding and working with the concept of ‘disability’ from a social justice and development perspective. It stresses that by targeting attitudes, actions and relationships, community disability workers can bring about social change in the lives of persons with disabilities and the communities in which they live.
The contribution of international health volunteers to the health workforce in sub-Saharan Africa
Laleman G, Kegels G, Marchal B, Van der Roost D, Bogaert I, Van Damme W: Human Resources for Health 5:19, 31 July 2007
This paper aims to quantify the contribution of international health volunteers (IHVs) to the health workforce in sub-Saharan Africa and to explore the perceptions of health service managers regarding these volunteers. The paper found that international health volunteers contribute relatively small numbers to the health workforce in sub-Saharan Africa, and it seems unlikely that they will do more in the future. In areas where they play a role, their contribution to service delivery can be significant.
The cost of health professionals brain drain in Kenya
Kirigia JM, Gbary AR, Muthuri LK, Nyoni J, Seddoh A: BMC Health Services Research 6 (89), 17 July 1006
Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii)to describe other losses from brain drain. Developed countries continue to deprive Kenya of millions of dollars worth of investments embodied in her human resources for health. If the current trend of poaching of scarce human resources for health (and other professionals) from Kenya is not curtailed, the chances of achieving the Millennium Development Goals would remain bleak. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Kenya and to keeping a majority of her people in the vicious circle of ill-health and poverty. Therefore, both developed and developing countries need to urgently develop and implement strategies for addressing the health human resource crisis.