This study aimed to determine the knowledge, opinions and practices of healthcare workers in maternity wards in a regional hospital in Bloemfontein, Free State Province, South Africa, regarding infant feeding in the context of HIV. For this descriptive cross-sectional study, all the healthcare workers in the maternity wards of Pelonomi Regional Hospital who voluntarily gave their consent during the scheduled meetings (n = 64), were enrolled and given self-administered questionnaires. Only 14% of the respondents considered themselves to be experts in HIV and infant feeding. Approximately 97% felt that breastfeeding was an excellent feeding choice provided proper guidelines were followed. However, 10% indicated that formula feeding is the safest feeding option. 45% stated that heat-treated breast milk is a good infant feeding option; however, 29% considered it a good infant feeding option but it requires too much work. Only 6% could comprehensively explain the term “exclusive breastfeeding” as per World Health Organisation (WHO) definition. Confusion existed regarding the period for which an infant could be breastfed according to the newest WHO guidelines, with only 26% providing the correct answer. Twenty per cent reported that no risk exists for HIV transmission via breastfeeding if all the necessary guidelines are followed. Healthcare workers' knowledge did not conform favourably with the current WHO guidelines, even though these healthcare workers were actively involved in the care of patients in the maternity wards where HIV-infected mothers regularly seek counselling on infant feeding matters.
Human Resources
Health-care provision in KwaZulu-Natal is reported to be approaching crisis with understaffing. Chronic under-funding continues of the provincial health department is reported to have led to critical posts being frozen, with existing staff, especially nurses, carrying heavier loads. This was reported by senior department officials during a health portfolio committee meeting in the KwaZulu-Natal legislature.
According to the authors of this study, in southern Africa, the sector most impacted by the brain drain is health. Despite the fact that Southern African Development Community (SADC) countries have adopted a number of financial and non-financial incentives to try to get doctors and nurses to stay, the pull factors attracting health professionals to foreign countries are strong and health workers remain very dissatisfied with existing work conditions. With regard to the migration of health professionals there has been a policy shift away from the early reactive ad hoc policy responses to the development of more comprehensive strategic responses which seek to manage the mobility of health professionals. The authors recommend improving the existing lack of knowledge and data to monitor flows of health professionals into and out of SADC. They also call for bilateral agreements with individual countries involving codes of practice for recruitment and treatment of health workers, exchange programmes for training and development and the provision of health professionals from specific countries. In addition, there is a need for a SADC-wide policy on the movement of health professionals within the region to discourage movement from the poorest and neediest countries to those which are relatively well-endowed, like South Africa.
As one of the oldest and most respected professions in the world, the work of midwives is celebrated annually on 5 May. To mark the occasion, the International Day of Midwives will be celebrated at WHO Headquarters on Friday 4 May. WHO staff will gather to show their support for the essential role of midwives in saving the lives of pregnant women who might otherwise die from malnourishment or lack of skilled care during pregnancy and childbirth.
The world's leading health and hospital professional associations have joined to produce the first-ever joint guidelines on incentives for the retention and recruitment of health professionals. Underlining both financial and non-financial incentives as critical to ensuring effective recruitment, retention and performance of health workers across the world, the Guidelines on Incentives describe different approaches taken by a number of countries. Examples of financial incentives cited include tax waivers, allowances (e.g. - housing, clothing, child care, remote location weighting etc.), insurance, and performance payments. Examples of non financial incentives include ensuring positive work environments, flexibility in employment arrangements and support for career development. The report underlines how incentives are important levers that organisations can use to attract, retain, motivate and improve the performance of their staff in all professions and walks of life. This is especially and urgently needed in the health care sector, where the growing gap between the supply of health care professionals and the demand for their services is reaching crisis levels in many countries.
Lay health workers are key to achieving universal health-care coverage, therefore measuring worker attrition and identifying its determinants should be an integral part of any lay health worker programme. Both published and unpublished research on lay health workers has largely focused on the types of interventions they can deliver effectively. This is an imperative since the main objective of these programmes is to improve health outcomes. However, high attrition rates can undermine the effectiveness of these programmes. There is a lack of research on lay health worker attrition, the authors of this paper note. Research that aims to answer the following three key questions would help address this knowledge gap. What is the magnitude of attrition in programmes? What are the determinants of attrition? What are the most successful ways of reducing attrition? With community-based interventions and task shifting high on the United Nations Millennium Development Goals’ policy agenda, research on lay health worker attrition and its determinants requires urgent attention, the authors conclude.
Lesotho faces a severe human resource shortage as it attempts to manage its HIV pandemic, with more than 25% of the population infected with HIV. This paper reports on a programme that provided HIV services in seven rural clinics in Lesotho. LHWs played an important role in the provision of HIV services that ranged from translation, adherence counseling, voluntary counseling and testing (VCT) for HIV and patient triage, to medication distribution and laboratory specimen processing. Training the LHWs was part of the clinic physicians' responsibilities and thus required no additional funding beyond regular clinic operations. This lent sustainability to the training of the LHWs. This paper describes the recruitment, training, activities, and perceptions of the LHW work between June 2006 and December 2008. LHWs participated successfully in the care of thousands of people with HIV in Lesotho and their experience can serve as a model for other countries facing the disease, the authors conclude.
Like many sub-Saharan African countries, Malawi is facing a critical shortage of skilled healthcare workers. In response to this crisis, a formal cadre of lay health workers (LHW) has been established and now carries out several basic health care services, including outpatient TB care and adherence support. While ongoing training and supervision are recognised as essential to the effectiveness of LHW programs, information is lacking as to how these needs are best addressed. The objective of this qualitative study was to explore LHWs responses to a tailored knowledge translation intervention they received, designed to address a previously identified training and knowledge gap. Forty-five interviews were conducted with 36 healthcare workers. Fourteen to sixteen interviews were done at each of 3 evenly spaced time blocks over a one year period, with 6 individuals interviewed more than once to assess for change both within and across individuals overtime. Reported benefits of the intervention included: increased TB, HIV, and job-specific knowledge; improved clinical skills; and increased confidence and satisfaction with their work. Suggestions for improvement were less consistent across participants, but included: increasing the duration of the training, changing to an off-site venue, providing stipends or refreshments as incentives, and adding HIV and drug dosing content. Despite the significant departure of the study intervention from the traditional approach to training employed in Malawi, the intervention was well received and highly valued by LHW participants. Given the relative low-cost and flexibility of the methods employed, this appears a promising approach to addressing the training needs of LHW programs, particularly in Low- and Middle-income countries where resources are most constrained.
In June 2010 a conference entitled ‘Innovative Health Management in the Public Sector’ was held in Cape Town under the banner of the Oliver Tambo Fellowship Programme at the University of Cape Town. Participants offered a number of key messages for policy makers. 1. Prioritise leadership and management development as a key element of health systems strengthening, providing strong political support yet avoiding political interference. 2. Develop a recruitment strategy that appoints appropriately skilled and committed managers to appropriate positions. 3. Recognise that improving physical infrastructure and the quality of services is essential to successful retention. 4. Build and affirm managers’ good values while challenging those who exhibit inappropriate values. 5. Prioritise leadership and management training across the Department of Health and at all levels by developing mentoring mechanisms. 6. Remove unnecessary bureaucratic obstacles that impede dynamic health systems management, decentralise authority for decision-making and reduce management fragmentation to create an enabling environment for managers. 6. Adopt a systemic approach to health systems transformation that includes experimenting with new management practices, creating the space for managers to act proactively rather than simply reacting to daily crises. 7. Explore team work and the creative use of information in developing interventions and assessing progress in an iterative cycle of change. 8. Strengthen the accountability of managers within a supportive environment that allows some mistakes to be made as part of the process of innovation. 9. Develop a strategy and mechanisms for managers around the country to share best practices and experience on an ongoing basis. 10. Create a platform for managers to express their views to senior provincial and national policy-makers. 11. Recognise, value and celebrate the achievements of managers.
In LMICs, Community Health Workers (CHW) increasingly play health promotion related roles involving 'empowerment of communities'. To be able to empower the communities they serve, the authors argue, it is essential that CHWs themselves be, and feel, empowered. The authors present here a critique of how diverse national CHW programs affect CHW's empowerment experience. They present an analysis of findings from a systematic review of literature on CHW programs in LMICs and 6 country case studies (Bangladesh, Ethiopia, Indonesia, Kenya, Malawi, Mozambique). Lee & Koh's analytical framework (4 dimensions of empowerment: meaningfulness, competence, self-determination and impact), is used. CHW programs empower CHWs by providing CHWs, access to privileged medical knowledge, linking CHWs to the formal health system, and providing them an opportunity to do meaningful and impactful work. However, these empowering influences are constantly frustrated by - the sense of lack/absence of control over one's work environment, and the feelings of being unsupported, unappreciated, and undervalued. CHWs expressed feelings of powerlessness, and frustrations about how organisational processual and relational arrangements hindered them from achieving the desired impact. While increasingly the onus is on CHWs and CHW programs to solve the problem of health access, attention should be given to the experiences of CHWs themselves. CHW programs need, it is argued, to move beyond an instrumentalist approach to CHWs, and take a developmental and empowerment perspective when engaging with CHWs. CHW programs should systematically identify disempowering organisational arrangements and take steps to remedy these. Doing so will not only improve CHW performance, it will pave the way for CHWs to meet their potential as agents of social change, beyond perhaps their role as health promoters.