South Africa has large public and private sectors and there is a common perception that public sector hospitals are inefficient and ineffective while the privately owned and managed hospitals provide superior care and are more sustainable. The underlying assumption is that there is a potential gap in management capacity between the two sectors. This study aims to ascertain the skills and competency levels of hospital managers in South Africa and to determine whether there are any significant differences in competency levels between managers in the different sectors. The findings confirm the supposition that there is a lack of management capacity within the public sector in South Africa and that there is a significant gap between private and public sectors. It provides evidence that there is a great need for further development of managers, especially those in the public sector. The onus is therefore on administrators and those responsible for management education and training to identify managers in need of development and to make available training that is contextually relevant in terms of design and delivery.
Human Resources
Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada?
This publication is designed to guide government departments in South Africa on the minimum requirements to effectively manage HIV/AIDS in the workplace and ensure a coordinated public service response. It is expected to assist departments in planning, developing, implementing, monitoring and evaluating workplace HIV/AIDS policies and programs.
The global phenomena of massive migration of health professionals and the advent of e-Health solutions are evidence of the fact that significant trends in health are no longer regional. Worldwide, doctors, nurses and ancillary staff are increasingly seeking better prospects for themselves, not only in the northern economic powerhouses but also in developing countries. However, a severe lack of knowledge-sharing mechanisms and appropriate funding has meant that patients and health professionals in poor countries are still denied the opportunity to benefit from pioneering e-Health programmes now being developed in countries such as the UK and Canada.
Providing maternal care requires a viable and effective health workforce. In many countries, and certainly in all countries where maternal mortality is high, the size, skills and infrastructure of the workforce is inadequate. The most visible features of the maternal health workforce crisis are the staggering shortages and imbalances in the distribution of health workers. With insufficient production, downsizing and caps on recruitment under structural adjustment and with frozen salaries and losses to the private sector, migration and HIV and AIDS, filling the supply gap will remain a major challenge for years to come.
This week, Nairobi hosted an important workshop to discuss the International Labour Organisation's Maternity Protection Convention.
A striking feature of the meeting was the low-level of involvement by both the Government and the Central Organisation of Trade Unions (Cotu).
As one speaker reminded the participants, women - biologically the only ones equipped to carry and bear children - should not be penalised for this vital role. Thus the campaign to provide better maternity protection is not a women's issue. It is a social responsibility that should be borne by all. ILO Convention 183 aims to provide better working conditions and terms for expectant and nursing mothers, including adequate paid leave and protection from discrimination, and a working environment that may harm the health of mother and child.
Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain.
In this study, researchers assessed health worker motivation as part of a health system strengthening intervention in three rural districts in Zambia. The intervention (Better Health Outcomes Through Mentoring and Assessment (BHOMA) aims to increase health worker motivation through training, mentoring and support. The researchers examined underlying issues grouped around relevant outcome constructs such as job satisfaction, general motivation, burnout, organisation commitment, conscientiousness and timeliness that collectively measure overall levels of motivation. Results showed variation in motivation score by sex, type of health worker, training and time in post. Female participants had the highest motivation scores. Nurses had the highest scores while environmental health technicians had the lowest score. Health workers who had been in their posts longer also had higher scores. Health workers who had received some form of training in the preceding 12 months were more likely to have a higher score; this was also true for those older than 40 years when compared to those less than 40 years of age. Further research is needed to establish why these health worker attributes were associated with motivation and whether health system interventions targeting health workers, such as the current intervention, could influence health worker motivation.
Tanzania faces a critical shortage of skilled health workers. While training, deployment, and retention are important, motivation is also necessary for all health workers, particularly those who serve in rural areas. This study measured the motivation of health workers who were posted at government-run rural primary health facilities. The authors sought to measure three aspects of motivation—management, performance, and individual aspects—among health workers deployed in rural primary level government health facilities. In addition, they also sought to identify the job-related attributes associated with each of these three aspects. Two regions in Tanzania were selected for the research. In each region, the authors further selected two rural districts in each in which they carried out their investigation. Motivation was associated with marital status, having a job description and number of years in the current profession for management aspects; having a job description for performance aspects; and salary scale for individual aspects. The authors conclude that having a clear job description motivates health workers, and that the existing Open Performance Review and Appraisal System, of which job descriptions are the foundation, needs to be institutionalised in order to effectively manage the health workforce in resource-limited settings.
In this study, researchers developed and piloted a methodology to establish tuberculosis-related work load at primary care level for clinical and laboratory staff. They found that workload was determined by the nature of the activities that staff had to implement, the amount of time they had to perform them and their frequency, as well as patient load. Of particular importance, the researchers note, is the patient pathway for diagnosis and treatment and the frequency of clinic visits. They recommend using observation with checklists, clocking, interviews and review of registers to assess the contribution of different factors on the workload.