Human Resources

400 new Kenyan doctors to be sent home
Mwaniki M, Siringi S: Nation Media

Some 400 newly qualified doctors in public hospitals are reported to be facing dismissal in December. This media report outlines the proposed measure which ends the automatic employment of interns due to budgetary retraints, to make way for incoming interns. While a share of these doctors may be rehired in the annual advertisement of positions this is reported to no longer be automatic.

Further details: /newsletter/id/32016
61st World Health Assembly: Health worker training falling far below needs
World Health Organization, 22 May 2008

The number of people currently being trained to become health workers falls far below the levels needed to ensure health goals are met, according to the Global Health Workforce Alliance (GHWA), a WHO partnership. The 2006 World Health Assembly Resolution (59.23) called on all Member States to help rapidly increase the number of health workers. In response, GHWA asked a group of experts to review and report on the experiences and research from around the world, and to draw up proposals on how to scale up the education and training of health workers. Drawing on case studies from 10 countries, the report details a set of recommendations.

A Community Health Worker “logic model”: towards a theory of enhanced performance in low- and middle-income countries
Naimoli JF, Frymus DE, Wuliji T, Franco LM and Newsome MH: Human Resources for Health12(56), 2014

There has been a resurgence of interest in national Community Health Worker (CHW) programs in low- and middle-income countries (LMICs). A lack of strong research evidence persists, however, about the most efficient and effective strategies to ensure optimal, sustained performance of CHWs at scale. To facilitate learning and research to address this knowledge gap, the authors developed from document review and consultations a generic CHW logic model that proposes a theoretical causal pathway to improved performance. The logic model draws upon available research and expert knowledge on CHWs in LMICs. The generic CHW logic model posits that optimal CHW performance is a function of high quality CHW programming, which is reinforced, sustained, and brought to scale by robust, high-performing health and community systems, both of which mobilize inputs and put in place processes needed to fully achieve performance objectives. Multiple contextual factors can influence CHW programming, system functioning, and CHW performance.The model is argued to offer new thinking about CHWs. It places CHW performance at the center of the discussion about CHW programming, recognizes the strengths and limitations of discrete, targeted programs, and is comprehensive, reflecting the current state of both scientific and tacit knowledge about support for improving CHW performance. It offers guidance for continuous learning about what works.

A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africa
Horwood C; Butler L; Barker P; et al.: Human Resources for Health 15(39), doi: 10.1186/s12960-017-0210-7, 2017

Community health workers (CHWs) play key roles in delivering health programmes in many countries worldwide. CHW programmes can improve coverage of maternal and child health services for the most disadvantaged and remote communities, leading to substantial benefits for mothers and children. However, there is limited evidence of effective mentoring and supervision approaches for CHWs. This cluster randomised controlled trial investigated the effectiveness of a continuous quality improvement intervention amongst CHWs providing home-based education and support to pregnant women and mothers. Thirty CHW supervisors were randomly allocated to intervention (n = 15) and control (n = 15) arms. Intervention CHWs received a 2-week training in WHO Community Case Management followed by mentoring for 12 months. Baseline and follow-up surveys were conducted with mothers of infants <12 months old living in households served by participating CHWs. At follow-up, compared to mothers served by control CHWs, mothers served by intervention CHWs were more likely to have received a CHW visit during pregnancy and the postnatal period. Intervention mothers had higher maternal and child health knowledge scores and reported higher exclusive breastfeeding rates to 6 weeks. HIV-positive mothers served by intervention CHWs were more likely to have disclosed their HIV status to the CHW. Uptake of facility-based interventions was not significantly different. Improved training and mentoring of CHWs can, it is thus argued, improve quantity and quality of CHW-mother interactions at household level, leading to improvements in mothers’ knowledge and infant feeding practices.

A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas
Wilson NW, Couper ID, De Vries E, Reid S, Fish T and Marais BJ: Rural and Remote Health 9(1060), 5 June 2009

This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors to rural and remote areas. A comprehensive search of the English literature was conducted using the National Library of Medicine’s (PubMed) database and a total of 110 articles were included. The available evidence was classified into five intervention categories: selection, education, coercion, incentives and support. The main definitions used to define ‘rural and/or remote’ in the articles reviewed were summarised before the evidence in support of each of the five intervention categories was presented. The review argues for the formulation of universal definitions to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. The review concludes that the impact of untested interventions needs to be evaluated in a scientifically rigorous fashion to identify winning strategies for guiding future practice and policy.

A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas
Wilson NW, Couper ID, De Vries E, Reid S, Fish T and Marais BJ: Rural and Remote Health 9(online): 1060, 5 June 2009

This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors to rural and remote areas. A comprehensive search of the English literature was conducted, 1,261 references were identified and screened and 110 articles were included. The study argues for the formulation of universal definitions to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. There remains an urgent need to evaluate the impact of untested interventions in a scientifically rigorous fashion in order to identify winning strategies for guiding future practice and policy.

A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas
Wilson NW, Couper ID, de Vries E, Reid S, Fish T and Marais BJ: Rural and Remote Health 9(1060), 5 June 2009

This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors in rural and remote areas. A comprehensive search identified 1,261 references and, of these, 110 articles were included. Available evidence was classified into five intervention categories: selection, education, coercion, incentives and support. The review argues for the formulation of universal definitions for the above categories to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. There remains an urgent need to evaluate the impact of untested interventions in a scientifically rigorous fashion in order to identify winning strategies for guiding future practice and policy.

A descriptive study on health workforce performance after decentralisation of health services in Uganda
Lutwama GW, Roos JH and Dolamo BL: Human Resources for Health 10(41), 7 November 2012

The purpose of this study was to investigate the performance of health workers since decentralisation of health services in Uganda in the 1990s in order to identify and suggest possible areas for improvement. Researchers conducted a cross-sectional descriptive survey, using quantitative research methods to collect quantitative data from 276 health workers in the districts of Kumi, Mbale, Sironko and Tororo in Eastern Uganda. The study revealed that even though the health workers are generally responsive to the needs of their clients, the services they provide are often not timely. Health workers take initiative to ensure that they are available for work, although low staffing levels undermine these efforts. While the data shows that the health workers are productive, over half (50.4%) of them reported that their organisations do not have indicators to measure their individual performance. In general, the results show that health workers are proficient, adaptive, proactive and client-oriented. Although Uganda is faced with a number of challenges as regards human resources for health, these findings show that the health workers that are currently working in the health facilities are enthusiastic to perform. This may serve as a motivator for the health workers to improve their performance and that of the health sector.

A descriptive study on health workforce performance after decentralisation of health services in Uganda
Lutwama G, Roos J and Dolamo B: Human Resources For Health 10(41), 7 November 2012

In this cross-sectional descriptive survey the authors investigated the performance of health workers after decentralisation of the health services in Uganda to identify and suggest areas for improvement. A structured self-administered questionnaire was used to collect quantitative data from 276 health workers in the districts of Kumi, Mbale, Sironko and Tororo in Eastern Uganda. Results revealed that even though the health workers are generally responsive to the needs of their clients, the services they provide are often not timely. The health workers take initiative to ensure that they are available for work, but low staffing levels undermine these efforts. While the study shows that the health workers are productive, over half (50.4%) of them reported that their organisations do not have indicators to measure their individual performance. The findings indicated that health workers are competent, adaptive, proactive and client oriented.

A descriptive study on health workforce performance after decentralisation of health services in Uganda
Lutwama G, Roos J and Dolamo B: Human Resources for Health 10(41), 7 November 2012

In this cross-sectional descriptive survey the authors investigated the performance of health workers after decentralisation of the health services in Uganda to identify and suggest areas for improvement. A structured self-administered questionnaire was used to collect quantitative data from 276 health workers in the districts of Kumi, Mbale, Sironko and Tororo in Eastern Uganda. Results revealed that even though the health workers are generally responsive to the needs of their clients, the services they provide are often not timely. The health workers take initiative to ensure that they are available for work, but low staffing levels undermine these efforts. While the study shows that the health workers are productive, over half (50.4%) of them reported that their organisations do not have indicators to measure their individual performance. The findings indicated that health workers are competent, adaptive, proactive and client oriented.

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