Human Resources

An approach to estimating human resource requirements to achieve the MDGs
Health Policy and Planning 2005 20(5):267-276

“In the context of the Millennium Development Goals, human resources represent the most critical constraint in achieving the targets. Therefore, it is important for health planners and decision-makers to identify what are the human resources required to meet those targets. Planning the human resources for health is a complex process. It needs to consider both the technical aspects related to estimating the number, skills and distribution of health personnel for meeting population health needs, and the political implications, values and choices that health policy- and decision-makers need to make within given resources limitations.”

An assessment of community health workers' ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: an observational study
Gaziano T; Abrahams-Gessel S; Denman C; Montano C; Khanam M; Puoane T; Levitt N: The Lancet Global Health 3 (9), e556–e563, 2015,

Cardiovascular disease contributes substantially to the non-communicable disease (NCD) burden in low-income and middle-income countries, which also often have substantial health personnel shortages. In this observational study the authors investigated whether community health workers could do community-based screenings to predict cardiovascular disease risk as effectively as could physicians or nurses, with a simple, non-invasive risk prediction indicator in low-income and middle-income countries. This observation study was done in Bangladesh, Guatemala, Mexico, and South Africa. Each site recruited at least ten to 15 community health workers based on usual site-specific norms for required levels of education and language competency. Community health workers had to reside in the community where the screenings were done and had to be fluent in that community's predominant language. These workers were trained to calculate an absolute cardiovascular disease risk score with a previously validated simple, non-invasive screening indicator. Community health workers who successfully finished the training screened community residents aged 35–74 years without a previous diagnosis of hypertension, diabetes, or heart disease. Health professionals independently generated a second risk score with the same instrument and the two sets of scores were compared for agreement. The study found that community health workers can be adequately trained to effectively screen for, and identify, people at high risk of cardiovascular disease.

Analysing the implementation of the rural allowance in hospitals in North West Province, South Africa
Ditlopo P, Blaauw D, Bidwell P and Thomas S: Journal of Public Health Policy 32(S80–S93), July 2011

Using a policy analysis framework, the authors of this study analysed the implementation and perceived effectiveness of a rural allowance policy and its influence on the motivation and retention of health professionals in rural hospitals in the North West province of South Africa. They conducted 40 in-depth interviews with policy-makers, hospital managers, nurses, and doctors at five rural hospitals and found weaknesses in policy design and implementation. These weaknesses included: lack of evidence to guide policy formulation; restricting eligibility for the allowance to doctors and professional nurses; lack of clarity on the definition of rural areas; weak communication; and the absence of a monitoring and evaluation framework. Although the rural allowance was partially effective in the recruitment of health professionals, it has had unintended negative consequences of perceived divisiveness and staff dissatisfaction. The authors recommend that government should take more account of contextual and process factors in policy formulation and implementation so that policies have the intended impact.

Apartheid regime backed Cape plc activities despite health warnings

It has been discovered that the former apartheid regime colluded with the mining giant, British Cape Asbestos Property Limited to run South African mines for another decade even though it impacted negatively on the workers' health. The company, which is now known as Cape Plc, has been sued by 6 500 South Africans who have contracted asbestosis.

Are doctors and nurses associated with coverage of essential health services in developing countries? A cross-sectional study
Kruk ME, Prescott MR, de Pinho H and Galea S: Human Resources for Health, March 2009

This study examined the relationship between doctor and nurse concentrations and utilisation rates of six essential health services in developing countries: antenatal care, attended delivery, caesarean section, measles immunisation, tuberculosis case diagnosis and care for acute respiratory infection. It found that nurses were associated with high levels of utilisation of skilled birth attendants and doctors were associated with high measles immunisation rates, but neither were associated with the remaining four services. It is plausible that other health workers, such as clinical officers and community health workers, may be providing a substantial proportion of these health services, which means that the human resources for health research agenda must be expanded to include these other workers.

Are health professions an obstacle to future health systems in low-income countries?
Dussault G: Social Science and Medicine 66(10), May 2008

In most low-income countries, there is no tradition of labour market regulation, and the professions have little capacity to regulate members' provision of health services, which tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. A "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role.

Are workplace health promotion programmes effective at improving presenteeism in workers? A systematic review and best evidence synthesis of the literature
Cancelliere C, Cassidy J, Ammendolia C and Cote P: BMC Public Health 11(395), 26 May 2011

Workplace health promotion (WHP) is a common strategy used to enhance on-the-job productivity. The primary objective of this study was to determine if WHP programmes are effective in improving workers presence at work. The Cochrane Library, Medline, and other electronic databases were searched from 1990 to 2010. After 2,032 titles and abstracts were screened, 47 articles were reviewed, and 14 were accepted (4 strong and 10 moderate studies). These studies contained preliminary evidence for a positive effect of some WHP programmes. Successful programmes offered organisational leadership, health risk screening, individually tailored programs, and a supportive workplace culture. Potential risk factors contributing to presenteeism included being overweight, a poor diet, a lack of exercise, high stress, and poor relations with co-workers and management.

ART adherence clubs to help overburdened health workers
Health-e News: 30 November 2012

Antiretroviral therapy (ART) adherence clubs, already operating in several high burden areas in Cape Town, have the potential to revolutionise the treatment of millions of HIV-positive South Africans and lighten the load on overburdened health workers, according to Medecins Sans Frontieres (MSF). In a nutshell, the ART adherence clubs are a long-term retention model of care for stable patients on ARVs. Between 20 and 30 patients meet and are facilitated by a non-clinical staff member who provides a quick clinical assessment, a referral where necessary and peer support in the form of a short group meeting. Pre-packed ARVs are distributed, enough to last for two months until the next meeting. Once a year, the patient is referred for blood tests and is seen by a doctor. This means that for one year the patient does not need to be seen by a professional health worker, essentially freeing the workers up to treat more complex cases and creating space in waiting rooms. By August 2012, 149 new clubs had been established in Khayelitsha, Cape Town, totalling 5,195 patients, which represents 20% of those enrolled for ART in the township. A spokesperson from the provincial health department said the province was also looking at integrating the clubs into a chronic care model, which means that patients with for example diabetes or high blood pressure could benefit.

Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania
Hoffman SJ, Guindon G, Lavis JN, Ndossi GD, Osei EJ, Sidibe M and Boupha B: Malaria Journal 10(363), 13 December 2011

This study compares what is known about insecticide-treated nets (ITNs) to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). In the survey, few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: training in acquiring systematic reviews through the Cochrane Library and ability to read and write English well or very well. Statistically significant factors associated with better clinical practices within each country included: reading scientific journals from their own country; working with researchers to improve their clinical practice or quality of working life; training on malaria prevention since their last degree; and easy access to the internet. The researchers conclude that improving healthcare providers' knowledge and practices is an untapped opportunity for expanding ITN utilisation and preventing malaria. Training on acquiring systematic reviews and facilitating internet access may be particularly helpful.

Assessing human resources for health: what can be learned from labour force surveys?

Human resources are an essential element of a health system's inputs, and yet there is a huge disparity among countries in how human resource policies and strategies are developed and implemented. The analysis of the impacts of services on population health and well-being attracts more interest than analysis of the situation of the workforce in this area. This article presents an international comparison of the health workforce in terms of skill mix, socio demographics and other labour force characteristics, in order to establish an evidence base for monitoring and evaluation of human resources for health.