Human Resources

Assessing performance enhancing tools: Experiences with the open performance review and appraisal system (OPRAS) and expectations towards payment for performance (P4P) in the public health sector in Tanzania
Songstad N, Lindkvist I, Moland K, Chimhutu V and Blystad A: Globalization and Health 8(33), 10 September 2012

To increase the quality of service delivery in the public health sector, Tanzania has implemented the Open Performance Review and Appraisal System (OPRAS) and a new results-based payment system, Payment for Performance (P4P). This paper addresses health workers' experiences with OPRAS, expectations towards P4P and how lessons learned from OPRAS can assist in the implementation of P4P. The broader aim is to generate knowledge on health worker motivation in low-income contexts. The authors conducted focus group discussions and in-depth interviews with public health nursing staff, clinicians and administrators. Results showed a general reluctance towards OPRAS as health workers did not see the system as leading to financial gains nor did it provide feedback on performance. In contrast, great expectations were expressed towards P4P due to its prospects of topping up salaries, but the links between the two performance enhancing tools were unclear. The authors conclude that health workers respond to performance enhancing tools based on whether the tools are found appropriate or yield any tangible benefits.

Assessment of human resources for health using cross-national comparison of facility surveys in six countries
Gupta Neeru and dal Poz MR: Human Resources for Health, March 2009

This is a series of facility-based surveys using a common approach in six countries, including Mozambique and Zimbabwe. The objectives were twofold: to inform the development and monitoring of human resources for health (HRH) policy within the countries; and to test and validate the use of standardised facility-based human resources assessment tools across different contexts. The findings revealed that, with increasing experience in health facility assessments for HRH monitoring comes greater need to establish and promote best practices regarding methods and tools for their implementation, as well as dissemination and use of the results for evidence-informed decision-making. The overall findings of multi-country facility-based survey should help countries and partners develop greater capacity to identify and measure indicators of HRH performance via this approach, and eventually contribute to better understanding of health workforce dynamics at the national and international levels.

Association between health worker motivation and healthcare quality efforts in Ghana
Alhassan RK, Spieker N, van Ostenberg P, Ogink A, Nketiah-Amponsah E and de Wit TF: Human Resources for Health 11(37), 14 August 2013

A baseline survey of 324 health workers in 64 primary healthcare facilities in two regions in Ghana found that the quality of care in health facilities was generally low. Most facilities did not have processes for continuous quality improvement and patient safety. Staff motivation appeared low, particularly in public facilities. Significant positive associations were found between staff satisfaction levels and working conditions and the clinic’s effort towards quality improvement and patient safety. The authors called for more comprehensive staff motivation interventions to be integrated into quality improvement strategies, especially in public health services where working conditions are perceived to be poor.

Band aid for southern African medical brain drain?
Integrated Regional Information Networks, 16 August 2006

New laws introduced by the British government in mid-August 2006 are unwittingly giving the southern African region a temporary reprieve from the brain drain of medical staff. The new laws stipulate that employers in Britain will only be granted work permits for foreign nurses if they can prove that no suitable British or European Union candidate can be found.

Better pay in store for health workers
Mail & Guardian (South Africa), 21 February 2007

Eextra money budgeted for the Health Department means better salaries for health workers -- particularly nurses, it said on Wednesday after Finance Minister Trevor Manuel's Budget speech. The additional R5,3-billion allocated for human resources was in response to the department's proposals, said spokesperson Sibani Mngadi.

Brain drain and health workforce distortions in Mozambique
Sherr K, Mussa A, Chilundo B, Gimbel S, Pfeiffer J et al: PLoS ONE 7(4), 27 April 2012

This observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980 and 2006. Data were collected 26 months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment and main work duties. Results showed that of 723 qualifying physicians between 1980 and 2006, a quarter had left the public sector, of which 62.4% continued working in-country and 37.6% emigrated. Of those cases of internal migration, 66.4% worked for non-governmental organisations (NGOs), 21.2% for external funders and 12.4% in the private sector. Annual incidence of physician migration was estimated to be 3.7%, predominately to work in the growing NGO sector. An estimated 36.3% of internal migration cases had previously held senior-level management positions in the public sector. The authors conclude that internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration. They call on external funders and NGOs to assess how their hiring practices may undermine the very systems they seek to strengthen.

Brain Drain Creating Problems in SADC

"The loss of professionals and other skilled people from the SADC region is fast assuming the dimensions of a major crisis," says this article on the website of Idasa. "The countries of southern Africa pour vast resources into training to ensure that future skills needs are met.  But is all this investment in human resource development really going to benefit the countries concerned?  Or are they, in effect, simply providing students with "skill passports" so that they can relocate to other parts of the world?"

BRAIN DRAIN HITS ZIMBABWE'S HEALTH SERVICE

Zimbabwe's brain drain has hit the medical profession particularly hard. More than 80% of doctors, nurses and therapists who graduated from the University of Zimbabwe medical school since independence in 1980 have gone to work abroad, primarily in Britain, Australia, New Zealand, Canada and the United States, according to recent surveys.

Brain Drain in Africa: The Case of Tackling Capacity Issues in Malawi's Medical Migration
The African Capacity Building Foundation: ACBF Occasional Paper No. 31, Zimbabwe, 2018

Malawi faces severe staffing shortages in the health sector and high migration of health workers. This paper suggests that, like most countries in Sub-Saharan Africa, local training of medical personnel has neither plugged these capacities deficits nor increased retention rates. Given the economic realities in Sub-Saharan Africa and the allure of countries in the Organization for Economic Cooperation and Development, many locally trained physicians migrate. The paper concludes that, like much of Sub-Saharan Africa, Malawi is victim of regional developments. Owing to growth in migration of physicians from South Africa to Organization for Economic Cooperation and Development countries, the paper raises that Malawi has turned to recruiting doctors from other African countries, exacerbating capacity constraints elsewhere in the region.

Brain drain now a gush in South Africa

A study by South Africa's Human Sciences Research Council (HSRC) has confirmed earlier findings regarding the under reporting of emigration by highly skilled South Africans to major consuming countries such as the United States, Canada, the United Kingdom, Australia and New Zealand, with the flow up to four times higher than the official figures of Statistics South Africa. Releasing the study, entitled "Flight of the Flamingos, the Study on Mobility of Research and Development (R&D) workers" in Cape Town, the HSRC said a key finding was that, although emigration figures of highly skilled researchers remain high, the greatest mobility of high-level skills is now within the country.

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