Human Resources

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.

Brain Drain: Advocating to Alleviate the Global Health Worker Migration Crisis
Chen J, Hampson S and Robertson A: Student Voices 5, February 2013

In this paper, the authors evaluate various policy options to address the global health worker migration crisis, which include: financial and technical support from destination countries; bilateral and multilateral agreements between states; creation of self-sufficient healthcare systems; and collection of reliable migration data. Implementation requires the support of key stakeholders such as the World Health Organisation, member states, and other international organisations. However, there are many obstacles to policy change, including the power disparities between source and destination countries, ethical sensitivity of policies, financial incentives, lack of data collection, and limited international cooperation. The authors argue that media campaigns can be used in destination countries to mobilise citizens and influence national policy. Research initiatives can galvanise action at grassroots, national and international levels. Regional conferences can bring together key stakeholders and promote collaboration between source and destination countries. All efforts should be overseen by an international advocacy group.

Brain Drain: Advocating to Alleviate the Global Health Worker Migration Crisis.
Chen J, Hampson S, Robertson A: Student Voices 5; McMaster Health Forum, March 2013

In this paper, the authors evaluate various policy options to address the global health worker migration crisis, which include: financial and technical support from destination countries; bilateral and multilateral agreements between states; creation of self-sufficient healthcare systems; and collection of reliable migration data. Implementation requires the support of key stakeholders such as the World Health Organisation, member states, and other international organisations. However, there are many obstacles to policy change, including the power disparities between source and destination countries, ethical sensitivity of policies, financial incentives, lack of data collection, and limited international cooperation.

Bridging the human resources gap
London School of Hygiene and Tropical Medicine, London, UK

Human resources are the crucial core of a health system, but they have been a neglected component of health-system development. The demands on health systems have escalated in low income countries, in the form of the Millennium Development Goals and new targets for more access to HIV/AIDS treatment. Human resources are in very short supply in health systems in low and middle income countries compared with high income countries or with the skill requirements of a minimum package of health interventions. Equally serious concerns exist about the quality and productivity of the health workforce in low income countries.

Building and retaining the neglected anaesthesia health workforce: Is it crucial for health systems strengthening through primary health care?
Cherian M, Choo S, Wilson I, Noel L, Sheikh M, Dayrit M and Groth S: Bulletin of the World Health Organization 88: 637–639, August 2010

Physician anaesthetists are scarce in many developing countries and not available at first referral level health facilities. According to this article, the shortage exists because there is not enough recognition of the need for surgical and anaesthesia services at all levels of the health system and their potential to reduce mortality and morbidity. As a result, there is a serious lack of equitable services in developing countries, especially in rural and remote areas. Creating awareness through better documentation of the burden of disease, in terms of death and disability that can be prevented by availability of surgical and anaesthesia services, would be an important step to generate political commitment and local investments in education, training and retention of the health workforce. This needs to be followed up by appropriate policies, legislation, and the establishment of innovative and effective anaesthesia training programmes that address both the immediate need as well as the long-term needs of the health system.

Building capacity without disrupting health services: Public health education for Africa through distance learning
Alexander L, Igumbor EU and Sanders D: Human Resources for Health, 1 April 2009

Through distance education, the School of Public Health of the University of the Western Cape, South Africa has provided access to master's level public health education for health professionals from more than 20 African countries while they remain in post. Since 2000, interest has increased overwhelmingly to a point where four times more applications are received than can be accommodated. This brief paper describes the innovative aspects of the programme, offering some evaluative indications of its impact, and reviews how the delivery of text-led distance learning has helped realise the objectives of public health training. Strategies are proposed for scaling up such a programme to meet the growing need for health professional development in Africa.

Building partnerships towards strengthening Makerere University College of Health Sciences: A stakeholder and sustainability analysis
Okui O, Ayebare E, Chalo RN, Pariyo GW, Groves S and Peters DH: BMC International Health and Human Rights 11(Suppl 1):S14, 9 March 2011

A stakeholder and sustainability analysis of 25 key informant interviews was conducted among past, current and potential stakeholders of Makerere University College of Health Sciences (MakCHS) to obtain their perspectives and contributions to sustainability of the College in its role to improve health outcomes. Results showed that the College has multiple internal and external stakeholders. Stakeholders from Uganda wanted the College to use its enormous academic capacity to fulfil its vision, take initiative, and be innovative in conducting more research and training relevant to the country’s health needs. External stakeholders felt that MakCHS was insufficiently marketing itself and not directly engaging the private sector or Parliament. Stakeholders also indicated MakCHS could better embrace information technology in research, learning and training, and many also wanted MakCHS to start leadership and management training programmes in health systems. This study points towards the need for MakCHS and other African public universities to build a broad network of partnerships to strengthen their operations, relevance and sustainability.

Building social capital in healthcare organisations: Thinking ecologically for safer care
Hofmeyer A and Marck PB: Nursing Outlook 56(4), July 2008

Drawing from the fields of nursing, healthcare ethics, health systems management, and ecological restoration, the authors of this paper outline the role of social capital for organisational integrity, healthy workplace cultures, sustainable resource management, improved nurse retention, effective knowledge translation and safer patient care. Nursing leaders can use ecological thinking to build the vital resource of social capital by taking concrete steps to commit the necessary human and material resources to: forge relations to foster bonding, bridging and linking social capital; build solidarity and trust; foster collective action and cooperation; strengthen communication and knowledge exchange; and create capacity for social cohesion and inclusion.

Burnout and use of HIV services among health care workers in Lusaka District, Zambia: A cross-sectional study
Kruse GR, Chapula BT, Ikeda S, Nkhoma M, Quiterio N, Pankratz D, Mataka K, Chi BH, Bond V and Reid SE: Human Resources for Health, 13 July 2009

The successful continuation of existing HIV care and treatment programmes is threatened by health care worker burnout and HIV-related illness. This study, conducted between March to June 2007, looks at occupational burnout and utilisation of HIV services among health providers in the Lusaka public health sector. Providers from thirteen public clinics were given a 36-item, self-administered questionnaire and invited for focus group discussions and key informant interviews. Focus group participants described burnout as feeling overworked, stressed and tired. In the survey, 51% reported occupational burnout. Risk factors were having another job and knowing a co-worker who left in the last year. Both discussion groups and survey respondents identified confidentiality as the prime reason for not undergoing HIV testing. In Lusaka primary care clinics, overwork, illness and death were common reasons for attrition. Programmes to improve access, acceptability and confidentiality of health care services for clinical providers and to reduce workplace stress could substantially benefit workforce stability.

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