Human Resources

Zimbabwe: Health Services Crippled As Doctors, Nurses Strike

A strike by government doctors and nurses crippled state hospital services in the country's main cities on Wednesday, AP reported. Quoting the Hospital Doctors Association, the agency said about 350 doctors stopped work on Tuesday in the cities of Harare, the capital, and Bulawayo, the second city, demanding better salaries and allowances.

Zimbabwe: Nurses Under Pressure

Stella Zengwa, President of Zimbabwe Nurses Association.
Zimbabwean nurses face difficult decisions in their day-to-day work. Health Services are now client centred and are being provided by a workforce, which is performance driven. A shortage of nurses means that at present all our new nurse graduates are bonded for 3 years, but experienced nurses continue to be lost to neighbouring countries and abroad. Hospital wards are still run with only one or two nurse per shift for a 40-bedded ward with the result that nurses continue to be overworked. Lack of transport has become a critical issue and poses a risk to nurses’ lives when arriving or knocking off duty given the shift work. Lack of accommodation at institutions is making retention of nurses very difficult since in some areas, rented accommodation is not available. Nurses have been pushed out of the traditional nurse’s residences. Inadequate and erratic supplies of drugs, surgical sundries and equipment including protective clothing like gloves are exposing nurses to HIV infection. Burnout syndrome is widespread with nurses overwhelmed with the stress of nursing a full ward of very ill patients with so little support. Unlike other health workers who are visitors to the ward, nurses spend long hours with patients. This requires ways of dealing with burnout so that nurses continue to provide quality health care services.Upholding of nursing ethics is critical building a positive image as desired by the communities that we serve. As a professional association, ZINA aspires to ensure that the services nurses provide in support of public protection and health care are exemplary and community driven.

Further details: /newsletter/id/29251
Zimbabwe: Unemployment Rate to Reach 70%

Zimbabwe's unemployment rate is set to reach an unprecedented 70% in 2002 due to company closures, labour economists said this week. The economic analysts said that it was imminent that failure by the economic stakeholders labour, business and government in creating opportunities to stimulate industrial expansion would lead to increases in unemployment.

Zimbabwe’s unsung heroes
British Medical Journal, editorial, 13 August 2008

From 29 March 2008, when Zimbabweans voted in the presidential and parliamentary elections, to 27 June when the presidential run-off election was held, Zimbabwe was hit by successive waves of gruesome political violence. The greatest intensity was in the rural provinces of east and central Mashonaland, but, as 27 June approached, violence engulfed urban areas and the numbers of victims of political violence increased. The world’s attention was on the political nature of the violence, and little focus was given to medical professionals, who risked their lives to assist the victims of political violence. The latest political violence occurred when Zimbabwe was already in dire economic difficulties that had adversely affected the health sector.

‘Conditional scholarships’ for HIV/AIDS health workers: Educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa
Bärnighausen T and Bloom DE: Social Sciences Medicine: 68(3):544-51, February 2009

Researchers conducted a cost-benefit analysis of a health care education scholarship that is conditional on the recipient committing to work for several years after graduation delivering ART in sub-Saharan Africa. Such a scholarship could address two of the main reasons for the low numbers of health workers in sub-Saharan Africa: low education rates and high emigration rates. Conditional scholarships for a HAHW team sufficient to provide ART for 500 patients have an expected net present value (eNPV) of US$1.24 million per year. The eNPV of the education effect of the scholarships is larger than eNPV of the migration effect. Policy makers should consider implementing ‘conditional scholarships’ for HAHW, especially in countries where health worker education capacity is currently underutilised or needs to be rapidly expanded.

‘I am treated well if I adhere to my HIV medication’: putting patient–provider interactions in context through insights from qualitative research in five sub-Saharan African countries
Ondenge K; Renju J; Bonnington O; et al.: Jo Sexually Transmitted Infections 93 (Issue Supplement 3), doi: http://dx.doi.org/10.1136/sextrans-2016-052973, 2017

The nature of patient–provider interactions and communication is widely documented to significantly impact on patient experiences, treatment adherence and health outcomes. Yet little is known about the broader contextual factors and dynamics that shape patient–provider interactions in high HIV prevalence and limited-resource settings. Drawing on qualitative research from five sub-Saharan African countries, the authors seek to unpack local dynamics that serve to hinder or facilitate productive patient–provider interactions. This qualitative study, conducted in Kisumu (Kenya), Kisesa (Tanzania), Manicaland (Zimbabwe), Karonga (Malawi) and uMkhanyakude (South Africa), draws upon 278 in-depth interviews with purposively sampled people living with HIV with different diagnosis and treatment histories, 29 family members of people who died due to HIV and 38 HIV healthcare workers. Data were collected using topic guides that explored patient testing and antiretroviral therapy treatment journeys. The authors analysis revealed an array of inter-related contextual factors and power dynamics shaping patient–provider interactions. These included participants’ perceptions of roles and identities of ‘self’ and ‘other’; conformity or resistance to the ‘rules of HIV service engagement’ and a ‘patient-persona’; the influence of significant others’ views on service provision; and resources in health services. They observed that these four factors/dynamics were located in the wider context of conceptualisations of power, autonomy and structure. They argue that patient–provider interaction is complex, multidimensional and deeply embedded in wider social dynamics, and that interventions to improve patient experiences and treatment adherence through enhanced interactions need to go beyond the existing focus on patient–provider communication strategies.

‘Why do an MPH?’ Motivations and intentions of physicians undertaking postgraduate public health training at the University of Cape Town
Zweigenthal VE, Marquez E; London L: Global Health Action, 9(1) http://dx.doi.org/10.3402/gha.v9.32735, 2017

Public health (PH) approaches underpin the management and transformation of health systems in low- and middle-income countries. Despite the Master of Public Health (MPH) rarely being a prerequisite for health service employment in South Africa, many physicians pursue MPH. This study identified their motivations and career intentions and explored MPH programme strengths and gaps in under- and post-graduate PH training. A cross-sectional study using an online questionnaire was completed by physicians graduating with an MPH between 2000 and 2009 and those enrolled in the programme in 2010 at the University of Cape Town. Nearly a quarter of MPH students were physicians. Of the 65 contactable physicians, 48% responded. They were mid-career physicians who wished to obtain research training (55%), who wished to gain broader perspectives on health (32%), and who used the MPH to advance careers (90%) as researchers, policy-makers, or managers. The MPH widened professional opportunities, with 62% changing jobs. They believed that inadequate undergraduate exposure should be remedied by applying PH approaches to clinical problems in community settings, which would increase the attractiveness of postgraduate PH training. The MPH was found to allow physicians to transition from pure clinical to research, policy and/or management work, preparing them to innovate changes for effective health systems, responsive to the health needs of populations.

“Why should I have come here?” - a qualitative investigation of migration reasons and experiences of health workers from sub-Saharan Africa in Austria
Jirovsky E; Hoffmann K; Maier M; Kutalek R: BMC Health Services Research 15(74), 2015

This paper explored the reasons African health workers raised for migration to Austria, as well as their personal experiences concerning the living and working situation in Austria. The authors conducted semi-structured, qualitative interviews with African health workers approached via professional networks and a snowball system. For most of the participants, the decision to migrate was not professional but situation dependent. Austria was not their first choice as a destination country. Several study participants left their countries to improve their overall working situation. The main motivation for migrating to Austria was partnership with an Austrian citizen. Other immigrants were refugees. Most of the immigrants found the accreditation process to work as a health professional to be difficult, resulting in some not being able to work in their profession. There was also reported experience of discrimination, but also of positive support.

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