Human Resources

Can lay counsellors fill the health worker gap?
PlusNews: 12 August 2009

Hundreds of lay health care workers are deployed in Kenyan communities to fill the gap caused by severe staff shortages in the health sector – but could they be doing more harm than good? Some lay health workers even dispense antiretroviral (ARV) drugs, but health experts have warned that using unqualified personnel to perform medical functions may not be such a good idea. Dr Andrew Suleh, chairman of the Kenya Medical Association, said lay counsellors should not become a long-term replacement for professional health workers. ‘The government must be pressured to train, employ and retain health professionals to ease the disease burden exerted on the health care workers by the twin challenges of HIV and TB – the management and care of HIV and AIDS is very labour intensive,’ he said. Most lay counsellors were volunteers employed by non-governmental organisations whose projects could end, leaving the country with even bigger shortages of health workers. ‘You cannot base health management on volunteerism; it is not sustainable,’ Suleh added.

Capacity-building for a strong public health nutrition workforce in low-resource countries
Delisle H; Shrimpton R; Blaney S; Du Plessis L; Atwood S; Sanders D; Margetts B: Bulletin of the World Health Organisation 95(5) 385-388, 2017

This paper highlights current issues and challenges in public health nutrition in low- and middle-income countries and shares recommendations for the development of this workforce. Several factors are argued to contribute to a scarcity of nutrition professionals in low- and middle-income countries, including: a lack of understanding of the role of public health nutrition in the prevention and management of the various forms of malnutrition; a low-income country priority for doctors and nurses (and sometimes also frontline workers) within meagre health workforce expenditures; a higher priority for undernutrition interventions than for those for nutrition-related chronic diseases, despite their escalation in these countries. Both food system changes, at the level of production, processing and distribution, and behaviour change communication are argued to be needed to reorient the nutrition transition, and nutritionists have a major role to play in this regard. Although it requires sustained efforts, training can be regarded as the easy part of nutrition workforce development in low- and middle-income countries. More challenging steps are recognition of the nutrition profession and its regulation, opening up government jobs for nutrition graduates and financing local training programmes and nutritionists’ salaries in the public sector. The underlying causes of malnutrition, and hence sustained solutions to the problem, lie to a large extent in the non-health sectors. The authors argue that nutrition has to be addressed not only by other health professionals, but also by agriculture and education professionals and field workers, who need to integrate relevant nutrition tasks into their professional activities (such as orienting food production towards meeting the population’s nutrition requirements or teaching healthy eating to schoolchildren).

Career and practice intentions of health science students at three South African health science faculties
Naidu C, Irlam J, Diab PN: African Journal of Health Professions Education, 5(2):68-71, November 2013

The distribution and accessibility of healthcare professionals as well as the quality of healthcare services are significantly affected by the career choices of medical and other health science graduates. While much has been reported on the career intentions of medical students, little is known about those of their counterparts in the health sciences. This study describes the career plans of non-medical health science students at three South African health science faculties, and identifies some key motivating factors. A self-administered survey of first- and final-year health science students was conducted at the health science faculties of the universities of Cape Town, KwaZulu-Natal and Limpopo. The findings demonstrated that health science students, similar to medical students, are influenced by a multitude of factors in making career choices. This emphasises the relevance to all health science disciplines of national strategies to address the maldistribution of healthcare professionals.

Carework and caring: A path to gender equitable practices among men in South Africa?
Morrell R and Jewkes R: International Journal for Equity in Health 10(17), May 2011

The purpose of this study was to examine the relationship between men who engage in carework and commitment to gender equity. The context of the study was that gender inequitable masculinities create vulnerability for men and women to HIV and other health concerns. A qualitative approach was used. Twenty men from three South African cities who were identified as engaging in carework were interviewed. They were engaged in different forms of carework and their motivations to be involved differed. Some men did carework out of necessity. Poverty, associated with illness in the family and a lack of resources propelled some men into carework. Other men saw carework as part of a commitment to making a better world. 'Care' interpreted as a functional activity was not enough to either create or signify support for gender equity. Only when care had an emotional resonance did it relate to gender equity commitment. Engagement in carework precipitated a process of identity and value transformation in some men suggesting that support for carework still deserves to be a goal of interventions to 'change men'. Changing the gender of carework contributes to a more equitable gender division of labour and challenges gender stereotypes, the authors argue. Interventions that promote caring also advance gender equity.

Catastrophe or controllable crisis? The impact of the AIDS epidemic on schooling in Africa

It is widely believed that children who are directly affected by AIDS are greatly disadvantaged at school and that teachers are a high risk group for HIV infection. Research in Botswana, Malawi and Uganda suggests that the situation is much more complex. An international team of researchers surveyed 41 primary and secondary schools across the three countries and interviewed education managers, teachers and other stakeholders. They investigated the effectiveness of HIV prevention programmes and the impact of the AIDS epidemic on pupils and teachers. They found little evidence that education on HIV/AIDS, sexual and reproductive health (SRH) and life skills has a major impact on behaviour. Economic and social pressures that fuel unsafe sexual practices among adolescents remain high. Teachers lack the training and commitment to integrate HIV/AIDS education into carrier subjects. The study identified an urgent need for full-time SRH/life skills teachers in both primary and secondary schools giving regular timetabled lessons.

Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers
Collins PY: Soc Sci Med 63 (4): 979-90, August 2006

Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers' perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support.

Challenges to tuberculosis control in Angola: the narrative of medical professionals
Brady P; Vita D: Journal of Public Health 40(4) 820–826, 2018

This study interviewed healthcare workers involved in tuberculosis (TB) control on what they consider to be the drivers of the TB epidemic in Angola. Twenty four in-depth qualitative interviews were conducted with medical staff working in this field in the provinces of Luanda and Benguela. The healthcare professionals see the migrant working poor as a particular problem for the control of TB. Migrants are constructed as ‘Rural People’ and are seen as non-compliant and late-presenting. This is a stigmatized and marginal group contending with the additional stigma associated with TB infection. The healthcare professionals interviewed also see the interruption of treatment and self-medication generally as a better explanation for the TB epidemic than urbanization or lack of medication. The local narrative is in contrast to explanations used elsewhere. To be effective policy must recognize the local issues of the migrant workforce, interruption of treatment and the stigma associated with TB in Angola.

Changing gender profile of medical schools in South Africa
Breier M, Wildschut A: South African Medical Journal 98(7):557-560

Since 1994, higher education policy has been committed to equity of access for all, irrespective of race and gender. This study investigated progress towards these goals in the education of medical doctors, with an emphasis on gender. Databases from the Department of Education (DoE), Health Professions Council of South Africa (HPCSA) and University of Cape Town (UCT) Faculty of Health Sciences were used to explore undergraduate (MB ChB) trends at all eight medical schools and postgraduate (MMed) trends at UCT. Nationally women have outnumbered men in MBChB enrolments since 2000, figures ranging between 52% and 63% at seven of the eight medical schools in 2005. However,the rate of change in the medical profession lags behind and it will take more than two decades for female doctors to outnumber male doctors. A study of UCT postgraduate enrolments shows that females had increased to 42% of MMed enrolments in 2005. However, female postgraduate students were concentrated in disciplines such as paediatrics and psychiatry and comprised no more than 11% of enrolments in the surgical disciplines between 1999 and 2005. The study provides a basic quantitative overview of the changing profile of medical enrolments and raises questions about the career choices of women after they graduate and the social factors influencing these choices.

Chemists leaving SA by the hundreds as US group dispenses big bucks

Having difficulty getting an airline booking to the US? The problem may well be that you're standing in line with a small army of pharmacists and their families due to leave SA over the next few weeks. Behind this exodus is Albertson's, a $28bn/year turnover US retail pharmacy group with a staff of 200 000. One of their recruits, Cape Town pharmacist Keith Hughes, will be leaving behind a 20-year career to begin afresh in Delaware. As an "intern" Hughes can expect an immediate $2 000/month income boost.

Classifying human resources constraints to attaining health-related Millennium Development Goals

This study explores the constraints related to human resources in the health (HRH) sector to achieving the Millennium Development Goals (MDGs) in low-income countries. The author finds that, at an individual level, the decision to enter, remain and serve in the health sector workforce is influenced by a series of social, economic, cultural and gender-related determinants.

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