The human resource crisis in health care is an important obstacle to attainment of the health-related targets for the Millennium Development Goals. One suggested strategy to alleviate the strain upon government services is to encourage new forms of non-government provision. Detail on implementation and consequences is often lacking, however. This article examines one new element of non-government provision in Tanzania: small-scale independent midwifery practices. A multiple case study analysis over nine districts explored their characteristics, and the drivers and inhibitors acting upon their development since permitted by legislative change. Because of their location and emphasis on personalized care, small-scale independent practices run by retired midwives could potentially increase rates of skilled attendance at delivery at peripheral level. The model also extends the working life of members of a professional group at a time of shortage. However, the potential remains unrealized. Successful multiplication of this model in resource-poor communities requires more than just deregulation of private ownership. Prohibitive start-up expenses need to be reduced by less emphasis on facility-based provision. On-going financing arrangements such as micro-credit, contracting, vouchers and franchising models require consideration.
Human Resources
This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study to identify the level of satisfaction and intent to stay among health workers, to inform strategies to improve retention.
There is significant concern about the worldwide migration of nursing professionals from low-income countries to rich ones, as nurses are lured to fill the large number of vacancies in upper-income countries. This study explores the views of nursing students in Uganda to assess their views on practice options and their intentions to migrate. Improving remuneration for nurses is the top priority policy change sought by nursing students in this study. Nursing schools may want to recruit students desiring work in rural areas or public practice to lead to a more stable workforce in Uganda.
South Africa has large public and private sectors and there is a common perception that public sector hospitals are inefficient and ineffective while the privately owned and managed hospitals provide superior care and are more sustainable. The underlying assumption is that there is a potential gap in management capacity between the two sectors. This study aims to ascertain the skills and competency levels of hospital managers in South Africa and to determine whether there are any significant differences in competency levels between managers in the different sectors. The findings confirm the supposition that there is a lack of management capacity within the public sector in South Africa and that there is a significant gap between private and public sectors. It provides evidence that there is a great need for further development of managers, especially those in the public sector. The onus is therefore on administrators and those responsible for management education and training to identify managers in need of development and to make available training that is contextually relevant in terms of design and delivery.
Rich countries are poaching so many African health workers that the practice should be viewed as a crime, a team of international disease experts said. If one of these countries that is being systematically poached were to pursue it as a crime, contributing to unrest they would have some leg to stand on.
This World Health Organization background paper reviews and summarises service delivery management at the district level in Uganda. Specifically, it looks at health sector management development approaches that have been recently implemented, changes in the management capacity and performance and links between management development and health service delivery outputs. The paper finds that significant effort has gone into developing managers using long and short courses and placing "technical advisers" with District Health Management Teams. The paper concludes that whilst opportunities exist for managers to develop skills, courses need to be better designed to produce the essential competencies needed. A health sector competency framework for managers will provide common performance objectives and standards in the sector.
The growing AIDS epidemic in southern Africa is placing an increased strain on health systems, which are experiencing rising steadily patient loads. Health care systems are tackling the barriers to serving large populations in scaled-up operations. One of the most significant challenges in this effort is securing the health care workforce to deliver care in settings where the manpower is already in short supply. A demand-driven staffing model is presented in this study using simple spreadsheet technology, based on treatment protocols for HIV-positive patients that adhere to Mozambican guidelines. The model can be adjusted for the volumes of patients at differing stages of their disease, varying provider productivity, proportion who are pregnant, attrition rates, and other variables.
Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV on hospital staff. Organisational responses should be integrated into responses to other problematic working conditions and adapted to the local context. Opportunities already exist, such as better use of supervision, educational sessions and staff meetings. However, exchanges on interventions to improve staff motivation and address HIV in the health sector are urgently required, including information on results and details of the context and implementation process.
Twelve percent of the adult population in Malawi is estimated to be HIV infected. The country has a public sector-led antiretroviral treatment program both in the private and public health sectors. Estimation of the clinical human resources needs is required to inform the planning and distribution of health professionals. HAART provision is a labour intensive exercise. Although data in this paper is insufficient to determine whether HAART scale-up has resulted in the weakening or strengthening of the health systems in Malawi, the human resources requirements for HAART scale-up are significant. Malawi is using far less human resources than would be estimated based on the literature from other settings.
This study examines the opinions of health professionals about the capacity and performance of the 'tecnico de cirurgia', a surgically trained assistant medical officer in the Mozambican health system. Particular attention is paid to the views of medical doctors and maternal and child health nurses. Health workers at all levels voiced satisfaction with the work of the "tecnicos de cirurgia". They stressed the life saving skills of these cadres, the advantages resulting from a reduction in the need for patient referrals and the considerable cost reduction for patients and their families. Important problems in the professional status and remuneration of "tecnicos de cirurgia" were identified. This study, the first one to scrutinise the judgements and attitudes of health workers towards the "tecnico de cirurgia", showed that this cadre is highly appreciated and that the health delivery system does not recognise and motivate them enough. The findings of this study can be used to direct efforts to improve motivation of health workers in general and of tecnicos de cirurgia in particular.