This qualitative paper reports on the experience of three community health worker (CHW) supervisors who were responsible for supporting infant feeding peer counsellors. The intervention took place in three diverse settings in South Africa. Each setting employed one CHW supervisor, each of whom was individually interviewed for this study. The study forms part of the process evaluation of a large-scale randomised controlled trial of infant feeding peer counselling support. The findings highlight the complexities of supervising and supporting CHWs. In order to facilitate effective infant feeding peer counselling, supervisors in this study had to move beyond mere technical management of the intervention to broader people management. While their capacity to achieve this was based on their own prior experience, it was enhanced through being supported themselves. In turn, resource limitations and concerns over safety and being in a rural setting were raised as some of the challenges to supervision. Adding to the complexity was the issue of HIV. Supervisors not only had to support CHWs in their attempts to offer peer counselling to mothers who were potentially HIV positive, but they also had to deal with supporting HIV-positive peer counsellors. This study highlights the need to pay attention to the experiences of supervisors so as to better understand the components of supervision in the field.
Human Resources
Durban health workers who treat patients with drug-resistant TB are noted to face increase risk of drug resistant TB. According to Dr Iqbal Master, head of clinical services at King George V Hospital in Durban, the province’s specialist hospital for drug-resistant TB, they should be given special incentives to recognise this. King George V Hospital has been trying to get itself declared 'inhospitable', which would mean that staff would get additional incentives for this. Workers at the facility are reported to be six times more likely to get drug-resistant TB than ordinary members of the public. In the last decade, 14 staff members are reported to have died of the TB and one staff member was being treated for drug-resistant (XDR) TB.
This study evaluated two models of routine HIV testing of hospitalised children in a high HIV-prevalence resource-constrained African setting. Both models incorporated task shifting, namely the allocation of tasks to the least-costly, capable health worker. Two models were piloted for three months each within the paediatric department of a referral hospital in Lilongwe, Malawi between January 1 and June 30, 2008. Model 1 utilised lay counsellors for HIV testing instead of nurses and clinicians, while Model 2 further shifted programme flow and advocacy responsibilities from counsellors to volunteer parents of HIV-infected children, called 'patient escorts'. The strategy presented here in the two models, namely task shifting from lay counsellors alone to lay counsellors and patient escorts, was found to improve programme outcomes greatly, while only marginally increasing operational costs. The wider implementation of this strategy could accelerate paediatric HIV care access in high-prevalence settings.
This paper is based on the premise that medical schools can play an important role in solving the problem of geographical imbalance of doctors in the United Republic of Tanzania. It reviews available research evidence that links medical students' characteristics with human resource imbalances and the contribution of medical schools in perpetuating an inequitable distribution of the health workforce. Structured questionnaires were also administered to 130 fifth-year medical students at the medical faculties of MUCHS (University of Dar es Salaam), HKMU (Dar es Salaam) and KCMC (Tumaini University, Moshi campus) in Tanzania. The study found a lack of a primary interest in medicine among medical school entrants, biases in recruitment, the absence of rural-related clinical curricula in medical schools, and a preference for specialisation not available in rural areas. These were considered the main obstacles for building a motivated health workforce to help correct the inequitable distribution of doctors in the Tanzania. The study suggests that there is a need to re-examine medical school admission policies and practices.
This dossier offers practical up to date information about how to address human resource problems and issues, drawing upon evidence about what works, and identifying innovations in approaches, policy and practice. Developing countries have committed to achieving the Millennium Development Goals (MDGs). They will need to make the most effective use of all available resources to achieve the MDGs - this includes human resources. Many countries are improving their short and medium term financial planning and budgetary processes but in the past, few, if any, have given human resource management a similar focus. Now, however, human resources are being seen to be as crucial as money in improving services for poor people. Sections include: planning for human resources; strengthening capacity; migration; management issues; international initiatives; and a section focusing on Africa.
This paper highlights and discusses changing patterns of outward migration of Zambian nurses in the light of policy developments in Zambia and in receiving countries. Prior to 2000, South Africa was the most important destination for Zambian registered nurses. In 2000, new destination countries, such as the United Kingdom, became available, resulting in a substantial increase in migration from Zambia. This was attributed to a policy of active recruitment by the United Kingdom's National Health Service and Zambia's policy of offering Voluntary Separation Packages: early retirement lump-sum payments promoted by the government, which nurses used towards migration costs. The dramatic decline in migration to the United Kingdom since 2004 was reported to be most likely due to increased difficulties in obtaining United Kingdom registration and work permits. Despite smaller numbers, enrolled nurses were also noted now to be leaving Zambia for other destination countries. This paper argues that the focus of any migration strategy should be on how to retain a motivated workforce through improving working conditions and policy initiatives to encourage nurses to stay within the public sector.
This paper presents and discusses a variety of experiences of faith-based organisations (FBOs) working in rural and remote areas of Anglophone Africa in dealing with human resources for health (HRH). The paper is intended to be used in discussions among people working in the field of HRH or who have tasks related to the management of health staff. It covers a number of case studies, including those in sub-Saharan Africa. It can be used for HRH discussions at different levels - at the level of umbrella organizations of FBOs, at district level, or at health facility level - and in different settings such as decentralised or centralised settings.
Mobile phone companies have announced a US$10 million initiative to help health workers in Africa deliver quality services to HIV and AIDS patients. The Phones for Health project will equip workers in remote areas of Rwanda with mobile phones and software for exchanging information on patients. Paul Meyer, chairman of US-based Voxiva who designed the software, said workers would also be able to order medicines, receive news alerts and download treatment guidelines and training materials. According to the National Institute of Statistics of Rwanda (NISR), health workers in remote areas of the country rely on paper records – often out of date – to track diseases' spread and have no transport for gathering field data or collecting medicines. The project aims to make things easier. Workers in the field can use phones to record patient information and send it to a central database via a high-speed network or text message. The information is then made available to health officials via the internet and can be sent to field staff by text message. The initiative is a partnership between the Global System for Mobile Communications Association (GSMA), the US President's Emergency Plan for AIDS Relief, the Accenture Development Partnership, and mobile phone operators. If it is successful it will be extended to other countries in Africa.
The KwaZulu-Natal Health Department has banned nurses and doctors from moonlighting, saying the practice is being abused. Two major health workers' unions have rejected the move, saying their members in the public sector are poorly paid and rely on after-hours work to help them make ends meet. Department spokesman, Chris Maxon, said that it was policy that health workers could not engage in remunerative work while employed by the department. Exceptions had been made in the past with a number of stipulations, among them that extra work should not be undertaken during working hours and there should be no conflict of interests. Nurses' union, Denosa, said that although some staff members might have abused the system, the department should have investigated each case. 'There have been cases, for example, where staff use their days off for extra work and they are tired when they go back to work and book off sick,' Denosa said. 'But (abusing the system) should not be dealt with as a blanket ruling. This type of restriction is not fair. There is a reason why people do extra work and it is because they need to supplement their income.'
Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. The literature review for this study found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. The study describes evidence about the benefits and pitfalls of current approaches to optimisal roles of health workers in health care. It concludes that health care organisations must consider a more systemic approach – one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions.