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.
Human Resources
Quest for quality: Guide for in-country discussions on human resources for health
Cordaid: February 2010
Mobile phones to help Africa's health workers deliver
Ngandwe T: Science and Development Network: 15 February 2007
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Institute of Statistics of Rwanda (NISR), health workers in remote areas of the country rely on paper records – often out of date – to track diseases' spread and have no transport for gathering field data or collecting medicines.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.
South African medical staff banned from moonlighting
Newman L: Independent Online, 6 January 2010
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.'
From staff-mix to skill-mix and beyond: Towards a systemic approach to health workforce management
Dubois C and Singh D: Human Resources for Health 7(87), 19 December 2009
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.
International flow of Zambian nurses
Hamada N, Maben J, McPake B and Hanson K: Human Resources for Health 7(83), 11 November 2009
This commentary paper highlights changing patterns of outward migration of Zambian nurses. The aim is to discuss these pattern changes 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 is attributable to the policy of active recruitment by the United Kingdom's National Health Service and Zambia's policy of offering voluntary separation packages. The dramatic decline in migration to the United Kingdom since 2004 is likely to be due to increased difficulties in obtaining United Kingdom registration and work permits. Despite smaller numbers, enrolled nurses are also leaving Zambia for other destination countries, a significant new development. This paper stresses the need for nurse managers and policy-makers to pay more attention to these wider nurse migration trends in Zambia, and 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.
International recruitment of health personnel: Draft global code of practice
World Health Organization (WHO): 3 December 2009
The WHO Secretariat has redrafted the code of practice in order to take into account, as requested, the views and comments expressed by members of the Board in January 2009 and the outcome of the subsequent sessions of the regional committees. Two core themes identified by the regional committees and incorporated in the revised draft code were that member states should strive to achieve a balance between the rights, obligations and expectations of source countries, destination countries and migrant health personnel, and that international health worker migration should have a net positive impact on the health system of developing countries and countries with economies in transition. The revised draft text emphasises that international health personnel should be recruited in a way that seeks to prevent a drain on valuable human resources for health. It also recommends that countries should abstain from active international recruitment of health personnel unless equitable bilateral, regional, or multilateral agreement(s) exist to support such recruitment activities.
Making migration work for development: Key findings in migration research
Development Research Centre on Migration, Globalisation and Poverty, University of Sussex: 2009
This report is a summary of six years of investigation into migration policy and practice. Its findings indicate that, for migration to have its full developmental impact, the most beneficial policy change would be to reduce barriers to migration, at all levels and particularly for the poorest. This paper examines the changing dynamics of migration, impacts of migration on poverty and livelihoods, new initiatives in international migration, and how the findings in relation to the development of policy on migration. It found that poor people are more likely to move over shorter distances, either within or between poor countries, and where poor people have a greater choice in terms of migration destinations, the net effect on inequality is more likely to be positive. In addition, skilled migration is largely a symptom, not a cause, of underdevelopment. Diaspora engagement can contribute to the development of countries of origin, but this is a highly politicised arena.
Ten best resources on health workers in developing countries
Grépin KA and Savedoff WD: Health Policy and Planning 24(6): 479–482, 2 September 2009
This paper found that, until recently, researchers and policymakers paid little attention to the role of health workers in developing countries but a new generation of studies are providing a fuller understanding of these issues using more sophisticated data and research tools. Recent research highlights the value of viewing health workers as active agents in dynamic labour markets who are faced with many competing incentives and constraints. Newer studies have provided greater insights into human resource requirements in health, the motivations and behaviours of health workers, and health worker migration. The authors note that they are encouraged by the progress but believe there is a need for even more, and higher-quality, research on this topic.
Explanations for persistent nursing shortages
Long MC, Goldfarb MG and Goldfarb RS: Forum for Health Economics & Policy 11(2): Article 10, 2008
This paper contributes to the economics literature on nursing market shortages by putting forward two new models that suggest three new explanations for perceived nursing shortages. The first model focuses on hospitals hiring both permanent staff nurses and temporary contract nurses. It shows that hiring both classes of nurses can represent optimising behaviour, and that an interesting kind of perceived nursing shortage results from this dual hiring. The second model posits two classes of hospitals – premier and funds-constrained – and generates two distinct kinds of nursing shortages: economic shortages, involving unfilled, budgeted positions, and non-economic professional standards shortages. The paper argues that the perceived existence of professional standards shortages may be a significant explanation for the widespread impression of persistent shortages.
Position paper on human resource for health fee hike
National Organisation of Nurses and Midwives of Malawi (NONM): 6 November 2009
The National Organisation of Nurses and Midwives of Malawi’s position paper is a response to the proposed introduction of fees for student nurses and midwives. It has been submitted to top leadership in government, parliament, civil society organisations, media, community and religious leaders, professional organisations, trade unions and other opinion leaders. The organisation asks for ‘revision of government decision on payment of fees by students and parents towards training in nursing and midwifery. Specifically, the fees are very high costing over K1 million per student for a three-year course of study. This is prohibitive to selected candidates who aspire to study nursing/midwifery… [ ] … Existing and alternative funding options can be maximised to address funding for nurses and midwives’ training.’ It notes that civil society has a critical role in ‘complementing government efforts to develop the country socio-economically, taking it from “Poverty to Prosperity”’ and hopes to build on the economic prosperity achieved by Malawi in the past six years, referring to ‘meaningful and sustainable funding… [ ] … for the training of nurses and midwives.’
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