In this assessment, researchers aimed to identify critical gaps in the core competencies of the Makerere University College of Health Sciences medicine and nursing, as well as ways to overcome them to achieve the government’s Health Sector Strategic Plan (HSSP) goals. Documents from the Uganda Ministry of Health as well as medicine and nursing curricula were analysed, and 19 key informant interviews) and seven focus group discussions with stakeholders were conducted. The researchers found that the core competencies that medicine and nursing students are expected to achieve by the end of their education were outlined for both programmes. The curricula are in the process of reform towards competency-based education and, on the surface, are well aligned with the strategic needs of the country. But implementation is inadequate, and the researchers argue that learning objectives need to be more applicable to achieving competencies, learning experiences need to be more relevant for competencies and setting in which students will work after graduation (i.e. not just clinical care in a tertiary care facility), and student evaluation needs to be better designed for assessing these competencies.
Human Resources
In this study, researchers in Zambia examined the relationship between health worker incomes and their satisfaction and motivation. Cross-sectional data collection was undertaken using both quantitative and qualitative methods. Data was collected in three regions that represent extremes in overall remuneration and benefits. Lusaka represented the favourable area while Monze and Nyimba represented less favourable areas for study in Zambia. The researchers found that there are hefty disparities between different health workers. There are also enormous salary differentials for the same workers between the public and private sectors. These salary differentials explain the experience of public-to-private migration of health workers as well as casual private sector work by public sector health workers, they argue. In addition, there are negligible efforts by government to reduce the benefits gaps among key public health cadres. The low incomes received by public health workers in Zambia have many negative implications: it begets absenteeism, results in low output, poor quality health care, and the departure of health workers to the private sector and overseas.
Globally, there is a lack of data tracking the movements of health workers within health systems. In this study, researchers aimed to collate what research exists in the form of a review of the available literature on implementation processes for human resources information systems (HRIS). They retrieved 11,923 articles in four languages published in peer-reviewed and grey literature, of which 95 articles with relevant HRIS information were reviewed, mostly from the grey literature, which comprised 84 % of all documents. Whereas a high percentage of countries reported the capability to generate workforce supply and deployment data, few systems were documented as being used for HRH planning and decision-making. Of the systems examined, only 23% explicitly stated they collect data on workforce attrition. Most countries experiencing crisis levels of HRH shortages (56%) did not report data on health worker qualifications or professional credentialing as part of their HRIS. This study is intended to serve as a baseline for scaling up HRIS at national, regional and global levels.
In this study, researchers developed and piloted a methodology to establish tuberculosis-related work load at primary care level for clinical and laboratory staff. They found that workload was determined by the nature of the activities that staff had to implement, the amount of time they had to perform them and their frequency, as well as patient load. Of particular importance, the researchers note, is the patient pathway for diagnosis and treatment and the frequency of clinic visits. They recommend using observation with checklists, clocking, interviews and review of registers to assess the contribution of different factors on the workload.
The objective of this study was to assess the extent to which the Health Economics Unit (HEU) has contributed to the development of health economics capacity in sub-Saharan Africa through the provision of Master’s and PhD programmes since the 1990s. The evaluation was based on a document review and 25 key informant interviews – with Master’s and PhD graduates, HEU staff members with management roles, beneficiaries of HEU’s internal capacity-building initiatives and international experts. The programmes have so far graduated 115 Master’s and 15 PhD graduates in health economics. Feedback from graduates indicated they are largely satisfied with the programmes. Most graduates are retained in the region if not in their home countries and find employment in a post that uses at least some of the skills gained during the programme, although not necessarily strictly in health economics. In terms of overall financial sustainability of HEU’s post-graduate programmes, SIDA funding has come to an end, which means there is a need to pursue financial support from the University in line with the usual funding of post-graduate training. The policy brief also makes some recommendations for improving future programmes.
With much smaller numbers relative to their counterparts in developed countries, pharmacists in developing countries tend to keep to the confines of dispensing roles mainly in community pharmacies. In this article the authors challenge these pharmacists to move away from the dispensing window and to demonstrate the value of the years invested in pharmacy schools to improve the well-being of communities. In Africa, another reason why pharmacy must be proactive in assuming service- and systems-based roles is the fact that physicians are often overloaded with clinical duties. By demonstrating that they can competently assume these roles and complement physicians in providing quality healthcare services, pharmacists have ready-made opportunities to enhance their role in the community. To arrest the waning image of the profession in Africa, there is need to identify service opportunities that would perpetuate the continued relevance of the profession to health systems and communities. Even though new opportunities in the areas of public health, pharmaceutical supply chain management, pharmacovigilance, regulation, management, rational drug use and others are emerging in different forms and designs, pharmacists appear slow to seize these opportunities. Changes in mind sets, perceptions, curricula and teaching methodologies are required, the article concludes.
A workshop on enhancing the global workforce for vaccine manufacturing was organised by the World Health Organisation from the 30 November to 2 December 2011, in Cape Town, South Africa. This workshop was attended by representatives from academia, pharmaceutical industries, research institutions, non-governmental organisations and regulatory agencies. A recurring theme during the discussions was the notion that international support for establishing or strengthening vaccine production capacity in developing and emerging economy countries must also include appropriate efforts to train and retain a skilled local workforce. A highly skilled workforce will support long term sustainability and viability of the operations of developing country vaccine manufacturers. Due to the synergies/similarities between the vaccine production workforce and the workforce producing other biological drugs, participants at the workshop argued that the two labour forces could complement each other during times of critical need. The management model of the biological drug manufacturing workforce could also serve as a benchmark for training, recruitment and retention policies.
The Sub-Saharan African Medical Schools Study (SAMSS) survey is a descriptive survey study of sub-Saharan African medical schools. Surveys were distributed to 146 medical schools in 40 of 48 sub-Saharan African countries. One hundred and five responses were received (72% response rate). Enrolments for medical schools ranged from 2 to 1,800 and graduates ranged from 4 to 384. Seventy-three percent of respondents increased first-year enrolments in the past five years. On average, 26% of respondents’ graduates were reported to migrate out of the country within five years of graduation. The most significant reported barriers to increasing the number of graduates and improving quality were related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower levels of loss of faculty staff. Strengthened institutional research tools and funded faculty research time were also linked to greater faculty involvement in research. The results of the SAMSS survey are intended to serve as a baseline for future research, policies and investment in the health care workforce in the region.
Africa lacks a system for defining, co-ordinating and growing the human resources for health research (HRHR) needed to support its health systems development, according to this review. The authors found that research consists of unco-ordinated, small-scale activities, primarily driven from outside Africa. They present examples of ongoing HRHR capacity building initiatives in Africa. There is no overarching framework, strategy or body for African countries to optimise research support and capacity in HRHR. A simple model is presented to help countries plan and strategise for a comprehensive approach to research capacity strengthening. Everyone engaged with global, regional and national research for health enterprises must proactively address human resource planning for health research in Africa, the authors argue. Unless this is made explicit in global and national agendas, Africa will remain only an interested spectator in the decisions, prioritisation, funding allocations, conduct and interpretation, and in the institutional, economic and social benefits of health research, rather than owning and driving its own health research agendas.
This paper reports on a survey of 415 South African doctors in Canada conducted in 2009-2010, representing almost 20% of the total number working in Canada. The researchers found that, while this group of South African professionals are proud to think of themselves as South African and take a relatively keen interest in events in that country, they are largely disengaged from any serious diasporic interest in and commitment (beyond contact with and some limited support for family members who remain). Amounts remitted by South African physicians are small in comparison to their incomes and remitting is infrequent, differing markedly in their remitting behaviour from physicians from other African countries and from African diasporas in general, where remittances are significant. More than half expressed no interest in returning to South Africa to help with nation building. Only 7% said they are likely to return within the next two years and another 10% within the next five years. Almost without exception, the respondents painted a very negative picture of life in South Africa and they do not see any role for themselves in helping address the country’s deep social and economic inequalities and needs. The findings of this study challenge assertions by neo-liberal economists that the negative impacts of the ‘medical brain drain’ in Africa are highly exaggerated and there is adequate compensation in the form of remittances, direct investment, knowledge and skills transfer, return migration and involvement in diaspora associations.