This observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980 and 2006. Data were collected 26 months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment and main work duties. Results showed that of 723 qualifying physicians between 1980 and 2006, a quarter had left the public sector, of which 62.4% continued working in-country and 37.6% emigrated. Of those cases of internal migration, 66.4% worked for non-governmental organisations (NGOs), 21.2% for external funders and 12.4% in the private sector. Annual incidence of physician migration was estimated to be 3.7%, predominately to work in the growing NGO sector. An estimated 36.3% of internal migration cases had previously held senior-level management positions in the public sector. The authors conclude that internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration. They call on external funders and NGOs to assess how their hiring practices may undermine the very systems they seek to strengthen.
Human Resources
In Tanzania, the authors of this study found that increasing numbers of universities are training many more health professionals to address the country’s extreme shortage of health care workers. In 2009 six universities admitted 756 medical students, but this is still many fewer than are needed based on population growth. Tanzania’s universities have the ability to support health professionals to build and maintain critical competencies by strengthening curricula and pre-service and internship training, and providing opportunities for continuing professional development, according to the study. For example, Muhimbili University of Health and Allied Sciences (MUHAS), the oldest health sciences academic institution in Tanzania, is partnering with the University of California San Francisco to transform MUHAS's educational environment through curricula revision and faculty development. However, enhancing the educational process involves a great deal of commitment from faculty across MUHAS and will only succeed if supported by long-term institutional reform. Sharing of early lessons learned by institutions undergoing educational reform will start to build a body of knowledge and experience to inform transformation of health professions education in Tanzania and elsewhere in Africa.
Little is known in Kenya on the extent to which community health workers (CHWs) are utilised, the characteristics of families who report utilising CHWs and whether utilisation is associated with improved access to prompt and effective malaria treatment. This paper addresses this research gap by examining factors associated with utilisation of CHWs in improving access to malaria treatment among children under five years of age by women caregivers in 113 hard-to-reach and poor rural villages in Malindi and Lamu districts Results indicate an increase in reported utilisation of CHWs as source of advice/treatment for child fevers from 2% to 35%, accompanied by a decline in care-seeking from government facilities (from 67% to 48%) and other sources (26% to 2%) including shops. The most poor households and poor households reported higher utilisation of CHWs at 39.4% and 37.9% respectively, compared to the least poor households (17%). Prompt access to timely and effective treatment was 5.7 times higher when CHWs were the source of care sought. The authors conclude that the utilisation of CHWs in improving access to malaria treatment at the community level will not only enhance access to treatment by the poorest households but also provide early and appropriate treatment to vulnerable individuals, especially those living in hard to reach areas.
Ethiopia is preparing for a major influx of medical doctors within three to four years, as government intends to save a public health system that has been losing doctors and specialists to internal and external migration. Medical schools report enrollment of more than 3,100 students, representing a tenfold increase from 2005, when less than 300 students enrolled. A draft of the country's Human Resource for Health Strategic Plan shows an intended increase in the number of physicians to 1 per 5,000 people by 2020. The plan seems on course, with a report presented to parliament in May 2012 revealing that 2,628 students had been enrolled in 22 universities over the previous nine months. Currently fewer than 200 doctors graduate annually. With the strong emphasis on health personnel numbers, experts have expressed concerns about the quality of medical education, a allegation that the Health Minister acknowledges, adding that government is taking steps to strengthen training of doctors through the Medical Education Partnership Initiative (MEPI), networking with known universities in the United States and offering students incentives to study further.
Salaries and other benefits are an obvious pull factor towards foreign countries, given the often-extreme differences in wages internationally. The introduction of the Occupation Specific Dispensation (OSD) in 2007 sought to address the challenge of high levels of South African health workers migrating overseas. In this study, researchers evaluate the effectiveness of the OSD by comparing salaries of health workers in South Africa with their counterparts in developed countries. Using a representative basket of commonly bought goods (including food, entertainment, fuel and utilities), they used a purchasing power parity (PPP) ratio to adjust earnings in order measure real differences in salaries. Their results showed that salaries of most South African health workers, particularly registered nurses, are dwarfed by their international counterparts, notably in the United States, Canada and Saudi Arabia, although the OSD has gone some way to reduce that disparity. These countries generally offer higher salaries on a PPP-adjusted basis, while other foreign countries also show large salary advantages if health workers emigrated. Given that their findings suggest that the OSD has narrowed the gap between South African and overseas salaries, the authors call for further research into the push factors underlying high levels of worker out-migration in the country.
In 2006, the World Health Organization (WHO) reported that 57 countries, most of them in Africa and Asia, face a severe health workforce crisis. They estimate that over 2 million health service providers and 1.8 million management support workers are needed to fill the gap (WHO, 2009). Health workers play a critical role in the effective delivery of health services, especially in high disease-burdened countries like South Africa. Constraints in the health workforce have emerged as a key obstacle to scaling-up access to prevention and treatment for the 5.7 million people currently living with HIV/AIDS in South Africa. A recent strategic plan, released in 2012 by the South African government, aims to address the gaps in human resources for health and is expected to mitigate the resource shortage within the next 15 to 25 years. This report analyses the plan and proposes that actors in other health systems, especially those in high HIV-burden, low-resource countries, may be able to learn from the forthcoming experience of implementing the strategy in South Africa.
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.
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.