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.
Human Resources
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.
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.