Rather than making progress towards the Millennium Development Goal of reducing maternal mortality by 75% by 2015, the number of deaths resulting from pregnancy or childbirth in South Africa has doubled in the past 20 years, according to government figures. For every 100,000 babies born, up to 625 mothers die due to childbirth complications. Loveday Penn-Kekana, from the University of the Witwatersrand in Johannesburg, believes South Africa's poor maternal health outcomes are linked to the lack of midwifery services. She called for the government to invest in more and better trained midwives, especially as they bore most of the responsibility for day-to-day operations in maternity wards. Midwives are classified as nurses in South Africa so there are no figures on their numbers, but she argues that there are too few. Low enrolment at nursing colleges is part of the problem, but many midwives have also left the public sector to work for higher salaries overseas or in managerial positions, because of the limited opportunities for career development and advancement in the clinical area. The Society of Midwives of South Africa has noted that lack of midwives means that the quality of the services they provide is declining, as existing midwives are overworked. Also, because they argue that people are first trained as a nurse and then given midwifery skills, midwifery is not prioritised. A plan by South Africa's Health Minister to reopen unused nursing colleges across the country and increase the number of nurses may result in more midwives being trained.
Human Resources
In this brief, Capacity Plus notes that people living in rural areas have less access to health workers, and fail to receive vital preventive, curative, and life-saving services. The problem is especially acute in countries with predominately rural populations. Investment in the development of doctors and nurses is wasted if countries cannot place or keep them in the areas where they are most needed, Capacity Plus argues, nor can they achieve their Millennium Development Goals. A number of recommendations are made. Departments of health should aim to understand and test the factors and incentives that influence health workers’ decisions to accept and remain in rural posts, and develop tailored retention schemes. They should prioritise rural retention schemes and strategies in national health workforce plans, involve professional medical and nursing associations in retention advocacy, strengthen and streamline human resources management (HRM) systems that can affect retention, and address gender discrimination in HRM and gender-based violence in health facilities. Furthermore, they should recruit primary health workers from their own communities and from rural backgrounds, locate health professional schools in rural regions and subsidise health worker education in return for service in rural areas.
Most of the 58 countries covered in this report have been identified as suffering from a crisis in human resources for health. Collectively, across these countries women gave birth to 81 million babies in 2009, accounting for 58% of the world’s total births. The inequitable ‘state of the world’ is most evident in the disproportionate number of deaths in these countries: 91% of the global burden of maternal mortality, 80% of stillbirths and 82% of newborn mortality. These figures partly reflect the distribution of the global workforce: less than 17% of the world’s skilled birth attendants are available to care for women in the 58 countries. There is a triple gap, consisting of competencies, coverage and access. The triad of education, regulation and association has insufficient focus on quality of care, the authors argue. Policy coherence is disjointed and access to the necessary strategic intelligence or evidence for action weak. They urge governments to recognise midwifery as a distinct profession, core to the provision of maternal and newborn health services, and promote it as a career with posts at the national policy level. They also make a number of recommendations for governments, regulatory bodies, schools and training institutions, professional midwifery organisations, international organisations and global partnerships, external funders and civil society organisations.
The authors of this article examined the influence of gender on workplace violence, and synthesised their findings with other research from Rwanda, before they examined the subsequent impact of the study on Rwanda's policy environment. Fifteen out of 30 districts were selected at random. Forty-four facilities at all levels were randomly selected in these districts. From these facilities, 297 health workers were selected at random, of whom 205 were women and 92 were men. Researchers administered health worker survey, facility audits, key informant and health facility manager interviews and focus groups to collect data in 2007. They found that 39% of health workers had experienced some form of workplace violence in year prior to the study. The study identified gender-related patterns of perpetration, victimisation and reactions to violence. Negative stereotypes of women, discrimination based on pregnancy, maternity and family responsibilities and the 'glass ceiling' affected female health workers' experiences and career paths and contributed to a context of violence. Addressing gender discrimination and violence simultaneously should be a priority for workplace and violence research, workforce policies, strategies, laws and human resources management training, the authors conclude.
Workplace health promotion (WHP) is a common strategy used to enhance on-the-job productivity. The primary objective of this study was to determine if WHP programmes are effective in improving workers presence at work. The Cochrane Library, Medline, and other electronic databases were searched from 1990 to 2010. After 2,032 titles and abstracts were screened, 47 articles were reviewed, and 14 were accepted (4 strong and 10 moderate studies). These studies contained preliminary evidence for a positive effect of some WHP programmes. Successful programmes offered organisational leadership, health risk screening, individually tailored programs, and a supportive workplace culture. Potential risk factors contributing to presenteeism included being overweight, a poor diet, a lack of exercise, high stress, and poor relations with co-workers and management.
This qualitative study was undertaken to understand how practising doctors and medical leaders in Ghana describe the key factors reducing recruitment and retention of health professionals into remote areas, and to document their proposed policy solutions. In-depth interviews were carried out with 84 doctors and medical leaders, including 17 regional medical directors and deputy directors from across Ghana, and 67 doctors chosen to represent progressively more remote distances from the capital of Accra. All participants felt that rural postings must have special career or monetary incentives given the loss of locum (i.e. moonlighting income), the higher workload, and professional isolation of remote assignments. Career 'death' and prolonged rural appointments were a common fear, and proposed policy solutions focused considerably on career incentives, such as guaranteed promotion or a study opportunity after some fixed term of service in a remote or hardship area. Short-term service in rural areas would be more appealing if it were linked to special mentoring and/or training, and led to career advancement.
This paper proposes a framework for carrying out a costing analysis of interventions to increase the availability of health workers in rural and remote areas with the aim to help policy decision makers. The authors review the evidence on costing interventions to improve health workforce recruitment and retention in remote and rural areas, provide guidance to undertake a costing evaluation of such interventions and investigates the role and importance of costing to inform the broader assessment of how to improve health workforce planning and management. They show show that while the debate on the effectiveness of policies and strategies to improve health workforce retention is gaining impetus and attention, there is still a significant lack of knowledge and evidence about the associated costs. To address the concerns stemming from this situation, key elements of a framework to undertake a cost analysis are proposed and discussed, which should help policy makers gain insight into the costs of policy interventions, to clearly identify and understand their financing sources and mechanisms, and to ensure their sustainability.
The purpose of this study was to examine the relationship between men who engage in carework and commitment to gender equity. The context of the study was that gender inequitable masculinities create vulnerability for men and women to HIV and other health concerns. A qualitative approach was used. Twenty men from three South African cities who were identified as engaging in carework were interviewed. They were engaged in different forms of carework and their motivations to be involved differed. Some men did carework out of necessity. Poverty, associated with illness in the family and a lack of resources propelled some men into carework. Other men saw carework as part of a commitment to making a better world. 'Care' interpreted as a functional activity was not enough to either create or signify support for gender equity. Only when care had an emotional resonance did it relate to gender equity commitment. Engagement in carework precipitated a process of identity and value transformation in some men suggesting that support for carework still deserves to be a goal of interventions to 'change men'. Changing the gender of carework contributes to a more equitable gender division of labour and challenges gender stereotypes, the authors argue. Interventions that promote caring also advance gender equity.
While Kenyan health workers treating tuberculosis patients are working without masks, government officials say problems with the supply chain and funding shortages are the main reason for the lack of protective gear. Health personnel cannot stop treating or offering services to patients even without these commodities and during that time, they risk getting infected by the very patients they treat. According to Joseph Sitienei, head of the National Leprosy and TB Control Programme, sometimes health facilities delay in requesting these much-needed materials and only do so when they completely run out. However, he pointed to increased funding to the health sector recently, which held promise that the situation would improve. He noted that the government is streamlining procurement and supply of commodities including protective gear to health facilities. In contrast, local NGOs say corruption within the health system is to blame for the haphazard availability of medical supplies, with drugs often 'disappearing' from government health facilities and sold to private pharmacies by government pharmacists.
The authors of this study estimated the shortage of mental health professionals in low- and middle-income countries (LMICs). They used data from the World Health Organisation’s Assessment Instrument for Mental Health Systems (WHO-AIMS) from 58 LMICs, country-specific information on the burden of various mental disorders and a hypothetical core service delivery package to estimate how many psychiatrists, nurses and psychosocial care providers would be needed to provide mental health care to the total population of the countries studied. All low-income countries and 59% of the middle-income countries in the sample were found to have far fewer professionals than they need to deliver a core set of mental health interventions. The 58 LMICs sampled would need to increase their total mental health workforce by 239 000 full-time equivalent professionals to address the current shortage, the authors conclude. Country-specific policies are needed to overcome the large shortage of mental health-care staff and services throughout LMICs.