The objective of this study was to estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Researchers calculated the financial cost of educating a doctor in nine source countries with a high HIV and AIDS burden (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), which ranged from US $21,000 in Uganda to $58,700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn, with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). They conclude that destination countries should consider investing in measurable training for source countries and strengthening of their health systems.
Human Resources
Communication between non-language-concordant health care workers (HCWs) and patients has been shown by international studies to adversely affect patient and staff satisfaction, yet the authors of this study note that, to the best of their knowledge, no such intervention studies have been conducted in Africa. They conducted research in South Africa to determine whether teaching Xhosa language skills and cultural understanding to HCWs affects patient satisfaction, HCWs’ ability to communicate effectively with Xhosa-speaking patients and HCWs’ job satisfaction levels. A before-and-after interventional study was performed at two community health centres and a district hospital in the Western Cape Province. Fifty-four randomly selected patients (27 pre- and 27 post-intervention) assessed communication with HCWs and rated their satisfaction. Six non-Xhosa-speaking HCW participants completed pre- and post-intervention questionnaires. HCWs completed a ten-week basic language course consisting of ten 120-minute interactive contact sessions developing basic Xhosa speaking and listening skills and cultural competence. Results showed that patient satisfaction showed significant improvements after the intervention. Patients perceived HCWs to be more understanding, respectful and concerned, and to show better listening skills, after the intervention. They were also better able to understand HCWs and their instructions. HCWs’ ability to communicate improved and HCWs experienced decreased frustration levels.
The aim of this study was to determine the need for resuscitation at the birth of babies delivered by elective caesarean section (CS) and to record the time spent by doctors attending such deliveries. Data were collected prospectively on all elective CSs performed at Groote Schuur Hospital in Cape Town, South Africa, over a three-month period. Data collected included: total time involved for paediatrician from call to leaving theatre, management of infant (requiring any form of resuscitation), Apgar scores and neonatal outcome (e.g. admission to nursery). The CSs were classified as low-risk or high-risk. Data were recorded for 138 deliveries. One-hundred-and-fifteen deliveries were classified as uncomplicated and 20 as high-risk. Only one of the babies born from the 115 low-risk CSs needed brief resuscitation, whereas nine of the 20 high-risk deliveries resulted in newborn resuscitation. The reasons for low-risk CS were: previous CS (81); infant of diabetic mother (IDM) and previous CS (16); IDM alone (6); estimated big baby (10); and other (2).The average time spent at each elective CS by the paediatrician was 37 minutes. The authors conclude that, for low-risk CS, the same medical attendance (i.e. a midwife) as for an uncomplicated normal vaginal delivery (NVD) would be appropriate. This would free up a doctor for other duties and assist in de-medicalising a low-risk procedure.
In June 2010 a conference entitled ‘Innovative Health Management in the Public Sector’ was held in Cape Town under the banner of the Oliver Tambo Fellowship Programme at the University of Cape Town. Participants offered a number of key messages for policy makers. 1. Prioritise leadership and management development as a key element of health systems strengthening, providing strong political support yet avoiding political interference. 2. Develop a recruitment strategy that appoints appropriately skilled and committed managers to appropriate positions. 3. Recognise that improving physical infrastructure and the quality of services is essential to successful retention. 4. Build and affirm managers’ good values while challenging those who exhibit inappropriate values. 5. Prioritise leadership and management training across the Department of Health and at all levels by developing mentoring mechanisms. 6. Remove unnecessary bureaucratic obstacles that impede dynamic health systems management, decentralise authority for decision-making and reduce management fragmentation to create an enabling environment for managers. 6. Adopt a systemic approach to health systems transformation that includes experimenting with new management practices, creating the space for managers to act proactively rather than simply reacting to daily crises. 7. Explore team work and the creative use of information in developing interventions and assessing progress in an iterative cycle of change. 8. Strengthen the accountability of managers within a supportive environment that allows some mistakes to be made as part of the process of innovation. 9. Develop a strategy and mechanisms for managers around the country to share best practices and experience on an ongoing basis. 10. Create a platform for managers to express their views to senior provincial and national policy-makers. 11. Recognise, value and celebrate the achievements of managers.
This presentation was delivered at BioMed’s Open Access Conference, held from 24-26 October 2011, in Kumasi, Ghana. It documents work by the African Medical And Research Foundation (AMREF), an international African non-governmental organisation (NGO) that focuses on community health development, with programme offices in seven African countries and direct reach through training, partnerships and consultancy in 33 other African countries. With major information challenges facing African health workers and systems, the use of emerging information and innovations have a huge role to play in improving health and health systems in Africa, the presenter argues, but he warns that tools alone cannot do it – the content needs to be developed and made available. Therefore, publishing and making information available to Africa’s health workers and practitioners is an urgent issue for the improvement of health services delivery in Africa. AMREF focuses on three broad health system approaches: capacity building for community and health systems including development and support to community health workers; improving health information; and human resources for health, particularly regarding the issues of health worker numbers and skills, training approaches including task shifting, and deployment and retention. Challenges in accessing research were identified as: low investment in research within the continent; lack of infrastructure for accessing research online in appropriate platforms to share research; and the prohibitive cost of accessing research (in print or online).
To address the shortage of healthcare workers providing comprehensive emergency obstetrical care (CEmOC) in Tanzania, an intensive three-month course was developed to train non-physician clinicians for remote health centres. Competency-based curricula for assistant medical officers' (AMOs) training in CEmOC, and for nurses, midwives and clinical officers in anaesthesia and operation theatre etiquette were developed and implemented in Ifakara. A total of 43 care providers from 12 health centres located in 11 rural districts in Tanzania and two from Somalia were trained from June 2009 to April 2010. Of these 14 were AMOs trained in CEmOC and 31 nurse-midwives and clinical officers trained in anaesthesia. The first eight months after introduction of CEmOC services in three health centres resulted in 179 caesarean sections, an increase of institutional deliveries by up to 300%, decreased fresh stillbirth rate and reduced obstetric referrals. There were two maternal deaths, both arriving in a moribund condition. The authors conclude that the training was a success and their model can be used for further training.
A stakeholder and sustainability analysis of 25 key informant interviews was conducted among past, current and potential stakeholders of Makerere University College of Health Sciences (MakCHS) to obtain their perspectives and contributions to sustainability of the College in its role to improve health outcomes. Results showed that the College has multiple internal and external stakeholders. Stakeholders from Uganda wanted the College to use its enormous academic capacity to fulfil its vision, take initiative, and be innovative in conducting more research and training relevant to the country’s health needs. External stakeholders felt that MakCHS was insufficiently marketing itself and not directly engaging the private sector or Parliament. Stakeholders also indicated MakCHS could better embrace information technology in research, learning and training, and many also wanted MakCHS to start leadership and management training programmes in health systems. This study points towards the need for MakCHS and other African public universities to build a broad network of partnerships to strengthen their operations, relevance and sustainability.
According to this profile document, health services and functions in Ghana have been decentralised and budget management centres have been created to improve both access to health services and community involvement in planning and delivery of services. There are about 52,258 individuals currently formally working in the health sector in Ghana. The Ministry of Health employs 42,299 staff, which represents about 81.5% of the total health sector workforce. In addition, about 21,791 people countrywide are registered as engaged in traditional medicine, while 367 people are registered as traditional birth attendants. Current human resources policies and plans emphasise the training of more middle-level cadres, which are cheaper to train and maintain. Distribution of health workers is skewed in favour of the more affluent regions, most of which are in the southern half of the country. Highly skilled professionals are concentrated in Greater Accra region, as well as in Korle Bu and Komfo Anokye Teaching Hospitals. Although training of health professionals has been a shared responsibility between the Ministries of Health and Education, there has not been clearly defined roles and collaboration. There is no comprehensive training policy to clarify roles and address issues.
In South Africa’s new human resources for health strategy, eight thematic priorities have been identified to form the strategy’s framework: leadership, governance and accountability; health workforce information and health workforce planning; re-engineering of the workforce to meet service needs; scaling up and revitalising education, training and research; creating the infrastructure for workforce and service development in the form of academic health complexes and nursing colleges; strengthening and professionalising the management of human resources and prioritising health workforce needs; ensuring professional quality care through oversight, regulation and continuing professional development; and improving access to health professionals and health care in rural and remote areas. The strategy aims to ensure necessary and equitable staffing of the health system and to ensure a workforce fit for purpose to meet health needs by: developing health professionals and cadres to meet health and health care needs; ensuring the health workforce has an optimal working environment and rewarding careers; ensuring innovative and efficient recruitment and retention of the health workforce; enabling clinical research which enhances clinical and service development; and providing the organisation and infrastructure for health workforce development. The Strategy also contains forecasts on the numbers of health workers required to fill critical gaps in public health service delivery.
South African health minister Aaron Motsoaledi has announced that R1.24-billion (US$ 155 million) will be spent to ‘revitalise nursing colleges’ and improve infrastructure to train more nurses, as part of the department's new human resource policy. For the current financial year, the department will spend US$27.5 million, and $64 million per year thereafter. A department spokesperson said nursing colleges standing empty would have to be fixed up so that they were fit for use. South African universities currently train 1200 doctors each year. Earlier this year Motsoaledi asked the deans of South Africa's medical schools to each train 40 more students per year. Wits University was the first to do so by taking in an extra 40 at the beginning of the year at the cost of R8-million. The Wits medical faculty dean said the country was short of every type of medical specialist and it would take a long time to fix because it took six to eight years to train specialists after they had qualified as doctors.