From 29 March 2008, when Zimbabweans voted in the presidential and parliamentary elections, to 27 June when the presidential run-off election was held, Zimbabwe was hit by successive waves of gruesome political violence. The greatest intensity was in the rural provinces of east and central Mashonaland, but, as 27 June approached, violence engulfed urban areas and the numbers of victims of political violence increased. The world’s attention was on the political nature of the violence, and little focus was given to medical professionals, who risked their lives to assist the victims of political violence. The latest political violence occurred when Zimbabwe was already in dire economic difficulties that had adversely affected the health sector.
Human Resources
In most low-income countries, there is no tradition of labour market regulation, and the professions have little capacity to regulate members' provision of health services, which tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. A "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role.
Drawing from the fields of nursing, healthcare ethics, health systems management, and ecological restoration, the authors of this paper outline the role of social capital for organisational integrity, healthy workplace cultures, sustainable resource management, improved nurse retention, effective knowledge translation and safer patient care. Nursing leaders can use ecological thinking to build the vital resource of social capital by taking concrete steps to commit the necessary human and material resources to: forge relations to foster bonding, bridging and linking social capital; build solidarity and trust; foster collective action and cooperation; strengthen communication and knowledge exchange; and create capacity for social cohesion and inclusion.
Core competencies have been used to redefine curricula across the major health professions in recent decades. In 2006, the Association of Schools of Public Health identified core competencies for the Master of Public Health degree in graduate schools and programmes of public health. The authors provide an overview of the model development process and a listing of twelve core domains and 119 competencies that can serve as a resource for faculty and students for enhancing the quality and accountability of graduate public health education and training. The primary vision for the initiative is the graduation of professionals who are more fully prepared for the many challenges and opportunities in public health in the forthcoming decade.
Two crises dominate the health sectors of sub-Saharan African countries: those of human resources and of HIV. Nevertheless, there is considerable variation in the extent to which these two phenomena affect sub-Saharan countries, with a few facing extreme levels of both: Lesotho, Zimbabwe, Zambia, Mozambique, the Central African Republic and Malawi. This paper reviews the continent-wide situation with respect to this double burden before considering the case of Malawi in more detail. In Malawi, there has been significant concurrent investment in both an Emergency Human Resource Programme and an antiretroviral therapy programme which was treating 60,000 people by the end of 2006. Both synergy and conflict have arisen as the two programmes have been implemented. These highlight important issues for programme planners and managers, particularly that planning for the scale-up of antiretroviral therapy while simultaneously strengthening health systems and human resources requires prioritisation of support and time, and not just resources.
This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources and responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. A ‘social contract’ - granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services - may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their roles.
This study aimed to highlight the experience and findings of an attempt at establishing the optimal staffing levels for a tertiary health institution using the Workload Indicators of Staffing Need (WISN) method popularised by the World Health Organisation (WHO), Geneva, Switzerland. The descriptive study captures the activities of a taskforce appointed to establish optimal staffing levels. The cadres of workers, working schedules, main activities, time taken to accomplish the activities, available working hours, category and individual allowances, annual workloads from the previous year's statistics and optimal departmental establishment of workers were examined. There was initial resentment to the exercise because of the notion that it was aimed at retrenching workers. The team was given autonomy by the hospital management to objectively establish the optimal staffing levels. Very few departments were optimally established with most either understaffed or overstaffed. There were intradepartmental discrepancies in optimal levels of cadres even though many of them had the right number of total workforce. The WISN method is a very objective way of establishing staffing levels but requires a dedicated team with adequate expertise to make the raw data meaningful for calculations.
Since 1994, higher education policy has been committed to equity of access for all, irrespective of race and gender. This study investigated progress towards these goals in the education of medical doctors, with an emphasis on gender. Databases from the Department of Education (DoE), Health Professions Council of South Africa (HPCSA) and University of Cape Town (UCT) Faculty of Health Sciences were used to explore undergraduate (MB ChB) trends at all eight medical schools and postgraduate (MMed) trends at UCT. Nationally women have outnumbered men in MBChB enrolments since 2000, figures ranging between 52% and 63% at seven of the eight medical schools in 2005. However,the rate of change in the medical profession lags behind and it will take more than two decades for female doctors to outnumber male doctors. A study of UCT postgraduate enrolments shows that females had increased to 42% of MMed enrolments in 2005. However, female postgraduate students were concentrated in disciplines such as paediatrics and psychiatry and comprised no more than 11% of enrolments in the surgical disciplines between 1999 and 2005. The study provides a basic quantitative overview of the changing profile of medical enrolments and raises questions about the career choices of women after they graduate and the social factors influencing these choices.
This article is the third in the Human Resources for Health journal's feature on the theme of leadership and management in public health leadership. It presents a successful application in Mozambique of a leadership development programme created by MSH, in which managers from 40 countries have learned to work in teams to identify their priority challenges and act to implement effective responses. From 2003 to 2004, 11 health units in Nampula Province participated in a leadership and management development programme called the Challenges Programme. The programme used several strategies that contributed to successful outcomes. It integrated leadership strengthening into the day-to-day challenges that staff were facing in the health units. Participatory teams were also created. After the programme, people no longer waited passively to be trained but instead proactively requested training in needed areas. Ministry of Health workers in Nampula reported that the programme's approach to improving management and leadership capacity at all levels promoted the efficient use of resources and empowered staff to make a difference.
The Global Health Workforce Alliance (GHWA) strongly welcomes G8 leaders’ commitment, in Hokkaido, Japan, to actively address the critical shortages of health workers across the world. GHWA applauds Japan and the other G8 nations for recognizing that a competent, supported health workforce is fundamental to developing robust health systems and to reaching health and development goals. GHWA also welcomes the G8’s noting of the importance of the Kampala Declaration and Agenda for Global Action to help guide the response to the health workforce crisis. While encouraged by the increased commitment shown by the G8, GHWA urges the leaders follow up with increased and new investment to ensure promises on the health workforce are turned into reality.