This desk review notes a lack of sex-disaggregated data, which hides the presence of women in the health workforce or misrepresents their work. Gender also influences the structural location of women and men in health occupations, resulting in significant gender differences in terms of employment security, promotion, remuneration etc. These differences are neither static nor universal, so they need to be analysed and monitored in changing national contexts, specific health system circumstances and by other social determinants. Recommendations include monitoring delegation, implementing strategies to address gender inequalities (such as affirmative action and training), halting the gender bias that questions the personal and professional prestige of women health workers and recognising home-based care efforts, which are mostly shouldered by women. Source and recipient countries must do more to retain local nursing staff, and recognise violence in the health work place. Individual efforts by women and men must be constructively and collectively amplified through policy and programme efforts at higher and broader levels in health systems.
Human Resources
Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities are only 50% and maldistribution of staff has left many people without access to antiretroviral therapy (ART). It typically takes one to two years to fill vacant positions, even when funding is available, so an emergency approach was needed to fast-track hiring and deployment. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model to mobilise 830 more health workers. The recruitment process was shortened to less than three months. By providing job orientation and on-time pay checks, the programme increased employee retention and satisfaction. Most active roadblocks to changes in the health workforce policies and systems are 'human' - not technical - stemming from a lack of leadership, a problem-solving mindset and the alignment of stakeholders from several sectors. Strengthening appointment on merit is a powerful, yet simple way to improve the image and efficiency of the health sector and governments. The quality and integrity of the public health sector can be improved only through professionalising human resources (HR), reformulating and consolidating fragmented HR functions, and bringing all pieces together under the authority and influence of HR departments and units with expanded scopes. HR staff must be specialists with strategic HR functions and not generalists who are confined to playing a restricted and bureaucratic role.
The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States reflects the mutual recognition of stakeholder interests relevant to the recruitment of foreign-educated nurses (FENs) to the United States. It is based on an acknowledgement of the rights of individuals to migrate, as well as an understanding that the legitimate interests and responsibilities of nurses, source countries, and employers in the destination country may conflict. It affirms that a careful balancing of those individual and collective interests offers the best course for maximising the benefits and reducing the potential harm to all parties. While it acknowledges the interests of these three primary stakeholder groups, its subscribers are the organisations that recruit and employ foreign educated nurses, namely, third party recruiting firms, staffing agencies, hospitals, long-term care organisations and health systems.
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.
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.