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.
Human Resources
Development of a core competency model for the Master of Public Health degree
Calhoun JG, Ramiah K, McGean Weist E and Shortell S: American Journal of Public Health 98(9):1598-1607, September 2008
The double burden of human resource and HIV crises: A case study of Malawi
McCoy D, McPake B and Mwapasa V: Human Resources for Health 6(16), 12 August 3008
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.
The health professions and the performance of future health systems in low-income countries: Support or obstacle?
Dussault G: Social Science and Medicine 66(10):2088-95, May 2008
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.
Workload indicators of staffing need method in determining optimal staffing levels at Moi Teaching and Referral Hospital
Musua P, Nyongesa P, Shikhule A, Birech E, Kirui D, Njenga M, Mbiti D, Bett A, Lagat L, Kiilu K: East African Medical Journal 85(5):232-239, 2008
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.
Changing gender profile of medical schools in South Africa
Breier M, Wildschut A: South African Medical Journal 98(7):557-560
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.
Empowering primary care workers to improve health services: Results from Mozambique's leadership and management development programme
Perry C: Human Resources for Health 6(14), 23 July 2008
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.
GHWA welcomes G8 commitment for action on chronic health worker shortages
Global Health Workforce Alliance, 9 July 2008
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.
Human resource development and antiretroviral treatment in Free State province, South Africa
van Rensburg DHCJ, Steyn FF, Schneider HH and Loffstadt LL: Human Resources for Health 6(15), 28 July 2008
In common with other developing countries, South Africa's public health system is characterised by human resource shortfalls. These are likely to be exacerbated by the escalating demand for HIV care and a large-scale antiretroviral therapy (ART) programme. Focusing on professional nurses, the main front-line providers of primary health care in South Africa, this study examines patterns of planning, recruitment, training and task allocation associated with an expanding ART programme in the districts of one province, the Free State. The researchers found that introduction of the ART programme has revealed both strengths and weaknesses of human resource development in one province of South Africa. Without concerted efforts to increase the supply of key health professionals, accompanied by changes in the deployment of health workers, the core goals of the ART programme - i.e. providing universal access to ART and strengthening the health system - will not be achieved.
KwaZulu Natal nurses overwhelmed
Mboto S: The Mercury, 30 July 2008
Health-care provision in KwaZulu-Natal is reported to be approaching crisis with understaffing. Chronic under-funding continues of the provincial health department is reported to have led to critical posts being frozen, with existing staff, especially nurses, carrying heavier loads. This was reported by senior department officials during a health portfolio committee meeting in the KwaZulu-Natal legislature.
Rethinking the role of community health workers
ID21 Health News, July 2008
The shortage of health staff in developing countries has led to renewed interest in community-based health care workers. However, poor populations are increasingly accessing health services from a wide variety of providers operating as private or semi-private agents in unregulated markets. Community health workers with little formal training do have a future. However, they will need to adapt to an environment where they must compete with other providers and prove their competence. They need to establish legitimacy and trust, and this is more likely in larger community development programmes with regular monitoring. They also need a livelihood that can be sustained.