Global Policy Advisory Council members have reviewed and responded to the WHO Draft Code of Practice and had a number of recommendations to make. They believe the Code needs to reflect further on World Health Assembly Resolutions 57.19 and 58.17 and to focus more strongly on mitigating the adverse effects of health personnel migration and its negative impact on health systems in developing countries. A strong preamble is needed to appropriately inform the rationale, context and vision underlying the accompanying articles. The current Code pays much attention to the role of member states generally, but the specific roles of source and destination countries, health workers, recruiters/ employers and other relevant stakeholders require further elaboration. There was wide, though not unanimous, agreement that the principle of shared responsibility is paramount: states that are global employers must help support their source countries’ local health workforce. Clear implementation guidelines are lacking, specifically about how and what information must be collected. Developing countries will need technical and capacity-related assistance, otherwise they will not be able to pay the costs of implementing the Code.
Human Resources
This article profiles three leaders who have made a significance difference in the HR situation in their countries. By taking a comprehensive approach and working in partnership with stakeholders, these leaders demonstrate that strengthening health workforce planning, management, and training can have a positive effect on the performance of the health sector. Three profiles are presented, from Afghanistan, South Africa and southern Sudan, revealing common approaches and leadership traits while demonstrating the specificity of local contexts. In the South African profile, Dr. Mahlathi, Deputy Director General of Human Resources for South Africa's national Department of Health (DOH) is discussed. South Africa will need a multisectoral approach, with strong health management and leadership and additional human and financial resources to help meet the needs of its citizens.
The Global Health Workforce Alliance (GHWA) has welcomed the pledges of commitment expressed at the United Nations High Level Meeting on the Millennium Development Goals and surrounding events that place resolving the health workforce crisis at the centre of ensuring progress on improving maternal and child health and addressing killer diseases such as malaria. Significant financial commitments were made to address the health workforce as part of the drive to move closer to the achievement of Millennium Development Goals 4 and 5 on reducing maternal and child mortality. Commitments included a pledge of £450 million from the UK over the next three years to support national health plans, incorporating training more nurses, midwives and doctors in eight of the poorest countries.
African leaders lack the foresight and political will required to ensure sustainable health development, financing and universal primary health care. By underlining the effects of institutional under-funding and the brain drain, the author contends that policy neglect is the equivalent of ‘institutional manslaughter’. Africa’s critical health workforce shortage is arguably the most serious obstacle to implementing global and African health frameworks and universal primary health care across the continent and governments must improve health workforce working conditions. The proper, moral and sustainable solution is to ensure that more developed countries invest in training of adequate numbers of their own health workforce, and that less-developed countries demonstrate full political commitment to training and retaining their health workers –with the support of more-developed countries, where necessary.
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.
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.