By focusing on the Masters of Public Health course, this study took a pragmatic approach to exploring the interface between public health education and public health practice. The commonly utilized ‘three domains of practice’ framework could provide a robust and explicit link between educational provision and practice for public health. This model provides the workforce, the university, the students and the potential funders of the course with an easily comprehensible framework for understanding how the modules of an MSc can support the development of competency within the context of practice.
Human Resources
The three domains of public health: An internationally relevant basis for public health education�
Thorpe A, Griffiths S, Jewell T and Adshead F: Public Health 122(2): 201-210, February 2008
Community health workers: a review of concepts, practice and policy concerns
Prasad BM and Muraleedharan VR: Consortium for Research on Equitable Health Systems, 2007
This paper, prepared for the International Consortium for Research on Equitable Health Systems, provides an overview of the concepts and practice of Community Health Workers (CHWs) in several developing and developed countries. In doing so it identifies critical factors that influence the overall performance of CHWs including gender, the nature of employment, career prospects and incentives, educational status and training. It finds that the selection of CHWs from the communities that they serve, population coverage and the range of services offered at the community levels are vital in the design of effective CHW schemes. The smaller the population coverage, the more integrated and intensive the service offered by CHWs.
Major surgery delegation to mid-level health practitioners in Mozambique: health professionals' perceptions
Cumbi A, Pereira C, Malalane R, Vaz F, McCord C, Bacci A and Bergstrom S: Human Resources for Health 5:27, 6 December 2007
This study examines the opinions of health professionals about the capacity and performance of the 'tecnico de cirurgia', a surgically trained assistant medical officer in the Mozambican health system. Particular attention is paid to the views of medical doctors and maternal and child health nurses. Health workers at all levels voiced satisfaction with the work of the "tecnicos de cirurgia". They stressed the life-saving skills of these cadres, the advantages resulting from a reduction in the need for patient referrals and the considerable cost reduction for patients and their families. Important problems in the professional status and remuneration of "tecnicos de cirurgia" were identified. This study, the first one to scrutinize the judgements and attitudes of health workers towards the "tecnico de cirurgia", showed that, despite some shortcomings, this cadre is highly appreciated and that the health delivery system does not recognize and motivate them enough. The findings of this study can be used to direct efforts to improve motivation of health workers in general and of tecnicos de cirurgia in particular.
Migrant remittances
Eldis
The movement of people across and within borders has characterised the development of most global regions, resulting in a rich intermingling of cultures. Such movement is often motivated by the desire for a better life, whether this entails finding new land to cultivate or money making opportunities. In recent years, the process of movement has itself been simplified, opportunities for work in services and industry have boomed and globally, numbers of migrants have increased dramatically . In response, an increasing number of studies are emphasising the impacts of migration, particularly for developing countries, in the form of remittances - money sent by migrant workers back to communities and households. This key issues page looks at some of these perceived impacts, and provides recommendations for further reading on the subject of migration and remittances.
Non-physician clinicians in 47 sub-Saharan African countries
Mullan F and Frehywot S: The Lancet 370 (9605): 2158-2163, 22 December 2007
Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3–4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology, and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.
Reducing child deaths: the contribution of community health workers
Haines A et al: The Lancet 369 (9579): 2121-2131
Insufficient progress is being made towards the Millennium Development Goals, including those dealing with child and maternal mortality. At the current rate of progress in sub-Saharan Africa, the target of a two-thirds reduction in child mortality by 2015 will only be reached in 2165. Renewed interest in the potential contribution of community health workers may be timely. Evidence suggests that over sixty percent of deaths in children under-five years could be prevented by interventions already in existence. Studies show that 41–72 percent of deaths in newborns are preventable using available interventions if there is high coverage, and about half of this reduction may be possible using community-based interventions. This study reviews the literature for evidence of whether community health workers are capable of carrying out the tasks required of them as part of a sustainable workforce. It concluded that several factors influence programme impact and sustainability and determine whether child death reductions can be realised on a national scale: national socio-economic and political factors, community factors, health system factors and international factors. For instance, particularly if the political context is not a participatory democracy, support within the community for community health workers may be undermined by social class and caste divisions.
Improve our conditions to attract the young - Midwives
Daily Graphic, 15 November 2007
Speakers at a two-day international conference in Africa on midwifery have called for more incentives to attract young people into the midwifery profession. They said the midwives of today were fast ageing and that unless immediate measures were put in place to attract more young ones into the profession, the fight for the reduction in maternal and infant mortality and morbidity would be a mirage. The speakers made the call at a two-day international conference of midwives on the theme, "African Midwives: Uniting to address the reduction of maternal and infant mortality and morbidity".
High level consultative meeting on the Health Workforce: Scaling up education and training
Hon Dr ME Tshabalala-Msimang, Minister of Health of South Africa: AU Conference Centre, Addis Ababa, Ethiopia, 16 November 2007
Dr Tshabala-Msimang said for Africa to scale up health work-force training, there is a need to mobilise adequate resources. She appealed to the developed world which has largely benefited from this exodus of health workers, to consider financially supporting Africa to train more health workers. Additional resources will also be required to rebuild the health infrastructure in some instances as well as training our lecturers, tutors and researchers.
Public-private options for expanding access to human resources for HIV/AIDS in Botswana
Dreesch N, Nyoni J, Mokopakgosi O, Seipone K, Kalilani JA, Kaluwa O and Musowe V: Human Resources for Health 5(25), 19 October 2007
In responding to the goal of rapidly increasing access to antiretroviral treatment (ART), the government of Botswana undertook a major review of its health systems options to increase access to human resources, one of the major bottlenecks preventing people from receiving treatment. In mid-2004, a team of government and World Health Organization (WHO) staff reviewed the situation and identified a number of public sector scale up options. The team also reviewed the capacity of private practitioners to participate in the provision of ART. Subsequently, the government created a mechanism to include private practitioners in rolling out ART. At the end of 2006, more than 4500 patients had been transferred to the private sector for routine follow up. It is estimated that the cooperation reduced the immediate need for recruiting up to 40 medically qualified staff into the public sector over the coming years, depending on the development of the national standard for the number and duration of patient visits to a doctor per year. Thus welcome relief was brought, while at the same time not exercising a pull factor on human resources for health in the sub-Saharan region.
Teachers' and Students' Perceptions of the Learning Environment in Clinical Departments at the School of Medicine, MuhimbilI University College of Health Sciences
Mkony C, Mbenbati N: Tanzania Medical Journal 22 (1): 9-11, 2007
The School of Medicine at Muhimbili is the main doctor-training institution in the country. It runs a five-year MD programme taking 200 students annually. As for many schools in low-income countries, the majority of teachers have no formal training in educational theory. The learning environment at the school has some strengths that should to be amplified, and numerous weaknesses that need to be corrected in order to make the environment more conducive to teaching and learning.