The authors explored perceptions of health workers on where and how to integrate tobacco use cessation services into TB treatment programs in Uganda, using nine focus group discussions and eight key informant interviews in high volume health centres, general hospitals and referral hospitals. Respondents highlighted that just like TB prevention starts in the community and TB treatment goes beyond health facility stay, integration of tobacco cessation should be started when people are still healthy and extended to those who have been healed as they go back to communities. Tobacco cessation activities should be provided in a continuum with coordination of different organizations like peers, the media and TB treatment supporters. TB patients needed regular follow up and self-management support for both TB and tobacco cessation. Patients needed to be empowered to know their condition and their caretakers needed to be involved. Effective referral between primary health facilities and specialist facilities was needed. Clinical information systems should identify relevant people for proactive care and follow up. In order to achieve effective integration, the health system needed to be strengthened especially health worker training and provision of more space in some of the facilities.
Human Resources
This study used physician registry data to analyse patterns of emigration and return migration only among South Africa-trained physicians registered to practice in top destination countries such as Australia, Canada, New Zealand, the USA or the UK between 1991 and 2017, which represent the top five emigration destinations for this group. It found a 6-fold decline in emigration rates from SA between 1991 and 2017, with declines in emigration to all five destination countries. About one in three South Africa physicians returned from destination countries as of 2017. Annual physician emigration fell by 0.16% for every $100 rise in South Africa gross domestic product per capita. As of 2017, 21.6% of all South Africa physicians had active registration in destination nations, down from a peak of 33.5% in 2005, a decline largely due to return migration. Changes to the UK’s licensing regulations were seen to be likely affected migration patterns while the Global Code of Practice on International Recruitment contributed little to changes. The authors propose that return migration monitoring be incorporated into health workforce planning.
The paper reviews evidence on interventions used to motivate health workers in low- and middle-income countries. The review found supervision, compensation interventions and systems support to play a role. The authors found there is limited evidence on successful interventions to motivate health workers in low- and middle-income countries and the authors call for studies that use validated and culturally appropriate tools to assess worker motivation.
This paper assessed the involvement of Community health workers (CHWs) in the prevention and control of non-communicable diseases (NCDs)in Wakiso District, Uganda with a focus on their knowledge, attitudes and practices, as well as community perceptions, through a cross-sectional mixed-methods study. The majority of CHWs correctly defined what NCDs are and mentioned high blood pressure, diabetes and cancer. Many CHWs said that healthy diet, physical activity, avoiding smoking/tobacco use, and limiting alcohol consumption were very important to prevent NCDs. The majority of CHWs who were involved in NCDs prevention and control reported challenges including inadequate knowledge, lack of training, and negative community perception towards NCDs. Community members were concerned that CHWs did not have enough training on NCDs and the community did not have much confidence in them regarding NCDs and rarely consulted them concerning these diseases. The authors recommend enhanced training and community engagement for CHWs to contribute to the prevention and control of NCDs.
This paper presents evidence from Sierra Leone, Liberia and Democratic Republic of Congo on how community health workers (CHWs) are .managed, the challenges they face and potential solutions. According to the findings: fragility disrupts education of community members so that they may not have the literacy levels required for the CHW role; with implications for the selection, role, training and performance of CHWs. Policy preferences about selection need discussion at the community level, so that they reflect community realities. CHWs’ scope of work is varied and may change over time, requiring ongoing training. The modular, local and mix of practical and classroom training approach worked well, helping to address gender and literacy challenges and developing a supportive cohort of CHWs. A package of supervision, community support, regular provision of supplies, performance rewards and regular remuneration is argued to be vital to the retention and performance of CHWs, as are predictable supervision, supplies, community recognition and allowances.
This study was implemented to understand the role of rural health motivators (RHMs) in decentralised HIV/TB activities. Participants were purposively selected RHMs, community stakeholders and local and non-government personnel. Significant confusion of the RHM role was observed, with community expectations beyond formally endorsed tasks. Community participants expressed dissatisfaction with receiving health information only, preferring physical assistance in the form of goods. Gender emerged as a significant influencing factor on the acceptability of health messages and RHM engagement with community members. The findings highlight the lack of recognition of RHMs at community and national levels, hindering their capacity to successfully contribute to positive health outcomes for rural communities.
Mozambique’s community health programme has a disproportionate number of male community health workers (known as Agentes Polivalentes Elementares (APEs)). This paper seeks to explore the current recruitment imbalance processes for APEs and how these are shaped by gender norms, roles and relations, as well as how they influence the experience and retention of APEs in Maputo Province, Mozambique. The authors employed qualitative methods with APEs, APE supervisors, community leaders and a government official in two districts within Maputo Province. Women reported difficulty leaving family responsibilities behind, and men reported challenges in providing for their families during training as other income-generating opportunities were not available to them. These dynamics were particularly acute in the case of single mothers, serving both a provider and primary carer role. Differences in attrition by gender were reported: women are likely to leave the programme when they marry, whereas men tend to leave when offered another job with a higher salary. Age and geographic location were also important intersecting factors, younger male and female APEs seek employment opportunities in neighbouring South Africa, whereas older APEs are more content to remain. The authors suggest that responsive policies to support gender equity within APE recruitment processes are required to support and retain a gender-equitable APE cadre.
This paper examined the training coverage and self-reported competence, knowledge, abilities, and attitudes, of health care workers caring for adolescents living with HIV in Kenya. Surveys were conducted with 24 managers and 142 health care workers. Health care workers had a median of 3 years of experience working with adolescents living with HIV, and 40% reported exposure to any adolescents living with HIV training. Median overall competence was 78%. More years caring for adolescents living with HIV and any prior training in adolescent HIV care were associated with significantly higher self-rated competence. Training coverage for adolescent HIV care remains sub-optimal. The authors suggest that targeting health care workers with less work experience and training exposure may be a useful and efficient approach to improve quality of youth-friendly HIV services.
This case study describes how Kenya created an inter-county, multi-stakeholder coordination framework that promotes consensus, commitment, and cooperation in devolved human resources management. The coordination framework has been instrumental in expediting development, customization, and dissemination of policies, enabling national human resources for health officers to mentor their county counterparts, and providing collaborative platforms for multiple stakeholders to resolve challenges and harmonize practices nationwide. Successes catalyzed through the inter-county forums include hiring over 20 000 health workers to address shortages; expanding the national human resources information system to all 47 counties; developing guidelines for sharing specialist providers; and establishing professionalized human resources for health units in all 47 counties. The coordination framework supports alignment of county health operations with national goals while enabling national policy responses to health gaps in the counties.
This paper provides a survey of the challenges and proposed interventions to protect healthcare workers on the continent, drawing on articles identified on Medline (Pubmed) in a search on 24 March 2020. Global jostling means that supplies of personal protective equipment are limited in Africa. Even low-cost interventions such as facemasks for patients with a cough and water supplies for handwashing may be challenging, as is ‘physical distancing’ in overcrowded primary health care clinics, raising the risk for healthcare workers and their families. The authors argue, however, that the continent has learnt invaluable lessons from Ebola and HIV control. HIV counselors and community healthcare workers are key and could promote social distancing and related interventions, dispel myths, support healthcare workers, perform symptom screening and trace contacts. Staff motivation and retention may be enhanced through carefully managed risk ‘allowances’ or compensation. International support with personnel and protective equipment, especially from China, could turn the pandemic’s trajectory in Africa around. Telemedicine holds promise as it rationalises personnel and reduces patient contact and thus infection risks. The authors argue that healthcare workers, using their authoritative voice, can promote effective COVID-19 policies and prioritization of their safety. Prioritizing healthcare workers for SARS-CoV-2 testing, hospital beds and targeted research, as well as ensuring that public figures and the population acknowledge the commitment of healthcare workers may help to maintain morale, while international support and national commitment could help safeguard healthcare workers in Africa, essential for limiting the pandemic’s impacts on the continent.