Human Resources

Comprehensive health workforce planning: re-consideration of the primary health care approach as a tool for addressing the human resource for health crisis in low and middle income countries
Munga MA, Mughwira A. Mwangu: Tanzania Journal of Health Research, 15:2 2013

Although the Human Resources for Health (HRH) crisis is apparently not new in the public health agenda of many countries, not many low and middle income countries are using Primary Health Care (PHC) as a tool for planning and addressing the crisis in a comprehensive manner. The aim of this paper is to appraise the inadequacies of the existing planning approaches in addressing the growing HRH crisis in resource limited settings. A descriptive literature review of selected case studies in middle and low income countries reinforced with the evidence from Tanzania was used. Consultations with experts in the field were also made. In this review, we propose a conceptual framework that describes planning may only be effective if it is structured to embrace the fundamental principles of PHC. We place the core principles of PHC at the centre of HRH planning as we acknowledge its major perspective that the effectiveness of any public health policy depends on the degree to which it envisages to address public health problems multi-dimensionally and comprehensively. The proponents of PHC approach in planning have identified inter-sectoral action and collaboration and comprehensive approach as the two basic principles that policies and plans should accentuate in order to make them effective in realizing their pre-determined goals. Two conclusions are made: Firstly, comprehensive health workforce planning is not widely known and thus not frequently used in HRH planning or analysis of health workforce issues; Secondly, comprehensiveness in HRH planning is important but not sufficient in ensuring that all the ingredients of HRH crisis are eliminated. In order to be effective and sustainable, the approach need to evoke three basic values namely effectiveness, efficiency and equity.

Perceived Impact of Health Sector Reform on Motivation of Health Workers and Quality of Health Care in Tanzania: the Perspectives of Healthcare Workers and District Council Health Managers in Four Districts
Mubyazi GM, Njunwa KJ: Rwanda Journal of Health Sciences, 2:1: 2013

Literature on the impact of health sector reform (HSR) on motivation of healthcare workers (HWs) and performance in health service provision in developing countries is still limited. This paper describes the impact of HSR on HW motivation and performance in providing quality health care in Tanzania. Methods: Four districts selected from three regions were covered, involving in-depth interviews with HWs in public health facilities (HFs), focus group discussions with district managers and researchers’ observations. The cost-sharing system in public HFs and national health ‘basket’ funding system introduced in 1990s were the key HSR elements identified by the study participants as impacting on HWs motivation and performance. User-fees for public healthcare services was acknowledged as having supplemented government funds allocated to public HFs, although such facilities still experienced ‘stock-outs’ of essential medicines and other supplies, HF understaffing, low/lack of essential remuneration, shortage of and unrepaired staff houses, meagre office space, lack of transport facilities for emergency cases, minimal recognition of HWs at local primary healthcare committees and the district health service budgeting system being controlled by district and central level authorities, leaving little room for lower level stakeholders to participate. For the national healthcare system to succeed, the authors argue that HSRs will need to involve and motivate HWs who are frontline implementers of the reform strategies.

Recruitment and Retention of Mental Health Workers in Ghana
Jack H; Canavan M; Ofori-Atta A; Taylor L; Bradley E: PLOS One; 8, 2, February 2013

Despite the great need to recruit and retain mental health workers in low-income countries, little is known about how these workers perceive their jobs and what drives them to work in mental health care. Using qualitative interviews, the authors aimed to explore factors motivating mental health workers in order to inform interventions to increase recruitment and retention. The authors conducted 28 in-depth, open-ended interviews with staff in Ghana’s three public psychiatric hospitals and used the snowballing method to recruit participants and the constant comparative method for qualitative data analysis, with multiple members of the research team participating in data coding to enhance the validity and reliability of the analysis. The use of qualitative methods allowed the authors to understand the range and depth of motivating and demotivating factors. Respondents described many factors that influenced their choice to enter and remain in mental health care. Motivating factors included 1) desire to help patients who are vulnerable and in need, 2) positive day-to-day interactions with patients, 3) intellectual or academic interest in psychiatry or behavior, and 4) good relationships with colleagues. Demotivating factors included 1) lack of resources at the hospital, 2) a rigid supervisory hierarchy, 3) lack of positive or negative feedback on work performance, and 4) few opportunities for career advancement within mental health. Because many of the factors are related to relationships, these findings suggest that strengthening the interpersonal and team dynamics may be a critical and relatively low cost way to increase worker motivation. The data also allowed the authors to highlight key areas for resource allocation to improve both recruitment and retention, including risk pay, adequate tools for patient care, improved hospital work environment, and stigma reduction efforts.

The Labour Market for Health Workers in Africa : New Look at the Crisis
Soucat A, Scheffler R: Journal of the World Bank, April 2013

Health systems in Sub-Saharan Africa have changed profoundly over the last 20 years. The economic crisis of the 1980s and 1990s rattled public health care systems, which were largely holdovers from the colonial and postcolonial eras. The later wave of structural adjustments and public sector reforms wrought further change. As African economies opened to market based approaches, the private sector became a sizable source of health care service. This paper presents data from the World Bank's Africa Region Human Resources for Health Program.

Career and practice intentions of health science students at three South African health science faculties
Naidu C, Irlam J, Diab PN: African Journal of Health Professions Education, 5(2):68-71, November 2013

The distribution and accessibility of healthcare professionals as well as the quality of healthcare services are significantly affected by the career choices of medical and other health science graduates. While much has been reported on the career intentions of medical students, little is known about those of their counterparts in the health sciences. This study describes the career plans of non-medical health science students at three South African health science faculties, and identifies some key motivating factors. A self-administered survey of first- and final-year health science students was conducted at the health science faculties of the universities of Cape Town, KwaZulu-Natal and Limpopo. The findings demonstrated that health science students, similar to medical students, are influenced by a multitude of factors in making career choices. This emphasises the relevance to all health science disciplines of national strategies to address the maldistribution of healthcare professionals.

Stemming the impact of health professional brain drain from Africa: a systemic review of policy options
Zimbudzi E: Journal of Public Health in Africa 4:1 June 2013

Africa has been losing professionally trained health workers who are the core of the health system of this continent for many years. Faced with an increased burden of disease and coupled by a massive exodus of the health workforce, the health systems of many African nations are risking complete paralysis. Several studies have suggested policy options to reduce brain drain from Africa. This paper reviewed policies which can stem the impact of health professional brain drain from Africa through a systemic literature review. 23 articles met the inclusion criteria. The review identified nine policy options, which were being implemented in Africa, but the most common was task shifting which had success in several African countries.

Brain Drain: Advocating to Alleviate the Global Health Worker Migration Crisis.
Chen J, Hampson S, Robertson A: Student Voices 5; McMaster Health Forum, March 2013

In this paper, the authors evaluate various policy options to address the global health worker migration crisis, which include: financial and technical support from destination countries; bilateral and multilateral agreements between states; creation of self-sufficient healthcare systems; and collection of reliable migration data. Implementation requires the support of key stakeholders such as the World Health Organisation, member states, and other international organisations. However, there are many obstacles to policy change, including the power disparities between source and destination countries, ethical sensitivity of policies, financial incentives, lack of data collection, and limited international cooperation.

International codes of medical recruitment: evolution and efficiency
Cehan I and Manea T: Romanian Journal of Bioethics, 10(1): 100-109, March 2012

The international migration of healthcare professionals has increased in the last decade, increasing the medical staff crisis in low income countries. The World Health Organisation adopted in 2010 The Global Code of Practice on the International Recruitment of Health Personnel to use it as a landmark for establishing and improving the necessary legal framework of medical staff international recruitment. This paper highlights analyses the effectiveness of codes on health worker recruitment, and the consequences that might result from disobeying them.

Health Workforce Brain Drain: From Denouncing the Challenge to Solving the Problem
Cometto G, Tulenko K, Muula AS and Krech R: PLoS Med 10(9): 1-3, September 2013

Migration of health workers from low- and middle-income countries (LMICs) to high-income countries is one of the most controversial aspects of globalization, having attracted considerable attention in the health policy discourse at both the technical and political level. Some countries train health workers to export them overseas and reap the financial benefits of remittances; such investments should therefore be considered as driven primarily by economic—rather than population health—motives. In most cases, however, migration of health professionals is unplanned for and represents a “brain drain” for source countries, a result of enormous wage differences and poor working conditions, including lack of support, adequate infrastructure, and career development opportunities, in LMICs. The paper presents the policy options for both low income and OECD countries for addressing health worker migration.

Monitoring the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel
Siyam A, Zurn P, Rø OC, Gedik G, Ronquillo K and Co CJ: Bulletin of the World Health Organisation 91: 816-823 2013

To present the findings of the first round of monitoring of the global implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel (“the Code”), WHO requested that its Member States designate a national authority for facilitating information exchange on health personnel migration and the implementation of the Code. Each designated authority was then sent a cross-sectional survey with 15 questions on a range of topics pertaining to the 10 articles included in the Code. A national authority was designated by 85 countries. Only 56 countries reported on the status of Code implementation. Of these, 37 had taken steps towards implementing the Code, primarily by engaging relevant stakeholders. In 90% of countries, migrant health professionals reportedly enjoy the same legal rights and responsibilities as domestically trained health personnel. In the context of the Code, cooperation in the area of health workforce development goes beyond migration-related issues. An international comparative information base on health workforce mobility is needed but can only be developed through a collaborative, multi-partnered approach. Reporting on the implementation of the Code has been suboptimal in all but one WHO region. Greater collaboration among state and non-state actors is needed to raise awareness of the Code and reinforce its relevance as a potent framework for policy dialogue on ways to address the health workforce crisis.

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