This article, from Human Resources for Health, examines the experiences of using substitute health workers (SHW) in Africa. The review focuses mainly on physicians and reviews data from Tanzania, Congo, Kenya, Malawi, Mozambique, Zambia and Ghana. Findings demonstrate the cost-effectiveness of using SHWs and higher rates of retention within countries and in rural communities. However, problems are also identified, including the potential among SHWs for poor clinical decision making and lack of adherence to clinical regulations.
Human Resources
Using mid-level cadres as substitutes for health professionals
Human resources for health: overcoming the crisis
Joint learning initiative / Global Health Trust , 2004
This report presents the findings and recommendations of the Joint Learning Initiative (JLI). The report highlights major global challenges in human resources for health. These include: global shortages of skilled workers; skill imbalances in existing workers; poor distribution of services worsened by increased migration; poor work environments; and a weak knowledge base. The findings show that effective workforce strategies, including community action and country leadership, enhance the performance of health systems even under difficult circumstances. The authors call for immediate action to harness the power of health workers, which must be country based and led.
Measures of the African brain drain
Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain.
Overcoming the human resources crisis
Human Resources for Health 2004
This report presents the findings and recommendations of the Joint Learning Initiative (JLI), an enterprise engaging more than 100 global health leaders in landscaping human resources for health and in identifying strategies to strengthen the workforce of health systems. The JLI was launched because the most critical factor driving health system performance, the health worker, was neglected and overlooked. At a time of opportunity to redress outstanding health challenges, there is a growing awareness that human resources rank consistently among the most important system barriers to progress.
Underpaid African Health Workers Flee the Frontline
Small antiretroviral drug programmes are beginning to take shape in some of the worst affected countries in Africa. But as the drugs flow in, the medical personnel needed to administer them are being lured away by the rich countries that talk loudly about finding a solution to Africa's AIDS crisis and whose companies provided the drugs. WHO estimates that only 750000 health workers are available to care for 682-million people in sub-Saharan Africa, which has more than 25-million people infected with HIV, or 60% of the global total.
Call to initiate HIV/AIDS worker protection plans
Unless sub-Saharan African countries initiate workplace anti-AIDS programmes, the pandemic will decimate the region's human resource capacity, experts warned in the Ghanaian capital, Accra, in November. "African companies already find it difficult to compete in global markets," Ghana's presidential advisor on HIV/AIDS, Professor Fred Sai, told the fourth interactive meeting of the UN Commission on HIV/AIDS and Governance in Africa (CHGA).
Classifying human resources constraints to attaining health-related Millennium Development Goals
This study explores the constraints related to human resources in the health (HRH) sector to achieving the Millennium Development Goals (MDGs) in low-income countries. The author finds that, at an individual level, the decision to enter, remain and serve in the health sector workforce is influenced by a series of social, economic, cultural and gender-related determinants.
Health worker scarcity in AIDS-ridden countries highlighted
A new study to be published in the Lancet has, for the first time, quantified the dangerous scarcity of healthcare workers in countries with climbing rates of HIV, tuberculosis and malaria. The report, 'Human Resources for Health: Overcoming the Crisis', says health workers from developing countries are lured by better salaries and safer working conditions in urban areas or richer countries, creating the so-called "brain-drain".
Public sector reform and demand for human resources for health
This article from the journal Human Resources for Health considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. The introduction of market mechanisms often involves the formation of an internal market within the health sector and market testing of different functions with the private sector. This has immediate implications for the employment of health workers in the public sector, because the public sector may reduce its workforce if services are purchased from other sectors or may introduce more short-term and temporary employment contracts.
Bridging the human resources gap
London School of Hygiene and Tropical Medicine, London, UK
Human resources are the crucial core of a health system, but they have been a neglected component of health-system development. The demands on health systems have escalated in low income countries, in the form of the Millennium Development Goals and new targets for more access to HIV/AIDS treatment. Human resources are in very short supply in health systems in low and middle income countries compared with high income countries or with the skill requirements of a minimum package of health interventions. Equally serious concerns exist about the quality and productivity of the health workforce in low income countries.