This article, from Human Resources for Health, considers the effect of fiscal reform and the introduction of decentralisation and market mechanisms on human resources in the health sector. Findings show that these reforms often result in 'corporatised' institutions, with reductions in the workforce as health services are contracted out, or increased short-term and temporary employment contracts. Increased private sector provision leads health workers to move to the private sector. This often leaves worsening working conditions, lack of employment security and dismantling of collective bargaining agreements for those who remain in the public sector.
Human Resources
Public sector reform and demand for human resources for health
South Africa: Overtime contracts and salaries: a personal view
Critical Health Perspectives Update
"The Friday ward round starts, like any other weekday round, at 7:30 and continues till 11:30. It involves a multidisciplinary team of specialists, therapists and nurses. The children are critically ill. We review each patient and plan management for the day. Our tools include mechanical devices and powerful drugs that support vital functions, and antibiotics. Our decisions have life-changing implications. The potential to do harm is enormous, the responsibility overwhelming. The buck stops with me.
After the round, team members implement the decisions, continuously monitoring changes in the patients’ conditions. Meanwhile new admissions arrive: children who have had major operations, critically ill children with medical conditions.
The afternoon round starts routinely at 4:30. On this Friday night it ended after 7 pm. I went home at 8:57 pm after updating my notes and discussing a child’s condition with her family, leaving two registrars to cover the night. Later, during the night I had 6 phone calls from the registrars to discuss patients." The latest issue of Critical Health Perspectives, produced by the People's Health Movement, examines the issue of the overtime contracts and salaries of health workers.
Further details: /newsletter/id/30884
TB control and the health workforce
The performance of health care systems is closely related to the numbers, distribution, knowledge, skills and motivation of its workforce, particularly of those individuals delivering the services, says an article in the journal Human Resources for Health. "Improvements in global health are greatly dependent on how well health systems can meet the demands placed on them by governments, programmes, communities and ultimately individuals. Human resources for health (HRH)... constitute a sine qua non of health systems. Therefore, developing HRH and fostering appropriate HR management are crucial steps towards achieving and sustaining improved and equitable health."
Brain Drain Creating Problems in SADC
"The loss of professionals and other skilled people from the SADC region is fast assuming the dimensions of a major crisis," says this article on the website of Idasa. "The countries of southern Africa pour vast resources into training to ensure that future skills needs are met. But is all this investment in human resource development really going to benefit the countries concerned? Or are they, in effect, simply providing students with "skill passports" so that they can relocate to other parts of the world?"
Stemming the brain drain
February's WHO Bulletin looks at the migration of skilled professionals to industrialized countries as one of the factors behind the chronic shortage of health workers in many developing countries. "….International recognition that the growing shortage of health workers poses a major threat to fighting diseases such as HIV/AIDS and tuberculosis has prompted a flurry of measures to stem the exodus of health professionals from developing countries."
The health workforce crisis in TB control
Human Resources for Health 2005, 3:2
"Human resources (HR) constraints have been reported as one of the main barriers to achieving the 2005 global tuberculosis (TB) control targets in 18 of the 22 TB high-burden countries (HBCs); consequently we try to assess the current HR available for TB control in HBCs...(The study concluded that) There were few readily available data on HR for TB control in HBCs, particularly in the larger ones. The great variations in staff numbers and the poor association between information on workforce, proportion of trained staff, and length and quality of courses suggested a lack of valid information and/or poor data reliability. There is urgent need to support HBCs to develop a comprehensive HR strategy involving short-term and long-term HR development plans and strengthening their HR planning and management capabilities."
Using mid-level cadres as substitutes for health professionals
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 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.