A qualitative study was conducted in Malawi to describe the perceptions of medical students, recent medical graduates, faculty members of the Malawi College of Medicine and private general practitioners (GPs) towards a proposed utilization of GPs in the teaching of undergraduate medical students. General Practitioners welcomed these proposed changes whilst the majority of students, recent graduates and faculty were opposed to this idea. General practitioners were perceived not to be able to adapt to the culture of public teaching hospitals.
Human Resources
"There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries...International medical graduates constitute between 23 and 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia, and lower-income countries supply between 40 and 75 percent of these international medical graduates. The United Kingdom, Canada, and Australia draw a substantial number of physicians from South Africa, and the United States draws very heavily from the Philippines. Nine of the 20 countries with the highest emigration factors are in sub-Saharan Africa or the Caribbean."
Migration has long been an important part of labour markets and livelihoods across Africa. It is estimated that there are between 20 and 50 million African migrants today. Migration flows have implications for meeting the Millennium Development Goals, but their effects are poorly understood. Most African governments, however, are concerned with the migration of educated professionals abroad, or the 'brain drain'. It is estimated that US$4 billion is spent on replacing African professionals with expatriates, mostly through aid programmes.
The United Nations Population Fund (UNFPA) hosted an Expert Group Meeting on International Migration and the Millennium Development Goals in Marrakech, Morocco on 11-12 May 2005. Invited experts were requested to speak on a number of topics relating to migration and development, including: poverty reduction, health, gender, environment, and global partnerships for development with a view towards exploring migration as both a facilitating and constraining factor in the achievement of the Millennium Development Goals (MDGs). This report is a compilation of selected papers presented at the meeting together with a synopsis of the discussion highlighting some of the more salient points raised by the experts.
"In low and middle income countries, health workers are essential for the delivery of health interventions. However, inadequate health-worker performance is a very widespread problem. We present an overview of issues and evidence about the determinants of performance and strategies for improving it. Health-worker practices are complex behaviours that have many potential influences. Reviews of intervention studies in low and middle income countries suggest that the simple dissemination of written guidelines is often ineffective, that supervision and audit with feedback is generally effective, and that multifaceted interventions might be more effective than single interventions." (Requires registration)
"Sub-Saharan Africa faces a human resources crisis in the health sector. Over the past two decades its population has increased substantially, with a significant rise in the disease burden due to HIV/AIDS and recurrent communicable diseases and an increased incidence of noncommunicable diseases. This increased demand for health services is met with a rather low supply of health workers, but this notwithstanding, sub-Saharan African countries also experience significant wastage of their human resources stock."
“In the context of the Millennium Development Goals, human resources represent the most critical constraint in achieving the targets. Therefore, it is important for health planners and decision-makers to identify what are the human resources required to meet those targets. Planning the human resources for health is a complex process. It needs to consider both the technical aspects related to estimating the number, skills and distribution of health personnel for meeting population health needs, and the political implications, values and choices that health policy- and decision-makers need to make within given resources limitations.”
Massive shortages in trained health care professionals in sub-Saharan Africa have led to an examination of substitute health workers as an immediate response to the workforce crisis. For many countries these substitute health workers (SHWs) are not new. They already play various minor roles in health services, especially in rural and deprived areas. In Tanzania, Malawi and Mozambique, assistant medical officers are used as substitutes for doctors. They perform surgery and a variety of other tasks.
The shortage of health workers with the right expertise and experience has reached crisis levels in many developing countries. The human resources (HR) crisis in the health sectors of many developing countries is now firmly on the international policy agenda. The work of the Joint Learning Initiative (JLI) and the High Level Forum on Health has described the magnitude of the HR challenge, identified the key contributory factors, and defined some of the potential solutions.
* Relating Link
The Joint Learning Initiative Report: overcoming the crisis
http://www.id21.org/health/InsightsHealth7art6.html
"Health care agencies report that the major limiting factor for implementing effective health policies and reforms worldwide is a lack of qualified human resources. Although many agencies have adopted policy development and clinical practice guidelines, the human resources necessary to carry out these policies towards actual reform are not yet in place. The goal of this article is to evaluate the current status of human resources quality, availability and distribution in Northern Tanzania in order to provide emergency obstetric care services to specific districts in this area. The article also discusses the usefulness of distribution indicators for describing equity in the decision-making process."