Worldwide mobility of health professionals is a growing phenomenon, impacting the health systems of receiving, transit, and sending countries, so the need to develop European policies to adequately address these issues is urgent. At the same time, reliable and differentiated knowledge and findings as a basis for such policy are lacking. MoHProf will contribute to improving this knowledge base and facilitate European policy on human resource planning. The general objective of the project is to research current trends of mobility of health professionals to, from and within the EU. The project comprises four phases over a three-year period starting from November 2008. There will be four project meetings, starting with a kick-off meeting and project launch and concluding with an international conference, and roundtables as appropriate.
Human Resources
In Malawi, mid-level cadres of health workers provide the bulk of emergency obstetric and neonatal care. These cadres undertake roles and tasks that are more usually the province of internationally recognised cadres, such as doctors and nurses. While several studies address retention factors for doctors and registered nurses, data and studies addressing the perceptions of these mid-level cadres on the factors that influence their performance and retention within health care systems are scarce. This exploratory qualitative study undertook focus group discussions and semi-structured interviews at in four rural mission hospitals in Malawi among mid-level providers of emergency obstetric and neonatal care. Participants confirmed the difficulties of their working conditions and the clear commitment they have to serving the rural Malawian population. Although insufficient financial remuneration had a negative impact on retention and performance, the main factors identified were limited opportunities for career development and further education (particularly for clinical officers) and inadequate or non-existent human resources management systems. The lack of performance-related rewards and recognition were perceived to be particularly demotivating. For optimal performance and quality of care mid-level cadres need to be supported and properly motivated. A structured system of continuing professional development and functioning human resources management would show commitment to these cadres and support them as professionals. Action needs to be taken to prevent staff members from leaving the health sector for less stressful, more financially rewarding alternatives.
South Africa is failing to produce more nurses to deal with its health demands, according to the Democratic Nursing Organisation of South Africa (Denosa). The closure of some nursing colleges by the government, citing 'funding' as a reason, did not assist in the production of nurses, it reported. Denosa called on government to re-open the training colleges that were closed, to accommodate those who were interested in pursuing this career. The union said one of the contributing factors to the shortage was that school-leavers lacked interest in becoming nurses because of the unsavoury working environments that nurses face daily. Poor salaries also drive nurses away from the profession and the country. Denosa called on the state to improve health services nationwide.
The aim of this paper is to give an overview of the development process of a computer-based job task analysis instrument for real-time observations to quantify the job tasks performed by physicians working in different medical settings. First, lists comprising tasks performed by physicians in different care settings were classified. Then, content validity of task lists was proved. After establishing the final task categories, computer software was programmed and implemented in a mobile personal computer. Finally, inter-observer reliability was evaluated. Content validity of the task lists was confirmed by observations and experienced specialists of each medical area. Development process of the job task analysis instrument was completed successfully. Simultaneous records showed adequate interrater reliability. Based on results using this method, possible improvements for health professionals' work organisation can be identified.
Drawing on IntraHealth International's lessons learned in designing reproductive health and HIV/AIDS training and performance improvement programmes, this commentary discusses promising practices for strengthening human resources for health through more efficient and effective training and learning programmes that avoid the same old traps. These promising practices include the following: assessing performance gaps and opportunities before designing a training initiative; addressing performance factors other than skills and knowledge that health workers need to perform well; applying a ‘learning for performance’ approach; standardising curricula throughout a country; linking pre-service education, in-service training and professional associations; enhancing traditional education; strengthening human resources information systems to improve workforce planning, policies and management; and applying technology to meet training needs.
This study aimed to determine the prevalence and associated factors of psychological distress among attendees of traditional healing practices in two districts in Uganda. Face-to-face interviews with the Lusoga version of the self-reporting questionnaire (SRQ-20) were carried out with 400 patients over the age of 18 years attending traditional healing in Iganga and Jinja districts in Eastern Uganda. Three hundred and eighty-seven questionnaire responses were analysed. The study found that a substantial proportion of attendees (61%) of traditional healing practices suffered from psychological distress. Among the socioeconomic indicators, lack of food and having debts were significantly associated with psychological distress. These findings may be useful for policy makers and biomedical health workers for engagement with traditional healers.
In this article, the authors describe health care workers (HCWs') experiences and perceptions of meeting clients exposed to intimate partner violence. Qualitative content analysis of in-depth interviews from 16 informants resulted in four main themes. The first, Internalising women's suffering and powerlessness’, describes HCWs' perceptions of violence, relating it to gender relations. The second, ’Caught between encouraging disclosure and lack of support tools, refers to views on possibilities for transparency and openness. The third, ’Why bother? A struggle to manage with limited resources’, illustrates the consequences of a heavy workload. Last, ‘Striving to make a difference’, emphasises a desire to improve abilities to support clients and advocate for prevention.
The WHO Secretariat held a global, web-based public hearing between 1 September and 3 October 2008 to obtain inputs on the first draft of the WHO code of practice from as wide a group of stakeholders as possible. Member States, national institutions, health professional organisations, nongovernmental organisations, academic institutions, international organisations and other stakeholders submitted more than 90 contributions to the public hearings. Some expressed the view that Article 4 should be revised to provide greater emphasis on the legal responsibilities of health personnel to source and destination countries, such as those to protect the public health interest. Others felt that Article 4 should recommend that states prohibit all active recruitment of health personnel from countries experiencing a health workforce crisis.
Ugandan radiography, medical, nursing, dentistry and pharmacy students are sent to community health facilities where they are expected to participate in community services and other primary healthcare activities for training (COBES). This study was designed to obtain the opinions of radiography teachers and students of the significance and relevance of this community-based training to radiography training. Both students and teachers (91.4%) affirmed the community training to be significant and relevant to radiography training. In total, 71.4% of the students had participated in X-ray services and 39.2% in ultrasound services during COBES; and 68.6% of the students reported the need to be better prepared for the COBES training. They confirmed community-based training to be relevant to Ugandan radiography training.
This study systematically reviewed and consolidated existing evidence of the impact of financial and non-financial incentives on the motivation and retention of health workers. Four literature databases were searched, as well as grey literature studies and informational papers. Twenty qualitative and quantitative studies were selected. There was some evidence to suggest that the use of initiatives to improve motivation had been effective in helping retention. While motivational factors are undoubtedly country specific, financial incentives, career development and management issues are core factors. Nevertheless, financial incentives alone are not enough to motivate health workers. Workplace recognition and adequate resources and infrastructure can also improve morale significantly.