A shortage of health care workers is paralysing the health system in Lesotho, Malawi, Mozambique and South Africa, and threatens the lives of millions, particularly in rural areas, warns Medecins Sans Frontieres. A new report by the organisation, launched in Johannesburg, shows that only South Africa has met the World Health Organisation (WHO) target for an adequate supply of health care workers: 74.3 doctors, 393 nurses and 468 health providers per 100,000 people.
Human Resources
Health Worker Shortage Limits Access To HIV/AIDS Treatment In Southern Africa
Medicens Sans Frontiers, 30 May 2007
Longitudinal analysis of community health workers’ adherence to treatment guidelines, Siaya, Kenya, 1997–2002
Rowe SY, Olewe MA, Kleinbaum DG, McGowan Jr JE, McFarland DA, Rochat R, Deming MS: Tropical Medicine & International Health 12(5): 651-663, May 2007
This report investigated community health workers’ (CHW) adherence over time to guidelines for treating ill children and to assess the effect of refresher training on adherence. The average adherence score was 79.4%. Multivariable analyses indicate that immediately after the first refresher training, the mean adherence level improved for patients with a severe illness, but worsened for patients without severe illness. Adherence scores declined rapidly during the 6 months after the second refresher training.
Medicines without Doctors: why the Global Fund must fund salaries of health workers to expand AIDS treatment
Ooms G, Van Damme W, Temmerman M: Public Library of Science Medicine , 2007
The Global Fund to Fight AIDS, Tuberculosis and Malaria was created to fight three of the world’s most devastating diseases. Recent internal comments from the Global Fund suggest an intention to focus more on these diseases, and to leave the strengthening of health systems and support for the health workforce to others. This article, in PLoS Med, examines the implications of this strategy, and suggests that it could create a ‘Medicines without Doctors’ situation in which the medicines to fight AIDS, tuberculosis, and malaria are available, but not the doctors or the nurses to prescribe those medicines adequately.
Migration of Nurses from Sub-Saharan Africa: A Review of Issues and Challenges
Dovlo D: Health Services Research 42 (3): 1373-1388, June 2007
The state of nursing practice in SSA appears to have been impacted negatively by migration. Available (though inadequate) quantitative data on stocks and flows, qualitative information on migration issues and trends, and on the main strategies being employed in both source and recipient countries indicate that the problem is likely to grow over the next 5–10 years. the paper reports that multiple actions are needed at various policy levels in both source and receiving countries to moderate negative effects of nurse emigration in developing countries in Africa; however, critically, source countries must establish more effective policies and strategies.
More non-physician clinicians will boost African healthcare workforce
Mullah F, Frehywot S: The Lancet, Early Online Publication, 14 June 2007
Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. These non-physician clinicians (NPCs) were found in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3–4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.
Nurses' experiences of recruitment and migration from developing countries: a phenomenological approach
Troy PH, Wyness LA, McAuliffe E: Human Resources for Health 5:15: 7 June 2007
There is growing concern globally at the current flows of nurse migration, particularly from low-income to middle and high-income countries. Recruitment practices of many countries such as Ireland are thought to be fuelling this rate of migration. This paper aims to establish the perceptions and opinions of those involved in the recruitment process on their role in recruitment and the effects recruitment has on both source and destination countries. A purposive sample of 12 directors of nursing, from major academic teaching hospitals in Dublin and hospitals in South Africa and the Philippines were recruited.
Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi
Chilopora G, Pereira C, Kamwendo F, Chimbiri A, Malunga E, Bergstrom S: Human Resources for Health 5:17, 14 June 2007
Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.
The exodus of health professionals from sub-Saharan Africa: balancing human rights and societal needs in the twenty-first century
Ogilvie L, Mill JE, Astle B, Fanning A, Opare M: Nursing Inquiry 14 (2): 114-124, June 2007
Increased international migration of health professionals is weakening healthcare systems in low-income countries, particularly those in sub-Saharan Africa. The migration of nurses, physicians and other health professionals from countries in sub-Saharan Africa poses a major threat to the achievement of health equity in this region. As nurses form the backbone of healthcare systems in many of the affected countries, it is the accelerating migration of nurses that will be most critical over the next few years. In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one's country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health.
For public service or money: understanding geographical imbalances in the health workforce
Serneels P, Lindelow M, Montalvo JG: Health Policy and Planning 22(3): 128-138, May 2007
Geographical imbalances in the health workforce are a consistent feature of nearly all health systems, especially in developing countries. This paper investigates the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analysing data obtained from contingent valuation questions for final year students from three medical schools and eight nursing schools, we find that there is substantial heterogeneity in the willingness to serve in rural areas.
Labour of love: celebrating 'International Day of Midwives'
World Health Organisation, May 2007
As one of the oldest and most respected professions in the world, the work of midwives is celebrated annually on 5 May. To mark the occasion, the International Day of Midwives will be celebrated at WHO Headquarters on Friday 4 May. WHO staff will gather to show their support for the essential role of midwives in saving the lives of pregnant women who might otherwise die from malnourishment or lack of skilled care during pregnancy and childbirth.