This paper aims to quantify the contribution of international health volunteers (IHVs) to the health workforce in sub-Saharan Africa and to explore the perceptions of health service managers regarding these volunteers. The paper found that international health volunteers contribute relatively small numbers to the health workforce in sub-Saharan Africa, and it seems unlikely that they will do more in the future. In areas where they play a role, their contribution to service delivery can be significant.
Human Resources
The contribution of international health volunteers to the health workforce in sub-Saharan Africa
Laleman G, Kegels G, Marchal B, Van der Roost D, Bogaert I, Van Damme W: Human Resources for Health 5:19, 31 July 2007
Developing a Nursing Database System in Kenya
Riley PL, Vindigni SM, Arudo J, Waudo AN, Kamenju A, Ngoya J, Oywer EO, Rakuom CP, Salmon ME, Kelley M, Rogers M, St. Louis ME, Marum LH: Health Services Research 42 (3): 1389-1405, June 2007
Creating a national electronic nursing workforce database provides more reliable information on nurse demographics, migration patterns, and workforce capacity. Data analyses are most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who elect to out-migrate are among Kenya's most qualified.
Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect
Ssengooba F, Rahman SA, Hongoro C, Rutebemberwa E, Mustafa A, Kielmann T, McPake B: Human Resources for Health 5:3, 1 February 2007
Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers' responses to the changes in their working environments by taking a 'realistic evaluation' approach.
Health Worker Shortage Limits Access To HIV/AIDS Treatment In Southern Africa
Medicens Sans Frontiers, 30 May 2007
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.
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.