Human Resources

A global dialogue on a global crisis
The Lancet 371(9619), 5 April 2008

At the first Global Forum on Human Resources for Health in Kampala, Uganda, delegates endorsed a Global Agenda for Action on the alarming imbalances in the availability and distribution of health workers worldwide. One component of the Agenda was a pledge to "accelerate negotiations for a code of practice on the international recruitment of health workers". The first step was taken on March 31 with the launch of a 3-week online global dialogue convened by the Health Worker Migration Policy Initiative. The global dialogue provided a unique opportunity for anyone affected by the vast complexities of health-worker migration, in whatever capacity, to share experiences and knowledge on the realities of migration, on effective strategies to retain health workers where they are needed most, and on what the key principles of a global code of practice should be. The paper questions whether another code of practice really required.

Addressing the Human Resource Crisis in Malawi’s health sector: Employment preferences of public sector registered nurses
Mangham, L: ESAU Working Paper 18, Overseas Development Institute, London, 4 April 2008

Many developing countries suffer from critical shortages of trained health workers, but Malawi’s shortage is severe even by African standards. Measures to recruit and retain more staff are urgently needed.This paper reports on the employment preferences of public sector registered nurses in Malawi to help design incentives to encourage them to remain in Malawi's public health sector. Improved pay was the single most important attribute identified that might improve job satisfaction, followed by opportunities for further education and the provision of basic housing. Improvements in the quality of housing provided would have little impact on how nurses value their employment. Establishing the relationship between pay increases and retention of registered nurses would require additional research.

Effects of a community-based delivery of intermittent preventive treatment of malaria in pregnancy on treatment seeking for malaria at health units in Uganda
Mbonyea, AK; Schultz, K; Hansenb, K; Bygbjergc, IC; Magnussend, P: Department of Health Services Research, Institute of Public Health, University of Aarhus, Denmark

The impact of intermittent preventive treatment (IPTp) on malaria in pregnancy is well known. However, in countries where this policy is implemented, poor access and low compliance have been widely reported. Novel approaches are needed to deliver this intervention. This paper assesses whether or not traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilisers can administer IPTp with sulphadoxine–pyrimethamine (SP) to pregnant women, reach those at greatest risk of malaria, and increase access and compliance with IPTp. The report found that the community approach was effective for the delivery of IPTp, although women still accessed and benefited from malaria treatment and other services at health units. However, the costs for accessing malaria treatment and other services are high and could be a limiting factor.

Nurses, community health workers, and home carers: gendered human resources compensating for skewed health systems
George A: Global Public Health 3(S1):75-89, 2008

This review examines the experiences of nurses, community health workers, and home carers in health systems from a gender analysis. With respect to nursing, current discussions around delegation take place over layers of historical struggle that mark the evolution of nursing as a profession. Female community health workers also struggle to be recognized as skilled workers, in addition to defending at a personal level the legitimacy of their work, as it transgresses traditional norms proscribing morality and the place of women in society, at times with violent consequences. The review concludes by exploring the characteristics of, and challenges faced by, home carers, who fail to be recognized as workers at all. A key finding is that these mainly female frontline health workers compensate for the shortcomings of health systems through individual adjustments, at times to the detriment of their own health and livelihoods. So long as these shortcomings remain as private, individual concerns of women, rather than the collective responsibility of gender, requiring public acknowledgement and resolution, health systems will continue to function in a skewed manner, serving to replicate inequalities in the health labour force and in society more broadly.

Prevalence of HIV infection and median CD4 counts among health care workers in South Africa
Connelly D, Veriava Y, Roberts S, Tsotetsi J, Jordan A, DeSilva E, Rosen S, DeSilva MB: South African Medical Journal 97(2):115-120, 2007

A cross-sectional voluntary, anonymous, unlinked survey including an oral fluid or blood sample and a brief demographic questionnaire where undertaken in two public hospitals in Gauteng, South Africa to determine the prevalence of HIV infection and the extent of disease progression based on CD4 count in a public health system workforce in southern Africa. The overall prevalence of HIV was 11.5%. By occupation, prevalence was highest among student nurses (13.8%) and nurses (13.7%). The highest prevalence by age was in the 25-34-year group (15.9%). Nineteen per cent of HIV-positive participants who provided blood samples had CD4 counts less than or equal to 200 cells/μl, 28% had counts 201-350 cells/μl, 18% had counts 351-500 cells/μl, and 35% had counts above 500 cells/μl. One out of 7 nurses and nursing students in this public sector workforce was HIV-positive. A high proportion of health care workers had CD4 counts below 350 cells/μl, and many were already eligible for antiretroviral therapy under South African treatment guidelines. Given the short supply of nurses in South Africa, knowledge of prevalence in this workforce and provision of effective AIDS treatment are crucial for meeting future staffing needs.

Steps towards achieving skilled attendance at birth
Stanton C: Bulletin of the World Health Organisation 86 (4): 241-320, April 2008

Who should assist women in childbirth, what should these attendants do and not do under various circumstances, and where should births take place? Policies regarding these questions have been debated for hundreds of years. WHO’s position on where and with whom women should deliver has evolved from emphasis on training of traditional birth attendants (TBAs) in developing countries in the late 1950s and 1960s, to a recommendation that TBAs work with the health-care system, to a recommendation that they be integrated into the health system via training, supervision and technical support, to today’s position of promoting professionally skilled attendance at all births. The facts that a) this position was adopted in 1997 and that it took an additional two years to specify the criteria required to be a “skilled attendant”, and b) that the policy sidesteps the issue of where births should take place, suggests that substantial internal debate swirled around this stance, as well. Although the WHO skilled attendance at birth policy remains today, it has now been incorporated into a continuum of maternal and child health care policy, resulting from the formation of the Partnership for Maternal, Newborn and Child Health in 2005.

University partnership to address the shortage of healthcare professionals in Africa
Taché S, Kaaya E, Omer S, Mkony CA, Lyamuya E, Pallangyo K, Debas HT, MacFarlane SB: Global Public Health 3(2): 137 - 148, April 2008

The shortage of qualified health professionals is a major obstacle to achieving better health outcomes in many parts of the world, particularly in Africa. The role of health science universities in addressing this shortage is to provide quality education and continuing professional development opportunities for the healthcare workforce. Academic institutions in Africa, however, are also short of faculty and especially under-resourced. We describe the initial phase of an institutional partnership between the Muhimbili University of Health and Allied Sciences (MUHAS) and the University of California San Francisco (UCSF) centred on promoting medical education at MUHAS. The challenges facing the development of the partnership include the need: (1) for new funding mechanisms to provide long-term support for institutional partnerships, and (2) for institutional change at UCSF and MUHAS to recognize and support faculty activities that are important to the partnership. The growing interest in global health worldwide offers opportunities to explore new academic partnerships. It is important that their development and implementation be documented and evaluated as well as for lessons to be shared.

An Agenda for Global Action
Global Health Workforce Alliance

This Agenda for Global Action will guide the initial steps in a coordinated global, regional and national response to the worldwide shortage and maldistribution of health workers, moving towards universal access to quality health care and improved health outcomes. It is meant to unite and intensify the political will and commitments necessary for significant and effective actions to resolve this crisis, and to align efforts of all stakeholders at all levels around solutions. It builds on commitments already made by high level policy makers in efforts designed to marshal the world’s collective knowledge and resources to reverse this crisis. Everyone committed to this agenda shares the vision that ‘all people, everywhere, shall have access to a skilled, motivated and facilitated health worker within a robust health system’.

Effectiveness of training supervisors to improve reproductive health quality of care: a cluster-randomised trial in Kenya
Reynolds HW, Toroitich-Ruto C, Nasution M, Beaston-Blaakman A, Janowitz B: Health Policy and Planning 23: 56-66, 2008

Health facility supervisors are in a position to increase motivation, manage resources, facilitate communication, increase accountability and conduct outreach. This study evaluated the effectiveness of a training intervention for on-site, in-charge reproductive health supervisors in Kenya using an experimental design with pre- and post-test measures in 60 health facilities. Cost information and data from supervisors, providers, clients and facilities were collected. Regression models with the generalized estimating equation approach were used to test differences between study groups and over time, accounting for clustering and matching. Total accounting costs per person trained were calculated. The intervention resulted in significant improvements in quality of care at the supervisor, provider and client–provider interaction levels. Indicators of improvements in the facility environment and client satisfaction were not apparent. The costs of delivering the supervision training intervention totalled US$2113 per supervisor trained. In making decisions about whether to expand the intervention, the costs of this intervention should be compared with other interventions designed to improve quality.

Financing Human Resources for Health: Five Questions for the International Community
Soucat A: World Bank; Global Health Workforce Alliance

This presentation was given at the First Forum on Human Resources for Health in Kampala. It presents five questions on the financial concerns of scaling up the number of health workers to provide adequate health care.

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