In common with other developing countries, South Africa's public health system is characterised by human resource shortfalls. These are likely to be exacerbated by the escalating demand for HIV care and a large-scale antiretroviral therapy (ART) programme. Focusing on professional nurses, the main front-line providers of primary health care in South Africa, this study examines patterns of planning, recruitment, training and task allocation associated with an expanding ART programme in the districts of one province, the Free State. The researchers found that introduction of the ART programme has revealed both strengths and weaknesses of human resource development in one province of South Africa. Without concerted efforts to increase the supply of key health professionals, accompanied by changes in the deployment of health workers, the core goals of the ART programme - i.e. providing universal access to ART and strengthening the health system - will not be achieved.
Human Resources
Health-care provision in KwaZulu-Natal is reported to be approaching crisis with understaffing. Chronic under-funding continues of the provincial health department is reported to have led to critical posts being frozen, with existing staff, especially nurses, carrying heavier loads. This was reported by senior department officials during a health portfolio committee meeting in the KwaZulu-Natal legislature.
The shortage of health staff in developing countries has led to renewed interest in community-based health care workers. However, poor populations are increasingly accessing health services from a wide variety of providers operating as private or semi-private agents in unregulated markets. Community health workers with little formal training do have a future. However, they will need to adapt to an environment where they must compete with other providers and prove their competence. They need to establish legitimacy and trust, and this is more likely in larger community development programmes with regular monitoring. They also need a livelihood that can be sustained.
Imbalances in quantity and quality of human resources for health (HRH) are increasingly recognised as perhaps the most critical impediment to achieving health outcome objectives in most African countries. However, reliable data on the HRH situation is not readily available. Some countries have hesitated to act in the absence of such data; other countries have not acted even when data are available while others have moved ahead in spite of the lack of reliable information. This paper addresses the issue of data use for HRH policy-making. It will provide valuable information to the body of literature available to policy-makers and their development partners as they grapple with the development and implementation of workable HRH policies.
The growing gap between the supply of health care professionals and the demand for their services is recognised as a key issue for health and development worldwide. Policy-makers, planners and managers continue to seek effective means to recruit and retain staff. One way to achieve this is to develop and implement effective incentive schemes. The World Health Organization report Working together for health (2006a) estimated a global shortage of 4.3 million health workers, including 2.4 million physicians, nurses and midwives. Translated into access to care, the shortage means that over a billion people have no access to heath care. Many countries are affected by the shortage and 57 have been identified as ‘in crisis’. An effective workforce strategy will address the three core challenges of improving recruitment, improving the performance of the existing workforce, and slowing the rate at which workers leave the health workforce. Incentives can play a role in all these areas, providing a means by which health systems can attract and retain essential and highly sought-after health care professionals. Effective incentive schemes also help build a better motivated, more satisfied and better performing workforce.
This article describes the human resource challenges that managers around the world report and analyses why solutions often fail to be implemented. Despite rising attention to the acute shortage of health care workers, solutions to the human resource (HR) crisis are difficult to achieve, especially in the poorest countries. Although HR strategies have been developed around the issues, the problem is that some old systems of leading and managing human resources for health do not work in today's context. The Leadership Development Program (LDP) is grounded on the belief that good leadership and management can be learned and practiced at all levels. Case studies were chosen to illustrate results from using the LDP at different levels of the health sector. The LDP makes a profound difference in health managers' attitudes towards their work. Rather than feeling defeated by a workplace climate that lacks motivation, hope, and commitment to change, people report that they are mobilized to take action to change the status quo. The lesson is that without this capacity at all levels, global policy and national HR strategies will fail to make a difference.
This article describes the experience of the Family Life Education Programme (FLEP), a reproductive health program that provides community-based health services through 40 clinics in five districts of Uganda, in improving retention and performance by using the Management Sciences for Health (MSH) Human Resource Management Rapid Assessment Tool. A few years ago, the FLEP of Busoga Diocese began to see an increase in staff turnover and a decrease in overall organisational performance. An action plan to improve their human resource management (HRM) system was developed and implemented. By implementing the various recommended changes, FLEP established an improved, responsive HRM system. Increased employee satisfaction led to less staff turnover, better performance, and increased utilisation of health services. These benefits were achieved by cost-effective measures focused on professionalising the organisation's approach to HRM.
In the case of health workers in Mozambique, the brain drain is not the biggest problem, neither are the salaries. There is a pure lack of doctors, with only up to 60 doctors a year being trained at the University for a population of 18 million. The funds from international donors for the National AIDS Plan are not accessible to the Faculty of Medicine to support the basic education of doctors because of restructions placed by donors.
The South African health department has started the training a new category of healthcare worker, but will need more money from treasury if it is to become a sustainable intervention. The first intake of 23 students to be trained as clinical associates, health workers ranked between a nurse and doctor, started at Walter Sisulu University in January this year. It is hoped that the clinical associates will lessen the burden facing critically understaffed hospitals and clinics. The health department has secured funding from the World Health Organisation, the United States Centres for Disease Control, the British government and the European Union to train the 23 students. Another 76 students are expected to be enrolled at the universities of the Witwatersrand, Pretoria and Limpopo as soon as the health department has finalised funding.
The quality and quantity of health care services delivered by the Malawi public health system is severely limited, due to, among other things the shortage of adequate numbers of trained health care workers. In order to suggest policy changes and implement corrective measures, there may be need to describe the perceptions of the legislature on how they perceive as the cause of the problem. Training more health workers, training new but lower cadres of health workers not marketable to the outside world, improving the working conditions and remuneration of health workers are suggested as some of the solutions. Even without the brain drain of health workers to other countries, Malawi's health sector personnel numbers are not adequate to serve the needs of the country. Relying on training more health workers in the numbers normally produced from the prevailing training institutions is unlikely to remove the shortages.