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.
Human Resources
Using Human Resource for Health Data: Health policy and program planning examples from four African countries
USAID, June 2008
Guidelines: Incentives for Health Professionals
International Council of Nurses, International Hospital Federation, International Pharmaceutical Federation, World Confederation for Physical Therapy, World Dental Federation, World Medical Association, 2008
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.
Human resource leadership: the key to improved results in health
O'Neil ML: Human Resources for Health 6(10), 20 June 2008
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.
Improving retention and performance in civil society in Uganda
O'Neil ML and Paydos M: Human Resources for Health 6(11), 20 June 2008
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.
Medicines without doctors: In Mozambique, salaries are not the biggest problem
de Oñate WA: PLoS Medicine 4(7): 1280-1281
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.
More money needed for new cadre of healthcare workers
Thom A: Health-e News, 5 June 2008
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.
Shortage of health workers in the Malawian public health services system: How do parliamentarians perceive the problem?
Muula A: African Journal of Health Sciences 13(1-2): 124-130 , 2008
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.
61st World Health Assembly: Health worker training falling far below needs
World Health Organization, 22 May 2008
The number of people currently being trained to become health workers falls far below the levels needed to ensure health goals are met, according to the Global Health Workforce Alliance (GHWA), a WHO partnership. The 2006 World Health Assembly Resolution (59.23) called on all Member States to help rapidly increase the number of health workers. In response, GHWA asked a group of experts to review and report on the experiences and research from around the world, and to draw up proposals on how to scale up the education and training of health workers. Drawing on case studies from 10 countries, the report details a set of recommendations.
Intent to migrate among nursing students in Uganda: Measures of the brain drain in the next generation of health professionals
Nguyen L, Ropers S, Nderitu E, Zuyderduin A, Luboga S and Hagopian A: Human Resources for Health 6(5), 12 February 2008
There is significant concern about the worldwide migration of nursing professionals from low-income countries to rich ones, as nurses are lured to fill the large number of vacancies in upper-income countries. This study explores the views of nursing students in Uganda to assess their views on practice options and their intentions to migrate. Most (70%) of the participants would like to work outside Uganda, and said it was likely that within five years they would be working in the US(59%) or the UK(49%). About a fourth (27%) said they could be working in another African country. Only eight percent of all students reported an unlikelihood to migrate within five years of training completion. Survey respondents were more dissatisfied with financial remuneration than with any other factor pushing them towards emigration. Those wanting to work in the settings of urban, private, or UK/US practices were less likely to express a sense of professional obligation and/or loyalty to the country. Those who have lived in rural areas were less likely to report wanting to emigrate. Students with a desire to work in urban areas or private practice were more likely to report an intention to emigrate for financial reasons or in pursuit of country stability, while students wanting to work in rural areas or public practice were less likely to want to emigrate overall.
Launch of first-ever guidelines on incentives for health professionals
Global Health Workforce Alliance, 20 May 2008
The world's leading health and hospital professional associations have joined to produce the first-ever joint guidelines on incentives for the retention and recruitment of health professionals. Underlining both financial and non-financial incentives as critical to ensuring effective recruitment, retention and performance of health workers across the world, the Guidelines on Incentives describe different approaches taken by a number of countries. Examples of financial incentives cited include tax waivers, allowances (e.g. - housing, clothing, child care, remote location weighting etc.), insurance, and performance payments. Examples of non financial incentives include ensuring positive work environments, flexibility in employment arrangements and support for career development. The report underlines how incentives are important levers that organisations can use to attract, retain, motivate and improve the performance of their staff in all professions and walks of life. This is especially and urgently needed in the health care sector, where the growing gap between the supply of health care professionals and the demand for their services is reaching crisis levels in many countries.