To mark International Day of the Midwife (5 May), AMREF is calling on African governments to accelerate implementation of Human Resources for Health (HRH) strategies to increase the number of midwives trained and upgraded in the country, to fast track the attainment of MDG 5 (maternal mortality) in all countries where targets have not been achieved and to adopt innovative mechanisms to support the training, recruitment, deployment and retention of midwives across rural and remote areas. Governments should ensure that midwives access to the UN Commission’s 13 lifesaving commodities for women and children, including long-term family planning methods and other commodities for reproductive health, for them to be able to provide appropriate quality health services. At the same time, AMREF recommends that development partners should adopt and support innovative mechanisms for training, recruitment, deployment and retention of midwives in Africa within the post MDG priority setting processes.
Human Resources
According to this article, health worker density/100,000 population is substantially lower in South Africa compared to the vast majority of countries against which South Africa is benchmarked, including the BRIC (Brazil, Russia, India and China) countries. The existing higher education sector is unable to meet the graduate output required by the health sector while foreign recruitment is constrained by current legislation on the registration and practice of foreign healthcare professionals by the Professional Councils and the WHO Global Code of Practice on the International Recruitment of Health Personnel. Existing and future health workforce production is not commensurate with the healthcare needs of the country. A number of challenges are identified: health challenges have outpaced curriculum reform; fragmented, outdated, static curricula produce ill-equipped health graduates; there are episodic encounters as opposed to a continuum of care; healthcare is hospi-centric as opposed to primary healthcare based; there is narrow technical focus without contextual understanding; there exists a mismatch of competencies and patient/population needs; and there is poor teamwork. Solutions to barriers related to the quantitative aspect of health workforce production in South Africa are presented in the article.
The South African government plans to increase the number of new medical students by 10% over the three to four years, raising the total from 1,800 to 2,395 by 2016. According to the Department of Health’s chief operating officer, the department’s plan to ensure more medical students at South African universities is part of its health systems strengthening strategy and aims to address the critical shortage of public health workers in the country, particularly in rural areas.
The African Union has announced its strong support for the new One Million Community Health Workers Campaign that was launched by Rwanda’s President Paul Kagame, Professor Jeffrey Sachs and Novartis CEO Joseph Jimenez at the World Economic Forum early in January 2013. The new campaign will work closely with governments and aid agencies to finance and train the health workers, each of whom would serve an average of around 500 rural inhabitants. The incremental costs for full coverage might sum to around US$2.5 billion per year, or $5 per person per year covered by the expanded CHW programme. The campaign will work to mobilise these additional funds from existing and new external funders, as well as from the host countries consistent with their budgetary means. The campaign aims to boost the ongoing community health worker programmes and policies of many leading institutions.
The Global Assessment of Functioning (GAF) is the standard method and an essential tool for representing a clinician’s judgment of a patient’s overall level of psychological, social and occupational functioning. It is probably the single most widely used method for assessing impairment among the patients with psychiatric illnesses. The authors of this study set out to assess the effects of one-hour training on application of the GAF by Psychiatric Clinical Officers’ in a Ugandan setting. They randomly selected five psychiatrists and five psychiatric clinical officers (PCOs) or assistant medical officers who hold a two-year diploma in clinical psychiatry to take part. Before receiving an hour of training on how to rate the GAF scale, they were asked to rate a video-recorded psychiatric interview, and they assessed the video again after training. The PCOs were then offered and asked to rate the video case interview again. Results showed that the interclass correlations (ICCs) between the psychiatrists and the PCOs before training in the past one year, at admission and current functioning were +0.48, +0.51 and +0.59 respectively. After training, the ICC coefficients were +0.60, +0.82 and +0.83. The findings of this study indicate that brief training given to PCOs improved the applications of their ratings of GAF scale to acceptable levels. There is need for formal training to this cadre of psychiatric practitioners in the use of the GAF.
This qualitative assessment was undertaken to identify factors that influence motivation and job satisfaction of health surveillance assistants (HSAs) in Mwanza district, Malawi, in order to inform development of strategies to influence staff motivation for better performance. Seven key informant interviews, six focus group discussions with HSAs and one group discussion with HSAs supervisors were conducted in 2009. Data were supplemented by a district wide survey involving 410 households, which included views of the community on HSAs performance. The main satisfiers identified were team spirit and coordination, the type of work to be performed by an HSA and the fact that an HSA works in the local environment. Dissatisfiers were low salary and position, poor access to training, heavy workload and extensive job description, low recognition, lack of supervision, communication and transport. Managers and had a negative opinion of HSA perfomance, while the community was much more positive: 72.9% of all respondents had a positive view on the performance of their HSA. Activities associated with worker appreciation, such as performance management were not optimally implemented. The district level can launch different measures to improve HSAs motivation, including human resource management and other measures relating to coordination of and support to the work of HSAs.
Rwanda is widely celebrated for having demonstrated that major improvements in health can be achieved in a poor country, at relatively low cost per capita, by good strategy, innovation and focusing on the best value for money. Rwandan health officials have installed well-trained, compensated health workers into every community to make sure that community members get to access the primary health care services they need, including routine prenatal care, immunisation and malaria diagnosis – early treatment significantly reduces health costs. The authors argue that the lesson learned from Rwanda’s success in health is that the country’s 45,000 community health workers (CHWs) are not viewed as complementary components to the public health system, but central to it.
South Africa launched its National Strategic Plan for Nurse Education, Training and Practice for 2012/13 - 2016/17 in March 2013. The plan aims to revitalise the ailing public health sector. According to the plan, nursing colleges will be declared higher education institutions in compliance with the provisions of the Higher Education Act (as amended in 2008). This will help to address provincial inequalities, norms and standards, quality, decrease fragmentation, eliminate fly-by-night nursing education institutions (NEIs), improve clinical training and enhance social accountability. Nursing students will also have the status of full students (rather than employees) while undergoing training. They should receive funding support paid monthly for tuition books and study materials, as well as living costs, medical aid and indemnity insurance, while tuition fees should be paid directly to the NEIs. The plan also addresses the need to emphasise modules that focus on caring, and these should be compulsory at all levels of nursing and midwifery. This should help address the issue of compassion in the profession. The plan also significantly proposes that an office for the chief nursing officer be established, which will then take responsibility for the implementation of the strategy over the next five years.
Developing mid-level health professionals who can complement existing staff is an additional strategy that has been debated since 1994 and incorporated into the government’s recent human resources policy. Yet progress in the production of mid-level health workers has been slow. Reasons for this are likely to include competing priorities, the practical difficulties associated with setting up and implementing new training programmes, constraints on absorbing new cadres into the existing health system, tensions between different cadres over role definition and working conditions, and the brain drain into the private sector. More fundamentally, concerns remain about whether mid-level workers are the correct choice for South Africa’s health system. The author discusses how the design and early implementation of a new programme to develop South Africa’s first mid-level medical health professionals took account of these concerns and realities. Also highlighted are the issues that need to be addressed by government in order to ensure that this new programme has a substantial impact on the quality of care delivered in public hospitals. The author concludes that clinical associates have the potential to bring good quality hospital care closer to communities in a way that is affordable for the country.
In this paper, the authors evaluate various policy options to address the global health worker migration crisis, which include: financial and technical support from destination countries; bilateral and multilateral agreements between states; creation of self-sufficient healthcare systems; and collection of reliable migration data. Implementation requires the support of key stakeholders such as the World Health Organisation, member states, and other international organisations. However, there are many obstacles to policy change, including the power disparities between source and destination countries, ethical sensitivity of policies, financial incentives, lack of data collection, and limited international cooperation. The authors argue that media campaigns can be used in destination countries to mobilise citizens and influence national policy. Research initiatives can galvanise action at grassroots, national and international levels. Regional conferences can bring together key stakeholders and promote collaboration between source and destination countries. All efforts should be overseen by an international advocacy group.