In this blog, the author argues that a palpable effect of Kenya’s new constitution is that it has allowed the formation of new trade unions such as the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU). Since its formation, the group has become a key stakeholder in promoting the needs of Kenyan health professionals. Another change the constitution brought about is the permission of dual citizenship, which has the potential to increase circular migration among health professionals who have previously departed the country. Finally, the new constitution prioritises the right to health in Section 43 (1) (a), noting that every Kenyan has the “right to the highest attainable standard of health which includes the right to health care services including reproductive health care.” This places a high level of expectation on the government and health care workers, creating a basis for the public to demand such a right. To convert these potential gains into practice, however, much work remains to be done, particularly in researching how the health system has responded. One of the greatest challenges the author has faced in conducting her own research on migration is in encountering stakeholders who are unwilling to cooperate either directly or indirectly, which she views as a part of a resistance to an evidence-based culture, even among some in the health sector.
Human Resources
The Tanzania Connect Project is a randomised cluster trial located in three rural districts with a population of roughly 360,000 ( Kilombero, Rufiji, and Ulanga). Connect aims to test whether introducing a community health worker into a general programme of health systems strengthening and referral improvement will reduce child mortality, improve access to services, expand utilisation, and alter reproductive, maternal, newborn and child health seeking behaviour; thereby accelerating progress towards Millennium Development Goals 4 and 5. Connect has introduced a new cadre — Community Health Agents (CHA) — who were recruited from and work in their communities. To support the CHAs, Connect developed supervisory systems, launched information and monitoring operations, and implemented logistics support for integration with existing district and village operations. Connect will not only address Tanzania’s need for policy and operational research, it will bridge a critical international knowledge gap concerning the added value of salaried professional community health workers in the context of a high density of fixed facilities.
In this paper, the authors explored the perspectives and experiences of key Mozambican public sector health managers who coordinate, implement, and manage the myriad donor-driven projects and agencies. Over a four-month period, they conducted 41 individual qualitative interviews with key Ministry workers at three levels in the Mozambique national health system, using open-ended semi-structured interview guides, as well as reviewed planning documents. All respondents emphasized the value and importance of international aid and vertical funding to the health sector and each highlighted program successes that were made possible by recent increased aid flows. However, three serious concerns emerged: 1) difficulties coordinating external resources and challenges to local control over the use of resources channeled to international private organizations; 2) inequalities created within the health system produced by vertical funds channeled to specific services while other sectors remain under-resourced; and 3) the exodus of health workers from the public sector health system provoked by large disparities in salaries and work. The vertical approach starved the Ministry of support for its administrative functions. Few studies have addressed the growing phenomenon of “internal brain drain” in Africa which proved to be of greater concern to Mozambique’s health managers.
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.
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.