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.
Human Resources
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.
In this study, researchers assessed health worker motivation as part of a health system strengthening intervention in three rural districts in Zambia. The intervention (Better Health Outcomes Through Mentoring and Assessment (BHOMA) aims to increase health worker motivation through training, mentoring and support. The researchers examined underlying issues grouped around relevant outcome constructs such as job satisfaction, general motivation, burnout, organisation commitment, conscientiousness and timeliness that collectively measure overall levels of motivation. Results showed variation in motivation score by sex, type of health worker, training and time in post. Female participants had the highest motivation scores. Nurses had the highest scores while environmental health technicians had the lowest score. Health workers who had been in their posts longer also had higher scores. Health workers who had received some form of training in the preceding 12 months were more likely to have a higher score; this was also true for those older than 40 years when compared to those less than 40 years of age. Further research is needed to establish why these health worker attributes were associated with motivation and whether health system interventions targeting health workers, such as the current intervention, could influence health worker motivation.
A key component of the proposed primary health care (PHC) re-engineering model in South Africa is creating ward-based outreach teams linked to primary health care clinics. Each team consists of a professional nurse team leader, three staff nurses and six community health workers (CHWs), with each team serving a population of approximately 6,000 people in a demarcated area. The model envisages the professional nurse team leader and two of the three staff nurses being based at the clinic, while the rest of the team is based in the community. Team leaders will spend 20-30% of their time in the community supporting the work of the team and visiting high risk households. The managers of the clinics to which these teams are linked are expected to lead, manage and oversee the outreach teams’ work in the community and their interactions with other stakeholders working in the same communities. The model requires clinic managers to promote an understanding of the facility catchment area’s epidemiology and burden of disease using health information and data collected during community activities, and to identify strategies to address the local health issues. The addition of these responsibilities will expand the clinic managers’ scope of work.
The authors of this study examined literature on the roles of mid-level managers to understand how they might influence service delivery quality in Kenyan hospitals. A total of 23 articles were finally included in the review from over 7,000 titles and abstracts initially identified. The most widely documented roles of mid-level managers were decision-making or problem-solving, strategist or negotiator and communicator. Others included being a therapist or motivator, goal setting or articulation and mentoring or coaching. In addition to these roles, the authors identified important personal attributes of a good manager, which included interpersonal skills, delegation and accountability, and honesty. Most studies included in the review concerned the roles that mid-level managers are expected to play in times of organisational change. The review highlights the possible significance of mid-level managers in achieving delivery of high-quality services in Kenyan public hospitals and strongly suggests that approaches to strengthen this level of management will be valuable. The findings from this review should also help inform empirical studies of the roles of mid-level managers in these settings.