Health MEC, Sibongiseni Dhlomo, says that South Africa should produce about 8,000 doctors annually to meet the dire shortage at public hospitals. He referred to a programme to study medicine in Cuba, which targets students mainly from underprivileged areas who would otherwise not have had the financial means for the studies. Dhlomo said universities were not producing enough doctors, which was contributing to the discrepancies in the country's health care system. ‘Producing 200 doctors per university per year is not good enough. We will be speaking to deans and pushing universities to produce at least 2,000 doctors annually, starting in the next year or two,’ he said. Dhlomo said the country had a total of about 8,000 doctors employed by the Health Department. However, he said Limpopo would be able to meet its doctor-patient ratio if all 8,000 doctors were deployed in that province.
Human Resources
The authors of this study conducted a survey among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes. Nurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunisation campaigns for polio and measles. This study shows that nurses and midwives play an important role in implementing immunisation activities at the district level and that their roles can be maximised by creating opportunities that lead to their having more responsibilities in their work and in particular, their involvement in early phases of planning of priority health activities. This should be accompanied by written job descriptions, tasks and clear lines of authority as well as good supportive supervision. The lessons from supplementary immunisation activities, where the roles of nurses and midwives are maximised, can be easily adopted to benefit the rest of the health services provided at district level.
This study sought to identify task shifting that has already occurred and assess the antiretroviral therapy (ART) training needs among clinicians to whom tasks have shifted. It surveyed health professionals and heads of ART clinics at a stratified random sample of 44 health facilities accredited to provide this therapy. A sample of 265 doctors, clinical officers, nurses and midwives reported on tasks they performed. Thirty of 33 doctors (91%), 24 of 40 clinical officers (60%), 16 of 114 nurses (14%) and 13 of 54 midwives (24%) reported that they prescribed ART. Yet, 64% of the people who prescribed antiretroviral therapy were not doctors. Seven percent of doctors, 42% of clinical officers, 35% of nurses and 77% of midwives assessed that their overall knowledge of antiretroviral therapy was lower than good. The study concluded that training initiatives should be an integral part of the support for task shifting, while making sure that ART is used correctly and toxicity or drug resistance do not reverse accomplishments to date.
Health care in South Africa’s rural areas is set to get a major boost, following the launch of the Centre for Rural Health by Wits University, in Johannesburg, recently. The centre’s inaugural Director, Prof Ian Couper, said the centre’s main focus is to ‘recruit human resources for rural health. We can do everything in terms of providing facilities, we can make sure the drug supplies are there, but unless we have the health workers, all of that will mean nothing. The centre is trying to focus on multiple strategies: selecting students in rural areas and supporting them to study health sciences, developing post graduate programmes, researching issues around how we can improve resources for rural health and advocacy to bring these issues to the attention of policy makers, politicians and other stake-holders.’ Deputy Health Minister, Dr Molefi Sefularo, expressed gratitude to the university for highlighting issues relating to rural health. ‘We would like you to become a leading academic centre in the field of human resources for rural health’, he said.
This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors to rural and remote areas. A comprehensive search of the English literature was conducted, 1,261 references were identified and screened and 110 articles were included. The study argues for the formulation of universal definitions to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. There remains an urgent need to evaluate the impact of untested interventions in a scientifically rigorous fashion in order to identify winning strategies for guiding future practice and policy.
Hundreds of lay health care workers are deployed in Kenyan communities to fill the gap caused by severe staff shortages in the health sector – but could they be doing more harm than good? Some lay health workers even dispense antiretroviral (ARV) drugs, but health experts have warned that using unqualified personnel to perform medical functions may not be such a good idea. Dr Andrew Suleh, chairman of the Kenya Medical Association, said lay counsellors should not become a long-term replacement for professional health workers. ‘The government must be pressured to train, employ and retain health professionals to ease the disease burden exerted on the health care workers by the twin challenges of HIV and TB – the management and care of HIV and AIDS is very labour intensive,’ he said. Most lay counsellors were volunteers employed by non-governmental organisations whose projects could end, leaving the country with even bigger shortages of health workers. ‘You cannot base health management on volunteerism; it is not sustainable,’ Suleh added.
This paper draws on studies of financial incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial incentive programmes aimed at retaining staff in underserved areas: using innovative financing; promoting health as a career; introducing specific selection criteria to ensure programme success and achieve goals; ensuring correct placement of new employees; offering support by staying in close contact with participants throughout enrolment and assigning them mentors; enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and routine performance evaluation of programmes. To improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible.
This paper uses a forecasting model to estimate the need for, supply of, and shortage of doctors, nurses, and midwives in thirty-nine African countries for 2015, the target date of the United Nations Millennium Development Goals. It forecasts that thirty-one countries will experience needs-based shortages of doctors, nurses, and midwives, totalling approximately 800,000 health professionals. It further estimates the additional annual wage bill required to eliminate the shortage at about US$2.6 billion, more than 2.5 times current wage-bill projections for 2015. Additional funds would be required to hire health care support staff, train and support staff, and pay for expenses. Raising the money required to eliminate the shortfall would be difficult for the countries involved, even under the most optimistic assumptions regarding economic growth and governmental commitments to the health sector. Global aid can help but will still not provide enough resources, the researchers say. They call for changes in the skills mix, worker incentives and improvements in training for health care workers.
Ugandan health workers are dissatisfied with their jobs, especially their compensation and working conditions, says this study. It found a shocking statistic – about one in four health workers, which includes half of all physicians, would like to leave the country. What can be done about this medical brain drain? The researchers urge that strategies for strengthening the health care workforce in Uganda should focus on salary and benefits, especially health coverage. Poor working conditions and excessive workloads should also be dealt with. Facility infrastructure needs to be upgraded to provide a decent work environment, including the supply of water and electricity. Management needs to be improved, as well as workforce camaraderie.
The successful continuation of existing HIV care and treatment programmes is threatened by health care worker burnout and HIV-related illness. This study, conducted between March to June 2007, looks at occupational burnout and utilisation of HIV services among health providers in the Lusaka public health sector. Providers from thirteen public clinics were given a 36-item, self-administered questionnaire and invited for focus group discussions and key informant interviews. Focus group participants described burnout as feeling overworked, stressed and tired. In the survey, 51% reported occupational burnout. Risk factors were having another job and knowing a co-worker who left in the last year. Both discussion groups and survey respondents identified confidentiality as the prime reason for not undergoing HIV testing. In Lusaka primary care clinics, overwork, illness and death were common reasons for attrition. Programmes to improve access, acceptability and confidentiality of health care services for clinical providers and to reduce workplace stress could substantially benefit workforce stability.