A descriptive, non-interventive, observational study design was used to audit of all public and private sector ICU and HCUs in South Africa to determine the profile and number of nurses working in South African intensive care units (ICUs) and high care units (HCUs); (ii) to determine the number of beds in ICU and HCUs in South Africa; and (iii) to determine the ratio of nurses to ICU/HC beds.This study demonstrates that ICU nursing in South Africa faces the challenge of an acute shortage of trained and experienced nurses. Nurses are tired, often not healthy, and are plagued by discontent and low morale.
Human Resources
National audit of critical care resources in South Africa – nursing profile
Scribante J, Bhagwanjee S: South African Medical Journal Vol. 97 (12): 1315-1318, 2007
New data on African Health Professionals Abroad
Clemens MA, Pettersson G: Human Resources for Health 6(1), 2008
The migration of doctors and nurses from Africa to developed countries has raised fears of an African medical brain drain. But empirical research on the causes and effects of the phenomenon has been hampered by a lack of systematic data on the extent of African health workers' international movements. This study uses destination-country census data to estimate the number of African-born doctors and professional nurses working abroad in a developed country circa 2000, and compares this to the stocks of these workers in each country of origin. About 65 000 African-born physicians and 70 000 African-born professional nurses were working overseas in a developed country in the year 2000. This represents about one fifth of African-born physicians in the world, and about one tenth of African-born professional nurses. The fraction of health professionals abroad varies enormously across African countries, from 1% to over 70% according to the occupation and country. The authors conclude that these numbers are the first standardised, systematic, occupation-specific measure of skilled professionals working in developed countries and born in a large number of developing countries.
Non-physician clinicians in 47 sub-Saharan African countries
Mullan F and Frehywot S: The Lancet 370(9605): 2158-2163, 22 December 2007
Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3–4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology, and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.
Reducing child deaths: the contribution of community health workers
Haines A: ID21 Health News,
Insufficient progress is being made towards the Millennium Development Goals, including those dealing with child and maternal mortality. At the current rate of progress in sub-Saharan Africa, the target of a two-thirds reduction in child mortality by 2015 will only be reached in 2165. Renewed interest in the potential contribution of community health workers may be timely. This study reviews the literature for evidence of whether community health workers are capable of carrying out the tasks required of them as part of a sustainable workforce. The study concluded that several factors influence programme impact and sustainability and determine whether child death reductions can be realised on a national scale: national socio-economic and political factors, community factors, health system factors and international factors. For instance, particularly if the political context is not a participatory democracy, support within the community for community health workers may be undermined by social class and caste divisions. Moreover, the success of a community health worker programme depends to a considerable extent on a successful interaction with the formal health services sector.
The three domains of public health: An internationally relevant basis for public health education�
Thorpe A, Griffiths S, Jewell T and Adshead F: Public Health 122(2): 201-210, February 2008
By focusing on the Masters of Public Health course, this study took a pragmatic approach to exploring the interface between public health education and public health practice. The commonly utilized ‘three domains of practice’ framework could provide a robust and explicit link between educational provision and practice for public health. This model provides the workforce, the university, the students and the potential funders of the course with an easily comprehensible framework for understanding how the modules of an MSc can support the development of competency within the context of practice.
Community health workers: a review of concepts, practice and policy concerns
Prasad BM and Muraleedharan VR: Consortium for Research on Equitable Health Systems, 2007
This paper, prepared for the International Consortium for Research on Equitable Health Systems, provides an overview of the concepts and practice of Community Health Workers (CHWs) in several developing and developed countries. In doing so it identifies critical factors that influence the overall performance of CHWs including gender, the nature of employment, career prospects and incentives, educational status and training. It finds that the selection of CHWs from the communities that they serve, population coverage and the range of services offered at the community levels are vital in the design of effective CHW schemes. The smaller the population coverage, the more integrated and intensive the service offered by CHWs.
Major surgery delegation to mid-level health practitioners in Mozambique: health professionals' perceptions
Cumbi A, Pereira C, Malalane R, Vaz F, McCord C, Bacci A and Bergstrom S: Human Resources for Health 5:27, 6 December 2007
This study examines the opinions of health professionals about the capacity and performance of the 'tecnico de cirurgia', a surgically trained assistant medical officer in the Mozambican health system. Particular attention is paid to the views of medical doctors and maternal and child health nurses. Health workers at all levels voiced satisfaction with the work of the "tecnicos de cirurgia". They stressed the life-saving skills of these cadres, the advantages resulting from a reduction in the need for patient referrals and the considerable cost reduction for patients and their families. Important problems in the professional status and remuneration of "tecnicos de cirurgia" were identified. This study, the first one to scrutinize the judgements and attitudes of health workers towards the "tecnico de cirurgia", showed that, despite some shortcomings, this cadre is highly appreciated and that the health delivery system does not recognize and motivate them enough. The findings of this study can be used to direct efforts to improve motivation of health workers in general and of tecnicos de cirurgia in particular.
Migrant remittances
Eldis
The movement of people across and within borders has characterised the development of most global regions, resulting in a rich intermingling of cultures. Such movement is often motivated by the desire for a better life, whether this entails finding new land to cultivate or money making opportunities. In recent years, the process of movement has itself been simplified, opportunities for work in services and industry have boomed and globally, numbers of migrants have increased dramatically . In response, an increasing number of studies are emphasising the impacts of migration, particularly for developing countries, in the form of remittances - money sent by migrant workers back to communities and households. This key issues page looks at some of these perceived impacts, and provides recommendations for further reading on the subject of migration and remittances.
Non-physician clinicians in 47 sub-Saharan African countries
Mullan F and Frehywot S: The Lancet 370 (9605): 2158-2163, 22 December 2007
Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3–4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology, and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.
Reducing child deaths: the contribution of community health workers
Haines A et al: The Lancet 369 (9579): 2121-2131
Insufficient progress is being made towards the Millennium Development Goals, including those dealing with child and maternal mortality. At the current rate of progress in sub-Saharan Africa, the target of a two-thirds reduction in child mortality by 2015 will only be reached in 2165. Renewed interest in the potential contribution of community health workers may be timely. Evidence suggests that over sixty percent of deaths in children under-five years could be prevented by interventions already in existence. Studies show that 41–72 percent of deaths in newborns are preventable using available interventions if there is high coverage, and about half of this reduction may be possible using community-based interventions. This study reviews the literature for evidence of whether community health workers are capable of carrying out the tasks required of them as part of a sustainable workforce. It concluded that several factors influence programme impact and sustainability and determine whether child death reductions can be realised on a national scale: national socio-economic and political factors, community factors, health system factors and international factors. For instance, particularly if the political context is not a participatory democracy, support within the community for community health workers may be undermined by social class and caste divisions.