Participatory research approaches such as the Health Workers for Change (HWC) initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. This study evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania. Six workshops were held, attended by 29 of 31 trained nurses and nurse attendants working on the paediatric ward. Two focus-group discussions were held with the workshop participants six months after the intervention. Some improvement was reported in the responsiveness of nurses to client needs (41.2% of parents were satisfied, up from 38.9%). But nurses felt hindered by persisting problems in their working environment, including poor relationships with other staff and a lack of response from hospital administration to their needs.
Human Resources
Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload.
According to this survey, more than half of nurses (53%) in South Africa said their workload was worse today when compared to five years ago. Nurses in South Africa indicated that the least favourable aspects of their profession were overwhelming workloads (32%), insufficient pay and benefits (22%), lack of recognition (11%), budget cuts and inadequate health care systems (11%). In contrast, the most favourable aspect was patient contact (39%). In South Africa, as in other countries surveyed, most nurses (85%) said they faced time constraints that prevented them from spending as much time with individual patients as they thought necessary. Some 87% of the nurses surveyed in South Africa said spending more time with individual patients would have a significant impact on patient health. On the plus side, they saw their professional associations as effective in advancing their interests (86%) and supportive of their needs (87%), and 63% perceived the nation's health care system as better than it was five years ago.
Migration has been one of the more important means of greater global integration, and, as the economic crisis has gripped the developed world, many have worried about its impact on such integration, especially falling remittances. A closer examination of the nature of migrant workers' role in the economy suggests more complex outcomes, with somewhat less of an impact than feared. It is true that most of this migration has been driven by economic forces and has given rise to rapidly expanding remittance flows, which have become the most important source of foreign exchange for many developing countries. The International Monetary Fund estimated total remittance flows to developing countries to be nearly US$300 billion in 2009, significantly more than all forms of capital flows put together. In any case, one of the basic pull factors still remains significant: the demographic transition in the North that is increasing the share of the older population that requires more care from younger workers, who must therefore come from abroad. So the current crisis may temporarily slow down the ongoing process of international migration for work, but it is unlikely to reverse it.
This study analysed data from a human resources health facility survey conducted in 2005 in 52 health centres and 22 public hospitals (including all provincial hospitals) across all eight provinces in Kenya. The study looked into the status of attrition rates and the proportion of attrition due to retirement, resignation or death among doctors, clinical officers, nurses and laboratory and pharmacy specialists in surveyed facilities. Results showed that overall health workers attrition rates from 2004 to 2005 were similar across type of health facility: provincial hospitals lost on average 4% of their health workers, compared to 3% for district hospitals and 5% for health centres. The main reason for health worker attrition (all cadres combined) at each level of facility was retirement, followed by resignation and death. Appropriate policies to retain staff in the public health sector may need to be tailored for different cadres and level of health facility. Further studies, perhaps employing qualitative research, need to investigate the importance of different factors in the decision of health workers to resign.
South African (SA) public servants, including doctors and nurses, are demanding a 15% wage increase across the board and want this year's pay talks to centre on the creation of ‘decent work’. Although SA is now under a new administration, one which is considered to be worker friendly, government spokesman Themba Maseko said after a Cabinet briefing earlier this month that the state would make its shrinking spending power known when the wage negotiations started. This year's wage negotiations are likely to be intense considering SA is in its first recession in seventeen years and that the state has still not made good on its occupation specific dispensation (OSD) offer on pay structures agreed to during the last talks in 2007. If the state spent all its money on wage increases, nothing would be left for essential services like textbooks and medical supplies, Maseko said. The state has not yet made known what increases it is willing to offer its employees and is expected to respond to their shortly.
This study attempts to assess if and how informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and, where possible, focus groups were divided by cadre. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem, with fear of detection as a main demotivating factor. Informal payments were not found to be related to retention of health workers in the public health system. The findings suggest that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed.
This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors in rural and remote areas. A comprehensive search identified 1,261 references and, of these, 110 articles were included. Available evidence was classified into five intervention categories: selection, education, coercion, incentives and support. The review argues for the formulation of universal definitions for the above categories 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.
In January, 2009, the World Health Organization’s (WHO) Executive Board considered the adoption of a global code of practice to address the movement of health workers from developing countries, the ‘WHO Draft Code of Practice for the International Recruitment of Health Workers’. This attention to brain drain is welcome, but the initiative does not begin to adequately address the consequences or roots of health-worker migration from sub-Saharan Africa to the rich developed world, especially to the United Kingdom, United States and Canada. The movement of skilled health workers constitutes a major transfer of riches from poor societies to the affluent, and the only appropriate redress is a bilaterally managed scheme of direct reimbursement of the value lost, along the lines proposed by Mensah and colleagues in 2005.
This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. Quantitative and qualitative data were collected by means of semistructured interviews from all active lay counsellors in each of the facilities, including a facility manager or counselling supervisor, and through focus group discussions with health care workers at each facility. The study found that lay counsellors provide counselling and testing services of quality and relieve the workload of overstretched health care workers, providing up to 70% of counselling and testing services at health facilities. The data review revealed lower error rates for lay counsellors, compared to health care workers, in completing the counselling and testing registers.