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.
Human Resources
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.
This study aimed to describe perceptions of medical students, recent medical graduates, faculty of the College of Medicine, University of Malawi and private medical practitioners (PMPs) towards an attachment of undergraduate medical students in private medical doctors' offices. A qualitative cross-sectional study was conducted in Blantyre, Malawi in 2004 using in-depth key informant interviews and content analysis. In general, private medical practitioners were favourable to the idea of having medical students within their consulting offices while the majority of students, recent graduates and faculty opposed, fearing compromising teaching standards. Private medical practitioners (PMPs) were seen as outdated in skills and knowledge. Faculty, medical students and recent graduates of the Malawi College of Medicine do not perceive PMPs as a resource to be tapped for the training of medical students.
This paper set out to estimate systematically the inflow and outflow of health workers in Africa and examine whether current levels of pre-service training in the region suffice to address this serious problem. Most data came from the 2005 WHO health workforce and training institutions' surveys. The study was restricted to 12 countries in sub-Saharan Africa. It found that the health workforce shortage in Africa is even more critical than previously estimated. In 10 of the 12 countries studied, current pre-service training is insufficient to maintain the existing density of health workers once all causes of attrition are taken into account - it would take 36 years for physicians and 29 years for nurses and midwives to reach WHO's recent target of 2.28 professionals per 1,000 population for the countries taken as a whole - and some countries would never reach it.
As part of ART services expansion in Lusaka, Zambia, this study implemented a comprehensive task-shifting programme among existing health providers and community-based workers. It provides on-going quality assessment using key indicators of clinical care quality at each site. Programme performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. Ongoing quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. The task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful so far, long-term solutions to the human resource crisis are urgently needed.