The United States (US), with its high salaries and technological innovation, is the world’s most powerful magnet for doctors, according to this article, attracting more every year than Britain, Canada and Australia combined. Some of the responsibility for the migration of health care workers lies with the immigration laws in the host countries. For example, in the US, some states may grant waivers to foreign doctors if they agree to practice in communities where doctors are in short supply. The author compares Zambia and the US, acknowledging that salaries and working conditions in a country like Zambia are never going to match those in the US, and considers some of the factors that influence a person’s decision to emigrate, such as family ties, the cost of living and home language. There are signs of change, as doctors from Ghana, who used to mass emigrate to the US, now prefer to stay home as salaries rose enough to weigh the scales in favour of staying. Although there are foreign-funded initiatives to train and recruit doctors, such as a project funded by the Global Fund to help Zambia recruit and retain doctors, these solutions can create further problems. For example, many of the doctors hired by aid agencies are doing research and don’t see patients so they don’t contribute to improving health services. Frustrated public health officials in Zambia and other developing countries call this the “internal brain drain”.
Human Resources
Over the past half decade South Africa has been developing, implementing and redeveloping its lay health worker (LHW) policies. The aim of this study was to explore contemporary LHW policy development processes and the extent to which issues of gender are taken up within this process. Eleven policy actors (policy makers and policy commentators) were interviewed individually. From the interviews it seems that gender as an issue never reached the policy making agenda. Although there was strong recognition that the working conditions of LHWs needed to be improved, poor working conditions were not necessarily seen as a gender concern. On the positive side, the authors note that LHW policy redevelopment was focused on resolving issues of LHW working conditions through an active process involving many actors and strong debates. But, within this process the issue of gender had no champion and never reached the LHW policy agenda.
Healthcare workers in South African healthcare facilities work in environments with a high density of tuberculosis patients due to the dual burden of tuberculosis and human immunodeficiency virus in the population, thus predisposing them to contracting tuberculosis. Despite the knowledge of the high tuberculosis incidence and the likelihood of tuberculosis transmission to both health care workers and patients, and the availability of basic infection control measures in our healthcare facilities, there is still inadequate implementation of infection control measures in healthcare facilities, according to this paper. The authors review the knowledge base, instruments for tuberculosis control, the implementation of these tools and the knowledge gaps within the healthcare system in South Africa. A comprehensive review of scholarly literature was conducted based on Internet search engines. The review revealed the availability of adequate knowledge and tools for the control of tuberculosis in healthcare facilities, but inadequate implementation of infection control measures.
This study aimed to assess the policy and programmatic implications of task shifting in Uganda. This was a qualitative, descriptive study through 34 key informant interviews and eight focus group discussions, with participants from various levels of the health system. Policy makers understood task shifting, but front-line health workers had misconceptions on the meaning and intention(s) of task shifting. There was apparently high acceptance of task shifting in HIV and AIDS service delivery, with involvement of community health workers (CHW) and people living with HIV and AIDS (PLWHAs) in care and support of AIDS patients. There was no written policy or guidelines on task shifting, but the policy environment was reportedly conducive with plans to develop a policy and guidelines on task shifting. The study identifies a number of factors favouring task shifting and barriers. There were widespread examples of task in Uganda, and task shifting was mainly attributed to HRH shortages coupled with the high demand for healthcare services. The authors emphasise a need for clear policy and guidelines to regulate task shifting and protect those who undertake delegated tasks.
The aim of this study was to estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Researchers included nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. In the nine source countries the estimated government subsidised cost of a doctor’s education ranged from US$21 000 in Uganda to $58 700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn, with costs for each country ranging from $2.16m for Malawi to $1.41bn for South Africa. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). Destination countries should consider investing in measurable training for source countries and strengthening of their health systems, the authors conclude.
The human resource crisis affects developed and developing countries, but the global poor suffer disproportionately, not only because they have a much smaller workforce but also because their needs are so much greater, according to this paper. Of the 57 countries with critical shortages, 36 are in Africa. Africa has 25% of the world’s disease burden, but only 3% of the world’s health workers and 1% of the economic resources. The causes of the human resource shortages are multifaceted and complex, but not so complex that they cannot be understood and acted upon, the authors argue. They make several recommendations. The United States (US) administration, using an “all-of-government” approach, should develop a strategic plan to address the global health worker shortage. The US government should also reform US global health assistance programmes to increase health workforce capacity in partner countries, as well as increase financial assistance for global health workforce capacity development. Finally, Congress should empower the Department of Health and Human Services or another appropriate agency to regulate the recruiters of foreign-trained health workers.
Lesotho faces a severe human resource shortage as it attempts to manage its HIV pandemic, with more than 25% of the population infected with HIV. This paper reports on a programme that provided HIV services in seven rural clinics in Lesotho. LHWs played an important role in the provision of HIV services that ranged from translation, adherence counseling, voluntary counseling and testing (VCT) for HIV and patient triage, to medication distribution and laboratory specimen processing. Training the LHWs was part of the clinic physicians' responsibilities and thus required no additional funding beyond regular clinic operations. This lent sustainability to the training of the LHWs. This paper describes the recruitment, training, activities, and perceptions of the LHW work between June 2006 and December 2008. LHWs participated successfully in the care of thousands of people with HIV in Lesotho and their experience can serve as a model for other countries facing the disease, the authors conclude.
The objective of this study was to determine the percentage of South African nurses initiating new HIV-positive patients on therapy within two months of attending the Nurse Initiation and Maintenance of Antiretroviral Therapy (NIMART) course, and to identify possible barriers to nurse initiation. A brief telephonic interview using a structured questionnaire of a randomly selected sample (126/1736) of primary care nurses who had attended the NIMART course between October 2010 and 31 March 2011 at primary care clinics in seven provinces. Outcome measures were the number of nurses initiating ART within two months of attending the FPD-facilitated NIMART course. Results showed that, of the nurses surveyed, 62% (79/126) had started initiating new adult patients on ART, but only 7% (9/126) were initiating ART in children. The main barrier to initiation was allocation to other tasks in the clinic as a result of staff shortages. In conclusion, despite numerous challenges, many primary care nurses working in the seven provinces surveyed have taken on the responsibility of sharing the task of initiating HIV-positive patients on ART. The barriers preventing more nurses initiating ART include the shortage of primary care nurses and the lack of sufficient consulting rooms. Expanding clinical mentoring and further training in clinical skills and pharmacology would assist in reaching the target of initiating a further 1.2 million HIV-positive patients on ART by 2012.
In this study, researchers examined the performance of community antiretroviral therapy and tuberculosis treatment supporters (CATTS) in scaling up antiretroviral therapy (ART) in Reach Out, a community-based ART program in Uganda. Retrospective data on home visits made by CATTS were analysed to examine the CATTS ability to perform home visits to patients based on the model's standard procedures. Qualitative interviews conducted with 347 randomly selected patients and 47 CATTS explored their satisfaction with the model. The CATTS ability to follow-up with patients worsened from patients requiring daily, weekly, monthly, to three-monthly home visits. Only 26% and 15% of them correctly home visited patients with drug side effects and a missed clinic appointment, respectively. Additionally, 83% visited stable pre-ART and ART patients (96%) more frequently than required. Six hundred eighty of the 3,650 (18%) patients were lost to follow-up (LTFU) during the study period. Ninety-two percent of the CATTS felt the model could be improved by reducing the workload. In conclusion, the Reach-Out CHW model may be too labour-intensive. Triaged home visits could improve performance and allow CATTS time to focus on patients requiring more intensive follow-up.
The aim of this study was to identify workforce ratios in nine allied health professions and to identify whether these measures are useful for planning allied health workforce requirements. A systematic literature search using relevant MeSH headings of business, medical and allied health databases and relevant grey literature for the period 2000-2008 was undertaken. Twelve articles were identified which described the use of workforce ratios in allied health services. Only one of these was a staffing ratio linked to clinical outcomes. The most comprehensive measures were identified in rehabilitation medicine. The authors conclude that evidence for use of staffing ratios for allied health practitioners is scarce and lags behind the fields of nursing and medicine.