The objective of this study was to assess the extent to which the Health Economics Unit (HEU) has contributed to the development of health economics capacity in sub-Saharan Africa through the provision of Master’s and PhD programmes since the 1990s. The evaluation was based on a document review and 25 key informant interviews – with Master’s and PhD graduates, HEU staff members with management roles, beneficiaries of HEU’s internal capacity-building initiatives and international experts. The programmes have so far graduated 115 Master’s and 15 PhD graduates in health economics. Feedback from graduates indicated they are largely satisfied with the programmes. Most graduates are retained in the region if not in their home countries and find employment in a post that uses at least some of the skills gained during the programme, although not necessarily strictly in health economics. In terms of overall financial sustainability of HEU’s post-graduate programmes, SIDA funding has come to an end, which means there is a need to pursue financial support from the University in line with the usual funding of post-graduate training. The policy brief also makes some recommendations for improving future programmes.
Human Resources
With much smaller numbers relative to their counterparts in developed countries, pharmacists in developing countries tend to keep to the confines of dispensing roles mainly in community pharmacies. In this article the authors challenge these pharmacists to move away from the dispensing window and to demonstrate the value of the years invested in pharmacy schools to improve the well-being of communities. In Africa, another reason why pharmacy must be proactive in assuming service- and systems-based roles is the fact that physicians are often overloaded with clinical duties. By demonstrating that they can competently assume these roles and complement physicians in providing quality healthcare services, pharmacists have ready-made opportunities to enhance their role in the community. To arrest the waning image of the profession in Africa, there is need to identify service opportunities that would perpetuate the continued relevance of the profession to health systems and communities. Even though new opportunities in the areas of public health, pharmaceutical supply chain management, pharmacovigilance, regulation, management, rational drug use and others are emerging in different forms and designs, pharmacists appear slow to seize these opportunities. Changes in mind sets, perceptions, curricula and teaching methodologies are required, the article concludes.
A workshop on enhancing the global workforce for vaccine manufacturing was organised by the World Health Organisation from the 30 November to 2 December 2011, in Cape Town, South Africa. This workshop was attended by representatives from academia, pharmaceutical industries, research institutions, non-governmental organisations and regulatory agencies. A recurring theme during the discussions was the notion that international support for establishing or strengthening vaccine production capacity in developing and emerging economy countries must also include appropriate efforts to train and retain a skilled local workforce. A highly skilled workforce will support long term sustainability and viability of the operations of developing country vaccine manufacturers. Due to the synergies/similarities between the vaccine production workforce and the workforce producing other biological drugs, participants at the workshop argued that the two labour forces could complement each other during times of critical need. The management model of the biological drug manufacturing workforce could also serve as a benchmark for training, recruitment and retention policies.
The Sub-Saharan African Medical Schools Study (SAMSS) survey is a descriptive survey study of sub-Saharan African medical schools. Surveys were distributed to 146 medical schools in 40 of 48 sub-Saharan African countries. One hundred and five responses were received (72% response rate). Enrolments for medical schools ranged from 2 to 1,800 and graduates ranged from 4 to 384. Seventy-three percent of respondents increased first-year enrolments in the past five years. On average, 26% of respondents’ graduates were reported to migrate out of the country within five years of graduation. The most significant reported barriers to increasing the number of graduates and improving quality were related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower levels of loss of faculty staff. Strengthened institutional research tools and funded faculty research time were also linked to greater faculty involvement in research. The results of the SAMSS survey are intended to serve as a baseline for future research, policies and investment in the health care workforce in the region.
Africa lacks a system for defining, co-ordinating and growing the human resources for health research (HRHR) needed to support its health systems development, according to this review. The authors found that research consists of unco-ordinated, small-scale activities, primarily driven from outside Africa. They present examples of ongoing HRHR capacity building initiatives in Africa. There is no overarching framework, strategy or body for African countries to optimise research support and capacity in HRHR. A simple model is presented to help countries plan and strategise for a comprehensive approach to research capacity strengthening. Everyone engaged with global, regional and national research for health enterprises must proactively address human resource planning for health research in Africa, the authors argue. Unless this is made explicit in global and national agendas, Africa will remain only an interested spectator in the decisions, prioritisation, funding allocations, conduct and interpretation, and in the institutional, economic and social benefits of health research, rather than owning and driving its own health research agendas.
This paper reports on a survey of 415 South African doctors in Canada conducted in 2009-2010, representing almost 20% of the total number working in Canada. The researchers found that, while this group of South African professionals are proud to think of themselves as South African and take a relatively keen interest in events in that country, they are largely disengaged from any serious diasporic interest in and commitment (beyond contact with and some limited support for family members who remain). Amounts remitted by South African physicians are small in comparison to their incomes and remitting is infrequent, differing markedly in their remitting behaviour from physicians from other African countries and from African diasporas in general, where remittances are significant. More than half expressed no interest in returning to South Africa to help with nation building. Only 7% said they are likely to return within the next two years and another 10% within the next five years. Almost without exception, the respondents painted a very negative picture of life in South Africa and they do not see any role for themselves in helping address the country’s deep social and economic inequalities and needs. The findings of this study challenge assertions by neo-liberal economists that the negative impacts of the ‘medical brain drain’ in Africa are highly exaggerated and there is adequate compensation in the form of remittances, direct investment, knowledge and skills transfer, return migration and involvement in diaspora associations.
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”.
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.