Human Resources

Transforming health professions’ education through in-country collaboration: examining the consortia among African medical schools catalyzed by the Medical Education Partnership Initiative
Talib ZM, Kiguli-Malwadde E, Wohltjen H, Derbew M, Mulla Y, Olaleye D, Sewankambo N: Human Resources for Health 2015, 13:1 doi:10.1186/1478-4491-13-1

African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward resources to support African medical schools. The Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning, through semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes. All of the consortia have prioritised efforts to increase the quality of medical education, support new schools in-country and strengthen relations with government. These in-country partnerships have enabled schools to pool and mobilise limited resources creatively and generate locally-relevant curricula based on best-practices. The established schools are helping new schools by training faculty and using grant funds to purchase learning materials for their students. The consortia have strengthened the dialogue between academia and policy-makers enabling evidence-based health workforce planning. All of the partnerships are expected to last well beyond the MEPI grant as a result of local ownership and institutionalisation of collaborative activities. The consortia demonstrate a paradigm shift in the relationship between medical schools. While schools in Africa have historically worked in silos, competing for limited resources, MEPI funding has created a culture of collaboration, with positive impact reported on the quality and efficiency of health workforce training. It suggests that future funding for global health education should prioritise such south-south collaborations.

A Community Health Worker “logic model”: towards a theory of enhanced performance in low- and middle-income countries
Naimoli JF, Frymus DE, Wuliji T, Franco LM and Newsome MH: Human Resources for Health12(56), 2014

There has been a resurgence of interest in national Community Health Worker (CHW) programs in low- and middle-income countries (LMICs). A lack of strong research evidence persists, however, about the most efficient and effective strategies to ensure optimal, sustained performance of CHWs at scale. To facilitate learning and research to address this knowledge gap, the authors developed from document review and consultations a generic CHW logic model that proposes a theoretical causal pathway to improved performance. The logic model draws upon available research and expert knowledge on CHWs in LMICs. The generic CHW logic model posits that optimal CHW performance is a function of high quality CHW programming, which is reinforced, sustained, and brought to scale by robust, high-performing health and community systems, both of which mobilize inputs and put in place processes needed to fully achieve performance objectives. Multiple contextual factors can influence CHW programming, system functioning, and CHW performance.The model is argued to offer new thinking about CHWs. It places CHW performance at the center of the discussion about CHW programming, recognizes the strengths and limitations of discrete, targeted programs, and is comprehensive, reflecting the current state of both scientific and tacit knowledge about support for improving CHW performance. It offers guidance for continuous learning about what works.

Community health workers programme in Luanda, Angola: an evaluation of the implementation process
Giugliani C, Duncan BB, Harzheim E, Lavor AC, Lavor MC, Machado MM, Barbosa MI, Bornstein VJ, Pontes AL and Knauth DR: Human Resources for Health 12(68), 9 December 2014

The Community Health Workers (CHWs) Programme was launched in Luanda, Angola, in 2007 as an initiative of the provincial government. The aim of this study was to assess its implementation process. This is a case study using document analysis, CHWs reports, individual interviews and focal groups. Until June 2009, the programme had placed in the community 2548 trained CHWs, providing potential coverage for 261 357 families. Analysis of qualitative data suggested an association of CHWs with improvements in maternal and child access to health care, as well as an increase in the demand for health services, generating further need to improve service capacity. Nevertheless, critical points for programme sustainability were identified. For continuity and scaling up, the programme needs medium- and long-term technical, political and financial support.

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia
Bazant E, Sarkar S, Banda J, Kanjipite W, Reinhardt S, Shasulwe H, Mulilo JMC, Kim YM: Human Resources for Health, 13 (1), 14 January 2015

At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers’ work environment and perceived quality of HIV-related care were assessed to complement data on provider performance. The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. The intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale. The performance and quality improvement intervention implemented at Zambian Defence Forces’ health facilities was associated with improvements in providers’ perceptions of work environments consistent with the intervention’s focus on commodities, skills acquisition, and receipt of constructive feedback.

A scoping review of training and deployment policies for human resources for health for maternal, newborn, and child health in rural Africa
Tomblin Murphy G, Goma F, MacKenzie A, Bradish S, Price S, Nzala S, Elliott Rose A, Rigby J, Muzongwe C, Chizuni N, Carey A and Hamavhwa D: Human Resources for Health 12(72), December 2014

Most African countries lack the required workforce to deliver basic health care, including care for mothers and children. This is especially acute in rural areas and has limited countries' abilities to meet maternal, newborn, and child health (MNCH) targets outlined by Millennium Development Goals 4 and 5. To address the challenges, evidence-based deployment and training policies are required. However, the resources available to country-level policy makers to create such policies are limited. A scoping review was conducted to identify the type, extent, and quality of evidence that exists on workforce policies for rural MNCH in Africa. Fourteen electronic health and health education databases were searched for peer-reviewed papers specific to training and deployment policies for doctors, nurses, and midwives for rural MNCH in African countries with English, Portuguese, or French as official languages. Non-peer reviewed literature and policy documents were also identified through systematic searches of selected international organizations and government websites. There was an overall paucity of information on workforce training and deployment policies for MNCH in rural Africa. Policies focusing exclusively on training or deployment were limited; most documents focused on both training and deployment or were broader with embedded implications for workforce management or MNCH. Relevant government websites varied in functionality and in the availability of policy documents.

Overcoming the Health Workforce Gap
Peoples Health Movement: Global Health Watch, November 2014

In this new piece, Remco van de Pas and Linda Mans, researchers in public health, draw attention to a key chapter, titled ‘The Global Health Workforce Crisis’, of the latest edition of the Alternative World Health Report, Global Health Watch 4. They argue that overcoming the health work force gap is one of the key lessons we should learn from the current Ebola outbreak.
The chapter of GHW4 discusses how 'ceilings’ in the public wage bill imposed by the International Monetary Fund in Africa have contributed to migration of health workforce from the continent towards northern countries. It provides shocking numbers on the cost of health workforce training to governments in the south, and corresponding subsidy to governments in the north. The chapter also highlights that concerns of ‘economic efficiency’ threaten reducing health workers' role to undertaking selective diagnosis and treatment. It concludes that a strong health workforce, supported by public funds, is a requirement for strong, universal health systems.

Rwanda's evolving community health worker system: a qualitative assessment of client and provider perspectives
Condo J, Mugeni C, Naughton B, Hall K, Antonia Tuazon M, Omwega A, Nwaigwe F, Drobac P, Hyder Z, Ngabo F and Binagwaho A: Human Resources for Health 12(72), December 2014

In Rwanda, which faces a significant gap in health workers, the Ministry of Health expanded its community health programme in 2007, eventually placing 4 trained CHWs in every village in the country by 2009. The aim of this study was to assess the capacity of CHWs and the factors affecting the efficiency and effectiveness of the CHW programme, as perceived by the CHWs and their beneficiaries. A cross-sectional descriptive study was conducted using focus group discussions to collect qualitative information regarding educational background, knowledge and practices of CHWs, and the benefits of community-based care as perceived by CHWs and household beneficiaries. A random sample of 108 CHWs and 36 beneficiaries was selected in 3 districts according to their food security level (low, middle and high). CHWs were found to be closely involved in the community, and widely respected by the beneficiaries. Rwanda's community performance-based financing was an incentive, but CHWs were also strongly motivated by community respect. The key challenges identified were an overwhelming workload, irregular trainings, and lack of sufficient supervision.

Health labour market policies in support of universal health coverage: a comprehensive analysis in four African countries
Sousa A, Scheffler R, Koyi G, Ngah Ngah S, Abu-Agla A, M’kiambati H, Nyoni J: Human Resources for Health 12(55), 26 September 2014

Progress toward universal health coverage in many low- and middle-income countries is hindered by the lack of an adequate health workforce that can deliver quality services accessible to the entire population. The authors used a health labour market framework to investigate the key indicators of the dynamics of the health labour market in Cameroon, Kenya, Sudan, and Zambia, and identified the main policies implemented in these countries in the past ten years to address shortages and maldistribution of health workers. Despite increased availability of health workers in the four countries, major shortages and maldistribution persist. Several factors aggravate these problems, including migration, an aging workforce, and imbalances in skill mix composition. In this paper, the authors provide new evidence to inform decision-making for health workforce planning and analysis in low- and middle-income countries. Partial health workforce policies are not sufficient to address these issues. It is argued top be crucial to perform a comprehensive analysis in order to understand the dynamics of the health labour market and develop effective polices to address health workforce shortages and maldistribution as part of efforts to attain universal health coverage.

Free State’s Community Health Workers’ Case Postponed to 29 January 2015
Sangonet pulse: October 14 2014

Over a hundred community health workers (CHW)’s and the members of the Treatment Action Campaign appeared at the Bloemfontein Magistrate’s Court today, regarding their criminal charges following their arrest at a peaceful vigil on 10 July 2014. The 129 community health care worker’s case was postponed to the 29th of January 2015. The South African Police Services (SAPS) arrested the CHW’s in the early hours of the 10th of July, during a peaceful vigil through which they were protesting the crumbling state of the public health system in Free State, their poor conditions of employment, and the 15 June’s autocratic decision of the MEC for Health in the Free State department of Health, Benny Malakoane to effectively terminate their employment without warning. The postponement is meant for the prosecution to provide the CHW’s the evidence against them and for the CHW’s to make representations to the National Director of Public Prosecutions, Mxolisi Nxasana, that the charges should be unconditionally withdrawn.

Heroes dressed in white
Hernández LM: Pambazuka October 2914

Cuba recently sent a medical team of 165 internationalist collaborators, consisting of 63 doctors and 102 nurses from across the country, with more than 15 years practical experience and of which 81 % had served on previous international missions. They went to Sierra Leone to support efforts to contain the Ebola outbreak. It is a mission they made clear were happy to undertake that goes to the heart of Cuba’s people-to-people solidarity. The author argues that is affirms that Cuba doesn’t give what it has left over, but its most precious commodity: its sons, its heroes in white coats.