Human Resources

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.

In the shadowlands of global health: Observations from health workers in Kenya
Prince RL, Otieno P: Global Public Health, 9(8):927-945, September 2014

This paper draws on ethnographic research conducted in HIV clinics and in a public hospital to examine how health workers experience and reflect upon the juxtaposition of 'global' medicine with 'local' medicine. We show that health workers face an uneven playing field. High-prestige jobs are available in HIV research and treatment, funded by donors, while other diseases and health issues receive less attention. Outside HIV clinics, patient's access to medicines and laboratory tests is expensive, and diagnostic equipment is unreliable. Clinicians must tailor their decisions about treatment to the available medical technologies, medicines and resources. How do health workers reflect on working in these environments and how do their experiences influence professional ambitions and commitments? The need to improvise in the face of inadequate diagnostic tools and unreliable facilities was stressful for all health workers. Added to this stress was the degree to which health workers had to attend to patient poverty. While staff within HIV/AIDS clinics also faced these issues, hospital staff often found them overwhelming as they were confronted daily and relentlessly with the moral dilemma of how to deal with patients who could not afford treatment. In this situation, the strain of being forced to practice medicine that was only ‘good enough’ was a source of stress and frustration. Among interns, the moral complexity of their situation added to their uneasy positioning as young professionals struggling to gain a sense of professional identity and competence.

The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study

Motivation and job satisfaction have been identified as key factors for health worker retention and turnover in low- and middle-income countries. District health managers in decentralised health systems usually have a broadened 'decision space' that enables them to positively influence health worker motivation and job satisfaction, which in turn impacts on retention and performance at district-level. The study explored the effects of motivation and job satisfaction on turnover intention and how motivation and satisfaction can be improved by district health managers in order to increase retention of health workers. The authors conducted a cross-sectional survey in three districts of the Eastern Region in Ghana and interviewed 256 health workers from several staff categories (doctors, nursing professionals, allied health workers and pharmacists) on their intentions to leave their current health facilities as well as their perceptions on various aspects of motivation and job satisfaction. The effects of motivation and job satisfaction on turnover intention were explored through logistic regression analysis. Overall, 69% of the respondents reported to have turnover intentions. Motivation and job satisfaction were significantly associated with turnover intention and higher levels of both reduced the risk of health workers having this intention. The dimensions of motivation and job satisfaction significantly associated with turnover intention included career development, workload, management, organisational commitment and burnout. The authors’ findings indicate that effective human resource management practices at district level influence health worker motivation and job satisfaction, thereby reducing the likelihood for turnover. Therefore, they argue that it is worth strengthening human resource management skills at district level and supporting district health managers to implement retention strategies.

What elements of the work environment are most responsible for health worker dissatisfaction in rural primary care clinics in Tanzania?
Mbaruku GM, Larson E, Kimweri A and Kruk ME: Human Resources for Health (12)38: August 2014

In countries with high maternal and newborn morbidity and mortality, reliable access to quality healthcare in rural areas is essential to save lives. Health workers who are satisfied with their jobs are more likely to remain in rural posts. Understanding what factors influence health workers' satisfaction can help determine where resources should be focused. Although there is a growing body of research assessing health worker satisfaction in hospitals, less is known about health worker satisfaction in rural, primary health clinics. This study explores the workplace satisfaction of health workers in primary health clinics in rural Tanzania. Overall, 70 health workers in rural Tanzania participated in a self-administered job satisfaction survey. Results showed that 73.9% of health workers strongly agreed that they were satisfied with their job; however, only 11.6% strongly agreed that they were satisfied with their level of pay and 2.9% with the availability of equipment and supplies. Two categories of factors emerged from the PCA: the tools and infrastructure to provide care, and supportive interpersonal environment. Nurses and medical attendants (compared to clinical officers) and older health workers had higher satisfaction scale ratings. Two dimensions of health workers' work environment, namely infrastructure and supportive interpersonal work environment, explained much of the variation in satisfaction among rural Tanzanian health workers in primary health clinics. Health workers were generally more satisfied with supportive interpersonal relationships than with the infrastructure. Human resource policies should, it is argued, consider how to improve these two aspects of work as a means for improving health worker morale and potentially rural attrition