Human Resources

Compulsory service programmes for recruiting health workers in remote and rural areas: Do they work?
Frehywot S, Mullan F, Paynea PW and Rossa H: Bulletin of the World Health Organization 88: 364–370, May 2010

Compulsory service programmes have been used worldwide as a way to deploy and retain a professional health workforce within countries. This study identified three different types of compulsory service programmes in 70 countries. These programmes are all governed by some type of regulation, ranging from a parliamentary law to a policy within the ministry of health. Depending on the country, doctors, nurses, midwives and all types of professional allied health workers are required to participate in the programme. Some of the compliance-enforcement measures include withholding full registration until obligations are completed, withholding degree and salary, or imposing large fines. This paper aims to explain these programmes more clearly, to identify countries that have or had such programmes, to develop a typology for the different kinds and to discuss the programmes in the light of important issues that are related to policy concepts and implementation. As governments consider the cost of investment in health professionals’ education, the loss of health professionals to emigration and the lack of health workers in many geographic areas, they are using compulsory service requirements as a way to deploy and retain the health workforce.

Compulsory service programmes for recruiting health workers in remote and rural areas: do they work?
Frehywot S, Mullan F, Payne PW and Ross H: Bulletin of the World Health Organization 88:350–356, May 2010

Compulsory service programmes have been used worldwide as a way to deploy and retain a professional health workforce within countries. Other names for these programmes include 'obligatory', 'mandatory', 'required' and 'requisite.' All these different programme names refer to a country’s law or policy that governs the mandatory deployment and retention of a heath worker in the underserved and/or rural areas of the country for a certain period of time. This study identified three different types of compulsory service programmes in 70 countries. These programmes are all governed by some type of regulation, ranging from a parliamentary law to a policy within the ministry of health. Depending on the country, doctors, nurses, midwives and all types of professional allied health workers are required to participate in the programme. Some of the compliance-enforcement measures include withholding full registration until obligations are completed, withholding degree and salary, or imposing large fines. This paper aims to explain these programmes more clearly, to identify countries that have or had such programmes, to develop a typology for the different kinds and to discuss the programmes in the light of important issues that are related to policy concepts and implementation. As governments consider the cost of investment in health professionals’ education, the loss of health professionals to emigration and the lack of health workers in many geographic areas, they are using compulsory service requirements as a way to deploy and retain the health workforce.

Conflicting priorities: Evaluation of an intervention to improve nurse-parent relationships on a Tanzanian paediatric ward
Manongi RN, Nasuwa FR, Mwangi R, Reyburn H, Poulsen A and Chandler CIR: Human Resources for Health, 23 June 2009

Participatory research approaches such as the Health Workers for Change (HWC) initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. This study evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania. Six workshops were held, attended by 29 of 31 trained nurses and nurse attendants working on the paediatric ward. Two focus-group discussions were held with the workshop participants six months after the intervention. Some improvement was reported in the responsiveness of nurses to client needs (41.2% of parents were satisfied, up from 38.9%). But nurses felt hindered by persisting problems in their working environment, including poor relationships with other staff and a lack of response from hospital administration to their needs.

Context counts: Training health workers in and for rural and remote areas
Strasser R and Neusy A: Bulletin of the World Health Organization 88(10): 777-782, October 2010

Access to well trained and motivated health workers is the major rural health issue. Without local access, it is unlikely that people in rural and remote communities will be able to achieve the Millennium Development Goals. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: a rural background; positive clinical and educational experiences in rural settings as part of undergraduate medical education; and targeted training for rural practice at the postgraduate level. This paper presents evidence for policy initiatives involving the training of medical students from, in and for rural and remote areas. It gives examples of medical schools in different regions of the world that are using an evidence-based and context-driven educational approach to producing skilled and motivated health workers. It demonstrates how context influences the design and implementation of different rural education programmes. Successful programmes have overcome major obstacles including negative assumptions and attitudes, and limitations of human, physical, educational and financial resources. Training rural health workers in the rural setting is likely to result in greatly improved recruitment and retention of skilled health-care providers in rural underserved areas with consequent improvement in access to health care for the local communities.

Contraceptive uptake after training community health workers in couples counselling: A cluster randomised trial
Lemani C; Tang J; Kopp D; Phiri B; Kumvula C; Chikosi L; Mwale M; Rosenberg N: PLoS One 12(4) e0175879, doi:https://doi.org/10.1371/journal.pone.0175879, 2017

Young women in Malawi face many challenges in accessing family planning, including distance to the health facility and partner disapproval. The author’s primary objective was to assess if training Health Surveillance Assistants in couples counselling would increase modern family planning uptake among young women. In this cluster randomised controlled trial, 30 Health Surveillance Assistants from Lilongwe, Malawi received training in family planning. The Health Surveillance Assistants were then randomised 1:1 to receive or not receive additional training in couples counselling. All Health Surveillance Assistants were asked to provide family planning counselling to women in their communities and record their contraceptive uptake over 6 months. Sexually-active women <30 years of age who had never used a modern family planning method were included in this analysis. Generalised estimating equations with an exchangeable correlation matrix to account for clustering by Health Surveillance Assistants were used to estimate risk differences and 95% confidence intervals. 430 (53%) young women were counselled by the 15 Health Surveillance Assistants who received couples counselling training, and 378 (47%) were counselled by the 15 Health Surveillance Assistants who did not. 115 (26%) from the couples counselling group had male partners present during their first visit, compared to only 6 (2%) from the other group. Nearly all (99.5%) initiated a modern family planning method, with no difference between groups. Women in the couples counselling group were 8% more likely to receive male condoms and 8% more likely to receive dual methods. Training Health Surveillance Assistants in family planning led to high modern family planning uptake among young women who had never used family planning. Couples counselling training increased male involvement with a trend towards higher male condom uptake.

Core competencies in human rights for health professionals
The University of Cape Town, School of Public Health and Family Medicine, Health and Human Rights Programme

The Health and Human Rights Programme at the University of Cape Town, South Africa, in conjunction with the Health Professions Council of South Africa, the South African Nursing Coulncil, the South African Medical Association and the Democratic Nurses Organisation, hosted a conference exploring what are Core Competencies in Human Rights for graduates in the health professions. The conference aimed to provide guidance to those bodies setting standards for our graduates as to what kinds of competencies and skills should be expected of doctors, nurses and other health professionals once they graduate from our training institutions. The conference took place from Wednesday 5th to Friday 7th July and helped to develop recommendations for curriculum standards for graduates in the health professions in South Africa.

Costing the scaling-up of human resources for health: Lessons from Mozambique and Guinea Bissau
Tyrrell AK, Russo G, Dussault G, Ferrinho P: Human Resources for Health 8(14), 25 June 2010

This paper reports on two separate experiences of costing for Human Resources Development Plans (HRDP) costing in Mozambique and Guinea Bissau, with the objective of providing an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on human resources costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved. From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process. The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process.

Cracks in ANC's alliance widening

DIVISIONS within the African National Congress (ANC), and between the Congress of SA Trade Unions (Cosatu) and the SA Communist Party (SACP) over privatisation have been thrown into sharp relief at a top-level meeting called to iron out differences in the alliance on the issue. The meeting came as the ANC tries to head off next month's anti privatisation strike by Cosatu. At the same time it is seeking consensus on the restructuring of state assets in the run-up to a two-day alliance meeting scheduled for August 17- 18.

Crisis and resilience at the frontline: Coping strategies of Kenyan primary health care managers in a context of devolution and uncertainty
Nyikuri M; Barasa E; Molyneux S; Tsofa B: Kemri Wellcome Trust Research Programme, Kenya, 2016

Primary health care (PHC) plays a vital role in maintaining population health, preventing suffering and providing coverage of essential services. In Kenya, primary health centres and dispensaries are often managed by the most senior clinical staff member at the facility who is responsible for performing both clinical and managerial duties. PHC managers, also known as in-charges, play a key role in the functioning of health services on a day-to-day basis. KEMRI-Wellcome Trust has conducted research in one of the 47 counties in Kenya to better understand the role and responsibilities of PHC managers and their coping strategies within the context of devolution and uncertainty. The key findings from the research are set out in this brief, as well as recommendations to support PHC managers. The research found that PHC managers carry out a variety of tasks to ensure facilities can function effectively. These include: developing annual work plans, ensuring coverage and delivery of services, providing leadership and management to frontline staff. Despite the challenges faced by PHC managers in the period since devolution, facilities remained open and functioning. A key support system for in-charges was the sub-county managers, some of whom had played the role of line managers to in- charges for decades.

Designing financial incentive programmes for return of medical service in underserved areas
Bärnighausen Till and Bloom DE: Human Resources for Health, 26 June 2009

Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload.

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