Human Resources

Empowering primary care workers to improve health services: Results from Mozambique's leadership and management development programme
Perry C: Human Resources for Health 6(14), 23 July 2008

This article is the third in the Human Resources for Health journal's feature on the theme of leadership and management in public health leadership. It presents a successful application in Mozambique of a leadership development programme created by MSH, in which managers from 40 countries have learned to work in teams to identify their priority challenges and act to implement effective responses. From 2003 to 2004, 11 health units in Nampula Province participated in a leadership and management development programme called the Challenges Programme. The programme used several strategies that contributed to successful outcomes. It integrated leadership strengthening into the day-to-day challenges that staff were facing in the health units. Participatory teams were also created. After the programme, people no longer waited passively to be trained but instead proactively requested training in needed areas. Ministry of Health workers in Nampula reported that the programme's approach to improving management and leadership capacity at all levels promoted the efficient use of resources and empowered staff to make a difference.

Enhancing the role of pharmacists in public health in developing countries
Matowe L, Mori AT and Mawa S: PJ Online, 15 May 2012

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.

Ensuring an infectious disease workforce: Education and training needs for the 21st century
Board on Global Health, Institute of Medicine of the National Academies

In recognition of the microbial and societal complexities underlying infectious disease control, this report emphasizes that mounting an effective response to infectious disease threats will require multidisciplinary efforts involving all sectors of the clinical medicine, public health, and veterinary medicine communities. Such a multidisciplinary approach must rest squarely on a well-prepared work-force within each of these communities. However, "the number of qualified individuals in the workforce required for microbial threat preparedness is dangerously low....".

eSIP-Saúde: Mozambique’s novel approach for a sustainable human resources for health information system
Waters K; Mazivila M; Dgedge M; Necochea E; Manharlal D; Zuber A; de Faria Leão B; Bossemeyer D; Vergara A: Human Resources for Health 14(66), 2016

Over the past decade, governments and international partners have responded to calls for health workforce data with ambitious investments in human resources information systems (HRIS). However, documentation of country experiences in the use of HRIS to improve strategic planning and management has been lacking. This case presentation documents for the first time Mozambique’s novel approach to HRIS, sharing key success factors and contributing to the scant global knowledge base on HRIS. Core components of the system are a Government of Mozambique (GOM) registry covering all workers in the GOM payroll and a “health extension” which adds health-sector-specific data to the GOM registry. Separate databases for pre-service and in-service training are integrated through a business intelligence tool. The first aim of the HRIS was to identify the following: who and where are Mozambique’s health workers? As of July 2015, 95 % of countrywide health workforce deployment information was populated in the HRIS, allowing the identification of health professionals’ physical working location and their pay point. HRIS data are also used to quantify chronic issues affecting the Ministry of Health (MOH) health workforce. Examples include the following: HRIS information was used to examine the deployment of nurses trained in antiretroviral therapy (ART) vis-à-vis the health facilities where ART is being provided. Such results help the MOH align specialized skill sets with service provision. Twenty-five percent of the MOH health workforce had passed the 2-year probation period but had not been updated in the MOH information systems. For future monitoring of employee status, the MOH established a system of alerts in semi-monthly reports. As of August 2014, 1046 health workers were receiving their full salary but no longer working at the facilities. The MOH is now analysing this situation to improve the retirement process and coordination with Social Security. The Mozambican system is an important example of an HRIS built on a local platform with local staff. Notable models of strategic data use demonstrate that the system is empowering the MOH to improve health services delivery, health workforce allocation, and management. Combined with committed country leadership and ownership of the program, this suggests strong chances of sustainability and real impact on public health equity and quality.

Establishing human resource systems for health during post-conflict reconstruction
Smith J, Kolehmainen-Aitken R-L: Management Sciences for Health Occasional Papers (3) 2006

This paper outlines the Human Resources for Health (HRH) issues during the period of reconstruction in post-conflict countries, drawing examples from Afghanistan and Cambodia. It explores issues of restoring a health workforce and outlines key HRH actions for workforce reconstruction, including: identifying available staff; developing HRH management structures, systems and capacity; clarifying HRH roles and responsibilities; establishing health worker equivalencies and upgrading skills; supporting civil service reconstruction; and widely disseminating HRH information.

Estimates of health care professional shortages in sub-Saharan Africa by 2015
Scheffler RM, Mahoney CB, Fulton B, Dal Poz MR and Preker AS: Health Affairs 28(5): 849–862, 6 August 2009

This paper uses a forecasting model to estimate the need for, supply of, and shortage of doctors, nurses, and midwives in thirty-nine African countries for 2015, the target date of the United Nations Millennium Development Goals. It forecasts that thirty-one countries will experience needs-based shortages of doctors, nurses, and midwives, totalling approximately 800,000 health professionals. It further estimates the additional annual wage bill required to eliminate the shortage at about US$2.6 billion, more than 2.5 times current wage-bill projections for 2015. Additional funds would be required to hire health care support staff, train and support staff, and pay for expenses. Raising the money required to eliminate the shortfall would be difficult for the countries involved, even under the most optimistic assumptions regarding economic growth and governmental commitments to the health sector. Global aid can help but will still not provide enough resources, the researchers say. They call for changes in the skills mix, worker incentives and improvements in training for health care workers.

Estimating health workforce needs for antiretroviral therapy in resource-limited settings

Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART), for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes.

Evaluated strategies to increase attraction and retention of health workers in remote and rural areas
Carmen Dolea, Laura Stormont & Jean-Marc Braichet: Bulletin of the World Health Organization 88:350–356, May 2010

The lack of health workers in remote and rural areas is a worldwide concern. Many countries have proposed and implemented interventions to address this issue, but very little is known about the effectiveness of such interventions and their sustainability in the long run. This paper provides an analysis of the effectiveness of interventions to attract and retain health workers in remote and rural areas from an impact evaluation perspective. It reports on a literature review of studies that have conducted evaluations of such interventions. It presents a synthesis of the indicators and methods used to measure the effects of rural retention interventions against several policy dimensions such as: attractiveness of rural or remote areas, deployment/recruitment, retention, and health workforce and health systems performance. It also discusses the quality of the current evidence on evaluation studies and emphasises the need for more thorough evaluations to support policy-makers in developing, implementing and evaluating effective interventions to increase availability of health workers in underserved areas and ultimately contribute to reaching the United Nations' Millennium Development Goals.

Evaluating a streamlined clinical tool and educational outreach intervention for health care workers in Malawi: the PALM PLUS case study
Sodhi S, Banda H, Kathyola D, Burciul B, Thompson S, Joshua M et al: BMC International Health and Human Rights 11(Suppl 2):S11, 8 November 2011

PALM PLUS (Practical Approach to Lung Health and HIV/AIDS in Malawi) is an intervention designed to simplify and integrate existing Malawian national guidelines into a single, simple, user-friendly guideline for mid-level health care workers. Training utilises a peer-to-peer educational outreach approach. Research is being undertaken to evaluate this intervention to generate evidence that will guide future decision-making for consideration of roll out in Malawi. In the first phase of qualitative inquiry respondents from intervention sites demonstrated in-depth knowledge of PALM PLUS compared to those from control sites. Participants in intervention sites felt that the PALM PLUS tool empowered them to provide better health services to patients. Interim staff retention data shows that there were, on average, three to four staff departing from the control and intervention sites per month. Additional qualitative, quantitative and economic analyses are planned. This initiative is an example of South-South knowledge translation between South Africa and Malawi, mediated by a Canadian academic-NGO hybrid. Success in developing and rolling out PALM PLUS in Malawi suggests that it is possible to adapt and implement this intervention for use in other resource-limited settings.

Evaluation of community-based education and service courses for undergraduate radiography students at Makerere University, Uganda
Mubuuke AG, Kiguli-Malwadde E, Byanyima R and Businge F: Rural and Remote Health 8 (976), 8 December 2008

Ugandan radiography, medical, nursing, dentistry and pharmacy students are sent to community health facilities where they are expected to participate in community services and other primary healthcare activities for training (COBES). This study was designed to obtain the opinions of radiography teachers and students of the significance and relevance of this community-based training to radiography training. Both students and teachers (91.4%) affirmed the community training to be significant and relevant to radiography training. In total, 71.4% of the students had participated in X-ray services and 39.2% in ultrasound services during COBES; and 68.6% of the students reported the need to be better prepared for the COBES training. They confirmed community-based training to be relevant to Ugandan radiography training.

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