Insecure access to food is increasingly recognized as a major contributor to cycles of poverty and HIV and AIDS in sub-Saharan Africa, according to this article. In this context, volunteers espouse desires for economic ‘progress’ amid a mix of pro-social and self-interested motivations to be volunteer AIDS caregivers. For these volunteers, food insecurity was particularly demotivating. Food crisis on top of chronic food insecurity pushed them to reconsider what they deemed as appropriate compensation for their efforts. Ironically, volunteers in such contexts may often be poorer than their clients. Ideally, effective and resilient community health workers should derive mental satisfaction and fair remuneration from their labour. The question for policy-makers is how to generate the spiritual benefits of altruistic, compassionate care as well as a level of remuneration that allows for secure livelihoods among volunteers who are often socioeconomically marginalized. WHO’s recent recommendation challenges various public and private entities to adapt to a system in which funding and other measures are used to create fairly-paid and secure health-care jobs in low-income countries facing pervasive food insecurity and high burdens of chronic and infectious disease. In sub-Saharan Africa, hiring, training and paying community health workers may be a win-win situation: people receive secure jobs that provide food security for their families and communities, and their participation strengthens health-care systems and people in need of care. The article emphasises that health programmers need to listen to what volunteers themselves – and the people whom they serve – say about the benefits and costs of volunteering.
The authors surveyed workforces in southern Africa to determine HIV prevalence among formally employed, largely male populations. Voluntary, anonymous, unlinked seroprevalence surveys of 34 workforces with 44 000 employees were carried out in South Africa, Botswana, and Zambia in 2000-2001. Average HIV prevalence for the entire sample was 16.6%. Country-wide prevalence was 14.5% in South Africa, 17.9% in Zambia, and 24.6% in Botswana.
Heads and implementing workers of fifty HIV and AIDS programs and institutions accredited to offer antiretroviral services in Uganda, Kenya, Tanzania and Rwanda were key informants in face-to- face interviews guided by structured questionnaires. Inadequate human resource capacity including, inability to select, quantify and distribute ARVs and related commodities, and irrational prescribing and dispensing were some of the problems identified. A competence gap existed in all the four countries with a variety of healthcare professionals involved in the supply and distribution of ARVs. There is inadequate capacity for managing medicines and related commodities in East Africa. There is an urgent need for training in aspects of pharmaceutical management to different categories of health workers. Skills building activities that do not take healthcare workers from their places of work are preferred.
Although task-shifting is widely promoted as the solution to expanding anti-retroviral therapy (ART) access, this article notes that the evidence for non-physician-provided ART in Africa is limited, with few studies comparing the performance of non-physicians with doctors. However, field reports from programmes that have used non-physicians to deliver ART, including from rural settings in South Africa, are more plentiful and report similarly positive (although less reliable) results in terms of both ART outcomes and improved access. The authors argue that positive results from trials in South Africa regarding nurse initiation and management of patients on ART may mean that this may become a key strategy for expanding ART access. Along with basic training and support and an appropriately phased implementation, the authors recommend drafting guidelines that are designed for and specific to nurses and that clarify referral options, so that nurses will feel adequately prepared and supported for their ART tasks.
Endorsing the Millennium Development Goals (MDG), the international community committed itself to significant improvements in the health of the poor and set ambitious targets. Achieving the MDG will depend on improving access to priority health interventions, which requires significant supply and demand side constraints to be overcome. The study investigated the human resource implications of expanding the coverage of priority health interventions in Tanzania and Chad. The authors conclude that the health workforce in Tanzania and Chad, and probably in many other SSA countries, is grossly insufficient for the expansion of priority interventions envisaged in current international dialogue. An immediate response at the national and international level is required to ensure progress towards the MDG.
Collaboration between traditional healers and biomedical practitioners is now being accepted by many African countries south of the Sahara because of the increasing problem of HIV/AIDS. The key problem, however, is how to initiate collaboration between two health systems which differ in theory of disease causation and management. This paper presents findings on experience learned by initiation of collaboration between traditional healers and the Institute of Traditional Medicine in Arusha and Dar-es-Salaam Municipalities, Tanzania where 132 and 60 traditional healers respectively were interviewed. Of these 110 traditional healers claimed to be treating HIV/AIDS. The objective of the study was to initiate sustainable collaboration with traditional healers in managing HIV/AIDS. Consultative meetings with leaders of traditional healers' associations and government officials were held, followed by surveys at respective traditional healers' "vilinge" (traditional clinics). The findings were analysed using both qualitative and quantitative methods.
In Tanzania staff shortages in the healthcare system are a persistent problem, particularly in rural areas. To explore this the authors explored which cadres are most problematic to recruit and keep in post, for what reasons and why do some stay and cope? Qualitative data were generated through semi-structured interviews with Council Health Management Teams, and Critical Incident Technique interviews with mid-level cadres. Complementary quantitative survey data were collected from district health officials. Mid-level cadres were problematic to retain and caused significant disruptions to continuity of care when they left. Reasons for wanting to leave included perceptions of personal safety, feeling patient outcomes were compromised by poor care or as a result of perceived failed promises. Staying and coping with unsatisfactory conditions was often about being settled into a community, rather than into the post. The Human Resources for Health system in Tanzania was reported to lack transparency. The authors suggest that centralised monitoring could help to avoid early departures, misallocation of training, and to enable other incentives. It should match workers' profiles to the most suitable post for them and track their progress and rewards; training managers and holding them accountable. In addition, they argue that priority should be given to workplace safety, late night staff transport, modernised and secure compound housing, and in measures to involve the community in reforming the culture and practices in services.
This paper contributes to the economics literature on nursing market shortages by putting forward two new models that suggest three new explanations for perceived nursing shortages. The first model focuses on hospitals hiring both permanent staff nurses and temporary contract nurses. It shows that hiring both classes of nurses can represent optimising behaviour, and that an interesting kind of perceived nursing shortage results from this dual hiring. The second model posits two classes of hospitals – premier and funds-constrained – and generates two distinct kinds of nursing shortages: economic shortages, involving unfilled, budgeted positions, and non-economic professional standards shortages. The paper argues that the perceived existence of professional standards shortages may be a significant explanation for the widespread impression of persistent shortages.
This paper examines and seeks to contribute to understanding of external multiple job holding practices in public health training institutions based in prominent public universities in three sub-Saharan Africa countries. A qualitative multiple case study approach was used. Data were collected through document reviews and in-depth interviews with 18 key informants. Data were then triangulated and analyzed thematically. External multiple job holding practices among faculty of the three public health training institutions were widely prevalent. Different factors at individual, institutional, and national levels were reported to underlie and mediate the practice. While the authors report that it contributes to increasing income of academics, which many described as enabling their continuing employment in the public sector, many pointed to negative effects. Similarities were found regarding the nature and drivers of the practice across the institutions, but differences exist with respect to mechanisms for and extent of regulation. Regulatory mechanisms were often not clear or enforced, and academics are often left to self-regulate their engagement. Lack of regulation is cited as allowing excessive engagement in multiple job holding practice among academics at the expense of their core institutional responsibility. This could further weaken institutional capacity and performance, and quality of training and support to students. The research describes the complexity of external multiple job holding practices, which is characterized by a cluster of drivers, multiple processes and actors, and lack of consensus about its implication for individual and institutional capacity. They argue that in the absence of a strong accountability mechanism, the practice could perpetuate and aggravate the fledgling capacity of public health training institutions.
In this study the authors explored the performance of by community health workers (CHWs) providing maternal and child health services at household level and the quality of the CHW-mother interaction using observations and in-depth interviews. Fifteen CHWs and 30 mothers/pregnant women were purposively selected in three rural districts of KwaZulu-Natal, South Africa. CHWs provided appropriate and correct health information but there were important gaps in the content provided. Mothers expressed satisfaction with CHW visits and appreciation that CHWs understood their life experiences and therefore provided advice and support that was relevant and accessible. CHWs expressed concern that they did not have the knowledge required to undertake all activities in the household, and requested training and support from supervisors during household visits. The authors assert that key building blocks for a successful CHW programme are in place to provide services for mothers and children in households but further training and supervision is required if the gaps in CHW knowledge and skills are to be filled.