Effective implementation and sustainability of quality laboratory programmes in Sub-Saharan Africa relies on the development of appropriate staff retention strategies, argue the authors of this paper. Assessing the factors responsible for job satisfaction and retention is key for tailoring specific interventions aiming at improving the overall impact of health programmes. They developed a survey to assess these factors among 224 laboratorians working in the laboratory programme the University of Maryland implemented in seven Sub-Saharan African countries. Lack of professional development was the major reason for leaving the previous job for 28% of interviewees who changed jobs in the past five years. Professional development/training opportunities was indicated by almost 90% of total interviewees as the most important or a very important factor for satisfaction at their current job. Similarly, regular professional development/opportunities for training was the highest rated incentive to remain at their current job by 80%. Laboratory professionals employed in the private sector were more likely to change jobs than those working in the public sector. The findings were used for developing specific strategies for human resources management, in particular targeting professional development, aiming at improving laboratory professionals within the University of Maryland laboratory programme and hence its long-term sustainability.
This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi. A cross-sectional cluster sample design was used to select 59 health facilities that yielded interviews with 404 health care workers, grouped into 10 different types of service providers. Data were collected in November 2011 using structured questionnaires and a Focus Group Discussion guide. Findings were analyzed using bivariate and multivariate methods of the associations and determinants of health worker motivation and retention. The levels of education and gender factors were lowest in Turkana with female HCWs representing only 30% of the workers against a national average of 53%. A smaller proportion of HCWs in Turkana feel that they have adequate training for their jobs. Overall, 13% of the HCWs indicated that they had changed their job in the last 12 months and 20% indicated that they could leave their current job within the next two years. In terms of work environment, inadequate access to electricity, equipment, transport, housing, and the physical state of the health facility were cited as most critical, particularly in Turkana. The working environment is rated as better in private facilities. Adequate training, job security, salary, supervisor support, and manageable workload were identified as critical satisfaction factors. Family health care, salary, and terminal benefits were rated as important There are distinct motivational and retention factors that affect HCWs in the three regions. Findings and policy implications from this study point to a set of recommendations to be implemented at national and county levels. These include gender mainstreaming, development of appropriate retention schemes, competitive compensation packages, strategies for career growth, establishment of a model HRH community, and the conduct of a discrete choice experiment.
Little is known in Kenya on the extent to which community health workers (CHWs) are utilised, the characteristics of families who report utilising CHWs and whether utilisation is associated with improved access to prompt and effective malaria treatment. This paper addresses this research gap by examining factors associated with utilisation of CHWs in improving access to malaria treatment among children under five years of age by women caregivers in 113 hard-to-reach and poor rural villages in Malindi and Lamu districts Results indicate an increase in reported utilisation of CHWs as source of advice/treatment for child fevers from 2% to 35%, accompanied by a decline in care-seeking from government facilities (from 67% to 48%) and other sources (26% to 2%) including shops. The most poor households and poor households reported higher utilisation of CHWs at 39.4% and 37.9% respectively, compared to the least poor households (17%). Prompt access to timely and effective treatment was 5.7 times higher when CHWs were the source of care sought. The authors conclude that the utilisation of CHWs in improving access to malaria treatment at the community level will not only enhance access to treatment by the poorest households but also provide early and appropriate treatment to vulnerable individuals, especially those living in hard to reach areas.
Management and supervision of community health workers (CHWs) is important for the success of CHW programmes. This study explored factors influencing motivations of supervisors in CHW programmes. The authors conducted qualitative interviews with 26 programme staff providing supervision to CHWs in eight community-based organisations in marginalised communities in the greater Durban area of South Africa from July 2010 to September 2011. Findings show that all the supervisors had previous experience working in the health or social services sectors and most started out as unpaid CHWs. Most of the participants were poor women from marginalised communities. Supervisors’ activities include the management and supply of material resources, mentoring and training of CHWs, record keeping and report writing. Supervisors were motivated by intrinsic factors like making a difference and community appreciation and non-monetary incentives such as promotion to supervisory positions; acquisition of management skills; participation in capacity building and the development of programmes; and support for educational advancement like salary, bonuses and medical benefits. Hygiene factors that serve to prevent dissatisfaction are salaries and financial, medical and educational benefits attached to the supervisory position. Demotivating factors identified are patients’ non-adherence to health advice and alienation from decision-making. Dis-satisfiers include working in crime-prevalent communities, remuneration for CHWs, problems with material and logistical resources, job insecurity, work-related stressors and navigating the interface between CHWs and management. While participants were dissatisfied with their low remuneration, they were not demotivated but continued to be motivated by intrinsic factors. The authors findings suggest that CHWs’ quest for remuneration and a career path continues even after they assume supervisory positions. Supervisors continue to be motivated to work in mid-level positions within the health and social services sectors. Global efforts to develop and increase the sustainability of CHW programmes will benefit immensely from insights gained from an exploration of supervisors’ perspectives. Further, they suggest that national CHW programmes be conceptualised with the dual purpose of building the capacity of CHWs to strengthen health systems and reducing unemployment especially in marginalised communities.
There is currently limited published evidence of health-related training programmes in Africa that have produced graduates, who remain and work in their countries after graduation. However, anecdotal evidence suggests that the majority of graduates of field epidemiology training programmes (FETPs) in Africa stay on to work in their home countries, many as valuable resources to overstretched health systems. In this study, alumni data from African FETPs were reviewed in order to establish graduate retention. Retention was defined as a graduate staying and working in their home country for at least three years after graduation. African FETPs are located in a number of African countries – this paper only includes the Uganda and Zimbabwe FETPs, as all the others are recent programmes. The review shows that enrolment increased over the years, and that there is high graduate retention, with 85.1% of graduates working within country of training, mostly for Ministries of Health and non-governmental organisations. Retention of graduates with a medical undergraduate degree was slightly higher than for those with other undergraduate qualifications. The paper concludes that African FETPs have unique features which may explain their high retention of graduates, including: programme ownership by ministries of health and local universities; well defined career paths; competence-based training coupled with a focus on field practice during training; awarding degrees upon completion; extensive training and research opportunities made available to graduates; and the social capital acquired during training.
According to this survey, more than half of nurses (53%) in South Africa said their workload was worse today when compared to five years ago. Nurses in South Africa indicated that the least favourable aspects of their profession were overwhelming workloads (32%), insufficient pay and benefits (22%), lack of recognition (11%), budget cuts and inadequate health care systems (11%). In contrast, the most favourable aspect was patient contact (39%). In South Africa, as in other countries surveyed, most nurses (85%) said they faced time constraints that prevented them from spending as much time with individual patients as they thought necessary. Some 87% of the nurses surveyed in South Africa said spending more time with individual patients would have a significant impact on patient health. On the plus side, they saw their professional associations as effective in advancing their interests (86%) and supportive of their needs (87%), and 63% perceived the nation's health care system as better than it was five years ago.
This presentation was given at the First Forum on Human Resources for Health in Kampala. It presents five questions on the financial concerns of scaling up the number of health workers to provide adequate health care.
The first Global Forum on Human Resources for Health held in Kampala, Uganda from 2-7 March, 2008 called for immediate and sustained action to resolve the critical shortage of health workers around the world. Attendees at the Forum endorsed the Kampala Declaration and the Agenda for Global Action. This high profile event was attended by nearly 1500 participants, including donors, experts and ministers of health, education and finance.
Progress towards the Millennium Development Goals (MDGs) in sub-Saharan Africa is slow. There is a growing consensus that human resources are a vital part of improving African health systems and making progress towards the MDGs. Reasons for human resource problems in African health systems are complex. Moreover, they vary greatly between and within countries. This means that solutions will be complex and are dependent on the political, economic, historic and social context of each country. Of particular concern are issues such as capacity and training of health workers, migration of skilled workers out of the region, the impact of HIV and AIDS, as well as the need for massive scale-up of ART
(anti-retroviral therapy) services.
With a shortage of health care workers and increasing demand to provide ART, existing ART delivery models may not be adequate and many have argued the need to rethink standard delivery models. Researchers and practitioners have argued that we should consider context-specific delivery models that rely much less on medical doctors in situations where they are in short supply. This feature discusess this matter in detail.