Human Resources

Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania
Hoffman SJ, Guindon G, Lavis JN, Ndossi GD, Osei EJ, Sidibe M and Boupha B: Malaria Journal 10(363), 13 December 2011

This study compares what is known about insecticide-treated nets (ITNs) to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). In the survey, few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: training in acquiring systematic reviews through the Cochrane Library and ability to read and write English well or very well. Statistically significant factors associated with better clinical practices within each country included: reading scientific journals from their own country; working with researchers to improve their clinical practice or quality of working life; training on malaria prevention since their last degree; and easy access to the internet. The researchers conclude that improving healthcare providers' knowledge and practices is an untapped opportunity for expanding ITN utilisation and preventing malaria. Training on acquiring systematic reviews and facilitating internet access may be particularly helpful.

Assessing human resources for health: what can be learned from labour force surveys?

Human resources are an essential element of a health system's inputs, and yet there is a huge disparity among countries in how human resource policies and strategies are developed and implemented. The analysis of the impacts of services on population health and well-being attracts more interest than analysis of the situation of the workforce in this area. This article presents an international comparison of the health workforce in terms of skill mix, socio demographics and other labour force characteristics, in order to establish an evidence base for monitoring and evaluation of human resources for health.

Assessing performance enhancing tools: Experiences with the open performance review and appraisal system (OPRAS) and expectations towards payment for performance (P4P) in the public health sector in Tanzania
Songstad N, Lindkvist I, Moland K, Chimhutu V and Blystad A: Globalization and Health 8(33), 10 September 2012

To increase the quality of service delivery in the public health sector, Tanzania has implemented the Open Performance Review and Appraisal System (OPRAS) and a new results-based payment system, Payment for Performance (P4P). This paper addresses health workers' experiences with OPRAS, expectations towards P4P and how lessons learned from OPRAS can assist in the implementation of P4P. The broader aim is to generate knowledge on health worker motivation in low-income contexts. The authors conducted focus group discussions and in-depth interviews with public health nursing staff, clinicians and administrators. Results showed a general reluctance towards OPRAS as health workers did not see the system as leading to financial gains nor did it provide feedback on performance. In contrast, great expectations were expressed towards P4P due to its prospects of topping up salaries, but the links between the two performance enhancing tools were unclear. The authors conclude that health workers respond to performance enhancing tools based on whether the tools are found appropriate or yield any tangible benefits.

Assessment of human resources for health using cross-national comparison of facility surveys in six countries
Gupta Neeru and dal Poz MR: Human Resources for Health, March 2009

This is a series of facility-based surveys using a common approach in six countries, including Mozambique and Zimbabwe. The objectives were twofold: to inform the development and monitoring of human resources for health (HRH) policy within the countries; and to test and validate the use of standardised facility-based human resources assessment tools across different contexts. The findings revealed that, with increasing experience in health facility assessments for HRH monitoring comes greater need to establish and promote best practices regarding methods and tools for their implementation, as well as dissemination and use of the results for evidence-informed decision-making. The overall findings of multi-country facility-based survey should help countries and partners develop greater capacity to identify and measure indicators of HRH performance via this approach, and eventually contribute to better understanding of health workforce dynamics at the national and international levels.

Assessment of interventions to attract and retain health workers in rural Zambia: a discrete choice experiment
Prust M; Kamanga A; Ngosa L; McKay C; et al: Human Resources for Health 17(26)1-12, 2019

The authors examined whether non-monetary employment incentives were cost-effective in attracting and retaining public sector health workers in rural areas of Zambia. The study consisted of two key phases: Firstly, in qualitative interviews with 25 health workers and focus group discussions with 253 health students, participants were asked to discuss job attributes and potential incentives that would influence their job choices. Based on this exercise and in consultation with policymakers, job attributes were selected for inclusion in a discrete choice experiment. A questionnaire, consisting of hypothetical job “choice sets,” was presented to 474 practicing health workers and students. Using administrative data, the authors estimated the cost of implementing potential attraction and retention strategies per health worker year worked. Although health workers preferred urban jobs to rural jobs, employment incentives influenced health workers’ decision to choose rural jobs. If superior housing was offered in a rural area compared to a basic housing allowance in an urban job, participants would be five times as likely to choose the rural job. Education incentives and facility-based improvements also increased the likelihood of rural job uptake. Housing benefits were estimated to have the lowest total costs per health worker year worked, and offer high value in terms of cost per percentage point increase in rural job uptake. The authors note that non-monetary incentives such as housing, education, and facility improvements can be important motivators of health worker choice of location and could mitigate rural health workforce shortages.

Association between health worker motivation and healthcare quality efforts in Ghana
Alhassan RK, Spieker N, van Ostenberg P, Ogink A, Nketiah-Amponsah E and de Wit TF: Human Resources for Health 11(37), 14 August 2013

A baseline survey of 324 health workers in 64 primary healthcare facilities in two regions in Ghana found that the quality of care in health facilities was generally low. Most facilities did not have processes for continuous quality improvement and patient safety. Staff motivation appeared low, particularly in public facilities. Significant positive associations were found between staff satisfaction levels and working conditions and the clinic’s effort towards quality improvement and patient safety. The authors called for more comprehensive staff motivation interventions to be integrated into quality improvement strategies, especially in public health services where working conditions are perceived to be poor.

Band aid for southern African medical brain drain?
Integrated Regional Information Networks, 16 August 2006

New laws introduced by the British government in mid-August 2006 are unwittingly giving the southern African region a temporary reprieve from the brain drain of medical staff. The new laws stipulate that employers in Britain will only be granted work permits for foreign nurses if they can prove that no suitable British or European Union candidate can be found.

Better pay in store for health workers
Mail & Guardian (South Africa), 21 February 2007

Eextra money budgeted for the Health Department means better salaries for health workers -- particularly nurses, it said on Wednesday after Finance Minister Trevor Manuel's Budget speech. The additional R5,3-billion allocated for human resources was in response to the department's proposals, said spokesperson Sibani Mngadi.

Brain drain and health workforce distortions in Mozambique
Sherr K, Mussa A, Chilundo B, Gimbel S, Pfeiffer J et al: PLoS ONE 7(4), 27 April 2012

This observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980 and 2006. Data were collected 26 months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment and main work duties. Results showed that of 723 qualifying physicians between 1980 and 2006, a quarter had left the public sector, of which 62.4% continued working in-country and 37.6% emigrated. Of those cases of internal migration, 66.4% worked for non-governmental organisations (NGOs), 21.2% for external funders and 12.4% in the private sector. Annual incidence of physician migration was estimated to be 3.7%, predominately to work in the growing NGO sector. An estimated 36.3% of internal migration cases had previously held senior-level management positions in the public sector. The authors conclude that internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration. They call on external funders and NGOs to assess how their hiring practices may undermine the very systems they seek to strengthen.

Brain Drain Creating Problems in SADC

"The loss of professionals and other skilled people from the SADC region is fast assuming the dimensions of a major crisis," says this article on the website of Idasa. "The countries of southern Africa pour vast resources into training to ensure that future skills needs are met.  But is all this investment in human resource development really going to benefit the countries concerned?  Or are they, in effect, simply providing students with "skill passports" so that they can relocate to other parts of the world?"