Human Resources

Towards better stewardship:
concepts and critical issues

Phyllida Travis, Dominique Egger, Philip Davies, Abdelhay Mechbal. Evidence and Information for Policy, World Health Organization, 2002.
The paper proposes that stewards should have access to reliable, up-to-date information on: Current and future trends in health and health system performance? For example, on levels, trends and inequalities in key areas such as national health expenditures; human resources; health system outcomes; health risk factors; vulnerable groups; coverage; provider performance; organisational / institutional challenges in provision, financing, resource generation, stewardship Important contextual factors and actors the political, economic and institutional context; the roles and motivation of different actors; user / consumer preferences; opportunities and constraints for change. Events / reforms in other sectors with implications for the health sector Possible policy options, based on national and international evidence and experience? For example, intelligence on different policy tools and instruments for similar problems; on their effects in different settings, and on managing change. It includes information on relatively specific things such as cost-effective interventions; and on possible institutional arrangements for different functions.

Further details: /newsletter/id/29173
Tracking and monitoring the health workforce: A new human resources information system (HRIS) in Uganda
Spero JC, McQuide PA, Matte R: Human Resources for Health 9(6), 17 February 2011

The purpose of this article is twofold. First, the authors describe Uganda's transition from a paper filing system to an electronic Human Resource Information System (HRIS) capable of providing information about country-specific health workforce questions. They examine the ongoing five-step process to strengthen the HRIS to track health worker data at the Uganda Nurses and Midwives Council (UNMC). Second, they describe how HRIS data can be used to address workforce planning questions via an initial analysis of the UNMC training, licensure and registration records from 1970 through May 2009. The data indicated that, for the 25,482 nurses and midwives who entered training before 2006, 72% graduated, 66% obtained a council registration, and 28% obtained a licence to practice. Of the 17,405 nurses and midwives who obtained a council registration as of May 2009, 96% are of Ugandan nationality and just 3% received their training outside of the country. Thirteen percent obtained a registration for more than one type of training. Most (34%) trainings with a council registration are for the enrolled nurse training, followed by enrolled midwife (25%), registered (more advanced) nurse (21%), registered midwife (11%), and more specialised trainings (9%). The authors found the UNMC database was valuable in monitoring and reviewing information about nurses and midwives. However, they add that information obtained from this system is also important in improving strategic planning for the wider health care system in Uganda.

Tracking and monitoring the health workforce: A new human resources information system (HRIS) in Uganda
Spero JC, McQuide PA and Matte R: Human Resources for Health 9(6), 17 February 2011

The purpose of this article is twofold. First, the authors describe Uganda's transition from a paper filing system to an electronic HRIS capable of providing information about country-specific health workforce questions. They then examine the ongoing five-step HRIS strengthening process used to implement an HRIS that tracks health worker data at the Uganda Nurses and Midwives Council (UNMC). Secondly, they describe how HRIS data can be used to address workforce planning questions via an initial analysis of the UNMC training, licensure and registration records from 1970 through May 2009. The data indicate that, for the 25 482 nurses and midwives who entered training before 2006, 72% graduated, 66% obtained a council registration, and 28% obtained a license to practice. Of the 17,405 nurses and midwives who obtained a council registration as of May 2009, 96% are of Ugandan nationality and just 3% received their training outside of the country. Thirteen per cent obtained a registration for more than one type of training. Most (34%) trainings with a council registration are for the enrolled nurse training, followed by enrolled midwife (25%), registered (more advanced) nurse (21%), registered midwife (11%), and more specialised trainings (9%). The authors conclude that the UNMC database is valuable in monitoring and reviewing information about nurses and midwives. However, information obtained from this system is also important in improving strategic planning for the greater health care system in Uganda.

Training health professionals in palliative care
Lessons from South Africa

Palliative care should be an integral part of every health care professional's role. A key aspect of palliative care training involves raising the awareness of health care professionals, service providers and users. Palliative care should not just be seen as the compassionate care of dying patients but as an active discipline including assessing and treating pain and other problems. Health care workers need specific training to be able to offer quality palliative care to their patients.

Training health service staff in developing countries

The quality of health care is hugely dependent on the skills of health professionals. Clinical skills centres are neutral and protected settings in which a variety of skills and techniques can be taught. In developing countries, resource constraints and pressure to direct skilled staff away from teaching to working in health service facilities can limit the opportunities for developing and implementing an effective training curriculum.

Training health service staff in developing countries

The quality of health care is hugely dependent on the skills of health professionals. Clinical skills centres are neutral and protected settings in which a variety of skills and techniques can be taught. In developing countries, resource constraints and pressure to direct skilled staff away from teaching to working in health service facilities can limit the opportunities for developing and implementing an effective training curriculum.

Training mid-level workers in Africa: A review
Ray S: University of Botswana, October 2010

This presentation is based on a literature review that was carried out as part of a research collaboration between the School of Public Health Wits University and the African Population Health Research Centre, Nairobi, Kenya, with feedback from colleagues in Kenya, Uganda, Nigeria and South Africa. The review found that mid-level workers (MLWs) were active in 25 of the 47 sub-Saharan African countries reviewed: 18 countries had non-nurse based programmes for training secondary school leavers, which avoided depleting scarce ranks of nurses. MLWs were treated as second-best or a temporary stop gap until enough physicians were trained, instead of being recognised as key front line health workers responsible for care of their communities. Problems affecting MLWs were identified as: poor work environment; perceptions of resource inadequacy, with staff members indicating that they had neither sufficient staff nor time to do their work; poor pay and low status; inadequate management support and a sense of not being valued by their managers; and burnout, emotional exhaustion and low personal accomplishment. The presentation cautions that increasing numbers of MLWs is not a solution on its own. Accompanying investment is needed in supervision, district team strengthening, morale building and training. Recognition, career and skills development are strong motivators for MLWs, while positive feedback from patients is valued and seen as indicator of professional conduct. The need for professionalisation of MLWs is also underscored.

Training needs assessment for clinicians at antiretroviral therapy clinics: Evidence from a national survey in Uganda
Lutalo IM, Schneider G, Weaver MR, Oyugi JH, Sebuyira LM, Kaye R, Lule F, Namagala E, Scheld WM, McAdam KPWJ and Sande MA: Human Resources for Health, 23 August 2009

This study sought to identify task shifting that has already occurred and assess the antiretroviral therapy (ART) training needs among clinicians to whom tasks have shifted. It surveyed health professionals and heads of ART clinics at a stratified random sample of 44 health facilities accredited to provide this therapy. A sample of 265 doctors, clinical officers, nurses and midwives reported on tasks they performed. Thirty of 33 doctors (91%), 24 of 40 clinical officers (60%), 16 of 114 nurses (14%) and 13 of 54 midwives (24%) reported that they prescribed ART. Yet, 64% of the people who prescribed antiretroviral therapy were not doctors. Seven percent of doctors, 42% of clinical officers, 35% of nurses and 77% of midwives assessed that their overall knowledge of antiretroviral therapy was lower than good. The study concluded that training initiatives should be an integral part of the support for task shifting, while making sure that ART is used correctly and toxicity or drug resistance do not reverse accomplishments to date.

Training needs for research in health inequities among health and demographic researchers from eight African and Asian countries
Haafkens J; Blomstedt Y; Eriksson M; Becher H; Ramroth H; Kinsman J: BMC Public Health 14(1254), 2014

To support equity focussed public health policy in low and middle income countries, more evidence and analysis of the social determinants of health inequalities is needed. This requires specific know how among researchers. The INDEPTH Training and Research Centres of Excellence (INTREC) collaboration identified learning needs among INDEPTH researchers from Ghana, Tanzania, South Africa, Kenya, Indonesia, India, Vietnam, and Bangladesh to conduct research on the causes of health inequalities in their country. Using an inductive method, online concept-mapping, participants were asked to generate statements in response to the question what background knowledge they would need to conduct research on the causes of health inequalities in their country. Of the 150 invited researchers, 82 participated in the study: 54 from Africa; 28 from Asia. African participants assigned the highest importance to further training on methods for assessing health inequalities. Asian participants assigned the highest importance to training on research and policy.

Training shopkeepers to improve malaria home management in rural Kenya
id21 Health News, 15 December 2006

In rural Kenya, where qualified pharmacists are rare, many people buy medicines from general shops to treat themselves at home. Often they receive incorrect medication or doses. Would the training of shopkeepers, who help treat the majority of children with fevers, be cost-effective in improving malaria treatment in young children?

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