Human Resources

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?

Transforming health professions’ education through in-country collaboration: examining the consortia among African medical schools catalyzed by the Medical Education Partnership Initiative
Talib ZM, Kiguli-Malwadde E, Wohltjen H, Derbew M, Mulla Y, Olaleye D, Sewankambo N: Human Resources for Health 2015, 13:1 doi:10.1186/1478-4491-13-1

African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward resources to support African medical schools. The Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning, through semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes. All of the consortia have prioritised efforts to increase the quality of medical education, support new schools in-country and strengthen relations with government. These in-country partnerships have enabled schools to pool and mobilise limited resources creatively and generate locally-relevant curricula based on best-practices. The established schools are helping new schools by training faculty and using grant funds to purchase learning materials for their students. The consortia have strengthened the dialogue between academia and policy-makers enabling evidence-based health workforce planning. All of the partnerships are expected to last well beyond the MEPI grant as a result of local ownership and institutionalisation of collaborative activities. The consortia demonstrate a paradigm shift in the relationship between medical schools. While schools in Africa have historically worked in silos, competing for limited resources, MEPI funding has created a culture of collaboration, with positive impact reported on the quality and efficiency of health workforce training. It suggests that future funding for global health education should prioritise such south-south collaborations.

Transforming rural health systems through clinical academic leadership: lessons from South Africa
Doherty JE, Couper ID, Campbell D, Walker J: Rural and Remote Health 13(2618), 8 July 2013

Under-resourced and poorly managed rural health systems challenge the achievement of universal health coverage, and require innovative strategies worldwide to attract healthcare staff to rural areas. One such strategy is rural health training programmes for health professionals. In addition, clinical leadership (for all categories of health professional) is a recognised prerequisite for substantial improvements in the quality of care in rural settings, argue the authors of this report. Rural health training programmes have been slow to develop in low- and middle-income countries (LMICs); and the impact of clinical leadership is under-researched in such settings. A 2012 conference in South Africa, with expert input from South Africa, Canada and Australia, discussed these issues and produced recommendations for change that will also be relevant in other LMICs. The two underpinning principles were that: rural clinical leadership (both academic and non-academic) is essential to developing and expanding rural training programs and improving care in LMICs; and leadership can be learned and should be taught. Lessons learned: The three main sets of recommendations focused on supporting local rural clinical academic leaders; training health professionals for leadership roles in rural settings; and advancing the clinical academic leadership agenda through advocacy and research. By adopting the detailed recommendations, South Africa and other LMICs could energise management strategies, improve quality of care in rural settings and impact positively on rural health outcomes, the authors conclude.

Treating HIV-Positive South Africans More Cost-Effective Than Not Providing Medications, TAC Says

Treating people with HIV/AIDS is more cost effective than not providing them with medications because "if you manage HIV properly, it would cut costs and have social benefits," Mark Heywood, secretary of the Treatment Action Campaign, has said in Johannesburg, the South African Press Association reports.

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