Human Resources

Underpaid and overworked: A cross-national perspective on care workers
Razavi S and Staab S: International Labour Review 149(4), December 2010

Over the past decades, changes in economic, social and demographic structures have spurred the growth of employment in care-related occupations. As a result care workers comprise a large and growing segment of the labour force in both North and South. One impetus for much of the research and policy work in this area is a concern about the labour market disadvantages of particular segments of the care workforce (such as migrant domestic workers, elderly carers, and nursing aides). Although the issue of care work and its vulnerability is a global phenomenon, this issue of the International Labour Review presents a collection of essays that pay particular attention to developing country contexts where issues of worker insecurity and exploitation are most intransigent, and where research has been sparse and data gaps are often significant. The special issue raises questions about who the care workers are, whether they are recognised as workers, how their wages compare to those of other workers with similar levels of education and skill, the conditions under which they work, and how their interests could be better secured.

Understanding African migration for pro-poor policymaking
id21 Research Highlight

Migration has long been an important part of labour markets and livelihoods across Africa. It is estimated that there are between 20 and 50 million African migrants today. Migration flows have implications for meeting the Millennium Development Goals, but their effects are poorly understood. Most African governments, however, are concerned with the migration of educated professionals abroad, or the 'brain drain'. It is estimated that US$4 billion is spent on replacing African professionals with expatriates, mostly through aid programmes.

Understanding informal payments in health care: Motivation of health workers in Tanzania
Stringhini S, Thomas S, Bidwell P, Mtui T and Mwisongo A: Human Resources for Health, 30 June 2009

This study attempts to assess if and how informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and, where possible, focus groups were divided by cadre. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem, with fear of detection as a main demotivating factor. Informal payments were not found to be related to retention of health workers in the public health system. The findings suggest that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed.

Understanding press coverage of cross border migration in Southern Africa since 2000
Southern African Migration Project (SAMP)

Xenophobia is a distinctive and widespread phenomenon in South and Southern Africa. The print media, in particular, has been accused of exacerbating xenophobic attitudes. This paper discusses press coverage of cross-border migration in Southern Africa from 2000-2003, with a focus on xenophobia. The study revisits research conducted in South Africa by the Southern African Migration Project (SAMP) in the 1990s to
determine what, if any, changes have occurred in that country’s press coverage of the issue.

Understanding the factors influencing health-worker employment decisions in South Africa
George G, Gow J and Bachoo S: Human Resources for Health 11 (15): 1-7, 2013

The provision of health care in South Africa has been compromised by the loss of trained health workers (HWs) over the past 20 years. The public-sector workforce is overburdened. There is a large disparity in service levels and workloads between the private and public sectors. There is little knowledge about the nonfinancial factors that influence HWs choice of employer (public, private or nongovernmental organization) or their choice of work location (urban, rural or overseas). This paper aims to fill these gaps in the literature. The study utilized cross-sectional survey data gathered in 2009 in the province of KwaZulu-Natal from three public hospitals, two private hospitals and one nongovernmental organization hospital in urban areas, from professional nurses, staff nurses and nursing assistants. HWs in the public sector reported the poorest working conditions, as indicated by participants’ self-reports on stress, workloads, levels of remuneration, standard of work premises, level of human resources and frequency of in-service training. Health workers in the non state sector expressed a greater desire than those in the public and private sectors to leave their current employer. Innovative efforts are required to address the causes of HWs dissatisfaction and to further identify the nonfinancial factors that influence work choices of HWs. The results highlight the importance of considering a broad range of nonfinancial incentives that encourage HWs to remain in the already overburdened public sector.

Understanding the factors influencing health-worker employment decisions in South Africa
George G, Gow J and Bachoo S: Human Resources for Health 11(15), 23 April 2013

Little is known about the nonfinancial factors that influence South African health workers’ (HWs) choice of employer (public, private or nongovernmental organisation) or their choice of work location (urban, rural or overseas). To fill these gaps in the literature, researchers used a cross-sectional survey to gather data in 2009 in the province of KwaZulu-Natal. HWs in the public sector reported the poorest working conditions, as indicated by participants’ self-reports on stress, workloads, levels of remuneration, standard of work premises, level of human resources and frequency of in-service training. However, HWs in the NGO sector expressed a greater desire than those in the public and private sectors to leave their current employer. The authors call for innovative efforts to address the causes of HWs dissatisfaction and to further identify the nonfinancial factors that influence work choices of HWs. Policymakers must consider a broad range of nonfinancial incentives that encourage HWs to remain in the already overburdened public sector.

Universal antiretroviral treatment: The challenge of human resources
Bärnighausen T, Blooma DE and Humair S: Bulletin of the World health Organization 88(12): 943-948, December 2010

Despite scale up of anti-retroviral therapy (ART) in Africa, this study draws attention to the shortage of quality data to assess the impact of task-shifting and the loss of doctors from other parts of the health system to HIV and AIDS programmes. It calls for greater documentation and further studies how past increases in ART coverage have been achieved, for instance, by assessing health worker performance using surveys of ART facilities. However, the paper argues that such research alone is not enough. Some of the most important factors determining the long-term progress towards universal coverage – such as ‘victim of our own success’ mechanisms – may only become apparent with time and as ART coverage increases. The challenge of predicting future need through the study of past outcomes is exacerbated by uncertainties around the definition of ART need (such as increases in the CD4 count threshold for treatment eligibility) and ART-related health problems (such as widespread viral resistance). Health policy-makers need to anticipate these factors with the aid of models, allow for significant uncertainty in their ART strategies, and set realistic expectations for the magnitude of resources required for universal ART coverage.

University partnership to address the shortage of healthcare professionals in Africa
Taché S, Kaaya E, Omer S, Mkony CA, Lyamuya E, Pallangyo K, Debas HT, MacFarlane SB: Global Public Health 3(2): 137 - 148, April 2008

The shortage of qualified health professionals is a major obstacle to achieving better health outcomes in many parts of the world, particularly in Africa. The role of health science universities in addressing this shortage is to provide quality education and continuing professional development opportunities for the healthcare workforce. Academic institutions in Africa, however, are also short of faculty and especially under-resourced. We describe the initial phase of an institutional partnership between the Muhimbili University of Health and Allied Sciences (MUHAS) and the University of California San Francisco (UCSF) centred on promoting medical education at MUHAS. The challenges facing the development of the partnership include the need: (1) for new funding mechanisms to provide long-term support for institutional partnerships, and (2) for institutional change at UCSF and MUHAS to recognize and support faculty activities that are important to the partnership. The growing interest in global health worldwide offers opportunities to explore new academic partnerships. It is important that their development and implementation be documented and evaluated as well as for lessons to be shared.

Unpaid Care Work Programme: Uganda Country Progress Report (2012–2014)
Nesbitt-Ahmed Z; Malinga Apila H: Institute of Development Studies Evidence Report 126, IDS Sussex, 2015

The Institute of Development Studies (IDS) partnered with ActionAid International (AAI) in Uganda to develop and implement an advocacy strategy to make unpaid care work more visible in public policy, as well as to integrate unpaid care issues into each country’s programming. It used an action learning methodology to look at what works and does not work in making the care economy more visible. It aimed to track and capture changes in policy and practice in order to improve understanding around the uptake of evidence. This report covers the progress of the programme in Uganda over the first two and a half years of the four-year programme. The work identified that making unpaid care work more visible calls for a collective voice amongst those involved and engaging and working effectively with the media with clear messaging.

Urgent need to get health workers back at their posts to tackle Zimbabwe cholera crisis
Zimbabwe Health Cluster Bulletin 1, 5 December 2008

On 2 December, the first meeting of the enlarged Health Cluster was held at the WHO office in Harare. Afterwards, a working group met with the Ministry of Health and Child Welfare (MoHCW) to work out details of a plan to disburse a £500,000 grant from the UK Department for Development Funding DFID to attract health workers back to their posts. This money could be used to kick-start the planned incentive scheme for health workers to be launched in January 2009. Immediate aims include ensuring effective coordination among all health partners providing cholera-related interventions; increasing capacity to provide more clean drinking water in health facilities; strengthening disease reporting, monitoring and assessment under WHO leadership; and procuring more supplies. This will be followed by longer-term support for the health sector’s revitalisation.

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