Human Resources

Trends In International Nurse Migration

Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. A twofold approach is required, involving greater diligence by developing countries in creating a largely sustainable domestic nurse workforce and their greater investment through international aid in building nursing education capacity in the less developed countries that supply them with nurses.

Turnover of health professionals in the West Nile region, Uganda
Onzubo P: Health Policy and Development 5(1): 28-34

The imbalances in Human Resources for Health that result from health professionals crossing borders of districts, countries, and moving from private to public sectors and vice versa or leaving health services to join other non-health related business leads to inequity in delivery of health services, especially in the parts of the world that do not have sufficient incentives to attract these professionals. This study compared attrition rates in three Private-Not-For-Profit and three Government General Hospitals in West Nile Region over a period of five years. It also examined the destination to which the health professionals were lost, the source of the new staff that replaced those lost by the hospitals, the reasons for attrition as perceived by the existing staff in the hospitals, what kept some of the staff working for longer period than others who chose to leave, and the incentives in place for attraction and retention of health professionals in these hospitals.

Uganda Health Workforce Study: Satisfaction and Intent to Stay Among Health Workers in Public and PNFP Facilities
McQuide P, Kiwanuka-Mukiibi P, Zuyerduin A, Isabirye C: Capacity Project; Global Health Workforce Alliance

This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study to identify the level of satisfaction and intent to stay among health workers, to inform strategies to improve retention.

Ugandan government to employ 1,000 doctors
Businge C and Bwambale T: New Vision, 22 November, 2010

A total of 1,000 doctors are to be hired to improve the delivery of health services, according to Uganda’s Health Service Commission. The Commission's chairman said an advert will be placed in the newspapers in December and the interviews will follow thereafter. He said the recruitment of health workers will be a continuous and consistent process every year. Makerere, the most prestigious medical school in the country, produces about 100 doctors a year. In total, the country produces about 250 doctors per year, including other universities. In Uganda, the doctor to patient ratio is 1:24,725, falling short of the 1:600 standard set by the World Health Organisation. The recruitment is part of the five-year new health sector strategic and investment plan. Plans are also in advanced stages to increase salaries for all health personnel, according the directorate of health services. The health service commission has also proposed to the Cabinet to have doctors availed vehicle and housing soft loans. The Government offers newly recruited medical officers a gross monthly salary of Ugandan sh626,181, while the highest medical officer at the level of a consultant takes home sh1.6 million per month. Despite a recent 30% increase in salaries for Ugandan health workers, they still earn three times less than workers in neighbouring Rwanda and Kenya.

UK demand for overseas health professionals severely affecting sub-Saharan Africa
The Lancet 2005; 365:1893-1900

"The already inadequate health systems of sub-Saharan Africa have been badly damaged by the emigration of their health professionals, a process in which the UK has played a prominent part. In 2005, there are special opportunities for the UK to take the lead in addressing that damage, and in focusing the attention of the G8 on the wider problems of health-professional migration from poor to rich countries. We suggest some practical measures to these ends. These include action the UK could take on its own, with the African countries most affected, and with other developed countries and WHO." (requires registration)

Underpaid African Health Workers Flee the Frontline

Small antiretroviral drug programmes are beginning to take shape in some of the worst affected countries in Africa. But as the drugs flow in, the medical personnel needed to administer them are being lured away by the rich countries that talk loudly about finding a solution to Africa's AIDS crisis and whose companies provided the drugs. WHO estimates that only 750000 health workers are available to care for 682-million people in sub-Saharan Africa, which has more than 25-million people infected with HIV, or 60% of the global total.

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.

Underpaid and overworked: A cross-national perspective on care workers
Razavi S and Staab S (eds): 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, according to this special edition of the International Labour Review (ILR). 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, the collection of papers in the ILR pays particular attention to developing country contexts where issues of worker insecurity and exploitation are most intransigent, and where research has been sparse and data challenges are often significant. The book 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. This ILR contains two research papers relevant to the east, central and southern African region, one of which deals with nurses and home-based caregivers in Tanzania and the other which deals with nurses, social workers and home-based care workers in South Africa.

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.

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