Human Resources

US agencies plan to invest US$130 million in African medical education
National Institutes of Health News: 7 October 2010

The United States (US) Department of Health and Human Services is partnering with the US President’s Emergency Plan for AIDS Relief (PEPFAR) with a plan to invest US$130 million over five years in African medical education to increase the number of health care workers. Through the Medical Education Partnership Initiative (MEPI), grants are being awarded directly to African institutions in a dozen countries, working in partnership with US medical schools and universities. The initiative will form a network including about 30 regional partners, country health and education ministries, and more than 20 US collaborators.

US plan to lure nurses may hurt poor nations
The New York Times, 24 May 2006: Dugger CW

As the United States runs short of nurses, senators are looking abroad. A little-noticed provision in their immigration bill would throw open the gate to nurses and, some fear, drain them from the world's developing countries.

Use of task-shifting to rapidly scale-up HIV treatment services: Experiences from Lusaka, Zambia
Morris MB, Chapula BT, Chi BH, Mwango A, Chi HF, Mwanza J, Manda H, Bolton C, Pankratz DS, Stringer JS and Reid SE: BMC Health Services Research, January 2009

As part of ART services expansion in Lusaka, Zambia, this study implemented a comprehensive task-shifting programme among existing health providers and community-based workers. It provides on-going quality assessment using key indicators of clinical care quality at each site. Programme performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. Ongoing quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. The task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful so far, long-term solutions to the human resource crisis are urgently needed.

Used and abused - community volunteers need a policy
Real Health News, 28 April 2008

Multiple health programmes are using unpaid or low-paid community volunteers, and other sectors such as environment, water and agriculture are doing the same. A new study of reimbursement of health volunteers is revealing the need for an internationally agreed strategy. Community volunteers – unpaid or very poorly paid local workers from the villages and slums of developing countries – are proving increasingly valuable to many health, water and agricultural programmes. But as this gets more widely known, programmes using them are beginning to overlap, some in the same villages and some even with the same volunteers – while there is no coherent policy for how “use” or to reward them. This is reported in the paper to be an unsustainable form of exploitation as demands and expectations of these people increase.

Using Human Resource for Health Data: Health policy and program planning examples from four African countries
USAID, June 2008

Imbalances in quantity and quality of human resources for health (HRH) are increasingly recognised as perhaps the most critical impediment to achieving health outcome objectives in most African countries. However, reliable data on the HRH situation is not readily available. Some countries have hesitated to act in the absence of such data; other countries have not acted even when data are available while others have moved ahead in spite of the lack of reliable information. This paper addresses the issue of data use for HRH policy-making. It will provide valuable information to the body of literature available to policy-makers and their development partners as they grapple with the development and implementation of workable HRH policies.

Using mid-level cadres as substitutes for health professionals

This article, from Human Resources for Health, examines the experiences of using substitute health workers (SHW) in Africa. The review focuses mainly on physicians and reviews data from Tanzania, Congo, Kenya, Malawi, Mozambique, Zambia and Ghana. Findings demonstrate the cost-effectiveness of using SHWs and higher rates of retention within countries and in rural communities. However, problems are also identified, including the potential among SHWs for poor clinical decision making and lack of adherence to clinical regulations.

Using mid-level cadres as substitutes for internationally mobile health professionals in Africa

Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. The findings raise interest in expanding the use of substitute cadres, as the demands of expanding access to services such as antiretroviral treatment requires substantial human resources capacity.

Using primary health care (PHC) workers and key informants for community based detection of blindness in children in Southern Malawi
Kalua K, Ng’ongola RT, Mbewe F and Gilbert C: Human Resources for Health: 10(37), 27 September 2012

This study compared the effectiveness of trained Health Surveillance Assistants (HSAs) versus trained volunteer Key Informants (KIs) in identifying blind children in southern Malawi. A cluster community based study was conducted in Mulanje district, population 435 753. Six clusters each with a population of approximately 70,000 to 80,000, 42% of whom were children were identified and randomly allocated to either HSA or KI training. A total of 59 HSAs and 64 KIs were trained. HSAs identified five children of whom two were confirmed as blind (one blind child per 29.5 HSAs trained). On the other hand, the KIs identified a total of 158 children of whom 20 were confirmed blind (one blind child per 3.2 KIs trained). More blind boys than girls were identified (77.3% versus 22.7%) respectively. Key Informants were found to be much better at identifying blind children than HSAs, even though both groups identified far fewer blind children compared with WHO estimates. HSAs reported lack of time as a major constraint in identifying blind children. Based on these findings using HSAs for identifying blind children would not be successful in Malawi, the authors argue. Gender differences need to be addressed in all childhood blindness programs to counteract the imbalance.

Using staffing ratios for workforce planning: Evidence on nine allied health professions
Cartmill L, Comans TA, Clark MJ, Ash S and Sheppard L: Human Resources for Health 10(2), 1 February 2012

The aim of this study was to identify workforce ratios in nine allied health professions and to identify whether these measures are useful for planning allied health workforce requirements. A systematic literature search using relevant MeSH headings of business, medical and allied health databases and relevant grey literature for the period 2000-2008 was undertaken. Twelve articles were identified which described the use of workforce ratios in allied health services. Only one of these was a staffing ratio linked to clinical outcomes. The most comprehensive measures were identified in rehabilitation medicine. The authors conclude that evidence for use of staffing ratios for allied health practitioners is scarce and lags behind the fields of nursing and medicine.

Vertical funding, non-governmental organisations, and health system strengthening: perspectives of public sector health workers in Mozambique
Mussa AH, Pfeiffer J, Gloyd SS, Sherr K: Human Resources for Health 11(26), 14 June 2013

In this paper, the authors explored the perspectives and experiences of key Mozambican public sector health managers who coordinate, implement, and manage the myriad donor-driven projects and agencies. Over a four-month period, they conducted 41 individual qualitative interviews with key Ministry workers at three levels in the Mozambique national health system, using open-ended semi-structured interview guides, as well as reviewed planning documents. All respondents emphasized the value and importance of international aid and vertical funding to the health sector and each highlighted program successes that were made possible by recent increased aid flows. However, three serious concerns emerged: 1) difficulties coordinating external resources and challenges to local control over the use of resources channeled to international private organizations; 2) inequalities created within the health system produced by vertical funds channeled to specific services while other sectors remain under-resourced; and 3) the exodus of health workers from the public sector health system provoked by large disparities in salaries and work. The vertical approach starved the Ministry of support for its administrative functions. Few studies have addressed the growing phenomenon of “internal brain drain” in Africa which proved to be of greater concern to Mozambique’s health managers.