Having difficulty getting an airline booking to the US? The problem may well be that you're standing in line with a small army of pharmacists and their families due to leave SA over the next few weeks. Behind this exodus is Albertson's, a $28bn/year turnover US retail pharmacy group with a staff of 200 000. One of their recruits, Cape Town pharmacist Keith Hughes, will be leaving behind a 20-year career to begin afresh in Delaware. As an "intern" Hughes can expect an immediate $2 000/month income boost.
This study explores the constraints related to human resources in the health (HRH) sector to achieving the Millennium Development Goals (MDGs) in low-income countries. The author finds that, at an individual level, the decision to enter, remain and serve in the health sector workforce is influenced by a series of social, economic, cultural and gender-related determinants.
Do African adolescents know enough about AIDS to protect themselves against infection? What is the best way to educate them about the risks of HIV? A report from Population Services International evaluates a peer-led HIV prevention programme in a secondary school in Zambia.
The recent thematic series on close-to-community providers published in this journal brings together 14 papers from a variety of contexts and that use a range of research methods. The series clearly illustrates the renewed emphasis and excitement about the potential of close-to-community (CTC) providers in realising universal health coverage and supporting the sustainable development goals. This editorial discusses key themes that have emerged from this rich and varied set of papers and reflect on the implications for evidence-based programming. The authors argue that it is a critical stage in the development of CTC programming and policy which requires the creation and communication of new knowledge to ensure the safety, sustainability, quality and accessibility of services, and their links with both the broader health system and the communities that CTCs serve.
This paper presents findings from a study which sought to understand why health workers working under the results-based financing (RBF) arrangements in Zimbabwe reported being satisfied with the improvements in working conditions and compensation, but paradoxically reported lower motivation levels compared to those not working under RBF arrangements. A qualitative study was conducted amongst health workers and managers working in health facilities that were implementing the RBF arrangements and those that were not. Through purposeful sampling, 4 facilities in RBF implementing districts that reported poor motivation and satisfaction, were included as study sites. Four facilities located in non-RBF districts which reported high motivation and satisfaction were also included. Data was collected through in-depth interviews and analyzed using the framework approach. Findings reveal that insufficient preparedness of people and processes for this change, constrained managers and workers performance. Results based financing arrangements introduce explicit and tacit changes, including but not limited to, incentive logics, in the system. Findings show that unless systematic efforts are made to enable the absorption of these changes in the system: eg, through reconfiguring the decision space available at various levels, through clarification of accountability relationships, through building personnel and process capacities, before instituting changes, the full potential of the RBF arrangements cannot be realised. This study demonstrates the importance of analysing existing institutional, management and governance arrangements and capabilities and taking these into account when designing and implementing RBF interventions. Introducing RBF arrangements cannot alone overcome chronic systemic weaknesses. For a system wide change, as RBF arguably is, to be effected, explicit organisational change management processes need to be put in place, across the system. The authors argue that carefully designed processes, which take into account the interest and willingness of various actors to change, and which are cognizant of and constructively engage with potential bottlenecks and points of resistance, should accompany any health system change initiative.
Malawi’s health service is struggling under the burden of HIV and AIDS and tuberculosis (TB). Its health workforce has only limited capacity to cope due to severe staff shortages, poor salaries and working conditions, high levels of HIV and AIDS-related deaths and chronic absenteeism due to illness among staff. Without a strong health workforce, community members may have an important role to play in providing HIV and TB care. Médecins Sans Frontières describes an example of community involvement in district level HIV and TB care. The study focuses on Thyolo district, a rural region of southern Malawi with 458,976 inhabitants, of which an estimated 41,000 are living with HIV. It covers a two-year period from January 2003 to December 2004.
On 25 May 2013, 98 community care workers representing over 50 organisations with the Community Care Workers (CCW) Forum, the Wellness Foundation and the People’s Health Movement of South Africa met to reaffirm the importance of community care workers in South Africa’s health system and to expose the terrible working conditions that many community care workers are experiencing. CCWs work in the homes of the poorest of the poor often without protective face masks, gloves and other basic materials. The People’s Health Movement calls for these CCWs to enjoy decent work conditions and receive adequate recognition. It proposes a ‘two-tier’ system like that of Thailand, where high coverage is achieved by instituting where there is one full-time CCW for every 300-500 households, who then supervises 10 part-time CCWs who have more limited training. Such high coverage of households has been shown to have a dramatic impact on health outcomes, especially of young children. The ratio currently proposed in South Africa of one CHW to 270 households is extremely unlikely to have such an effect given South Africa’s very high burden of disease, and the large percentage of people requiring time-consuming home care. In addition to rendering health care more accessible and equitable, the two-tier system would create jobs, and indirectly improve health by reducing the prevalence and depth of poverty.
In 2015, the One Million Community Health Workers (1mCHW) Campaign and mPowering Frontline Health Workers (mPowering) conducted a series of interviews and held an online discussion, hosted on the Healthcare Information for All forum, on the need for improved data on community health workers (CHWs) to help achieve the Sustainable Development Goals. The key findings showed that CHWs deliver life-saving health care services than can address health issues in poor rural communities. They help keep track of disease outbreaks and overall public health, and offer a vital link between underserved populations and the primary health care system. CHWs have been recognised for their success in reducing morbidity and averting mortality in mothers, newborns and children. While they have proven crucial in settings where the primary health care system is weak, or where there are health workforce shortages, they are most effective when properly supported and deployed within the context of an appropriately financed health system.
In 2010, South Africa’s National Department of Health launched a national primary health care (PHC) initiative to strengthen health promotion, disease prevention, and early disease detection. The strategy, called Re-engineering Primary Health Care (rPHC), aims to provide a preventive and health-promoting community-based PHC model. A key component of rPHC is the use of community-based outreach teams staffed by generalist community health workers (CHWs). The authors conducted focus group discussions and surveys on the knowledge and attitudes of 91 CHWs working on community-based rPHC teams in the King Sabata Dalindyebo (KSD) sub-district of Eastern Cape Province. The CHWs studied enjoyed their work and found it meaningful, as they saw themselves as agents of change. They also perceived weaknesses in the implementation of outreach team oversight, and desired field-based training and more supervision in the community. The authors find that there is a need to provide CHWs with basic resources like equipment, supplies and transport to improve their acceptability and credibility to the communities they serve.
In 2010, South Africa’s National Department of Health launched a national primary health care initiative to strengthen health promotion, disease prevention, and early disease detection. The strategy, called Re-engineering Primary Health Care, aims to provide a preventive and health-promoting community-based Primary Health Care model. A key component is the use of community-based outreach teams staffed by generalist community health workers. The authors conducted focus group discussions and surveys on the knowledge and attitudes of 91 Community Health Care Workers working on community-based teams in Eastern Cape Province. The community health workers who were studied enjoyed their work and found it meaningful, as they saw themselves as agents of change. They also perceived weaknesses in the implementation of outreach team oversight, and desired field-based training and more supervision in the community. The authors propose providing community health workers with basic resources like equipment, supplies and transport to improve their acceptability and credibility to the communities they serve.