Endorsing the Millennium Development Goals (MDG), the international community committed itself to significant improvements in the health of the poor and set ambitious targets. Achieving the MDG will depend on improving access to priority health interventions, which requires significant supply and demand side constraints to be overcome. The study investigated the human resource implications of expanding the coverage of priority health interventions in Tanzania and Chad. The authors conclude that the health workforce in Tanzania and Chad, and probably in many other SSA countries, is grossly insufficient for the expansion of priority interventions envisaged in current international dialogue. An immediate response at the national and international level is required to ensure progress towards the MDG.
Human Resources
This paper discusses how Mozambique coped with the health system needs in terms of specialised doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. Different scenarios, partnerships and contract schemes that have evolved since independence are briefly described, as well as self-reliance option possibility and implications. Lessons learned about donor initiatives aimed at contracting specialists from other developing countries are singled out. The issue of obtaining expertise and knowledge in the global market as cheap as possible is stressed, and realistic figures of cost planning are highlighted, as determined by the overall health system necessities and budget limitations.
This report presents a comprehensive analysis of the human resources for health (HRH) currently available and required to reach the targets set by the President’s Emergency Plan for AIDS Relief and the Millennium Development Goals (MDGs) in both the public sector and the faith-based organisations (FBOs) in Kenya. A stratified convenience sample of health facilities at all levels of care in each of the eight provinces was selected for the assessment. A sample of Ministry of Health and FBO health facilities at all levels of service in each of the eight provinces was selected for the assessment. Conclusions include that the geographical distribution of skilled HRH in Kenya is heavily skewed towards urban areas; and substantial annual growth rates (across all staff categories) are needed to meet the future requirements.
"Swaziland is dying. Will the last nurse on duty please turn off the lights?" reads a handwritten note at a clinic in Manzini, the country's AIDS-hit commercial centre, 35km southeast of the capital, Mbabane. The wry note disguises the pain of Swaziland's diminishing number of nurses and hints at the reason why their colleagues have fled the country to offer their services elsewhere.
On World AIDS Day, Physicians for Human Rights sent a letter to President Bush urging the US government to address the massive health worker shortage in Africa. An estimated one million additional health workers are needed in sub-Saharan Africa alone to fight AIDS and other diseases. The letter was signed by over 100 prominent US health professionals, including 33 deans of medical, nursing, and public health schools, representing some of the country's most influential health leaders. Many of these health experts have seen first-hand the devastation caused by the lack of health workers, medicines, and supplies in many African countries struggling with the AIDS pandemic.
Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers' perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support.
The shortage of healthcare workers is a global crisis, but developed countries can afford to throw money at the problem, attracting nurses and doctors from developing countries with vastly better salaries and working conditions. In Malawi, the fourth poorest country in the world, where UNAIDS has put HIV prevalence at 14 percent, the health worker shortage is so acute that the ministry of health and international donors are now treating it as an emergency.
This paper describes the current situation of the health workforce in the public sector in Swaziland. Swaziland, like most other countries in southern Africa, is facing a human resources crisis that is exacerbated by the impact of HIV and AIDS. The paper identifies the major factors that contribute to losses in the health workforce as emigration and attrition due to AIDS. It describes the initiatives that the government has undertaken to tackle the crisis. These include retention strategies such as increased salaries to retain staff, and scaling up anti retroviral therapy (ART) for health-care workers to reduce attrition.
Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries; and (iii) to describe other losses from brain drain. Results showed that Developed countries continue to deprive Kenya of millions of dollars worth of investments embodied in her human resources for health. If the current trend of poaching of scarce human resources for health (and other professionals) from Kenya is not curtailed, the chances of achieving the Millennium Development Goals would remain bleak.
Absence of current reliable human resources data for health workers at the country level limits the ability to monitor and improve HRH leadership, management, policy and planning. Responding to this health workforce crisis, about 90 participants from fifteen African countries and international organizations have joined forces for the African Health Workforce Observatory. The East, Central and Southern African Health Community (ECSA), the World Health Organisation, World Bank and USAID/Capacity Project have partnered to accelerate the establishment of Africa Health Workforce Observatory. This three-day meeting focussed on developing mechanisms to create up-to-date reliable information that enables evidence-based decision making for human resources for health.