Human Resources

How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework
Steege R; Taegtmeyer M; McCollum R; et al: Social Science & Medicine 209 (2018) 1–13, 2018

This paper synthesises current evidence on gender and close-to-community (CTC) providers and the services they deliver. The review included 58 papers from literature to inform the development of a conceptual framework. The authors present a holistic conceptual framework to show how gender roles and relations shape CTC provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. The authors present suggestions for how the role of a CTC provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities.

Postgraduate training for trauma prevention, injury surveillance and research, Uganda
Bachani A; Paichadze N; Bentley J; et al: Bulletin of the World Health Organisation; 96(6):423–427, 2018

This paper addressed the gaps in shortage of trained people and lack of national data on non-communicable diseases and their risk factors in Uganda. The authors developed and implemented a new track within an existing master of public health programme, aimed at developing graduate-level capacity and promoting research on key national priorities for trauma and injuries. They also offered training opportunities to a wider audience and set up a high-level national injury forum to foster national dialogue on addressing the burden of trauma, injuries and disability. Over the years 2012 to 2017 there were four cohorts of master’s students, with a total of 14 students. Over 1300 individuals participated in workshops and seminars of the short-term training component of the programme. The forum hosted three research symposia and two national injury forums. The authors note that institutional support and collaborative engagement is important for developing and implementing successful capacity development programmes, and that integration of training components within existing academic structures is key to sustainability and appropriate mentorship for motivated and talented students.

South Africa: Health workers say they are undervalued and poorly equipped
Mutandiro K: GroundUp, July 2018

Representatives from the Democratic Nursing Organization of South Africa (Denosa), a trade union that represents nurses and professional midwives, say that nursing staff work under bad conditions. A Denosa spokesman said South African nurses and nursing staff were seeking work out of the country where they were appreciated and would get better salaries. “People who rely on the services of public healthcare workers are disadvantaged when public health workers are understaffed or strike due to unresolved grievances,” said Ashwell Jenneker of Statistics South Africa. In a dialogue, the South Africa Minister of Health, Aaron Motsoaledi said, “We will do our best to ensure that all health workers are given better working conditions. We will also work on making sure that the minimum service level of health workers is implemented.” Those attending the dialogue agreed that a formal investigation was needed into the working conditions of all health workers.

Community health workers and accountability: reflections from an international “think-in”
Schaaf M; Fox J; Topp S; et al: International Journal for Equity in Health 17(66) 1-5, 2018

Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and as a means for improvement in health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” This jointly authored commentary resulted from the authors’ deliberations. While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. Several propositions were made for further conceptual development and research related to the question of CHWs and accountability.

Community-based training of medical students is associated with malaria prevention and treatment seeking behaviour for children under 5 years in Uganda: a study of MESAU-MEPI COBERS in Uganda
Obol J; Akera P; Ochola P; et al: BMC Medical Education 18(131), doi:, 2018

This paper seeks to assess if targeted community-based medical education programme is associated with better prevention and treatment seeking behaviours in the management of malaria, a leading cause of morbidity and mortality of children under five in Uganda. A cross-sectional survey was done to compare communities around health facilities where medical students were placed at community-based education and Research Service (COBERS) sites with communities around similar health facilities where medical students were not placed (non-COBERS sites). The authors randomly selected two villages near each health facility and consecutively selected 10 households per village for interviews using nearest-neighbour method. The authors used a structured questionnaire to interview household heads on malaria prevention and treatment seeking behaviour for children under 5 years. The authors performed univariate analysis to determine site and demographic characteristics and performed a multivariate logistic regression to assess association between dependent and independent variables. Five hundred twenty-three of the children under 5 years in COBERS communities slept under insecticide treated nets the night before survey compared with 1451 in non-COBERS communities. 100 of children under 5 years in COBERS communities sought care for fever within 24 h of onset compared with 268 in non-COBERS communities. The presence of COBERS in communities is associated with improved malaria prevention and treatment-seeking behaviour for parents of children under 5 years. Further study needs to be done to determine the long-term impact of COBERS training program on malaria control and prevention in Uganda, along with its other effects.

Grandmothers help to scale up mental health care
Fleck F, Chibanda D: Bulletin of the World Health Organisation 96(66), doi:, 2018

Dixon Chibanda developed the Friendship Bench approach to mental health care in Zimbabwe. In this interview he tells Fiona Fleck how he is taking the innovative approach to other countries. The idea of the Friendship Bench arose when he lost a patient to suicide in 2005. After identifying a large burden of mental health conditions, Chibanda talked to the authorities, but they had no money, staff or facilities to offer. So in 2007 he worked with 14 grandmothers in Mbare, a suburb of Harare that was badly affected by the clearance operation of informally built suburbs in the city. The grandmothers were from the community and already doing community work and the friendship bench formalized their role. The first four years were focused on developing a culturally appropriate evidence-based intervention that they could deliver. They developed a problem-solving therapy in the local language drawing on familiar concepts in the local culture while incorporating elements of cognitive behavioural therapy. Together with the grandmothers, they came up with key terms – kuvhura pfungwa, which means opening the mind, kusimudzira, (uplifting), and kusimbisa(strengthening) – that formed the basis of the Friendship Bench approach. The benches are outside each health facility, initially they were set apart, but now they are quite public, because the programme is widely accepted in the communities. Harare has more than 53 primary health care facilities, each with one to four of these benches. When people come to these facilities seeking mental health services, they are screened with the Shona Symptoms Questionnaire 14 to determine the level of mental health disorders and referred to the grandmothers –lay health workers who have been trained and who are supervised by health professionals. Chibanda’s own grandmother lived in Mbare and – although she was not one the therapists – she was instrumental in coming up with the income generating component of the approach, which is an important part of the group peer support. After finishing sessions on the bench, the grandmothers sit in a circle and share the challenges they face with their colleagues, while crocheting bags with recycled plastic to sell. Now, after completing therapy, the grandmothers give their patients further support and show them how to make the bags, as a forum for problem solving and income generation. In Zimbabwe, the approach has been scaled up in more than 70 communities in Harare, Chitungwiza and Gweru and further roll out is taking place, with a component for adolescents under development. The approach is being rolled out in Tanzania, the USA, Canada, Australia and New Zealand.

What should the African health workforce know about disasters? Proposed competencies for strengthening public health disaster risk management education in Africa
Olu O, Usman A, Kalambay K, et al.: BMC Medical Education, 18; 60,, 2018

As part of efforts to implement the human resources capacity building component of the African Regional Strategy on Disaster Risk Management (DRM) for the health sector, the African Regional Office of the World Health Organization, in collaboration with selected African public health training institutions, followed a multistage process to develop core competencies and curricula for training the African health workforce in public health DRM. In this article, we describe the methods used to develop the competencies, present the identified competencies and training curricula, and propose recommendations for their integration into the public health education curricula of African member states. The authors identified 14 core competencies and 45 sub-competencies/training units grouped into six thematic areas: 1) introduction to DRM; 2) operational effectiveness; 3) effective leadership; 4) preparedness and risk reduction; 5) emergency response and 6) post-disaster health system recovery. These were defined as the skills and knowledge that African health care workers should possess to effectively participate in health DRM activities. To suit the needs of various categories of African health care workers, three levels of training courses are proposed: basic, intermediate, and advanced.

Nursing education challenges and solutions in Sub Saharan Africa: an integrative review
Bvumbwe T; Mtshali N: BMC Nursing, 17:3,, 2018

This integrative review examined literature on nursing education challenges and solutions in Sub Saharan Africa to inform development of a model for improving the quality, quantity and relevance of nursing education at local level through a search of online libraries. Twenty articles and five grey sources were included. The findings of the review generally support World Health Organisation framework for transformative and scale up of health professions education. Six themes emerged; curriculum reforms, profession regulation, transformative teaching strategies, collaboration and partnership, capacity building and infrastructure and resources. Challenges and solutions in nursing education are common within countries. The review shows that massive investment by development partners is resulting in positive development of nursing education in Sub Saharan Africa. However, strategic leadership, networking and partnership to share expertise and best practices are argued from the evidence to be critical. The authors propose that Sub Saharan Africa needs more reforms to increase capacity of educators and mentors, responsiveness of curricula, strongly regulatory frameworks, and availability of infrastructure and resources.

Practitioner Expertise to Optimize Community Health Systems: Harnessing Operational Insight
Ballard M; Schwarz R; Johnson A; et al: Community Health Worker Impact, USA, 2017

To harness the potential of community health workers (CHWs) to extend health services to poor and marginalized populations the authors argue that there is a need to better understand how CHW programs can be optimized. This paper presents the experience of and insights from application by selected organizations that have developed high-impact CHW programs with governments and communities in different countries globally. They present a series of design principles that, in their experience, drive programmatic quality and are debated or not commonly found in programs across the globe: CHWs must meet minimum standards before working; point of care fees should be avoided when possible; CHWs should go door to door and provide training on when to seek help; continuing training should be a requirement; CHWs should benefit from a dedicated supervisor and be paid and should be part of a strong local health system and data feedback loops.

Exploring the care provided to mothers and children by community health workers in South Africa: missed opportunities to provide comprehensive care
Wilford A; Phakathi S; Haskins L; et al: BMC Public Health 18(171), doi:, 2018

In this study the authors explored the performance of by community health workers (CHWs) providing maternal and child health services at household level and the quality of the CHW-mother interaction using observations and in-depth interviews. Fifteen CHWs and 30 mothers/pregnant women were purposively selected in three rural districts of KwaZulu-Natal, South Africa. CHWs provided appropriate and correct health information but there were important gaps in the content provided. Mothers expressed satisfaction with CHW visits and appreciation that CHWs understood their life experiences and therefore provided advice and support that was relevant and accessible. CHWs expressed concern that they did not have the knowledge required to undertake all activities in the household, and requested training and support from supervisors during household visits. The authors assert that key building blocks for a successful CHW programme are in place to provide services for mothers and children in households but further training and supervision is required if the gaps in CHW knowledge and skills are to be filled.