Developed countries' gains in health human resources (HHR) from developing countries with significantly lower ratios of health workers have raised questions about the ethics or fairness of recruitment from such countries. Little is known, however, about actual recruitment practices. In this study, the researchers focus on Canada (a country with a long reliance on internationally trained HHR) and recruiters working for Canadian health authorities. They conducted interviews with health human resources recruiters employed by Canadian health authorities to describe their recruitment practices and perspectives and to determine whether and how they reflect ethical considerations. HHR recruiters' reflections on the global flow of health workers from poorer to richer countries mirror much of the content of global-level discourse with regard to HHR recruitment. A predominant market discourse related to shortages of HHR outweighed discussions of human rights and ethical approaches to recruitment policy and action that consider global health impacts. The researchers conclude by suggesting that the concept of corporate social responsibility may provide a useful approach at the local organisational level for developing policies on ethical recruitment. Such local policies and subsequent practices may inform public debate on the health equity implications of the HHR flows from poorer to richer countries inherent in the global health worker labour market, which in turn could influence political choices at all government and health system levels.
Human Resources
The objective of this study was to estimate the shortage of mental health professionals in low- and middle-income countries (LMICs). The researchers used data from the World Health Organisation’s Assessment Instrument for Mental Health Systems (WHO-AIMS) from 58 LMICs, as well as country-specific information on the burden of various mental disorders, focusing on eight mental health issues: depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs, and paediatric mental disorders. The researchers found that all low-income countries and 59% of the middle-income countries in the sample had far fewer professionals than needed to deliver a core set of mental health interventions. According to their calculations, the 58 LMICs sampled would need to increase their total mental health workforce by 239,000 full-time equivalent professionals to address the current shortage. The authors of the study call for country-specific policies to overcome the large shortage of mental health-care staff and services in LMICs.
The purpose of this article is twofold. First, the authors describe Uganda's transition from a paper filing system to an electronic HRIS capable of providing information about country-specific health workforce questions. They then examine the ongoing five-step HRIS strengthening process used to implement an HRIS that tracks health worker data at the Uganda Nurses and Midwives Council (UNMC). Secondly, they describe how HRIS data can be used to address workforce planning questions via an initial analysis of the UNMC training, licensure and registration records from 1970 through May 2009. The data indicate that, for the 25 482 nurses and midwives who entered training before 2006, 72% graduated, 66% obtained a council registration, and 28% obtained a license to practice. Of the 17,405 nurses and midwives who obtained a council registration as of May 2009, 96% are of Ugandan nationality and just 3% received their training outside of the country. Thirteen per cent obtained a registration for more than one type of training. Most (34%) trainings with a council registration are for the enrolled nurse training, followed by enrolled midwife (25%), registered (more advanced) nurse (21%), registered midwife (11%), and more specialised trainings (9%). The authors conclude that the UNMC database is valuable in monitoring and reviewing information about nurses and midwives. However, information obtained from this system is also important in improving strategic planning for the greater health care system in Uganda.
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.
The purpose of this article is to explore the responses of nurses to a point-of-care e-health system that was implemented in a large private hospital in South Africa, to find out why the nursing staff rejected the implementation of the system. The authors of the study examined user responses with reference to a model designed to account for the use and adoption of mobile handheld devices, having adapted the model for an e-health context. In addition to the input features of technological characteristics and individual differences identified in the model, the added features of nursing culture and group differences were found to be influential factors in fuelling the nurses' resistance to the point-of-care system. Nurses perceived a lack of cultural fit between the system and their work. Their commitment to their nursing culture meant that they were not prepared to adapt their processes to integrate the system into their work, believing it might reduce quality of care. The study shows that the model is useful for understanding adoption in an organisational context and also that the additional elements of nursing culture and group differences are important in an e-health context.
Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training, is a potential strategy to address health worker shortages in low-income countries. This study uses an economics perspective to review the skill mix literature to determine the evidence in favour of task shifting, identify gaps in the evidence and propose a research agenda. Thirty-one studies, primarily from low-income countries and published between 2006 and September 2010, were included. First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. Second, although task shifting is promising, it can present its own challenges, the authors argue, such as quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided - if any care at all - had task shifting not occurred. The authors conclude that task shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost. Future studies should examine the development of new professional cadres that evolve with technology and country-specific labour markets. To strengthen the evidence, skill mix changes need to be evaluated with a rigorous research design to estimate the effect on patient health outcomes, quality of care, and costs.
The author of this study assessed the situation of nurses and home-based care givers in Tanzania and found a number of challenges. Most non-household care services for PLWHAs were found to be carried out by a few civil society organisations, which are heavily reliant on external funding and the labour of volunteers, mostly women. This dependency on external funding and volunteer labour is argued to threaten the sustainability of the HBC programme. Volunteers include retired nurses, PLWHAs and poor women, who subsidise the cost of care out of their pockets by helping PLWHAs, such as with transport to clinics. Within the health workforce, the nursing cadre (the majority of whom are women) carry a disproportionate burden of care without adequate compensation, with gaps in provision of proper protective gear and allowances for HBC nurses not adequately covering transport costs and other hidden expenses. The authors note that this gap could be addressed, but many district councils do not have capacity to utilise the AIDS money allocated to them. They conclude that the HBC programme appears to have created unexpected financial burdens for households, and for paid HBC employees and volunteers.
With increased global attention on health worker retention, this analysis of the current situation finds a diversity of country contexts and situations that affect health worker retention and proposes that policy-makers develop a tailored bundle of interventions to attract health workers to rural service and encourage them to stay that are most appropriate for their own context and situation.
In South Africa, many health care workers managing HIV-infected patients - particularly those in rural areas and primary care health facilities - have minimal access to information resources and to advice and support from experienced clinicians. The Medicines Information Centre, based in the Division of Clinical Pharmacology at the University of Cape Town, has been running the National HIV Health Care Worker (HCW) Hotline since 2008, providing free information for HIV treatment-related queries via telephone, fax and e-mail. This questionnaire-based study showed that 224 (44%) of the 511 calls that were received by the hotline during the two-month study period were patient-specific. Ninety-four completed questionnaires were included in the analysis. Of these, 72 (77%) were from doctors, 13 (14%) from pharmacists and 9 (10%) from nurses. Ninety-six percent of the callers surveyed took an action based on the advice they received from the National HIV HCW Hotline. Most of the queries concerned the start, dose adaptation, change or discontinuation of medicines. Less frequent actions taken were adherence and lifestyle counselling, further investigations, referring or admission of patients. The authors of this study conclude that the information provided by the National HIV HCW Hotline on patient-specific requests has a direct positive impact on the management of patients.
The purpose of this article is twofold. First, the authors describe Uganda's transition from a paper filing system to an electronic Human Resource Information System (HRIS) capable of providing information about country-specific health workforce questions. They examine the ongoing five-step process to strengthen the HRIS to track health worker data at the Uganda Nurses and Midwives Council (UNMC). Second, they describe how HRIS data can be used to address workforce planning questions via an initial analysis of the UNMC training, licensure and registration records from 1970 through May 2009. The data indicated that, for the 25,482 nurses and midwives who entered training before 2006, 72% graduated, 66% obtained a council registration, and 28% obtained a licence to practice. Of the 17,405 nurses and midwives who obtained a council registration as of May 2009, 96% are of Ugandan nationality and just 3% received their training outside of the country. Thirteen percent obtained a registration for more than one type of training. Most (34%) trainings with a council registration are for the enrolled nurse training, followed by enrolled midwife (25%), registered (more advanced) nurse (21%), registered midwife (11%), and more specialised trainings (9%). The authors found the UNMC database was valuable in monitoring and reviewing information about nurses and midwives. However, they add that information obtained from this system is also important in improving strategic planning for the wider health care system in Uganda.