Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. These non-physician clinicians (NPCs) were found in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3–4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.
Human Resources
There is growing concern globally at the current flows of nurse migration, particularly from low-income to middle and high-income countries. Recruitment practices of many countries such as Ireland are thought to be fuelling this rate of migration. This paper aims to establish the perceptions and opinions of those involved in the recruitment process on their role in recruitment and the effects recruitment has on both source and destination countries. A purposive sample of 12 directors of nursing, from major academic teaching hospitals in Dublin and hospitals in South Africa and the Philippines were recruited.
Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.
Increased international migration of health professionals is weakening healthcare systems in low-income countries, particularly those in sub-Saharan Africa. The migration of nurses, physicians and other health professionals from countries in sub-Saharan Africa poses a major threat to the achievement of health equity in this region. As nurses form the backbone of healthcare systems in many of the affected countries, it is the accelerating migration of nurses that will be most critical over the next few years. In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one's country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health.
Geographical imbalances in the health workforce are a consistent feature of nearly all health systems, especially in developing countries. This paper investigates the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analysing data obtained from contingent valuation questions for final year students from three medical schools and eight nursing schools, we find that there is substantial heterogeneity in the willingness to serve in rural areas.
As one of the oldest and most respected professions in the world, the work of midwives is celebrated annually on 5 May. To mark the occasion, the International Day of Midwives will be celebrated at WHO Headquarters on Friday 4 May. WHO staff will gather to show their support for the essential role of midwives in saving the lives of pregnant women who might otherwise die from malnourishment or lack of skilled care during pregnancy and childbirth.
In countries with a high AIDS prevalence, the health workforce is affected by AIDS in several ways. In Zambia, which has a 16.5% prevalence rate, a 2004 study aimed to: explore the impact of HIV/AIDS on health workers, describe their coping mechanisms and recommend supportive measures. Interviews revealed that counsellors and nurses were especially at risk for emotional exhaustion. AIDS complicates the already difficult work environment. In addition to health workers, management also needs support in dealing with AIDS at the workplace.
Effective and often cheap interventions exist to achieve the MDGs by 2015. In Tanzania, one of the poorest countries of the world, we explored the human resources challenges of expanding the coverage of such priority interventions. Even in an optimistic scenario, human resource availability will limit the extent to which priority interventions can be expanded in Tanzania, and the government will not be able to avoid adjusting the globally set targets for service coverage and health outcomes to local realities and priorities.
Increased international migration of health professionals is weakening healthcare systems in low-income countries, particularly in sub-Saharan Africa. As nurses form the backbone of healthcare systems in many of the affected countries, accelerating migration of nurses is most critical. In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one’s country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality.
Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration.