This paper reports on a study into the delivery of services and care at the Muhimbili National Hospital, to measure the extent to which workers in the hospital were satisfied with the tasks they performed and to identify factors associated with low motivation in the workplace. Almost half of both doctors and nurses were not satisfied with their jobs, as was the case for 67% of auxiliary clinical staff and 39% of supporting staff. Among the contributing factors reported were low salary levels, the frequent unavailability of necessary equipment and consumables to ensure proper patient care, inadequate performance evaluation and feedback, poor communication channels in different organisational units and between workers and management, lack of participation in decision-making processes, and a general lack of concern for workers welfare by the hospital management. Based on the study findings, several recommendations were made, including setting defined job criteria and description of tasks for all staff, improving availability and quality of working gear for the hospital, the introduction of a reward system commensurate with performance, improved communication at all levels, and introduction of measures to demonstrate concern for the workers' welfare.
Human Resources
The European Economic and Social Committee decided to draw up an opinion, under Rule 29(2) of its Rules of Procedure, on Migration and development: opportunities and challenges. It says the process of globalisation has led to the liberalised movement of capital, goods, and services. The movement of people, however, still remains globalisation's most restricted branch. In order to give less-developed economies a bigger share of the economic growth driven by globalisation, more attention should be given to the free movement of people. This opinion follows the school of thought that migration is a chance for developing countries to participate more equally in today's globalised economy and that migration has the potential to decrease inequality.
The imbalances in Human Resources for Health that result from health professionals crossing borders of districts, countries, and moving from private to public sectors and vice versa or leaving health services to join other non-health related business leads to inequity in delivery of health services, especially in the parts of the world that do not have sufficient incentives to attract these professionals. This study compared attrition rates in three Private-Not-For-Profit and three Government General Hospitals in West Nile Region over a period of five years. It also examined the destination to which the health professionals were lost, the source of the new staff that replaced those lost by the hospitals, the reasons for attrition as perceived by the existing staff in the hospitals, what kept some of the staff working for longer period than others who chose to leave, and the incentives in place for attraction and retention of health professionals in these hospitals.
Multiple health programmes are using unpaid or low-paid community volunteers, and other sectors such as environment, water and agriculture are doing the same. A new study of reimbursement of health volunteers is revealing the need for an internationally agreed strategy. Community volunteers – unpaid or very poorly paid local workers from the villages and slums of developing countries – are proving increasingly valuable to many health, water and agricultural programmes. But as this gets more widely known, programmes using them are beginning to overlap, some in the same villages and some even with the same volunteers – while there is no coherent policy for how “use” or to reward them. This is reported in the paper to be an unsustainable form of exploitation as demands and expectations of these people increase.
At the first Global Forum on Human Resources for Health in Kampala, Uganda, delegates endorsed a Global Agenda for Action on the alarming imbalances in the availability and distribution of health workers worldwide. One component of the Agenda was a pledge to "accelerate negotiations for a code of practice on the international recruitment of health workers". The first step was taken on March 31 with the launch of a 3-week online global dialogue convened by the Health Worker Migration Policy Initiative. The global dialogue provided a unique opportunity for anyone affected by the vast complexities of health-worker migration, in whatever capacity, to share experiences and knowledge on the realities of migration, on effective strategies to retain health workers where they are needed most, and on what the key principles of a global code of practice should be. The paper questions whether another code of practice really required.
Many developing countries suffer from critical shortages of trained health workers, but Malawi’s shortage is severe even by African standards. Measures to recruit and retain more staff are urgently needed.This paper reports on the employment preferences of public sector registered nurses in Malawi to help design incentives to encourage them to remain in Malawi's public health sector. Improved pay was the single most important attribute identified that might improve job satisfaction, followed by opportunities for further education and the provision of basic housing. Improvements in the quality of housing provided would have little impact on how nurses value their employment. Establishing the relationship between pay increases and retention of registered nurses would require additional research.
The impact of intermittent preventive treatment (IPTp) on malaria in pregnancy is well known. However, in countries where this policy is implemented, poor access and low compliance have been widely reported. Novel approaches are needed to deliver this intervention. This paper assesses whether or not traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilisers can administer IPTp with sulphadoxine–pyrimethamine (SP) to pregnant women, reach those at greatest risk of malaria, and increase access and compliance with IPTp. The report found that the community approach was effective for the delivery of IPTp, although women still accessed and benefited from malaria treatment and other services at health units. However, the costs for accessing malaria treatment and other services are high and could be a limiting factor.
This review examines the experiences of nurses, community health workers, and home carers in health systems from a gender analysis. With respect to nursing, current discussions around delegation take place over layers of historical struggle that mark the evolution of nursing as a profession. Female community health workers also struggle to be recognized as skilled workers, in addition to defending at a personal level the legitimacy of their work, as it transgresses traditional norms proscribing morality and the place of women in society, at times with violent consequences. The review concludes by exploring the characteristics of, and challenges faced by, home carers, who fail to be recognized as workers at all. A key finding is that these mainly female frontline health workers compensate for the shortcomings of health systems through individual adjustments, at times to the detriment of their own health and livelihoods. So long as these shortcomings remain as private, individual concerns of women, rather than the collective responsibility of gender, requiring public acknowledgement and resolution, health systems will continue to function in a skewed manner, serving to replicate inequalities in the health labour force and in society more broadly.
A cross-sectional voluntary, anonymous, unlinked survey including an oral fluid or blood sample and a brief demographic questionnaire where undertaken in two public hospitals in Gauteng, South Africa to determine the prevalence of HIV infection and the extent of disease progression based on CD4 count in a public health system workforce in southern Africa. The overall prevalence of HIV was 11.5%. By occupation, prevalence was highest among student nurses (13.8%) and nurses (13.7%). The highest prevalence by age was in the 25-34-year group (15.9%). Nineteen per cent of HIV-positive participants who provided blood samples had CD4 counts less than or equal to 200 cells/μl, 28% had counts 201-350 cells/μl, 18% had counts 351-500 cells/μl, and 35% had counts above 500 cells/μl. One out of 7 nurses and nursing students in this public sector workforce was HIV-positive. A high proportion of health care workers had CD4 counts below 350 cells/μl, and many were already eligible for antiretroviral therapy under South African treatment guidelines. Given the short supply of nurses in South Africa, knowledge of prevalence in this workforce and provision of effective AIDS treatment are crucial for meeting future staffing needs.
Who should assist women in childbirth, what should these attendants do and not do under various circumstances, and where should births take place? Policies regarding these questions have been debated for hundreds of years. WHO’s position on where and with whom women should deliver has evolved from emphasis on training of traditional birth attendants (TBAs) in developing countries in the late 1950s and 1960s, to a recommendation that TBAs work with the health-care system, to a recommendation that they be integrated into the health system via training, supervision and technical support, to today’s position of promoting professionally skilled attendance at all births. The facts that a) this position was adopted in 1997 and that it took an additional two years to specify the criteria required to be a “skilled attendant”, and b) that the policy sidesteps the issue of where births should take place, suggests that substantial internal debate swirled around this stance, as well. Although the WHO skilled attendance at birth policy remains today, it has now been incorporated into a continuum of maternal and child health care policy, resulting from the formation of the Partnership for Maternal, Newborn and Child Health in 2005.