The number of people currently being trained to become health workers falls far below the levels needed to ensure health goals are met, according to the Global Health Workforce Alliance (GHWA), a WHO partnership. The 2006 World Health Assembly Resolution (59.23) called on all Member States to help rapidly increase the number of health workers. In response, GHWA asked a group of experts to review and report on the experiences and research from around the world, and to draw up proposals on how to scale up the education and training of health workers. Drawing on case studies from 10 countries, the report details a set of recommendations.
Human Resources
61st World Health Assembly: Health worker training falling far below needs
World Health Organization, 22 May 2008
Intent to migrate among nursing students in Uganda: Measures of the brain drain in the next generation of health professionals
Nguyen L, Ropers S, Nderitu E, Zuyderduin A, Luboga S and Hagopian A: Human Resources for Health 6(5), 12 February 2008
There is significant concern about the worldwide migration of nursing professionals from low-income countries to rich ones, as nurses are lured to fill the large number of vacancies in upper-income countries. This study explores the views of nursing students in Uganda to assess their views on practice options and their intentions to migrate. Most (70%) of the participants would like to work outside Uganda, and said it was likely that within five years they would be working in the US(59%) or the UK(49%). About a fourth (27%) said they could be working in another African country. Only eight percent of all students reported an unlikelihood to migrate within five years of training completion. Survey respondents were more dissatisfied with financial remuneration than with any other factor pushing them towards emigration. Those wanting to work in the settings of urban, private, or UK/US practices were less likely to express a sense of professional obligation and/or loyalty to the country. Those who have lived in rural areas were less likely to report wanting to emigrate. Students with a desire to work in urban areas or private practice were more likely to report an intention to emigrate for financial reasons or in pursuit of country stability, while students wanting to work in rural areas or public practice were less likely to want to emigrate overall.
Launch of first-ever guidelines on incentives for health professionals
Global Health Workforce Alliance, 20 May 2008
The world's leading health and hospital professional associations have joined to produce the first-ever joint guidelines on incentives for the retention and recruitment of health professionals. Underlining both financial and non-financial incentives as critical to ensuring effective recruitment, retention and performance of health workers across the world, the Guidelines on Incentives describe different approaches taken by a number of countries. Examples of financial incentives cited include tax waivers, allowances (e.g. - housing, clothing, child care, remote location weighting etc.), insurance, and performance payments. Examples of non financial incentives include ensuring positive work environments, flexibility in employment arrangements and support for career development. The report underlines how incentives are important levers that organisations can use to attract, retain, motivate and improve the performance of their staff in all professions and walks of life. This is especially and urgently needed in the health care sector, where the growing gap between the supply of health care professionals and the demand for their services is reaching crisis levels in many countries.
Motivation of health care workers in Tanzania: A case study of Muhimbili National Hospital
Leshabari MT, Muhondwa EP, Mwangu MA and Mbembati NA: East African Journal of Public Health 5 (1):32-37
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.
Opinion of the European Economic and Social Committee on Migration and development: opportunities and challenges
Official Journal of the European Union, 16 May 2008/C 120/18
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.
Turnover of health professionals in the West Nile region, Uganda
Onzubo P: Health Policy and Development 5(1): 28-34
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.
Used and abused - community volunteers need a policy
Real Health News, 28 April 2008
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.
A global dialogue on a global crisis
The Lancet 371(9619), 5 April 2008
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.
Addressing the Human Resource Crisis in Malawi’s health sector: Employment preferences of public sector registered nurses
Mangham, L: ESAU Working Paper 18, Overseas Development Institute, London, 4 April 2008
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.
Effects of a community-based delivery of intermittent preventive treatment of malaria in pregnancy on treatment seeking for malaria at health units in Uganda
Mbonyea, AK; Schultz, K; Hansenb, K; Bygbjergc, IC; Magnussend, P: Department of Health Services Research, Institute of Public Health, University of Aarhus, Denmark
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.