This article investigates whether present community health worker programmes for antiretroviral treatment are taking into account the lessons learnt from past experiences with community health worker programmes in primary health care and to what extent they are seizing the new antiretroviral treatment-specific opportunities. It is based on a desk review of multi-purpose community health worker programmes for primary health care and of recent experiences with antiretroviral treatment-related community health workers. The renewed attention to community health workers is very welcome, but the scale-up of community health worker programmes runs a high risk of neglecting the necessary quality criteria if it is not aligned with broader health systems strengthening. To achieve universal access to antiretroviral treatment, this is of paramount importance and should receive urgent attention.
Human Resources
The paper examines trends in inflow of health professionals to the United Kingdom from other countries, using professional registration data and data on applications for work permits. Available data show a considerable reduction in inflow of health professionals, from the peak years up to 2002 (for nurses) and 2004 (for doctors). There are multiple causes for this decline, including declining demand in the United Kingdom. Regulatory and education changes in the United Kingdom in recent years have also made international entry more difficult. Two lessons were learnt: comprehensive data is needed for proper monitoring of the impact of a code and countries with many independent, private-sector health care employers struggle to implement a code. the authors note therefore the significant challenges in implementing and monitoring a global code.
On the occasion of World Health Day 2009, the Global Health Workforce Alliance has underlined the important and critical role played by health workers at times of disaster and emergency. At the heart of making hospitals safer are the people responsible for saving lives - the health workers. And when an emergency strikes - health workers are on the frontline. Often 'first on scene', health workers are tragically also often the first casualties themselves - there are many examples around the work where health workers have been killed in large numbers in the early instances of disaster. Added to this, health workers - like all members of populations in crisis zones - lose family members, friends, colleagues and others close to them.
This paper reports on the first international attempt to investigate the migration intentions of pharmacy students and identify migration factors and their relationships. Nine countries were surveyed, including Zimbabwe. Results showed a significant difference in attitudes towards the professional and sociopolitical environment of the home country and perceptions of opportunities abroad between those who have no intention of migrating and those who intend to migrate on a long-term basis. Given the influence of the country context and environment on migration intentions, research and policy should frame the issue of migration in the context of the wider human resource agenda, thus viewing migration as one form of attrition and a symptom of other root causes. Policy development must take into account both remuneration and professional development to encourage retention.
This is a series of facility-based surveys using a common approach in six countries, including Mozambique and Zimbabwe. The objectives were twofold: to inform the development and monitoring of human resources for health (HRH) policy within the countries; and to test and validate the use of standardised facility-based human resources assessment tools across different contexts. The findings revealed that, with increasing experience in health facility assessments for HRH monitoring comes greater need to establish and promote best practices regarding methods and tools for their implementation, as well as dissemination and use of the results for evidence-informed decision-making. The overall findings of multi-country facility-based survey should help countries and partners develop greater capacity to identify and measure indicators of HRH performance via this approach, and eventually contribute to better understanding of health workforce dynamics at the national and international levels.
Heads and implementing workers of fifty HIV and AIDS programs and institutions accredited to offer antiretroviral services in Uganda, Kenya, Tanzania and Rwanda were key informants in face-to- face interviews guided by structured questionnaires. Inadequate human resource capacity including, inability to select, quantify and distribute ARVs and related commodities, and irrational prescribing and dispensing were some of the problems identified. A competence gap existed in all the four countries with a variety of healthcare professionals involved in the supply and distribution of ARVs. There is inadequate capacity for managing medicines and related commodities in East Africa. There is an urgent need for training in aspects of pharmaceutical management to different categories of health workers. Skills building activities that do not take healthcare workers from their places of work are preferred.
Human resources for health (HRH) is a critical component of health systems Many governments of our member states have expressed the need to determine the status HRH in relation to supply, utilization and management systems. The DJCC meeting of July 2003 recommended the establishment of the Human Resources for Health Technical Advisory Group to oversee the implementation ofthe many recommendations and the resolutions of health ministers at their 38thRegional Health Minister’s Conference of November 2003, all aimed at addressing the HRH Crisis in ECSA. To address this resolution, ECSA Health Community has conducted a series ofrelated studies addressing the issue of HRH in the region. Three studies have been on the impact of HIV/AIDS on the health workforce and this study focused on establishing the situation of HRH in the region. The findings of this study will assist not only in identifying further areas of research in relation to HRH but aid in developing both regional and national level strategies on training, deployment and retention.
Worldwide mobility of health professionals is a growing phenomenon, impacting the health systems of receiving, transit, and sending countries, so the need to develop European policies to adequately address these issues is urgent. At the same time, reliable and differentiated knowledge and findings as a basis for such policy are lacking. MoHProf will contribute to improving this knowledge base and facilitate European policy on human resource planning. The general objective of the project is to research current trends of mobility of health professionals to, from and within the EU. The project comprises four phases over a three-year period starting from November 2008. There will be four project meetings, starting with a kick-off meeting and project launch and concluding with an international conference, and roundtables as appropriate.
In Malawi, mid-level cadres of health workers provide the bulk of emergency obstetric and neonatal care. These cadres undertake roles and tasks that are more usually the province of internationally recognised cadres, such as doctors and nurses. While several studies address retention factors for doctors and registered nurses, data and studies addressing the perceptions of these mid-level cadres on the factors that influence their performance and retention within health care systems are scarce. This exploratory qualitative study undertook focus group discussions and semi-structured interviews at in four rural mission hospitals in Malawi among mid-level providers of emergency obstetric and neonatal care. Participants confirmed the difficulties of their working conditions and the clear commitment they have to serving the rural Malawian population. Although insufficient financial remuneration had a negative impact on retention and performance, the main factors identified were limited opportunities for career development and further education (particularly for clinical officers) and inadequate or non-existent human resources management systems. The lack of performance-related rewards and recognition were perceived to be particularly demotivating. For optimal performance and quality of care mid-level cadres need to be supported and properly motivated. A structured system of continuing professional development and functioning human resources management would show commitment to these cadres and support them as professionals. Action needs to be taken to prevent staff members from leaving the health sector for less stressful, more financially rewarding alternatives.
South Africa is failing to produce more nurses to deal with its health demands, according to the Democratic Nursing Organisation of South Africa (Denosa). The closure of some nursing colleges by the government, citing 'funding' as a reason, did not assist in the production of nurses, it reported. Denosa called on government to re-open the training colleges that were closed, to accommodate those who were interested in pursuing this career. The union said one of the contributing factors to the shortage was that school-leavers lacked interest in becoming nurses because of the unsavoury working environments that nurses face daily. Poor salaries also drive nurses away from the profession and the country. Denosa called on the state to improve health services nationwide.