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.
Human Resources
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.
Over the past decades, changes in economic, social and demographic structures have spurred the growth of employment in care-related occupations, according to this special edition of the International Labour Review (ILR). 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, the collection of papers in the ILR pays particular attention to developing country contexts where issues of worker insecurity and exploitation are most intransigent, and where research has been sparse and data challenges are often significant. The book 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. This ILR contains two research papers relevant to the east, central and southern African region, one of which deals with nurses and home-based caregivers in Tanzania and the other which deals with nurses, social workers and home-based care workers in South Africa.
This summary of a report by the Portfolio Committee on Health and Child Welfare in Zimbabwe notes that the shortage of doctors in Zimbabwe has reached crisis levels with the country having only 21% of the required medical practitioners. The report by the Portfolio Committee on Health and Child Welfare provided statistics showing that vacancy levels stand at 80% for midwives, 62% for nursing tutors, 63% for medical school lecturers and over 50% for pharmacy, radiology and laboratory personnel. Poor working conditions were cited as among the reasons for the high vacancy rates. The report added that these shortages and disruption of transport and telecommunications have compromised patient transfers, malaria indoor residual spraying, drug distribution and supervision of districts and rural health centres.
This study sought to analyse the effect of Kenya’s Emergency Hiring Plan for nurses on their inequitable distribution in rural and underserved areas, using data from the Kenya Health Workforce Informatics System. It found that, of the 18,181 nurses employed in Kenya’s public sector in 2009, 1,836 (10%) had been recruited since 2005 through the Emergency Hiring Plan. Nursing staff increased by 7% in hospitals, 13% in health centres and 15% in dispensaries. North Eastern province, which includes some of the most remote areas, benefited most, with nurses increasing by 37%. By February 2010, 94% of the nurses hired under pre-recruitment absorption agreements had entered the civil service. The study cautions that, despite promising preliminary indicators of sustainability, continued monitoring will be necessary over the long term to evaluate future nurse retention.
A total of 1,000 doctors are to be hired to improve the delivery of health services, according to Uganda’s Health Service Commission. The Commission's chairman said an advert will be placed in the newspapers in December and the interviews will follow thereafter. He said the recruitment of health workers will be a continuous and consistent process every year. Makerere, the most prestigious medical school in the country, produces about 100 doctors a year. In total, the country produces about 250 doctors per year, including other universities. In Uganda, the doctor to patient ratio is 1:24,725, falling short of the 1:600 standard set by the World Health Organisation. The recruitment is part of the five-year new health sector strategic and investment plan. Plans are also in advanced stages to increase salaries for all health personnel, according the directorate of health services. The health service commission has also proposed to the Cabinet to have doctors availed vehicle and housing soft loans. The Government offers newly recruited medical officers a gross monthly salary of Ugandan sh626,181, while the highest medical officer at the level of a consultant takes home sh1.6 million per month. Despite a recent 30% increase in salaries for Ugandan health workers, they still earn three times less than workers in neighbouring Rwanda and Kenya.