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.
Human Resources
Partnering to keep health workers in the communities that need them
Dwyer S: Capacity Plus, January 2011
The impact of the National HIV Health Care Worker Hotline on patient care in South Africa
Chisholm BS, Cohen K, Blockman M, Kinkel H, Kredo TJ and Swart AM: AIDS Research and Therapy 8(4), 26 January 2011
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.
Tracking and monitoring the health workforce: A new human resources information system (HRIS) in Uganda
Spero JC, McQuide PA, Matte R: Human Resources for Health 9(6), 17 February 2011
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.
Underpaid and overworked: A cross-national perspective on care workers
Razavi S and Staab S (eds): International Labour Review 149(4), December 2010
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.
Shortage of doctors hits hospitals in Zimbabwe
Manyukwe C: The Financial Gazette, 5 November 2010
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.
The impact of an emergency hiring plan on the shortage and distribution of nurses in Kenya: The importance of information systems
Gross JM, Riley PL, Kiriinya R, Rakuom C, Willy R, Kamenju A et al: Bulletin of the World Health Organization 88:798, November 2010
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.
Ugandan government to employ 1,000 doctors
Businge C and Bwambale T: New Vision, 22 November, 2010
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.
Universal antiretroviral treatment: The challenge of human resources
Bärnighausen T, Blooma DE and Humair S: Bulletin of the World health Organization 88(12): 943-948, December 2010
Despite scale up of anti-retroviral therapy (ART) in Africa, this study draws attention to the shortage of quality data to assess the impact of task-shifting and the loss of doctors from other parts of the health system to HIV and AIDS programmes. It calls for greater documentation and further studies how past increases in ART coverage have been achieved, for instance, by assessing health worker performance using surveys of ART facilities. However, the paper argues that such research alone is not enough. Some of the most important factors determining the long-term progress towards universal coverage – such as ‘victim of our own success’ mechanisms – may only become apparent with time and as ART coverage increases. The challenge of predicting future need through the study of past outcomes is exacerbated by uncertainties around the definition of ART need (such as increases in the CD4 count threshold for treatment eligibility) and ART-related health problems (such as widespread viral resistance). Health policy-makers need to anticipate these factors with the aid of models, allow for significant uncertainty in their ART strategies, and set realistic expectations for the magnitude of resources required for universal ART coverage.
Doubling the number of health graduates in Zambia: Estimating feasibility and costs
Aaron T, Kapihya M, Libetwa M, Lee J, Pattinson C, McCarthy E and Schroder K: Human Resources for Health 8(22), 22 September 2010
In response to its critical health worker shortages, the Ministry of Health (MoH) in Zambia plans to double the annual number of health training graduates in the next five years to increase the supply of health workers. This study sought to determine the feasibility and costs of doubling training institution output through an individual school assessment framework. Assessment teams consulted faculty, managers and staff in all of Zambia's 39 public and private health training institutions in 2008. The individual school assessments affirmed the MoH's ability to double the graduate output of Zambia's public health training institutions. Lack of infrastructure was determined as a key bottleneck in achieving this increase while meeting national training quality standards. The authors argue that an investment of US$ 58.8 million is required to meet infrastructure needs, and the number of teaching staff must increase by 111% over the next five years.
Examining health-care volunteerism in a food- and financially insecure world
Maes K: Bulletin of the World Health Organization 88(11), November 2010
Insecure access to food is increasingly recognized as a major contributor to cycles of poverty and HIV and AIDS in sub-Saharan Africa, according to this article. In this context, volunteers espouse desires for economic ‘progress’ amid a mix of pro-social and self-interested motivations to be volunteer AIDS caregivers. For these volunteers, food insecurity was particularly demotivating. Food crisis on top of chronic food insecurity pushed them to reconsider what they deemed as appropriate compensation for their efforts. Ironically, volunteers in such contexts may often be poorer than their clients. Ideally, effective and resilient community health workers should derive mental satisfaction and fair remuneration from their labour. The question for policy-makers is how to generate the spiritual benefits of altruistic, compassionate care as well as a level of remuneration that allows for secure livelihoods among volunteers who are often socioeconomically marginalized. WHO’s recent recommendation challenges various public and private entities to adapt to a system in which funding and other measures are used to create fairly-paid and secure health-care jobs in low-income countries facing pervasive food insecurity and high burdens of chronic and infectious disease. In sub-Saharan Africa, hiring, training and paying community health workers may be a win-win situation: people receive secure jobs that provide food security for their families and communities, and their participation strengthens health-care systems and people in need of care. The article emphasises that health programmers need to listen to what volunteers themselves – and the people whom they serve – say about the benefits and costs of volunteering.