According to this profile document, health services and functions in Ghana have been decentralised and budget management centres have been created to improve both access to health services and community involvement in planning and delivery of services. There are about 52,258 individuals currently formally working in the health sector in Ghana. The Ministry of Health employs 42,299 staff, which represents about 81.5% of the total health sector workforce. In addition, about 21,791 people countrywide are registered as engaged in traditional medicine, while 367 people are registered as traditional birth attendants. Current human resources policies and plans emphasise the training of more middle-level cadres, which are cheaper to train and maintain. Distribution of health workers is skewed in favour of the more affluent regions, most of which are in the southern half of the country. Highly skilled professionals are concentrated in Greater Accra region, as well as in Korle Bu and Komfo Anokye Teaching Hospitals. Although training of health professionals has been a shared responsibility between the Ministries of Health and Education, there has not been clearly defined roles and collaboration. There is no comprehensive training policy to clarify roles and address issues.
Human Resources
In South Africa’s new human resources for health strategy, eight thematic priorities have been identified to form the strategy’s framework: leadership, governance and accountability; health workforce information and health workforce planning; re-engineering of the workforce to meet service needs; scaling up and revitalising education, training and research; creating the infrastructure for workforce and service development in the form of academic health complexes and nursing colleges; strengthening and professionalising the management of human resources and prioritising health workforce needs; ensuring professional quality care through oversight, regulation and continuing professional development; and improving access to health professionals and health care in rural and remote areas. The strategy aims to ensure necessary and equitable staffing of the health system and to ensure a workforce fit for purpose to meet health needs by: developing health professionals and cadres to meet health and health care needs; ensuring the health workforce has an optimal working environment and rewarding careers; ensuring innovative and efficient recruitment and retention of the health workforce; enabling clinical research which enhances clinical and service development; and providing the organisation and infrastructure for health workforce development. The Strategy also contains forecasts on the numbers of health workers required to fill critical gaps in public health service delivery.
South African health minister Aaron Motsoaledi has announced that R1.24-billion (US$ 155 million) will be spent to ‘revitalise nursing colleges’ and improve infrastructure to train more nurses, as part of the department's new human resource policy. For the current financial year, the department will spend US$27.5 million, and $64 million per year thereafter. A department spokesperson said nursing colleges standing empty would have to be fixed up so that they were fit for use. South African universities currently train 1200 doctors each year. Earlier this year Motsoaledi asked the deans of South Africa's medical schools to each train 40 more students per year. Wits University was the first to do so by taking in an extra 40 at the beginning of the year at the cost of R8-million. The Wits medical faculty dean said the country was short of every type of medical specialist and it would take a long time to fix because it took six to eight years to train specialists after they had qualified as doctors.
In an effort to expand much-needed HIV services in the Ugandan capital of Kampala, the Infectious Disease Institute, an affiliate of Makerere University College of Health Science, has established a community-university partnership with the Ministry of Health to implement an innovative model to build capacity in HIV service delivery. In this paper, the authors evaluate the impact on the nurses from this programme to provide more health care in six nurse-managed Kampala City Council (KCC) Clinics. A mixed method approach was used. The descriptive study collected key informant interviews from the clinics’ six nurse managers, and administered a questionnaire to 20 staff nurses between September and December 2009. Results showed that introducing new HIV services into the KCC clinics was positive for the nurses. They identified the project as successful because of perceived improved work environment, increase in useful in-service training, new competence to manage patients and staff, improved physical infrastructure, provision of more direct patient care, motivation to improve the clinic because the project acted on their suggestions, and involvement in role expansion. All of these helped empower the nurses, improving quality of care and increasing job satisfaction.
This Draft Human Resources for Health (HRH) Strategy for South Africa was developed through reviewing policy and research reports and consolidating them in consultation with key informants. It addresses a range of issues affecting HRH in South Africa including: sectoral analysis by professional category and the costs; skills mix; level of human resources; equity and maldistribution; factors affecting shortages; provincial HR and Service Transformation (STP) plans and their use in workforce planning, the re-engineered primary health care (PHC) approach and its impact on HRH, retention and recruitment issues, and management and leadership. The draft strategy also provides projections on future staffing needs, how these quotas will be filled and projected training and educational requirements.
This study was conducted to determine the prevalence of substance use and identify factors that influenced the behaviour among undergraduate medical students of Addis Ababa University in Ethiopia. A cross-sectional study using a pre-tested structured self-administered quantitative questionnaire was conducted in June 2009 among 622 medical students (Year I to Internship programme) at the School of Medicine. Results showed that in the 12 months prior to the study, alcohol was consumed by 22% of students and khat use was reported by 7%. Being male was strongly associated with alcohol use in the last 12 months. Khat use and use of tobacco was strongly and positively associated with alcohol consumption. In conclusion, concordant use of alcohol, khat and tobacco was observed and exposure to friends' use of substances was often implicated. While the findings of this study suggest that substance use among the medical students was not alarming, but its trend increased among students from Year I to Internship programme. The authors caution the university to be vigilant in monitoring and educating the students about the consequences of substance use.
Health worker training is a key component of the integrated management of childhood illness (IMCI). The researchers in this study conducted in-depth case studies in two east African countries to examine the factors underlying low training coverage ten years after IMCI had been adopted as policy. A document review and in-depth semi-structured interviews with stakeholders at facility, district, regional/provincial and national levels in two districts in Kenya (Homa Bay and Malindi) and Tanzania (Bunda and Tarime) were carried out in 2007 and 2008. The researchers found that Bunda and Malindi achieved higher levels of training coverage (44% and 25%) compared with Tarime and Homa Bay (5% and 13%). Key factors allowing the first two districts to perform better were: strong district leadership and personal commitment to IMCI, which facilitated access to external funding and encouraged local-level policy adaptation; sensitisation and training of district health managers; and lower staff turnover. However, IMCI training coverage remained well below target levels across all sites. The main barrier to expanding coverage was the cost of training due to its duration, the number of facilitators and its residential nature. Mechanisms for financing IMCI also restricted district capacity to raise funds. Critically, the low priority given to IMCI at national and international levels also limited the expansion of training. Levels of domestic and external funding for IMCI have diminished over time in favour of vertical programmes, partly due to the difficulty in monitoring and measuring the impact of an integrated intervention like IMCI. Alternative, lower cost methods of IMCI training need to be promoted, and greater advocacy for IMCI is needed both nationally and internationally, the authors conclude.
In this study, researchers assessed whether text-message reminders sent to health workers' mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya. From March 6, 2009, to May 31, 2010, they conducted a cluster-randomised controlled trial at 107 rural health facilities in 11 districts in coastal and western Kenya. Health facilities were randomly allocated to either the intervention group, in which all health workers received text messages on their personal mobile phones on malaria case-management for six months, or the control group, in which health workers did not receive any text messages. They found that 119 health workers received the intervention. Case-management practices were assessed for 2,269 children who needed treatment, indicating that correct artemether-lumefantrine management improved by 23.7% immediately after intervention and by 24.5% six months later. The authors conclude that in resource-limited settings, malaria control programmes should consider use of text messaging to improve health workers' case-management practices.
Using a policy analysis framework, the authors of this study analysed the implementation and perceived effectiveness of a rural allowance policy and its influence on the motivation and retention of health professionals in rural hospitals in the North West province of South Africa. They conducted 40 in-depth interviews with policy-makers, hospital managers, nurses, and doctors at five rural hospitals and found weaknesses in policy design and implementation. These weaknesses included: lack of evidence to guide policy formulation; restricting eligibility for the allowance to doctors and professional nurses; lack of clarity on the definition of rural areas; weak communication; and the absence of a monitoring and evaluation framework. Although the rural allowance was partially effective in the recruitment of health professionals, it has had unintended negative consequences of perceived divisiveness and staff dissatisfaction. The authors recommend that government should take more account of contextual and process factors in policy formulation and implementation so that policies have the intended impact.
In this study, researchers surveyed the alumni of Community-Based Education and Service (COBE) programmes at Makerere University, Uganda, to obtain their perceptions of the management and administration of COBE and whether COBE had helped develop their confidence as health workers, competence in primary health care and willingness and ability to work in rural communities. A total of 150 alumni were contacted, of which 24 (13 females and 11 males) were selected for focus group discussions. The alumni almost unanimously agree that the initial three years of COBES were very successful in terms of administration and coordination. COBES was credited for contributing to development of confidence as health workers, team work, communication skills, competence in primary health care and willingness to work in rural areas. The alumni also identified various challenges associated with administration and coordination of COBES at Makerere. The authors conclude that health planners should take advantage of the long-term positive impact of COBES and provide the programmes with more support.