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.
Human Resources
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.
This study was undertaken to assess the scope and nature of community-based education (CBE) for various health worker cadres in Uganda. Curricula and other materials on CBE programmes in Uganda were reviewed to assess nature, purpose, intended outcomes and evaluation methods used by CBE programmes. In-depth and key informant interviews were conducted with people involved in managing CBE in twenty-two selected training institutions, as well as stakeholders from the community, Ministry of Health, Ministry of Education, civil society organisations and local government. The researchers found that CBE curriculum is implemented in most health training institutions in Uganda and is a core course in most health disciplines at various levels. The CBE curriculum is systematically planned and implemented with major similarities among institutions. Organisation, delivery, managerial strategies, and evaluation methods are also largely similar. Strengths recognised included providing hands-on experience, knowledge and skills generation and the linking learners to the communities. Almost all CBE implementing institutions cited human resource, financial, and material constraints. It is still uncertain whether this approach is increasing the number graduates seeking careers in rural health service, one of the stated programme goals.
Have AIDS external funders harmed or strengthened health workforce development in countries with severe shortages? This research led to six key findings. First, to staff AIDS programmes, external funders have relied on training existing workers and taskshifting, not on training new health workers. Second, AIDS external funders have swamped countries with in-service training programmes for HIV/AIDS-specific skills. Third, PEPFAR and the Global Fund have relied on task-shifting to lower level health workers without assuring adequate resources or support. Fourth, community health workers are employed as a quick fix without considering their long -term role. Fifth, the incentives that AIDS external funders offer health workers to achieve HIV and AIDS programme targets distort allocations of time and resources to the detriment of other health sector objectives. Finally, AIDS external funders pay health workers through short-term special arrangements without addressing long-term constraints on the public and private health workforce.
According to the authors of this study, in southern Africa, the sector most impacted by the brain drain is health. Despite the fact that Southern African Development Community (SADC) countries have adopted a number of financial and non-financial incentives to try to get doctors and nurses to stay, the pull factors attracting health professionals to foreign countries are strong and health workers remain very dissatisfied with existing work conditions. With regard to the migration of health professionals there has been a policy shift away from the early reactive ad hoc policy responses to the development of more comprehensive strategic responses which seek to manage the mobility of health professionals. The authors recommend improving the existing lack of knowledge and data to monitor flows of health professionals into and out of SADC. They also call for bilateral agreements with individual countries involving codes of practice for recruitment and treatment of health workers, exchange programmes for training and development and the provision of health professionals from specific countries. In addition, there is a need for a SADC-wide policy on the movement of health professionals within the region to discourage movement from the poorest and neediest countries to those which are relatively well-endowed, like South Africa.