For this study, researchers analysed health worker policies in developing countries to assess current strategies aimed at alleviating the ‘brain drain’ of medical professionals from these countries. Although governments and private organisations have tried to address this policy challenge, the researchers found that brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.
Human Resources
Although task-shifting is widely promoted as the solution to expanding anti-retroviral therapy (ART) access, this article notes that the evidence for non-physician-provided ART in Africa is limited, with few studies comparing the performance of non-physicians with doctors. However, field reports from programmes that have used non-physicians to deliver ART, including from rural settings in South Africa, are more plentiful and report similarly positive (although less reliable) results in terms of both ART outcomes and improved access. The authors argue that positive results from trials in South Africa regarding nurse initiation and management of patients on ART may mean that this may become a key strategy for expanding ART access. Along with basic training and support and an appropriately phased implementation, the authors recommend drafting guidelines that are designed for and specific to nurses and that clarify referral options, so that nurses will feel adequately prepared and supported for their ART tasks.
In the absence of benchmarks on the density and distribution of health workers required to achieve universal health coverage (UHC) in developing countries, the authors of this study call for more specific targets that consider country needs and realities, as well as the potential contribution of non-traditional cadres, such as community health workers and mid-level health providers. Multi-pronged approaches for health workforce development, such as task shifting, training and retention efforts, were found to have led to progress in improving coverage for infectious disease control. The authors argue that comprehensive strengthening of the health workforce, and scaling up workforce production for the continuum of maternal, newborn and child health care should be central to the UHC agenda. They recommend that governments and other stakeholders should implement policies and approaches of proven efficacy, such as those enshrined in the Kampala Declaration and Agenda for Global Action, and strengthen the evidence base to better inform policy making. The authors report success stories in the literature review in achieving universal health coverage, but they call for further research into contextual differences enabling these successes before findings may be extrapolated to other contexts.
In 2007, when Médicins Sans Frontières (MSF) came to Swaziland to assist the Ministry of Health in its response to HIV co-infection with tuberculosis (TB) in the Shiselweni region, treatment for co-infection was not available at any of the rural region’s 21 clinics. Instead, patients had to travel to urban facilities. MSF worked with government to bring services to the clinics, but some patients were either too weak or too poor to reach the clinics. So the organisation trained 80 community caregivers, who live close to the patients, on how to administer multi-drug resistant TB injections. Experts from MSF, from time to time, visit the patients and their caregivers to monitor if the medication is administered properly. MSF reports that task-shifting has helped in the decentralisation of HIV/TB services in the region, where trained lay people help with basic responsibilities such as collecting sputum, counselling and education. Critics maintain that administering a TB injection incorrectly can cause complications, and the legal implications of a lay person administering the injection incorrectly are not clear, but MSF argues that a health service provided by a lay person is better than no service at all.
This review and assessment of Tanzania’s current distance learning programmes for health care workers, as well as those in countries with similar human resource challenges, was undertaken to determine the feasibility of using distance learning to meet the need of an increased and more skilled health workforce. Data was collected from 25 distance learning programmes at health training institutions, universities and non-governmental organizations throughout Tanzania from May to August 2008. The authors identified a number of challenges, including: a lack of guidelines for administrators, instructors and preceptors of distance learning programmes regarding roles and responsibilities; absence of competencies for clinical components of curricula; and technological constraints such as lack of access to computers and to the internet. Insufficient funding resulted in personnel shortages, lack of appropriate training for personnel and lack of materials for students. Nonetheless, current and prospective students expressed overwhelming enthusiasm for scale-up of distance learning. The authors argue that a blended print-based distance learning model is most feasible at the national level due to current resource and infrastructure constraints.
The Southern African Network of Nurses and Midwives (SANNAM) met in Johannesburg, South Africa, from 2–4 December 2010, and made a number of resolutions for 2011. SANNAM called on the World Health Organization (WHO) and the Southern African Development Community to recognise the network as a partner in monitoring the implementation of WHO’s Global Code of Practice for recruiting health workers, and resolved to maintain a database on information on health worker migration in the southern African region. To help countries in the region to reach their child and maternal health Millennium Development Goal targets, SANNAM will lobby for midwifery to be declared a specialisation after midwives have completed their basic training, as well as lobby for nursing regulatory bodies in countries that don’t have them and help to implement these bodies. SANNAM will also develop a position statement that seeks to remove bureaucratic obstacles to free movement of nurses wishing to work in different countries in the region.
This paper examines the issue of workforce stability and turnover in the context of policy attempts to improve retention of health workers. The author argues that there are significant benefits to supporting policy makers and managers to develop a broader perspective of workforce stability and methods of monitoring it. The objective of the paper is to contribute to developing a better understanding of workforce stability as a major aspect of the overall policy goal of improved retention of health workers. Some of the limited research is examined on the complex interaction between staff turnover and organisational performance or quality of care in the health sector, with details and examples of the measurement of staff turnover and stability, and an illustration of an approach to costing staff turnover. The paper concludes with the author advocating that these types of assessment can be valuable to managers and policy makers as they examine which policies may be effective in improving stability and retention, by reducing turnover. They can also be used as part of advocacy for the use of new retention measures. The very action of setting up a local working group to assess the costs of turnover can in itself give managers and staff a greater insight into the negative impacts of turnover, and can encourage them to work together to identify and implement stability measures.
A total of 65,000 South African community health workers (CHWs) are largely responsible for providing counselling services in the government’s HIV counselling and testing programme, which aims to test 15 million South Africans for HIV by April 2011. Many other government health programmes also rely on this cadre of workers for their success. Most of them are employed by non-governmental organisations through funding from provincial health departments and others. But their contribution to public health may be at risk, as this article reports that CHWs are working full time without any payment, sometimes waiting up to six months without receiving their salaries. There is uncertainty about whether the non-governmental organisations that manage funds for the salaries of CHWs are receiving these funds from government and, if they are, why they are not paying them out as salaries. The Health Department has registered its concern about the problem. Health Department Director-General, Precious Matsoso, said the department is working on a solution and cited an overlap of responsibility between her department and social development services as to blame for the lack of action to address the claims of failed salary payments.
In this paper, the author elaborates what South African medical specialists find satisfying about working in the public and private sectors, at present, and how to better incentivise retention in the public sector. He conducted 74 qualitative interviews among specialists and key informants in one public and one private urban hospital in South Africa. All qualitative specialist respondents were engaged in dual practice, generally working in both public and private sectors. Results demonstrate that although there are strong financial incentives for specialists to migrate from the public to the private sector, public work provides more of a team environment, more academic opportunities, and greater opportunities to feel 'needed' and 'relevant'. However, public specialists suffer under poor resource availability, lack of trust for the Department of Health, and poor perceived career opportunities. These non-financial issues of public sector dissatisfaction appeared just as important, if not more important, than wage disparities. Policy recommendations centre around boosting public sector resources and building trust of the public sector through including health workers more in decision-making, inter alia. These interventions may be more cost-effective for retention than wage increases, and imply that it is not necessarily just a matter of putting more money into the public sector to increase retention.
In this cross-sectional descriptive survey the authors investigated the performance of health workers after decentralisation of the health services in Uganda to identify and suggest areas for improvement. A structured self-administered questionnaire was used to collect quantitative data from 276 health workers in the districts of Kumi, Mbale, Sironko and Tororo in Eastern Uganda. Results revealed that even though the health workers are generally responsive to the needs of their clients, the services they provide are often not timely. The health workers take initiative to ensure that they are available for work, but low staffing levels undermine these efforts. While the study shows that the health workers are productive, over half (50.4%) of them reported that their organisations do not have indicators to measure their individual performance. The findings indicated that health workers are competent, adaptive, proactive and client oriented.