A ten-point plan to improve the nursing profession through education and training was recently agreed upon by the national Health Ministry in South Africa. Health minister, Aaron Motsoaledi, said discussions were underway between the department of Higher Education and Training, his department, the Council on Higher Education and Umalusi on the role of new quality councils in quality assurance of the diversity of health science offerings. From this discussion, an agreement emerged between the Department of Health and the Department of Higher Education and Training on the need for a diversified nursing education and training system. The next step was to revitalise the nursing colleges sector. This followed a recognition that strengthening colleges would contribute to a vibrant nursing education and training system. ‘What we need to do is work out how we can retain nurse educators, encourage nurse education as a critical career path and more generally attract young people into the profession,’ Motsoaledi said.
Human Resources
The findings in this report by the United Nations Development Programme (UNDP) cast new light on some common misconceptions about migration. Most migrants do not cross national borders, but instead move within their own country: 740 million people are internal migrants, almost four times the number of international migrants. Among international migrants, less than 30% move from developing to developed countries. For example, only 3% of Africans live outside their country of birth. Contrary to commonly held beliefs, migrants typically boost economic output and give more than they take. Detailed investigations show that immigration generally increases employment in host communities, does not crowd out locals from the job market and improves rates of investment in new businesses and initiatives. Overall, the impact of migrants on public finances is relatively small, while there is ample evidence of gains in other areas such as social diversity and the capacity for innovation. The gains to people who move can be enormous. Research found that migrants from the poorest countries, on average, experienced a 15-fold increase in income, a doubling of school enrolment rates and a 16-fold reduction in child mortality after moving to a developed country.
African countries, much poorer and less resourced than South Africa, are using trained mid-level health workers to perform tasks traditionally reserved for doctors, including surgery, and, in the process, are saving the lives. Presenters from Mozambique, Tanzania and Malawi at the 14th FIGO (International Federation of Gynecology & Obstetrics) World Congress of Gynecology and Obstetrics on 4 October shared details of how mid-level health workers are performing caesareans and other emergency surgical procedures in hospitals where there are simply no doctors and often no professional nurses. In Mozambique, 92% of all Caesarean sections at the district hospital level are carried out my mid-level providers – tecnicos de cirugia. In Tanzania the percentage is 84%. Studies in all three countries have shown that with the right training these mid-level providers – some trained straight after school while other have some experience of working in the health sector – have similar outcomes to doctors when providing life-saving emergency obstetric surgical care. Compared to doctors, their retention rates, especially in rural and district areas where the need is desperate, are excellent.
This survey was conducted among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes. Nurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunisation campaigns for polio and measles. The survey shows that nurses and midwives play an important role in implementing immunisation activities at the district level and that their roles can be maximised by creating opportunities that lead to their having more responsibilities in their work and in particular, their involvement in early phases of planning of priority health activities. This should be accompanied by written job descriptions, tasks and clear lines of authority as well as good supportive supervision. The lessons from supplementary immunisation activities, where the roles of nurses and midwives are maximised, can be easily adopted to benefit the rest of the health services provided at district level.
Health MEC, Sibongiseni Dhlomo, says that South Africa should produce about 8,000 doctors annually to meet the dire shortage at public hospitals. He referred to a programme to study medicine in Cuba, which targets students mainly from underprivileged areas who would otherwise not have had the financial means for the studies. Dhlomo said universities were not producing enough doctors, which was contributing to the discrepancies in the country's health care system. ‘Producing 200 doctors per university per year is not good enough. We will be speaking to deans and pushing universities to produce at least 2,000 doctors annually, starting in the next year or two,’ he said. Dhlomo said the country had a total of about 8,000 doctors employed by the Health Department. However, he said Limpopo would be able to meet its doctor-patient ratio if all 8,000 doctors were deployed in that province.
The authors of this study conducted a survey among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes. Nurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunisation campaigns for polio and measles. This study shows that nurses and midwives play an important role in implementing immunisation activities at the district level and that their roles can be maximised by creating opportunities that lead to their having more responsibilities in their work and in particular, their involvement in early phases of planning of priority health activities. This should be accompanied by written job descriptions, tasks and clear lines of authority as well as good supportive supervision. The lessons from supplementary immunisation activities, where the roles of nurses and midwives are maximised, can be easily adopted to benefit the rest of the health services provided at district level.
This study sought to identify task shifting that has already occurred and assess the antiretroviral therapy (ART) training needs among clinicians to whom tasks have shifted. It surveyed health professionals and heads of ART clinics at a stratified random sample of 44 health facilities accredited to provide this therapy. A sample of 265 doctors, clinical officers, nurses and midwives reported on tasks they performed. Thirty of 33 doctors (91%), 24 of 40 clinical officers (60%), 16 of 114 nurses (14%) and 13 of 54 midwives (24%) reported that they prescribed ART. Yet, 64% of the people who prescribed antiretroviral therapy were not doctors. Seven percent of doctors, 42% of clinical officers, 35% of nurses and 77% of midwives assessed that their overall knowledge of antiretroviral therapy was lower than good. The study concluded that training initiatives should be an integral part of the support for task shifting, while making sure that ART is used correctly and toxicity or drug resistance do not reverse accomplishments to date.
Health care in South Africa’s rural areas is set to get a major boost, following the launch of the Centre for Rural Health by Wits University, in Johannesburg, recently. The centre’s inaugural Director, Prof Ian Couper, said the centre’s main focus is to ‘recruit human resources for rural health. We can do everything in terms of providing facilities, we can make sure the drug supplies are there, but unless we have the health workers, all of that will mean nothing. The centre is trying to focus on multiple strategies: selecting students in rural areas and supporting them to study health sciences, developing post graduate programmes, researching issues around how we can improve resources for rural health and advocacy to bring these issues to the attention of policy makers, politicians and other stake-holders.’ Deputy Health Minister, Dr Molefi Sefularo, expressed gratitude to the university for highlighting issues relating to rural health. ‘We would like you to become a leading academic centre in the field of human resources for rural health’, he said.
This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors to rural and remote areas. A comprehensive search of the English literature was conducted, 1,261 references were identified and screened and 110 articles were included. The study argues for the formulation of universal definitions to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. There remains an urgent need to evaluate the impact of untested interventions in a scientifically rigorous fashion in order to identify winning strategies for guiding future practice and policy.
Hundreds of lay health care workers are deployed in Kenyan communities to fill the gap caused by severe staff shortages in the health sector – but could they be doing more harm than good? Some lay health workers even dispense antiretroviral (ARV) drugs, but health experts have warned that using unqualified personnel to perform medical functions may not be such a good idea. Dr Andrew Suleh, chairman of the Kenya Medical Association, said lay counsellors should not become a long-term replacement for professional health workers. ‘The government must be pressured to train, employ and retain health professionals to ease the disease burden exerted on the health care workers by the twin challenges of HIV and TB – the management and care of HIV and AIDS is very labour intensive,’ he said. Most lay counsellors were volunteers employed by non-governmental organisations whose projects could end, leaving the country with even bigger shortages of health workers. ‘You cannot base health management on volunteerism; it is not sustainable,’ Suleh added.