South Africa launched its National Strategic Plan for Nurse Education, Training and Practice for 2012/13 - 2016/17 in March 2013. The plan aims to revitalise the ailing public health sector. According to the plan, nursing colleges will be declared higher education institutions in compliance with the provisions of the Higher Education Act (as amended in 2008). This will help to address provincial inequalities, norms and standards, quality, decrease fragmentation, eliminate fly-by-night nursing education institutions (NEIs), improve clinical training and enhance social accountability. Nursing students will also have the status of full students (rather than employees) while undergoing training. They should receive funding support paid monthly for tuition books and study materials, as well as living costs, medical aid and indemnity insurance, while tuition fees should be paid directly to the NEIs. The plan also addresses the need to emphasise modules that focus on caring, and these should be compulsory at all levels of nursing and midwifery. This should help address the issue of compassion in the profession. The plan also significantly proposes that an office for the chief nursing officer be established, which will then take responsibility for the implementation of the strategy over the next five years.
Human Resources
Developing mid-level health professionals who can complement existing staff is an additional strategy that has been debated since 1994 and incorporated into the government’s recent human resources policy. Yet progress in the production of mid-level health workers has been slow. Reasons for this are likely to include competing priorities, the practical difficulties associated with setting up and implementing new training programmes, constraints on absorbing new cadres into the existing health system, tensions between different cadres over role definition and working conditions, and the brain drain into the private sector. More fundamentally, concerns remain about whether mid-level workers are the correct choice for South Africa’s health system. The author discusses how the design and early implementation of a new programme to develop South Africa’s first mid-level medical health professionals took account of these concerns and realities. Also highlighted are the issues that need to be addressed by government in order to ensure that this new programme has a substantial impact on the quality of care delivered in public hospitals. The author concludes that clinical associates have the potential to bring good quality hospital care closer to communities in a way that is affordable for the country.
In this paper, the authors evaluate various policy options to address the global health worker migration crisis, which include: financial and technical support from destination countries; bilateral and multilateral agreements between states; creation of self-sufficient healthcare systems; and collection of reliable migration data. Implementation requires the support of key stakeholders such as the World Health Organisation, member states, and other international organisations. However, there are many obstacles to policy change, including the power disparities between source and destination countries, ethical sensitivity of policies, financial incentives, lack of data collection, and limited international cooperation. The authors argue that media campaigns can be used in destination countries to mobilise citizens and influence national policy. Research initiatives can galvanise action at grassroots, national and international levels. Regional conferences can bring together key stakeholders and promote collaboration between source and destination countries. All efforts should be overseen by an international advocacy group.
In this study, researchers assessed health worker motivation as part of a health system strengthening intervention in three rural districts in Zambia. The intervention (Better Health Outcomes Through Mentoring and Assessment (BHOMA) aims to increase health worker motivation through training, mentoring and support. The researchers examined underlying issues grouped around relevant outcome constructs such as job satisfaction, general motivation, burnout, organisation commitment, conscientiousness and timeliness that collectively measure overall levels of motivation. Results showed variation in motivation score by sex, type of health worker, training and time in post. Female participants had the highest motivation scores. Nurses had the highest scores while environmental health technicians had the lowest score. Health workers who had been in their posts longer also had higher scores. Health workers who had received some form of training in the preceding 12 months were more likely to have a higher score; this was also true for those older than 40 years when compared to those less than 40 years of age. Further research is needed to establish why these health worker attributes were associated with motivation and whether health system interventions targeting health workers, such as the current intervention, could influence health worker motivation.
A key component of the proposed primary health care (PHC) re-engineering model in South Africa is creating ward-based outreach teams linked to primary health care clinics. Each team consists of a professional nurse team leader, three staff nurses and six community health workers (CHWs), with each team serving a population of approximately 6,000 people in a demarcated area. The model envisages the professional nurse team leader and two of the three staff nurses being based at the clinic, while the rest of the team is based in the community. Team leaders will spend 20-30% of their time in the community supporting the work of the team and visiting high risk households. The managers of the clinics to which these teams are linked are expected to lead, manage and oversee the outreach teams’ work in the community and their interactions with other stakeholders working in the same communities. The model requires clinic managers to promote an understanding of the facility catchment area’s epidemiology and burden of disease using health information and data collected during community activities, and to identify strategies to address the local health issues. The addition of these responsibilities will expand the clinic managers’ scope of work.
The authors of this study examined literature on the roles of mid-level managers to understand how they might influence service delivery quality in Kenyan hospitals. A total of 23 articles were finally included in the review from over 7,000 titles and abstracts initially identified. The most widely documented roles of mid-level managers were decision-making or problem-solving, strategist or negotiator and communicator. Others included being a therapist or motivator, goal setting or articulation and mentoring or coaching. In addition to these roles, the authors identified important personal attributes of a good manager, which included interpersonal skills, delegation and accountability, and honesty. Most studies included in the review concerned the roles that mid-level managers are expected to play in times of organisational change. The review highlights the possible significance of mid-level managers in achieving delivery of high-quality services in Kenyan public hospitals and strongly suggests that approaches to strengthen this level of management will be valuable. The findings from this review should also help inform empirical studies of the roles of mid-level managers in these settings.
This paper summarises the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles. Of the relevant articles found, most referred to e-learning in Brazil (14 articles), India (14), Egypt (10) and South Africa (10). While e-learning has been used by a variety of health workers in LMICs, most (58%) reported on physician training, while 24% focused on nursing, pharmacy and dentistry training. Blended learning approaches were the most common methodology presented (49 articles) of which computer-assisted learning (CAL) comprised the majority (45 articles). Other approaches included simulations and the use of multimedia software (20 articles), web-based learning (14 articles), and eTutor/eMentor programmes (3 articles). The authors conclude that e-learning in medical education is a means to an end, rather than the end in itself. Utilising e-learning can result in greater educational opportunities for students while simultaneously enhancing faculty effectiveness and efficiency. However, this potential of e-learning assumes a certain level of institutional readiness in human and infrastructural resources that is not always present in LMICs.
This study was conducted to determine how 20 low- and middle-income countries are operationalising health governance to improve health workforce performance. The 20 countries assessed showed mixed progress in implementing the eight governance principles. Strengths highlighted include increasing the transparency of financial flows from sources to providers by implementing and institutionalising the National Health Accounts methodology; increasing responsiveness to population health needs by training new cadres of health workers to address shortages and deliver care to remote and rural populations; having structures in place to register and provide licensure to medical professionals upon entry into the public sector; and implementing pilot programs that apply financial and non-financial incentives as a means to increase efficiency. Common weaknesses included difficulties with developing, implementing and evaluating health workforce policies that outline a strategic vision for the health workforce; implementing continuous licensure and regulation systems to hold health workers accountable after they enter the workforce; and making use of health information systems to acquire data from providers and deliver it to policymakers. Further research is warranted into the effectiveness of specific interventions that enhance the links between the health workforce and governance to determine approaches to strengthening the health system.
The South African government wants to use the newly launched Academy for Leadership and Management in Healthcare to set benchmarks, norms and standards for the leadership and management of hospitals in South Africa. The academy was launched in November 2012 to provide leadership and management skills to hospital CEOs. Just over a hundred CEOs started orientation week on 4 February 2013. At the start of orientation week, Minister of Health Aaron Motsoaledi argued that hospital CEOs were key to addressing problems such as staff constraints and fraud. In the future, he expected that no person would become a hospital CEO or manager without first having attended the academy. He added that problems in South African hospitals often related to leadership and management, rather than staffing.
In 2007, the South African government introduced the occupation-specific dispensation (OSD), a financial incentive strategy to attract, motivate, and retain health professionals in the public sector. Implementation commenced with the nursing sector. In this paper, researchers examine implementation of the OSD for nurses and highlight the conditions for the successful implementation of financial incentives. They conducted a qualitative case study design using a combination of a document review and in-depth interviews with 42 key informants, finding several implementation weaknesses. Only a few of the pre-conditions were met for OSD policy implementation. The information systems required for successful policy implementation, such as the public sector human resource data base and the South African Nursing Council register of specialised nurses, were incomplete and inaccurate, thus undermining the process. Insufficient attention was paid to time and resources, dependency relationships and task specification. In conclusion, the implementation of financial incentives requires careful planning and management in order to avoid loss of morale and staff grievances.