This study analysed the effect of Kenya’s Emergency Hiring Plan for nurses on their inequitable distribution in rural and underserved areas. It used data from the Kenya Health Workforce Informatics System on the nursing workforce to determine the effect of the Emergency Hiring Plan on nurse shortages and maldistribution. Of the 18,181 nurses employed in Kenya’s public sector in 2009, 1,836 (10%) had been recruited since 2005 through the Emergency Hiring Plan. Nursing staff increased by 7% in hospitals, 13% in health centres and 15% in dispensaries. North Eastern province, which includes some of the most remote areas, benefited most: the number of nurses per 100 000 population increased by 37%. The next greatest increase was in Nyanza province, which has the highest prevalence of HIV infection in Kenya. Emergency Hiring Plan nurses enabled the number of functioning public health facilities to increase by 29%. By February 2010, 94% of the nurses hired under pre-recruitment absorption agreements had entered the civil service. Preliminary indicators of sustainability are promising, as most nurses hired are now civil servants. However, continued monitoring will be necessary over the long term to evaluate future nurse retention.
Human Resources
The United States (US) Department of Health and Human Services is partnering with the US President’s Emergency Plan for AIDS Relief (PEPFAR) with a plan to invest US$130 million over five years in African medical education to increase the number of health care workers. Through the Medical Education Partnership Initiative (MEPI), grants are being awarded directly to African institutions in a dozen countries, working in partnership with US medical schools and universities. The initiative will form a network including about 30 regional partners, country health and education ministries, and more than 20 US collaborators.
Access to well trained and motivated health workers is the major rural health issue. Without local access, it is unlikely that people in rural and remote communities will be able to achieve the Millennium Development Goals. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: a rural background; positive clinical and educational experiences in rural settings as part of undergraduate medical education; and targeted training for rural practice at the postgraduate level. This paper presents evidence for policy initiatives involving the training of medical students from, in and for rural and remote areas. It gives examples of medical schools in different regions of the world that are using an evidence-based and context-driven educational approach to producing skilled and motivated health workers. It demonstrates how context influences the design and implementation of different rural education programmes. Successful programmes have overcome major obstacles including negative assumptions and attitudes, and limitations of human, physical, educational and financial resources. Training rural health workers in the rural setting is likely to result in greatly improved recruitment and retention of skilled health-care providers in rural underserved areas with consequent improvement in access to health care for the local communities.
This paper compares the socioeconomic profile of medical students registered at the Faculty of Medicine of Universidade Eduardo Mondlane (FM-UEM), Maputo, for the years 1998/99 and 2007/08. Its objective is to describe the medical students' social and geographical origins, expectations and perceived difficulties regarding their education and professional future. Data was collected through questionnaires administered to all medical students. The response rate in 1998/99 was 51% and 50% in 2007/08. The main results reflect a doubling of the number of students enrolled for medical studies at the FM-UEM, associated with improved student performance (as reflected by failure rates). Nevertheless, satisfaction with the training received remains low and, now as before, students still identify lack of access to books or learning technology and inadequate teacher preparedness as major problems. Despite a high level of commitment to public sector service, students, as future doctors, have very high salary expectations that will not be met by current public sector salary scales, as reflected in an increasing degree of orientation to double sector employment after graduation.
This presentation is based on a literature review that was carried out as part of a research collaboration between the School of Public Health Wits University and the African Population Health Research Centre, Nairobi, Kenya, with feedback from colleagues in Kenya, Uganda, Nigeria and South Africa. The review found that mid-level workers (MLWs) were active in 25 of the 47 sub-Saharan African countries reviewed: 18 countries had non-nurse based programmes for training secondary school leavers, which avoided depleting scarce ranks of nurses. MLWs were treated as second-best or a temporary stop gap until enough physicians were trained, instead of being recognised as key front line health workers responsible for care of their communities. Problems affecting MLWs were identified as: poor work environment; perceptions of resource inadequacy, with staff members indicating that they had neither sufficient staff nor time to do their work; poor pay and low status; inadequate management support and a sense of not being valued by their managers; and burnout, emotional exhaustion and low personal accomplishment. The presentation cautions that increasing numbers of MLWs is not a solution on its own. Accompanying investment is needed in supervision, district team strengthening, morale building and training. Recognition, career and skills development are strong motivators for MLWs, while positive feedback from patients is valued and seen as indicator of professional conduct. The need for professionalisation of MLWs is also underscored.
This study presents an innovative approach to healthcare worker (HCW) training using mobile phones as a personal learning environment. Twenty physicians used individual Smartphones, each equipped with a portable solar charger. A set of 3D learning scenarios simulating interactive clinical cases was developed and adapted to the Smartphones for a continuing medical education programme lasting three months. A mobile educational platform supporting learning events tracked participant learning progress. Learning outcomes were verified through mobile quizzes using multiple choice questions at the end of each module. Training, supervision and clinical mentoring of health workers are the cornerstone of the scaling up process of HIV and AIDS care in resource-limited settings. Educational modules on mobile phones can give flexibility to HCWs for accessing learning content anywhere. However lack of software interoperability and the high investment cost for the Smartphones' purchase could represent a limitation to the wide spread use of such learning programmes.
This compendium of examples of promising practices for evidence-based planning and decision-making for dealing with the HIV pandemic is based on the premise that building national strategic information (SI) and monitoring and evaluation (M&E) capacity requires supportive policies for health workers, as well as organisational and leadership development and individual technical capacity development. The promising practices cover the core components of SI (M&E; surveys and surveillance; and health management information systems, including geographical information systems) and span six ‘action fields’ (policy, leadership, partnership, finance, human resource management systems and education) to provide a comprehensive lens through which to strategically plan for and implement M&E workforce strengthening initiatives. By examining the experiences in detail, reviewing available results and supporting materials as well as considering the implementation context, users of the compendium may be able to identify approaches worth testing in their own countries. While the list of practices is by no means exhaustive or representative, it does provide an important starting point upon which to build a more comprehensive learning resource for human resources capacity building for effective HIV M&E systems and strategic information.
Retaining health workers in rural facilities remains a major challenge facing South Africa and other developing nations. But an initiative in the Western Cape shows that the challenge of retaining health workers in rural facilities can be overcome. After unsuccessful attempts by Tygerberg Hospital to recruit and retain rural health workers, the hospital decided to open a nursing college in the Boland region, a large farming area nearby. Helise Schumann, who co-ordinates the activities of the college, pointed out that 70% of all nursing staff in the Boland area (about 800 nursing staff) have been trained through the school. The school uses a step-ladder approach by first starting with training the school’s own staff, like cleaners, porters, food services aid and laundry staff, so they could qualify as nursing assistants. Neighbouring facilities, like Worcester and a number of district hospitals, also owe their staffing levels to the nursing college. She says the college follows a strict selection process when recruiting candidates. The nursing college trains up to 100 students per year. It targets unemployed people and school leavers.
Physician anaesthetists are scarce in many developing countries and not available at first referral level health facilities. According to this article, the shortage exists because there is not enough recognition of the need for surgical and anaesthesia services at all levels of the health system and their potential to reduce mortality and morbidity. As a result, there is a serious lack of equitable services in developing countries, especially in rural and remote areas. Creating awareness through better documentation of the burden of disease, in terms of death and disability that can be prevented by availability of surgical and anaesthesia services, would be an important step to generate political commitment and local investments in education, training and retention of the health workforce. This needs to be followed up by appropriate policies, legislation, and the establishment of innovative and effective anaesthesia training programmes that address both the immediate need as well as the long-term needs of the health system.
There is currently limited published evidence of health-related training programmes in Africa that have produced graduates, who remain and work in their countries after graduation. However, anecdotal evidence suggests that the majority of graduates of field epidemiology training programmes (FETPs) in Africa stay on to work in their home countries, many as valuable resources to overstretched health systems. In this study, alumni data from African FETPs were reviewed in order to establish graduate retention. Retention was defined as a graduate staying and working in their home country for at least three years after graduation. African FETPs are located in a number of African countries – this paper only includes the Uganda and Zimbabwe FETPs, as all the others are recent programmes. The review shows that enrolment increased over the years, and that there is high graduate retention, with 85.1% of graduates working within country of training, mostly for Ministries of Health and non-governmental organisations. Retention of graduates with a medical undergraduate degree was slightly higher than for those with other undergraduate qualifications. The paper concludes that African FETPs have unique features which may explain their high retention of graduates, including: programme ownership by ministries of health and local universities; well defined career paths; competence-based training coupled with a focus on field practice during training; awarding degrees upon completion; extensive training and research opportunities made available to graduates; and the social capital acquired during training.