Human Resources

The social accountability of doctors: a relationship based framework for understanding emergent community concepts of caring
Green-Thompson L; McInerney P; Woollard B: Biological Medical Centre Health Services Research 17(269), doi: 10.1186/s12913-017-2239-7, 2017

Social accountability is defined as the responsibility of institutions to respond to the health priorities of a community. There is an international movement towards the education of health professionals who are accountable to communities. There is little evidence of how communities experience or articulate this accountability. In this grounded theory study eight community based focus group discussions were conducted in rural and urban South Africa to explore community members’ perceptions of the social accountability of doctors. The discussions were conducted across one urban and two rural provinces. Group discussions were recorded and transcribed verbatim. Initial coding was done and three main themes emerged following data analysis: the consultation as a place of respect (participants have an expectation of care yet are often engaged with disregard); relationships of people and systems (participants reflect on their health priorities and the links with the social determinants of health) and Ubuntu as engagement of the community (reflected in their expectation of Ubuntu based relationships as well as part of the education system). These themes were related through a framework which integrates three levels of relationship: a central community of reciprocal relationships with the doctor-patient relationship as core, a level in which the systems of health and education interact and together with social determinants of health mediate the insertion of communities into a broader discourse. The paper outlines an ubuntu framing in which the tensions between vulnerability and power interact and reflect rights and responsibility as important for social accountability. Communities are argued to bring a richer dimension to social accountability through their understanding of being human and caring.

Community health worker perspectives on a new primary health care initiative in the Eastern Cape of South Africa
Austin-Evelyn K; Rabkin M; Macheka T: PLoS ONE 12(3) 2017, doi: https://doi.org/10.1371/journal.pone.0173863

In 2010, South Africa’s National Department of Health launched a national primary health care initiative to strengthen health promotion, disease prevention, and early disease detection. The strategy, called Re-engineering Primary Health Care, aims to provide a preventive and health-promoting community-based Primary Health Care model. A key component is the use of community-based outreach teams staffed by generalist community health workers. The authors conducted focus group discussions and surveys on the knowledge and attitudes of 91 Community Health Care Workers working on community-based teams in Eastern Cape Province. The community health workers who were studied enjoyed their work and found it meaningful, as they saw themselves as agents of change. They also perceived weaknesses in the implementation of outreach team oversight, and desired field-based training and more supervision in the community. The authors propose providing community health workers with basic resources like equipment, supplies and transport to improve their acceptability and credibility to the communities they serve.

Health workforce metrics pre- and post-2015: a stimulus to public policy and planning
Pozo-Martin F, Nove A, Castro Lopes S, et al.: Human Resources for Health 15(11), 3, 2017

In low- and middle-income countries, scaling essential health interventions to achieve health development targets is constrained by the lack of skilled health professionals to deliver services. The authors take a labour market approach to project the future health workforce demand using an economic model based on projected economic growth, demographics, and health coverage, and using health workforce data (1990–2013) for 165 countries from the WHO Global Health Observatory. The demand projections are compared with the projected growth in health worker supply and the health worker “needs” as estimated by WHO to achieve essential health coverage. The model predicts that, by 2030, global demand for health workers will rise to 80 million workers, double the current (2013) stock of health workers, while the supply of health workers is expected to reach 65 million over the same period, resulting in a worldwide net shortage of 15 million health workers. Growth in the demand for health workers will be highest among upper middle-income countries, driven by economic and population growth and ageing. This results in the largest predicted shortages which may fuel global competition for skilled health workers. Middle-income countries will face workforce shortages because their demand will exceed supply. By contrast, low-income countries will face low growth in both demand and supply, which are estimated to be far below what will be needed to achieve adequate coverage of essential health services. In many low-income countries, demand may stay below projected supply, leading to the paradoxical phenomenon of unemployed (“surplus”) health workers in those countries facing acute “needs-based” shortages. Opportunities exist to bend the trajectory of the number and types of health workers that are available to meet public health goals and the growing demand for health workers.

Retention and sustainability of community-based health volunteers' activities: A qualitative study in rural Northern Ghana
Chatio S; Akweongo P: PLoS ONE 12(3), 2017, doi:10.1371/journal.pone.0173983

The shortage of formal health workers has led to the utilisation of Community-Based Health Volunteers to provide health care services to people especially in rural and neglected communities. This study explored factors affecting retention and sustainability of community-based health volunteers’ activities in a rural setting in Northern Ghana, through a qualitative study with thirty-two in-depth interviews with health volunteers and health workers overseeing their activities. Study participants reported that the desire to help community members, prestige and recognition as doctors in the community were key motivations for the health volunteers. Lack of incentives and logistical supplies such as raincoats, torch lights, wellington boots and transportation in the form of bicycles to facilitate the movement of health volunteers affected their work and discouraged them. Most of the dropout volunteers said lack of support and respect from community members made them to stop working as health volunteers. They recommended that community support, incentives and logistical supplies such as raincoats, torch light, wellington boots and bicycles can help retain community-based health volunteers and also sustain their activities at community level.

Kenyan medical students are learning through a community outreach model
Mining S: The Conversation, March 2017

This is a time of unprecedented change in medical education globally. Medical schools, postgraduate bodies and other organisations are responding to rapid advances in medicine and changes in health care delivery. New education approaches are being adopted to exchange information. This enables the institutions to produce relevant health professionals. There are a number of innovations and models that are being explored to improve the learning of students studying medicine and public health. This Kenyan case study reports on how partnerships between the higher education institution and the community are working. It gives an account of the Moi University community programme that uses adaptive instruction for health trainees in the schools of medicine and public health. Adaptive instruction is a student centred approach where they are given real life cases to solve health problems theoretically as tutorial cases. This discussion, with the guidance of a tutor, promotes active learning. The model encourages active learner participation in the provision of health services. It introduces the students to a community health framework where they work in rural health facilities as part of their continuous assessment. It means that graduates entering the profession are able to apply and practise knowledge and skills beyond the theory learnt at the university. The students diagnose issues affecting the local community, develop a research proposal, work with district health management teams and implement activities. They conduct surveillance and monitor diseases and in the event of an epidemic, they are expected to respond effectively. They master the principles of how rural health facilities are run. The programme is divided into five phases: Introduction to the community, Community diagnosis, Writing a research proposal, Investigation executing the research plan, District health service attachment. The research projects designed and implemented in phase three and four have produced fascinating reports with research topics that address issues affecting the communities. It takes 20% to 30% of curriculum content and makes the graduand socially responsible and accountable team players in health care delivery. The authors hope that other tutors in Kenya, Eastern Africa and beyond the continent will benefit from this model. The experience provides tutorial guidance towards building a resilient and experienced crop of health professionals at par with global health training standards.

Knowledge, attitudes and practices of South African healthcare workers regarding the prevention and treatment of influenza among HIV-infected individuals
Duque J; Gaga S; Clark D et al.: PLoS ONE 12(3) 2017, doi:10.1371/journal.pone.0173983

The South African Department of Health publishes annual guidelines identifying priority groups, including immunosuppressed individuals and healthcare workers (HCW), for influenza vaccination and treatment. How these guidelines have impacted HCW and their patients, particularly those infected with HIV, remains unknown. The authors aimed to describe the knowledge, attitudes and practices regarding influenza and the vaccine among South African HCW. Surveys were distributed by two local non-governmental organisations in public health clinics and hospitals in 21 districts/municipalities (5 of 9 provinces). There were 1164 respondents. One-third (34%) of HCW reported getting influenza vaccine and most (94%) recommended influenza vaccine to patients infected with HIV. The ability to get vaccine free of charge and having received influenza government training were significantly associated with self-reported vaccination in 2013/2014. Self-reported vaccination and availability of influenza vaccine during the healthcare visit were significantly associated with recommending influenza vaccine to patients infected with HIV/AIDS. Free and close access to influenza vaccine were associated with a higher likelihood of getting vaccinated. HCW who reported getting the influenza vaccine themselves, had vaccine to offer during the patient consult and were familiar with guidelines and training were more likely to recommend vaccine to HIV-infected patients.

3rd Board Meeting of the African Platform on Human Resources for Health (APHRH)
APHRH: Kampala, Uganda, 2016

The Board of the APHRH met on the 30th Nov 2016 in Kampala to discuss key issues that concerning the Health Workforce in Africa. A resolution was made to convene a regional consultation meeting of key stakeholders and networks to develop a consensus on ways to accelerate advocacy for a strengthened health workforce in Africa. The Board made a number of decisions to initiate acceleration of the work of the platform at all levels and enhance lobby and advocate for the prioritization of the Health Workforce agenda in Africa, outlined in this document, including: to request the WHO Regional Director for Africa to urgently consider an enhanced technical support program to African countries to strengthen country level health workforce development and management departments, especially at the ministries of health headquarters of member states; to support African Member states in translating for action key regional and global policies including the African Health Strategy, the Global Health Workforce Strategy and Sustainable Development Goals (SDGs) and to fast track the strengthening of Health Workforce information systems of countries to manage workforce inflows, stock and outflow by implementation of the WHO code on International Recruitment and track progress of strengthening through improved reporting on the code at the 3rd round due in 2018.

Community health worker perspectives on a new primary health care initiative in the Eastern Cape of South Africa
Austin-Evelyn K; Rabkin M; Machete T; Mutiti A; Mwansa-Kambafwile J; Dlamini T; El-Sadr W: PLoS ONE 12(3) 2017, doi:10.1371/journal.pone.0173983

In 2010, South Africa’s National Department of Health launched a national primary health care (PHC) initiative to strengthen health promotion, disease prevention, and early disease detection. The strategy, called Re-engineering Primary Health Care (rPHC), aims to provide a preventive and health-promoting community-based PHC model. A key component of rPHC is the use of community-based outreach teams staffed by generalist community health workers (CHWs). The authors conducted focus group discussions and surveys on the knowledge and attitudes of 91 CHWs working on community-based rPHC teams in the King Sabata Dalindyebo (KSD) sub-district of Eastern Cape Province. The CHWs studied enjoyed their work and found it meaningful, as they saw themselves as agents of change. They also perceived weaknesses in the implementation of outreach team oversight, and desired field-based training and more supervision in the community. The authors find that there is a need to provide CHWs with basic resources like equipment, supplies and transport to improve their acceptability and credibility to the communities they serve.

Global Health Workforce Labor Market Projections for 2030
Liu J; Goryakin Y; Maeda A; Bruckner T; Scheffler R: Human Resources for Health 15(11) 3, 2017

In low- and middle-income countries, scaling essential health interventions to achieve health development targets is constrained by the lack of skilled health professionals to deliver services. The authors project the future health workforce demand based on projected economic growth, demographics and health coverage. They used health workforce data for 1990–2013 for 165 countries from the WHO Global Health Observatory. The demand projections are compared with the projected growth in health worker supply and the health worker “needs” as estimated by WHO to achieve essential health coverage. The model predicts that, by 2030, global demand for health workers will rise to 80 million workers, double the current (2013) stock of health workers, while the supply of health workers is expected to reach 65 million over the same period, resulting in a worldwide net shortage of 15 million health workers. Growth in the demand for health workers will be highest among upper middle-income countries, driven by economic and population growth and ageing. This results in the largest predicted shortages which may fuel global competition for skilled health workers. Middle-income countries will face workforce shortages because their demand will exceed supply. By contrast, low-income countries will face low growth in both demand and supply, both of which are estimated to be far below what will be needed to achieve adequate coverage of essential health services. This may lead to the paradoxical phenomenon of unemployed (“surplus”) health workers in those countries facing acute “needs-based” shortages.

Kenyan doctors’ strike: Why the centre can no longer hold
Oyoo S: Pambuzuka News, February 2017

The doctors’ strike now in its third month in Kenya has caused great suffering to the majority poor people who cannot afford medical care in private hospitals. The author writes that the strike is not merely about the welfare of the healthcare workers, but about a public health system crumbling under deliberate state neglect and corruption. By mid-February Kenyan doctors had been on strike for over two months. They have made several demands including: better remuneration, availability of more doctors in public hospitals, better equipment and availability of drugs in these facilities, and more allocation of funds to health research. They are, according to the author, demanding better healthcare for all Kenyan citizens. The author comments that the doctors’ demands have been spurned by government, and the media to some extent, in what is part of a wider effort to portray the doctors as greedy individuals. The negotiation process has been long and tortuous, with the government side not keen on implementing a Collective Bargaining Agreement (CBA) it signed with the doctors in 2013. Private healthcare providers on the other hand are argued to stealthily lie like vultures – waiting for the public healthcare system to implode so they can expand their ‘investments’ in Kenya, a country that’s been described as ‘a lucrative market for private healthcare service provision’. One can almost imagine that this is part of a wider scheme to privatise the Kenyan healthcare system, a move which would drive the cost of treatment beyond reach of the majority. Kenya was ranked 145 out of 176 in Transparency International’s corruption perception index in 2016. The author writes that it is no longer possible to stand by and watch as up to a third of the Kenyan budget is lost to corruption, and disappears into the pockets of a select few. Kenyans can no longer stand by and watch the state audaciously claim it cannot pay their doctors. Kenyans just cannot afford to be spectators in such a matter of life and death.

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