This document presents the recommendations of the EQUINET–ECSA HC regional meeting on health worker retention in east and southern Africa (ESA) was held in Windhoek, Namibia from 25-27 February 2009 hosted by University of Namibia, and involving delegates from government, academic and research institutions, health worker organisations, parliament and civil society from ten ESA countries and from regional organisations including SADC and WHO. The recommendations cover proposals for policy options, guidelines and further research on health worker retention, migration, on health worker orientation and roles in primary health care and task shifting.
Latest Equinet Updates
Recommendations from the regional meeting on health worker retention in East and Southern Africa
EQUINET, ECSA HC February 27 2009
Discussion paper 71: A review on the impact of HIV and AIDS programmes on health worker retention
Dambisya YM, Modipa SI, Nyazema NZ
This study, commissioned by EQUINET, ECSA-HC and WHO, aimed to review and critically analyse the literature and secondary evidence on the impact of HIV and AIDS programmes on health care worker (HCW) retention in east and southern Africa. Early studies reported negative effects of HIV and AIDS and the delivery of HIV and AIDS services on HCW morale with stigma, burn-out, resignation and deaths due to HIV and AIDS, while more recent ones speak of hope, high prestige, high motivation and better retention of HCWs in HIV and AIDS programmes, largely due to effective antiretroviral therapy (ART) which has improved the prognosis of AIDS. Global Health Initiatives have contributed to the expansion of HCW numbers through training, higher salaries or salary supplements, such as better furnished facilities or appointment at higher levels, often to the exclusion of other HCWs. Selectively applied incentives tend to demoralise and discourage those who are excluded; as illustrated by examples from programmes in South Africa, Tanzania and Guyana. But well funded HIV and AIDS programmes are attractive to HCWs and may contribute to internal brain drain. In contrast, more inclusive approaches, such as in Malawi where MSF supplemented salaries of all health workers in the operational districts, and Namibia where the Ministry of Health and Social Services applied uniform terms and conditions of service for all HCWs, reportedly experienced no problems. Some countries have an ‘emergency response’ approach to HIV and AIDS; hence they accept any help, usually on the funders’ terms, leading to fragmented vertical programmes. The lack of integration of HIV and AIDS services into other health programmes is a problem in many countries. Where successfully integrated programmes do exist - such as HIV and TB, HIV and sexual and reproductive health, and even those where HIV and AIDS services are fully integrated into the public health system - integrated programmes benefited the whole system. There have been fears that existing inequalities in health care may be intensified in scaling up HIV and AIDS services. There are, however, reports showing that a public health and equitable approach to the roll-out of ART is possible across all socio-economic groups with similar outcomes. HIV and AIDS programmes have the potential to benefit the health system by attracting and retaining HCWs in the health system; and indeed, innovations such as task shifting and the integrated management of adult and adolescent illness have been applied to more efficiently use available HCWs. Many vertical programmes recruit their own HCWs, especially counsellors and home-based caregivers. This can increase the pool of HCWs. By relying on the health system for the more skilled health professionals, however, HIV and AIDS programmes may also undermine other health programmes. We recommend that country-level case studies be undertaken to document the various approaches, such as engagement between countries and funding agencies, country perspective on NGO roles, the implementation of the ‘Three Ones’, SWAP and public health approach; and the impact of national and project specific initiatives on HCWs.
Policy Brief 21: Protecting health and health services in the services of the ESA-EU EPA
Munyuki E, Machemedze R, Mabika A, Loewenson R
Negotiations are underway on the services agreements towards concluding a full and comprehensive Economic Partnership Agreement (EPA) between East and Southern African countries (ESA) and the European Union (EU). The services negotiations will impact on health services and access to health care. The brief outlines the issues affecting health services, and presents options for ESA negotiators to ensure that the negotiations meet international and African health and human rights commitments, use available trade flexibilities, promote public health and ensure adequate assessment and information to support the negotiations.
Discussion Paper 68: Retention strategies for Swaziland's health sector workforce: Assessing the impact of non-financial incentives
Masango S, Gathu K, Sibandze S, University of Swaziland, Swaziland Ministry of Health and Social Welfare
Have non-financial incentives been successful in retaining health workers in Swaziland? This study reviewed health policy and programme documents in Swaziland relevant to health workers and found that only one that mentioned non-financial incentives, suggesting that the value of these incentives is under-rated in policy. In contrast, a field study interviewing health workers at different levels of the health system revealed that most workers in Swaziland consider non-financial incentives to be more important than salary in determining whether or not they will remain in their jobs or join the 'medical brain drain' overseas.
Participatory approaches to strengthening youth and health worker relations: The ‘Auntie Stella’ Toolkit
Post conference workshop at the September 2009 EQUINET conference
Training and Research Support Centre offer a one day workshop on September 26 2009 for 30 people at the EQUINET Conference in September 2009. The workshop draws on experiences from TARSC and other partners in the field of Youth Reproductive Health, with a particular emphasis on the relationship between youth and health workers. In exploring ways to strengthen the gap between the two, this workshop will offer insight and adaptable strategies that can be used to facilitate dialogue, using participatory approaches including use of the ‘Auntie Stella’ toolkit. Deliberations will include:
• The importance of health worker and youth relations in building a more people-centred health system
• A discussion on the barriers to youth-health worker relations
• How these barriers can be overcome, with a particular focus on participatory approaches
• Discussion on how the interactive toolkit, ‘Auntie Stella’: Teenagers talk about sex, life and relationships can be used and adapted to strengthen youth-health worker understanding and communication (See www.tarsc.org/auntiestella for more information about ‘Auntie Stella’.)
The workshop will be interactive and will introduce a number of participatory tools that participants can use in their work with youth. At the end of the workshop we will also share with the participants follow up activities To register fill in the registration form available on the EQUINET conference site at www.equinetafrica.org/conference2009/index.php giving the name of the workshop and email us on admin@equinetafrica.org
Workshop on Health Policy analysis
University of Cape Town September 22 2009
The University of Cape Town is offering a pre conference workshop on September 22 2009 at the EQUINET Conference September 2009 to:
* Reflect on health policy analysis and its role in health system development
* Share experience in the use of health policy analysis to support policy development and implementation
* Share experience in teaching health policy analysis (in short course, post-graduate programmes etc)
* Develop shared ideas of how to strengthen this field of work in Africa.
This workshop is relevant to you if you seek to influence and shape health policy agendas; analyse or support the processes of health policy-making and implementation at any level of the health system; work as a health leader and want to develop your ideas about how to strengthen the implementation of policy, or teach others about health policy analysis.
The workshop will be interactive and based on the experience that those attending it wish to share. To register fill in the registration form available at http://www.equinetafrica.org/conference2009/index.php giving the name of the workshop and email it to admin@equinetafrica.org
ABSTRACT SUBMISSION CLOSING JANUARY 30 2009! Regional conference on equity in health in east and southern Africa, Uganda 23-25 September 2009
The closing date for abstract submission for EQUINET Regional Conference on Equity in Health in east and southern Africa is approaching. Please visit the conference website to download the abstract form and the registration form for submission. Preference for sponsorship will be given to accepted abstracts. We look forward to welcoming people from government, non state organisations, academic and research institutions, civil society, parliaments, regional and international organisations and other institutions promoting and working on equity in health in east and southern Africa! For more information, please visit the conference website at http://www.equinetafrica.org/conference2009/index.php or send queries to admin@equinetafrica.org, with EQUINET CONFERENCE in the subject line
EQUINET Conference Abstract submission CLOSING January 30 2009!
Regional conference on equity in health in east and southern Africa, Uganda 23-25 September 2009
The closing date for abstract submission for EQUINET Regional Conference on Equity in Health in east and southern Africa is on January 30 2009. Please visit the conference website to download the abstract form and the registration form for submission. Preference for sponsorship will be given to accepted abstracts. We look forward to welcoming people from government, non state organisations, academic and research institutions, civil society, parliaments, regional and international organisations and other institutions promoting and working on equity in health in east and southern Africa! For more information, please visit the conference website at http://www.equinetafrica.org/conference2009/index.php or send queries to admin@equinetafrica.org, with EQUINET CONFERENCE in the subject line.
EQUINET Discussion Paper 67: Evaluating the implementation of the Tanzanian National Voucher Scheme: A case study from the Ruvuma region, Tanzania
A Komba: December 2008
In 2004, the Tanzanian government launched its Tanzania National Voucher Scheme (TNVS). The scheme aimed to subsidise the cost of anti-malaria nets for pregnant women and children across the country. But has the implementation of the scheme so far been equitable? This study used a case study approach to analyse the power relations between key implementers of the scheme and the mothers served in four rural district health facilities in Namtumbo and Mbinga districts. The study found that despite the scheme’s impact in reducing severe malaria cases, inadequate national prioritisation of malaria is affecting implementation, leading to inadequate funding, felt most severely at facility level. No resources were allocated specifically for voucher distribution, resulting in periodic shortages, while health workers involved in the scheme had other competing demands on their time. A top-down managerial approach to implementation allowed health workers to exercise unfair power over mothers and pregnant women seeking nets and treatment and women were asked to pay for vouchers in some areas, when they are actually entitled to get them free. The study, building on previous studies in Tanzania and elsewhere, demonstrated that a top-down approach to policy intervention is contributing to implementation gaps. The voucher scheme is not just a tool for ensuring access and equity in health care delivery – it must be carefully considered in the context of those entrusted with the task of overseeing its implementation.
EQUINET Discussion Paper 69: How power relations affect the implementation of policy on equity in access to anti-retroviral therapy: The case of rural health centres in Malawi
Simwaka LK: December 2008
The national ART scale-up plan contains several measures to promote equity, considering also that there are insufficient resources to cover everyone who is eligible. Thus study focused on four of these covering ART enrolment on an open ‘first-come, first-served’ basis; targeted gender-sensitive health promotion of ART, measures to overcome specific geographical barriers to access for remote populations and prioritisation of people already on ART, pregnant women and young children. Using a case study approach the study analysed the power relations that influenced outcomes on these policy measures on four health facilities in Malawi. The findings indicate that health workers commonly exercise power in relation to patients, and that patient acquiesce with health worker behaviours. In poorly performing facilities, implementation of policy measures is negatively affected by managerial practices that discourage teamwork and de-motivate health workers, while in the two better performing facilities, management practices had a more positive role in supporting positive health worker practices. The study findings highlight that implementing equity policies needs to include measures to orient and involve staff, and address power and resource imbalances that can undermine access.