This paper investigates the impact of the framework and strategies to retain critical health professionals (CHPs) that the Zimbabwean government has put in place, particularly regarding non-financial incentives, in the face of continuing high out-migration. The study investigated and reports on the causes of migration of health professionals; the strategies used to retain health professionals, how they are being implemented, monitored and evaluated and their impact, in order to make recommendations to enhance the monitoring, evaluation and management of non-financial incentives for health worker retention. The field survey results showed that Zimbabwe is losing experienced CHPs, but that even newly qualified staff aspire to migrate to gain experience. The major factor driving out-migration is the economic hardship that CHPs face due to deterioration in the country’s economy. Other factors identified include poor remuneration, unattractive financial incentives and poor working conditions. The Zimbabwe Health Service Board (ZHSB) has implemented a retention package but constraints in its adequacy and coverage appear to have limited its impact, whilethe ZHSB itself has limited autonomy to decide on health worker incentives.
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The Regional analysis of Equity in Health in East and Southern Africa presents a synthesis of the evidence gathered from a range of sources: published literature on and from the region, reviews of current evidence, where available, data drawn primarily from government, intergovernmental, particularly Africa Union and UN sources and the less commonly documented and heard experience within the region, found in grey literature, in interviews and testimonials and gathered through participatory processes. The report is written for many audiences. For the diverse community involved in health equity within east and southern Africa, it provides a source book of evidence and analysis to support and advance work.
New information can be found at the website for the EQUINET Conference September 2009 on pre and post conference workshops. Regional workshops will be held on issues covering health literacy, policy analysis, participatory methods, writing skillsand health financing. Visit the website at ww.equinetafrica.org/conference2009/index.php for further information. Places are limited so we urge youto register early.
Implementing any policy or intervention faces a range of challenges, especially for those seeking to benefit the poorest social groups. Much public health analysis focuses on the technical aspects of good policy design. However, experience shows that it can be more difficult to deal with the political and institutional barriers to implementation than to design new policies and programmes. Predicting and managing these political and institutional factors is essential to make the changes necessary to strengthen equitable health systems. This guidance brief outlines the frameworks and tools usedin health policy analysis for investigating and tackling these issues. It also presents a range of resources in Africa and elsewhere to support this key area of work in health.
Devoting 15% of domestic public funds to the health sector is necessary - both to address the health and health care needs within east and southern Africa (ESA) and to ensure progress towards building a universal and comprehensive health system. The target of 15% is not unrealistic – it is very much in line with levels of public spending in other countries around the world. Achieving the 15% target demands that public funds not be consumed by debt servicing, so rapid implementation of debt cancellation is critical. The 15% is understood to mean domestic public spending on health, excluding external funding. This policy brief provides information on progress towards meeting the Abuja commitment in east and southern Africa, the obstacles and challengesto address,and the arguments for enhanced effort to prioritising health in national budgets.
The Regional Meeting of Parliamentary Committees on Health in East and Southern Africa on Health Equity and Primary Health Care: Responding to the Challenges and Opportunities, Munyonyo Uganda September 16-18 2008, gathered members of parliamentary committees responsible for health from twelve countries in East and Southern Africa, with sixteen technical, government and civil society and regional partners to promote information exchange, facilitate policy dialogue and identify key areas of follow up action to advance health equity and sexual and reproductive health in the region. This document presents the resolutions of the meeting,and the immediate and long term commitments made by the parliamentarians and their partners towards advancing health equity and Primary Health Care in the region.
SAFM is the largest English language current affairs radio station in South Africa. In its 'Workers on Wednesday' slot the host, live studio guests and call-in audience discussed the reasons for migration of health workers - from rural to urban areas, from the public to the private sector, and from South Africa to other countries - and the effectiveness of incentives to retain health workers in the South African public sector.
On October 23rd 2008 the Community Working group on Health (CWGH) held a national conference gathering district and national members, and an evening event in Harare, Zimbabwe to mark its tenth anniversary. Speakers from civil society, parliament, state and from the region reflected on the challenges to people centred health systems and the contribution of the CWGH. EQUINET joined in this event to present evidence on progress and challenges towards health equity in Zimbabwe and to launch the EQUINET book, "Reclaiming the Resources for Health". The delegates to the conference identified areas for follow up action to promote health equity, including advocating for the right to health to be included in the constitution, and a priority for resources to be directed to resotring the environments for health and to investments in primary health care.
The Tanzanian public health sector is losing workers to internal and external migration. This paper examines the implementation of policies to govern non-financial incentives to retain health workers. It examines a range of non-financial incentives, including training; leave; promotion; housing; and a safe and supportive working environment. It also examines the systems for managing personnel and the implementation of incentives as a factor in retention, including the participatory personnel appraisal system; worker participation in discussing their job requirements and welfare; supervision; recognition and respect. Drawing on a review of policy, published and grey literature and on a field stidy of seven districts, including five underserved districts, the paper finds that while a number of incentives exist in policy, their sustainability is eroded by the absence of special earmarked funding for their implementation. Decentralised districts also lack adequate powers and authority to manage health workers weakening their ability to implement non-financial incentives. There was general consensus from health workers and managers that interventions such as training and education, promotion and the provision of safe working and living environments, can be strong motivators if implemented in an effective and sustainable manner. In contrast, health workers interviewed pointed to the demotivating effect of poor implementation of available non-financial incentives. The management and resource barriers to implementing non financial retention incentives are further explored in the paper and recommendations made to strengthen the implementation of incentives. The authors conclude that analysis of issues driving retention needs to take into account both individual and structural factors that shape individual health workers' preference structures and the complex nature of the health care labour market. A trivialised pull and push factors framework in analysing complex problems like retention, will not guide sustainable solutions, which need to be based on an understanding of factors that not only guide the design of incentive regimes, but also the resources, management systems and other factors that enable their implementation in practice.
Parliaments have a significant role to play in ensuring that people are able to access the right to health, that health rights are enshrined in national laws, and that national governments make proper provisions for implementing health rights. This brief sets out the international legal framework for the right to health and the responsibilities of national legislatures in making that right to health real. Parliaments and their committee structures play a key role in the oversight of international human rights commitments, passing and reviewing laws to implement these commitments, overseeing the executive and monitoring implementation of these laws, and in including civil society in such processes.