What effect does the increased number of Malawians living with HIV/AIDS have on the public health sector? To address this question, the Commonwealth Regional Health Community Secretariat (CRHCS) and Malawian researchers from the Ministry of Health and Population (MoHP), with support from the U.S. Agency for International Development, Bureau for Africa, undertook an assessment to explore the effects of HIV/AIDS on the health workforce. [author’s description]
This report is aimed at policy makers both in developing country governments and in international agencies. It was a key input to the second meeting of the High Level Forum on the Health Millennium Development Goals held in Abuja in December 2004. It was written to raise awareness of a looming crisis in human resources for health confronting most countries in sub-Saharan Africa, and to help serve as a catalyst for action to avert this crisis.
The causes of brain drain are complex and interrelated, involving social, political, and economic factors. The necessary responses will therefore be varied and cover an array of areas. Drawing on growing interest and scholarship, Physicians for Human Rights (PHR) proposes this plan of action for addressing brain drain and the unequal distribution of health personnel within countries, recommending actions by high-income countries, African governments, WHO, international financial institutions, private businesses, and others. [author’s description]
This paper discusses the implications for health personnel of the HIV epidemic, and health sector responses to it, in southern Africa, using Malawi as a case study. Published and grey literature has been consulted to assess the situation and its implications for equity. [author’s description]
This report explores potential strategies for mobilizing U.S. health personnel and technical experts to assist in the battle against HIV/AIDS in 15 African, Caribbean, and Southeast Asian countries highly affected by the disease. Commissioned by the U.S. Department of State as part of a historic global health initiative—the President’s Emergency Plan for AIDS Relief (PEPFAR)—the report presents the results of a study conducted by the Institute of Medicine’s Committee on the Options for Overseas Placement of U.S. Health Professionals. [Description from author]
Note: Online book
Policy Brief Two: Rehabilitating the Workforce: The Key to Scaling up MNCH (World Health Report 2005: Making Every Mother and Child Count)
This policy brief from the World Health Report 2005 argues that it will not be possible to effectively scale up Maternal, Newborn and Child Health (MNCH) care without confronting the global health workforce crisis. It highlights how lack of managerial autonomy, gender discrimination and violence in the workplace, dwindling salaries, poor working conditions and some donor interventions have all contributed to a lack of productivity, as well as the rural to urban, public to private and poor to rich country brain drain and migration. The brief argues the need to plan the expansion of the workforce while implementing corrective measures to rehabilitate productivity and morale.
An initial investment of an estimated $2.0 billion in 2006, rising to an estimated $7.7 billion annually by 2010, is needed from African governments and the collective donor community to double sub-Saharan Africa’s health workforce while increasing its effectiveness, thus making significant progress towards developing the workforces required for countries in sub-Saharan Africa to achieve national and global health goals. [author’s description]
This report, written for the World Summit on Sustainable Development, Johannesburg 2002, discusses the impact of HIV on the workforce and calls for governments to live up to the benchmark of action agreed to in the 2001 Declaration of Commitment to HIV/AIDS.
Contracting with non-state entities, including non-governmental organisations, has been proposed as a means for improving health care delivery, and the global experience with such contracts is reviewed here. The ten investigated examples indicate that contracting for the delivery of primary care can be very effective and that improvements can be rapid. [from author]
This article takes up the relatively neglected issue of gender in human resources policy and planning (HRPP), with particular reference to the health sector in developing countries.
Using Mid-level Cadres as Substitutes for Internationally Mobile Health Professionals in Africa: A Desk Review
Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. This desk review was conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization.
Over the past few years, the human resources situation in the Zambia public sector has reached a point of severe crisis and inability to provide basic health services, primarily due to three interrelated factors. First, the country is losing substantial numbers of health workers to countries that offer better conditions of service, or are changing professions to ones that offer more attractive opportunities. Second, Zambia’s medical and professional schools have a limited capacity to train additional staff.
This review highlighted the fact that employment equity debates and policies largely refer to high-income countries. Even in these countries, there is more rhetorical commitment than hard evidence of successful outcomes. Evaluations have been mainly post hoc and many initiatives have not been evaluated at all. There is a continuing debate about what is the appropriate kind of intervention, a number of competing models being advocated. The most noticeable trend seems to be away from reliance on targeting by numbers (particularly for recruitment) and towards more comprehensive approaches across a range of inter- and intra-organizational interventions and over the whole career of the employee.
In this analysis of the global workforce, the Joint Learning Initiative (JLI) - a consortium of more than 100 health leaders - proposes that mobilisation and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world’s poorest countries and for building sustainable health systems in all countries. Nearly all countries are challenged by worker shortage, skill mix imbalance, maldistribution, negative work environment, and weak knowledge base.
This issue of The Manager provides a comprehensive framework for addressing human capacity development. It presents steps for developing a strategy that will help managers sustain a supply of adequately trained health staff. It examines four components of planning and managing the workforce: policy and financial requirements, human resource management, partnerships, and leadership. The issue also suggests actions managers and policymakers can take to address issues in these areas so that appropriately trained staff are available in the right places at the right time. [editors’ description]
Considered an introduction to the Performance Improvement Approach in low resource settings. Stages, Steps and Tools presents an easy-to-use guide for finding the root causes of performance problems and then selecting and implementing interventions to fix those deficits. A set of tools can be used independently or in conjunction with other interventions to improve the quality and accessibility of health care services. [
The paper summarizes the rapidly accumulating evidence and growing recognition of the HRH crisis, especially in sub-Saharan Africa. The nature of the crisis is briefly outlined, drawing attention to escalating activities, demand and momentum emerging from Africa and other countries calling for appropriate and effective global and regional support. There are clear needs for quality technical work, stronger regional cooperation, harmonization of health systems and global initiatives, and for sound fiscal and migration policies.
Despite their high level of training and medical knowledge, health professionals remain a population that is vulnerable to HIV/AIDS. AIDS-related mortality has been recognized as a significant factor in the loss of trained health staff in high prevalence countries, but little empirical research has been done to quantify the damage. In this study, we applied a case/comparison methodology to estimate the costs of HIV infection in the professional workforce at three Zambian healthcare institutions: Lusaka District Health Management Team, University Teaching Hospital (the national tertiary care hospital) and Kasama District Hospital and Health Management Team. Deaths or medical retirements among professional staff were analyzed wherever the complete personnel records were available, with the exclusion of cases resulting from violence, accident or disease of sudden onset. 108 cases were identified over a three-year period ending in October 2003. Each case was matched with two comparisons of similar age, sex and professional training. Data were collected for both cases and comparisons on absenteeism, compensation and medical care and reimbursement. Data were also collected on death and retirement benefits paid, or owed, to the cases. [author’s description]
Guidelines for Implementing Supportive Supervision: A Step-by-Step Guide with Tools for Immunization
This resource guide assists program managers in planning and implementing supervision systems in healthcare settings. Emphasis is placed on clear job expectations, leadership, and communication.
The human resource (HR) problem in the health sector in sub-Saharan Africa has worsened to an extent that it has reached crisis proportions in some countries. Although the gravity of the problem varies across the continent, the situation in some of the countries is so grave that urgent action is needed. A complex set of factors has contributed to this problem, some exogenous, such as the austere fiscal measures introduced by structural adjustment, often resulting in cutbacks in the number of health workers.
The ILO and the WHO decided to join forces in order to assist health services in building their capacities to provide their workers with a safe, healthy and decent working environment, as the most effective way both to reduce transmission of HIV and other blood-borne pathogens and to improve the delivery of care to patients.
This report was commissioned by OECD to examine the evidence on role change and delegation from physicians to advanced practice nurses (APN), nurse practitioners and nurses in other advanced roles in the hospital setting and primary care. The report has three components: a literature review, an assessment of country responses to an OECD questionnaire, and two more detailed country case studies, on England and the US. [author’s description]