Every year a million women infected with HIV deliver babies without professional help. This article suggests that traditional birth attendants could be involved in preventing perinatal transmission of HIV by offering services such as HIV testing and counseling and short courses of antiretroviral drugs. [publisher’s description]
In much of the developing world, private health care providers and pharmacies are the most important sources of medicine and medical care and yet these providers are frequently not considered in planning for public health. This paper presents the available evidence, by socioeconomic status, on which strata of society benefit from publicly provided care and which strata use private health care. [from abstract]
This article proposes a conceptual framework for the analysis of human resources for health interventions according to their degree of technical complexity; this complements the notion of institutional capacity in considering the feasibility of implementing an intervention.
An editorial by Gijs Elzinga in an issue of the Bulletin of the World Health Organization dedicated to the theme of Human Resources for Health. Elzinga discusses the importance of effective interplay between the goals of vertical programs and the horizontal health care system within which vertical programs are implemented.
Several countries are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals. This trend has led to concerns that in many of the source countries—especially within Africa—the outflow of health care professionals is adversely affecting the health care system. This paper examines the role of wages in the migration decision and discusses the likely effect of wage increases in source countries in slowing migration flows. [from abstract]
This paper reviews the strategies for polio eradication, summarizes the skills and number of people required for their implementation, outlines the approach used to mobilize and manage these human resources, and discusses the impact of this approach. [from introduction]
Increasing the numbers of health workers and improving their skills requires that countries confront a number of ethical dilemmas. The ethical considerations in answering five important questions on enabling health workers to deal appropriately with the circumstances in which they must work are described.
We are beginning to recognize that, parallel to biological action, the HIV/AIDS pandemic also attacks the human capacity and social defence systems. By destroying the fabric of health systems, the spread and impact of the epidemic is hugely augmented. [author’s description]
The definition of the ideal numbers and distribution of human resources required for control of road traffic injury (RTI) is not as advanced as for other health problems. We can nonetheless identify functions that need to be addressed across the spectrum of injury control. [from abstract]
This news article introduces an approach to HIV/AIDS treatment that has helped Uganda scale up treatment in the midst of limited health workers. The approach, called Integrated Management of Adult and Adolescent Illness (IMAI), has been inspired by successes in Latin America, the former Soviet Union and Africa, where lay health workers who are often relatives, friends or other community volunteers have been trained to help treat tuberculosis patients in poor settings. [adapted from author]
Ghana’s health sector has lost many health care workers, including those migrating to other countries. Strategies aimed at keeping personnel have had varied results. This article briefly reviews these strategies. [adapted from author]
Approach to Classifying Human Resources Constraints to Attaining Health-related Millennium Development Goals
For any wide-ranging effort to scale up health-related priority interventions, human resources for health (HRH) are likely to be a key to success. This study explores constraints related to human resources in the health sector for achieving the Millennium Development Goals (MDGs) in low-income countries. [adapted from author]
Building health research expertise in developing countries often requires personnel to receive training beyond national borders. For research funding agencies that sponsor this type of training, a major goal is to ensure that trainees return to their country of origin: attaining this objective requires the use of proactive strategies. This paper describes the strategies employed to discourage brain drain by the principle investigators of five of the longest-funded AIDS International Training and Research Program. [from abstract]
With a population of more than 8 million, Chad has around 3,600 health workers: 50 percent of these are unskilled, and 35 percent are nurses and midwives. Chad also faces geographical imbalances in the distribution of health professionals, with approximately half working in the capital N’Djamena. This article provides an overview of the issues related to the health workforce in Chad. [adapted from author]
Despite the undoubted importance of human resources to the functions of health systems, there is little consistency between countries in how human resource strategies are monitored and evaluated. This paper presents an integrated approach for developing an evidence base on human resources for health (HRH) to support decision making, drawing on a framework for health systems performance assessment. [from abstract]
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]
Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised. The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration. [from abstract]
International recognition that the growing shortage of health workers poses a major threat to fighting diseases such as HIV/AIDS and tuberculosis has prompted a flurry of measures to stem the exodus of health professionals from developing countries. The initiatives — such as ethical recruitment codes to try to limit damage inflicted by the brain drain, and exchange and training programmes and projects to tap the resources of what has become known as the diaspora of migrant health workers — remain fragmented but at least mark a start in the search for solutions to the crisis. [autho
Though reforms in the health sector have recently been common around the world, their success has, for a variety of reasons, been mixed. The paper aims to examine and explain the importance of human resources (HR) to the success or failure of health reforms using case studies from Russia, Zambia and the United Kingdom. [from abstract]
The departure of a large proportion of the most competent and innovative individuals from developing nations slows the achievement of the critical mass needed to generate the enabling context in which knowledge creation occurs. To favourably modify the movement and distribution of global talent, developing countries must implement bold and creative strategies that are backed by national policies.
Billions of dollars have been invested in efforts to prevent the spread of HIV and other diseases in the world’s poorest countries. Yet at the same time, qualified health workers are leaving the same areas to work in the world’s richest countries. This article provides a brief overview of this issue. [author’s description]
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.
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.
This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States.
There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration, less developed countries lose important health capabilities as a result of the loss of physicians. With the use of World Health Organization data, this article presents an emigration factor for the countries of origin of the immigrant physicians to provide a relative measure of the number of physicians lost by emigration. [from abstract]
How Can We Achieve and Maintain High-Quality Performance of Health Workers in Low-Resource Settings?
In low and middle income countries, health workers are essential for the delivery of health interventions. However, inadequate health-worker performance is a very widespread problem. We present an overview of issues and evidence about the determinants of performance and strategies for improving it. [authors’ description]
Most statistics on the migration of health-care workers are neither complete nor fully comparable, and they are often underused, limited, because they often give only a broad description of the phenomena, and are not as timely as required. This paper presents information on the uses of statistics and those who use them, the strengths and limitations of the main data sources, and other challenges that need to be met to obtain good evidence on the migration of health workers. This paper also proposes methods to improve the collection, analysis, sharing, and use of statistics on the migration of health workers.