Journal Articles

We report on income generation and work mix among 100 civil servants who manage public health services in developing countries. Their salary puts these managers among the better-off in their countries. However, 87% of the respondents complement their salaries with other income-generating activities.

For a health district to function, referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. [from abstract]

There has been a lively debate in the media about working conditions in rural South African Hospitals, with a particular focus on staffing and quality of care. From a medical perspective, it has been stated that poorly equipped and managed hospitals, inappropriate training and an excessive workload are significant contributors to the problem. This study was conducted to investigate the experiences of medical practitioners in performing their professional duties in rural district hospitals in the Western Cape. [from abstract]

Academic medicine has the opportunity to improve the quantity and quality of the health workforce as a means of strengthening the broader health system. However, it must address the gender dimensions of enrollment, curriculum, and promotion to have a positive impact on human resources for health around the world. [author’s description]

No satisfactory strategy for reducing high child mortality from malaria has yet been established in tropical Africa. The authors compared the effect on under-5 mortality of teaching mothers to promptly provide antimalarials to their sick children at home, with the present community health worker approach. The study concludes that a major reduction in under-5 mortality can be achieved in holoendemic malaria areas through training local mother coordinators to teach mothers to give under-5 children antimalarial drugs. [adapted from abstract]

This paper reports on income generation practices among civil servants in the health sector, with a particular emphasis on dual practice. It first approaches the subject of public-private overlap. Thereafter it focuses on coping strategies in general and then on dual practice in particular. In this paper dual practice is approached from six different perspectives: what is meant by dual practice; typology of dual practices; prevalence; impact on personal income, the health care system and health status; reasons; and possible interventions. [adapted from author]

In this paper, we focus on those policy instruments with monetary incentives that are used to contain public health expenditure in high-income countries.

Action is underway to increase access to antiretroviral drugs, especially in countries with high rates of HIV. The role of private providers is largely ignored, although they are an important source of care for stigmatizing diseases in many poor countries. Evidence is emerging that antiretroviral drugs are leaking into formal and informal private markets. Uncontrolled use of drugs in the private sector will lead to rapid development of HIV resistance. Countries require guidance and support from international policy makers and pharmaceutical companies to implement strategies for working with private providers.

This study aims at analysing the impact of international service trade on the health care system, particularly in terms of human resources for health (HRH), using Thailand as a case study. [from abstract]

This article discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. [from abstract]

To provide good quality health care services, it is important to develop strategies influencing staff motivation for better performance. An exploratory qualitative research was carried out among health workers in two provinces in North Viet Nam so as to identify entry points for developing strategies that improve staff performance in rural areas. [from abstract]

Using Thailand as a case study, this paper aims to explore the potential implications of integrated health system intervention. Within the Thai context, it is argued in this paper that autonomy of a network of public providers, rather than autonomy of individual hospitals, should be encouraged if management of health manpower is to be optimized. [from abstract]

This issue shows how managing and leading can be practiced at the same time by managers at all levels. It discusses effective leadership values and practices that exist around the world. It explains how managers can, individually and together, undertake leadership development. [editors’ description]

This paper reviews lessons learned regarding getting decision-makers to recognise the nexus between workforce planning, overall health service development and operational policy; data collection and collation; moving beyond a simple personnel to population ratio approach; and adjusting the model to suit local circumstances. The project has identified some emerging and worrying trends in health workforce development. The need for consistent, sustained technical assistance which reflects long and wide experience in health service development and management is underlined. [abstract]

This study explored the factors that motivate lay volunteers to join tuberculosis (TB) control programmes in high burden but resource-limited settings. [adapted from abstract]

This issue of The Manager offers financial and program managers—from headquarters to the service delivery level - reasons to assess their financial management systems and a method for performing this assessment. It introduces FIMAT, the Financial Management Assessment Tool, a step-by-step process and instrument for rapidly assessing budgeting, accounting, purchasing and other financial systems. It describes how managers can use their assessment results to develop detailed action plans that can be incorporated into their organization’s annual operation plans. [from author]

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels. [from abstract]

UniNet is an Internet-based thematic network for a virtual community of users. It supports a virtual multidisciplinary community for physicians, focused on the improvement of clinical practice. This is a study of the effects of a thematic network such as UniNet on primary care medicine in a rural area, specifically as a platform of communication between specialists at the hospital and doctors in the rural area. [from abstract]

This paper addresses the problem of wastage of the qualified labor force, which takes place both during the education process and when trained personnel try to find jobs in the local market. Reducing wastage at both the educational and labor levels should improve the capacity of social investment, thereby increasing the capacity of the health system as a whole to provide services, particularly to those populations who are most in need. [from abstract]

This article considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. [adapted from abstract]

Donor funds may be inadequate to support the growing demand for services provided by community-based distribution (CBD) programs. One solution may be to reduce the remuneration of CBD agents, but this approach may lower their productivity. Programs also need to consider reducing other costs, including those for supervision and training. The cost per agent visit—including costs associated with payments to agents and to supervisors and the costs of training—was calculated for three CBD programs in Tanzania. The output measure was visits in which contraceptives were provided or referrals made for family planning services.

African public health care systems suffer from significant brain drain of its health care professionals and knowledge as health workers migrate to wealthier countries. In this paper, the brain drain is defined as both a loss of health workers (hard brain drain) and unavailability of research results to users in Africa (soft brain drain).

The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed. [from abstract]

In the face of rising demand for medical services due to ageing populations, physician migration flows are increasingly affecting the supply of physicians in Organisation for Economic Co-operation and Development (OECD) countries. This paper offers an integrated perspective on the impact of physician migration on home and host countries and discusses international regulation and policy approaches governing physician migration. [from abstract]

Only a few studies have investigated the link between human resources for health and health outcomes, and they arrive at different conclusions. The authors tested the strength and significance of density of human resources for health with improved methods and a new WHO dataset on maternal mortality rate, infant mortality rate, and under-five mortality rate. [from summary]

This issue defines public-private partnerships, lists potential partners at different administrative levels, reviews the factors behind the growth in partnerships, looks at some of the benefits and challenges of partnerships, and offers thoughts on preparing for and implementing them. It also describes the steps involved in developing a contractual relationship and provides examples of several successful partnerships. [editors’ description]

This study estimates the personnel cost implications of implementing the newly proposed Integrated Management of Childhood Illness (IMCI) algorithm in the first level health care facilities in rural Bangladesh. Policy makers need to know the additional resource requirements for IMCI before its actual implementation so that appropriate levels and combinations of personnel and drugs can be allocated. [abstract]

This pilot study focused on self-identified factors of nursing students who expressed an interest in rural practice post-graduation. The sample included students from the USA and Canada, who were enrolled in graduate and undergraduate programs of nursing, and were attending an international rural nursing conference. [From abstract]

An editorial arguing for expanding the professional category of the formal health care workers to include home-based informal caregivers, political community leaders, shop vendors of health products, and traditional health practitioners. The editorial further notes that formal health workers can become informal health workers when operating outside the rules of the health system.

This paper illustrates that the way human resources for health (HRH) are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers.