Sub-Saharan Africa

Sub-Saharan Africa has the worst rate of maternal ill-health in the world. Maternal deaths occur partly because health systems are inadequately staffed to deal effectively with birth complications. How can maternal health human resources be managed better to ensure that all women, especially in poor, rural areas, can access good quality maternal health care? [author’s description]

The African Region continues to experience loss of a sizeable number of highly skilled health professionals (physicians, nurses, dentists and pharmacists) to Australia, North America and European Union. Past attempts to estimate cost of migration were limited to education cost only and did not include the lost returns from investment. The objective of this study was to estimate the social cost of emigration of doctors and nurses from the African Region to the developed countries. [from abstract]

Given the very limited health infrastructure and resources and the need to provide a palliative care service to about one percent of the population each year, community and home-based care is viewed as the key to responding to these needs. Some countries have already developed strong home-based care networks in coordination with the PHC system to respond to the HIV/AIDS epidemic. Palliative care, as part of the continuum of care of HIV/AIDS, cancer and other chronic conditions can be integrated into this existing network. [author’s description]

Significant numbers of African-trained health workers migrate every year to developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon. The population of Sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. [from introduction]

In southern Africa, rapid out-migration of health professionals is compounding the problems of health systems already faced with budget constraints and the impacts of HIV/AIDS. The authors outline a program of research on how Canada and the international community might address the negative impacts of the brain drain. [abstract]

Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries… Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes. [summary]

This report is the result of a regional meeting held March 17-19 in Arusha, Tanzania and presents the regional context for work on migration and retention; an overview of the current situation, integrating evidence from background papers and country experiences; and summarizes the discussions held on follow-up work on migration and retention. [adapted from introduction]

A growing body of evidence suggests that the quality of a health system depends greatly on highly motivated health workers who are satisfied with their jobs, and therefore stay at their stations and work. This paper reviewed evidence from published and grey literature on the use of non-financial incentives for health worker retention in sixteen countries in east and southern Africa. [adapted from author]

Although the [critical shortage of health care workers] is not new, recent international efforts to vaccinate children and to fight HIV/AIDS, malaria, tuberculosis, and other diseases have brought it into sharper focus. The worker shortage derives from a combination of underproduction, internal maldistribution, and emigration of trained workers (“brain drain”). Fortunately, many African countries have begun attacking the problem by implementing innovative programs that may serve as models for other countries. Once effective pilot programs have been identified, scaling up will be the next hurdle: programs that are found to work on a small scale or in a particular environment may not be easy to expand or replicate.

Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration. [from abstract]

The report of the Africa Working Group (Joint Learning Initiative) is in 4 main parts covering a situation analysis, opportunities that arise and the preconditions for effective strategies.

This document brings together the promising practices identified by the PVO community. Our definition of promising is purposefully broad to include the many ideas and experiences of different organizations that seem likely to combat HIV/AIDS successfully. [from foreword]

This study uses a new database of health worker emigration from Africa to test whether exogenous decreases in emigration raise the number of domestic health professionals, increase the mass availability of basic primary care, or improve a range of public health outcomes.

The purpose of this document is to provide Africa 2010’s strategy for strengthening regional and local capacity for adopting effective policies and innovations to improve the health status of Africans. [from introduction]

The report provides evidence of inadequate ratios of personnel to population for key skilled health personnel, and a maldistribution of personnel along three different axes, between: public and private heath sectors, urban and rural areas and tertiary and primary levels of the health system. It describes the exodus of healthcare workers from areas of poverty and low socio-economic development, to more highly developed areas. [from executive summary]

One of the challenges of continuing professional development (CPD) is to ensure that members of the medical profession maintain and improve the competencies in medical practice. CPD is an evolving system and different countries in Africa are at different levels of development. This article focuses on the developments and challenges of CPD among medical and dental practitioners in Africa. [abstract]

This is a summary report from the Africa Health Workforce Observatory meeting held September 26-29, 2006, at the ECSA headquarters in Arusha, Tanzania. The meeting focused on developing mechanisms to create up-to-date and reliable information that enables evidence-based decision making for HRH. [adapted from author’s description]

Addressing the current state of human resources in health, the paper highlights the critical situation of the health workforce in sub-Saharan Africa. It examines the most recent workforce statistics and trends, including geographical distribution. The factors that have and are influencing the availability of human resources are briefly reviewed, focusing on the workforce motivation, the serious brain drain of health professionals, and the increasing impact of HIV/AIDS.

The African continent is facing 25% of the world’s morbidity rate with only 3% of its healthcare personnel. This is the result of years of neglect and underinvestment by African governments and the international community, plus harsh IMF restraints on nations’ budgetary expeditures. [author’s descripton]

This consultation was convened jointly by the Global Health Workforce Alliance, the World Health Organization and the Swedish International Development Agency to discuss issues relating to the current crisis in human resources for health. The objectives of the Consultation were: to provide information on the global and regional crisis in human resources for health and propose activities based on the main recommendations of the World Health Report 2006; to share experiences in human resources for health, including issues related to priority programmes such as HIV/AIDS in the countries represented; and to present the African Human Resources for Health Platform and discuss possible solutions to the alleviation of the crisis in the African region.

This presentation gives an outline of the current challenges and opportunities for HRH in the Sub-Saharan Africa AIDS crisis, some possible solutions, key messages and ways forward.

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The loss of human resources through migration of professional health staff to developed countries usually results in a loss of capacity of the health systems in developing countries to deliver health care equitably. Migration of health workers also undermines the ability of countries to meet global, regional and national commitments…

This study describes the work of the Choose to Care initiative of the Catholic Church in Southern Africa which began in 2000. It shows that effective scaling-up of programmes in the response to HIV does not necessarily have to be the expansion of a single central service. Working through the diocesan and parish system,…the Catholic Church scaled up service provision by the replication of smaller scale programmes rooted in and responsive to the needs expressed by local communities in this five-country area.

This resource paper uses a simple framework to provide an analytical review of human resources for health (HRH) strategic plans that have been generated over the last few years by countries in sub-Saharan Africa that are faced with an HRH crisis. The author collected and analyzed HRH strategic plans for the following countries: Eritrea, Kenya, Lesotho, Malawi, South Africa, Swaziland and Zambia. The paper explores some of the key dynamics and steps in the evolution of these plans, including the plan development process and content, implementation bottlenecks and the frequency with which the plans are reviewed or evaluated.

While the scale of the [health worker shortage] crisis is huge, solutions do exist. Many countries and communities around the world have begun to develop and implement innovative initiatives to sustain and build the health workforce. Several such examples are highlighted here. They address such issues as retention in rural areas, AIDS treatment for health workers, and the deployment of paraprofessionals to extend health care access deeper into communities. Many of these examples focus on rural areas, which typically have only a fraction of the number of health workers as urban areas due to more difficult living conditions, social and professional isolation, and weaker health infrastructure. [publisher’s description]

The HIPC/PRSP process is intended to be a major instrument for achieving improved service delivery for poor people Crucially, improved service delivery depends on having the right professional, technical and other human resources in the right place at the right time. This review examined for 6 African countries, the country based poverty reduction strategy paper (PRSP) documentation and the associated World Bank/IMF HIPC documentation for human resources for health content. These documents were supplemented with other relevant country documents such as health strategies.

As part of the African Growth and Opportunitues Forum, this paper addresses how African businesses are responding to the HIV/AIDS crisis. It is imperative that businesses take immediate action to lessen the economic and social consequences of HIV/AIDS. If they take action, businesses can ensure that economic initiatives, such as the African Growth and Opportunities Act (AGOA) will succeed in stimulating economic growth in Africa. While both the public and private sector should have HIV/AIDS policies and programs, this paper addresses only the private business sector response to the epidemic. However, many of the actions, best practices, and conclusions discussed in this paper are also applicable to public sector policies and programs.

This working paper is from the African regional consultative meeting on human resources for health (HRH) in Brazzavile, Congo. It describes the issues in health systems and HRH in the region and outlines the strategies and actions required for improvement. The document also discusses the Observatory of Health Human Resources for Africa, which was proposed as a cooperative network initiative among the countries and different partners of the region to produce the information and knowledge necessary for improving human resources policy decisions, and to share the country experiences in order to improve human resource development in the health services. [adapted from author]

Various constraints are being experienced in the health delivery systems, namely weak health infrastructure, limited tools, inadequate human resource capacity, limited public financing to the health sector as a whole (and not only to disease specific programs), poor management and planning and lack of integrated health systems and misapplication of human, technical and financial resources. In order to improve health in Africa, inequalities to health service access between and within countries should be addressed within the health system. [author’s description]

HIV/AIDS mainstreaming has traditionally been equated with adjusting programs to be more relevant to beneficiaries affected by HIV/AIDS. Bitter experience is demonstrating, however, that civil society organizations (CSOs) are not immune to the impacts of AIDS within their own organizations. Few local CSOs are responding adequately to this threat, partly because they simply do not know the extent of these costs. This paper suggests how CSOs in sub-Saharan Africa can build organizational resilience in order to survive the loss of valuable staff, time and money that HIV/AIDS will cause. It also concludes with practical recommendations for their donors in how they can move beyond being concerned bystanders. [publisher’s description]