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This case study describes how five Integrated Management of Childhood Illness (IMCI) trainers and supervisors conducted an assessment of provider knowledge and skill to carry out IMCI at 38 facilities in two districts in Kenya. [author’s description]

This presentation was part of a USAID Mini-University session in October 2007. It gives an outline of healthcare worker issues and shortages, including worker density by region, and a breakdown of the reasons for the HRH crisis in Africa. The presentation also presents solutions to address the problem.


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This report was developed to outline broad strategy, create a common vision for developing a new core health information system, and describe specific technical development tasks in detail. The new information system must be designed from the top down based on information demand. This should focus development on clear data collection and processing priorities, eliminate collection of unused data, and produce an efficient and relevant system.

This report presents results from the Egypt Health Care Providers Surveys, the objectives of which were to: provide a comprehensive picture of all sources of health care services; provide policy relevant data on critical issues for health sector reform; and create a database on health care providers for use by the Ministry of Health and Population in developing policy reform proposals. Five separate surveys were conducted on health care institutions, private clinics, pharmacies, dayas (traditional birth attendants), and other practitioners. The sample of 10,048 providers was developed from a complete enumeration of all health care providers in sampling areas and data from the 1986 national census.

In Egypt there is increasingly strong political support for health sector reform including a widespread recognition that a working information system is necessary to undertake and monitor this reform. This paper assesses the role of USAID technical support to help build health management information systems in Egypt.

The objectives of the study were to identify exemplary medical and nurse practitioners in primary health care, to document their practices and perceptions with regard to their community involvement, to analyse the common themes arising from the findings, and to present recommendations based on the findings. The lack of a clearly defined role in the community outside of the clinical role that deals with the individual patient who presents for care is discussed in relation to the policy of the primary health care approach. The concept of community-oriented primary care provides a framework for a more systematic approach to community engagement, and this study serves as a basis for further research into the subject.

This paper discusses how Mozambique coped with the health system needs in terms of specialized doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. The Ministry of Health (MOH) managed to make up for its severe scarcity of specialist MDs especially through contracting expatriate technical assistance.

This handbook is intended to help bridge the gap between the theoretical constructs behind mentoring (and associated cultural change in health-care settings) and real practitioner experience. Although mentoring has taken hold in a variety of professional settings, we focus specifically upon mentoring for service-delivery change within clinical health-care settings. Our audience is likely to be a practitioner who sees the need for a new process, protocol or procedure.

This study was implemented as part of the EQUINET theme work on Human Resources for Health coordinated by Health systems Trust. The study set out to explore and describe the influence of conditions of service on the movement and retention of the health professionals in Namibia. It is a qualitative study targeting mainly professional nurses, doctors, social workers and health inspectors at both operational and managerial levels, in public and private sectors. [from executive summary]

Since 1994, Brazil has developed a primary care system based on multidisciplinary teams which include not only a physician and a nurse, but also 4-6 lay community health workers. Yet relatively few investigations have examined its effectiveness, especially in contrast with that of the traditional multi-specialty physician team approach it is replacing, or that of other existing family medicine approaches placing less emphasis on lay community health workers. The main objective of the study is to evaluate the quality of care offered to adults through different models of care currently present.

This article provides an historical overview of the three major ways that nursing regulates the profession, its members, and their performance, i.e., licensure, certification, and accreditation. Each type of regulation mechanism is described and differences between them are explained. Current issues related to accreditation of schools of nursing are outlined. [abstract]

The aims of this study are: to examine to what extent critical care and advanced practice nurses’participation in an online listserv constituted a community of practice, and to explore how the nurses use electronic media to communicate with one another. Findings suggest that the online listserv environment, as a whole, did function as an online community of practice, where participation not only served as an avenue for knowledge sharing situated in the actual context of the nurses’ everyday work experience, but also helped to reinforce identity of the nursing practice itself. [from abstrac

Universal Basic Precautions (UBP) are not well understood nor implemented by health professionals, though crucial in HIV/AIDS prevention. UBP refers to the prevention of transmission of blood borne pathogens like HIV through strict respect by health workers of rules concerning care and nursing. The objectives of this study were to find out knowledge and attitudes of medical personnel doctors in the Department of Surgery of the Korle Bu Teaching Hospital to HIV transmission and to find out their current practices of UBP in surgery.

The integration of HIV-prevention activities into care has received little attention within or outside formal healthcare settings. The contribution of community home-based care services in facilitating disclosure of HIV status and reducing stigma have also not been described. This study examines the community impact of an integrated community home-based care (ICHC) programme on HIV-prevention efforts and disclosure of status. Quantitative data was collected from 363 people living with HIV (PLHIV) and 1 028 members of their micro-communities. [from abstract]

This study investigates the experiences of informal caregivers of people living with HIV in two semi-rural communities in South Africa. It is argued that a thorough understanding of how home-based care undermines the physical health and psychological wellbeing of already vulnerable women is crucial for informing policies on home-based care. Thus, there is a need to incorporate gender perspectives when planning and implementing home-based care programs. [from abstract]

The purpose of this study is to estimate the cost implications of implementing the newly proposed Integrated Management of Childhood Illnesses algorithm in first-level health care facilities in rural areas of Bangladesh. Bangladesh policymakers need to know the cost of IMCI prior to its implementation so that they allocate adequate resources, particularly personnel and drugs, and the associated financial resources to health facilities. [from author]

In 1993, Uganda began decentralization of its health care sector to the district and subdistrict levels. Its objectives were to increase local revenue for health service provision, in part through user fees; involve the consumers in the management of their health care services; and integrate all providers, including non-governmental organizations, missions, and non-traditional providers, into the care delivery system. The increased revenues and consumer participation was expected to improve quality and increase utilization of services. With a focus on maternal and child health (MCH) services, this study used statistical data and interviews with local health administrators and physicians to assess how the reform policies have been implemented and how they have impacted MCH service provision and utilization.

The purpose of this technical effort by the Partnerships for Health Reform was to assess various issues, problems, and opportunities facing the University Teaching Hospital (UTH) in Zambia. This review serves to catalyze and provide input for the development of an effective strategic plan for the UTH and Zambia’s health services in general. Findings from this review provide a basis for recommendations on how to effectively address these issues in order to improve management and, ultimately, positively affect efficiency, quality, equity, and sustainability of services. [from abstract]

The Assessment Approach is designed to provide a rapid yet comprehensive assessment of key health systems functions and related resources. The approach is organized around technical modules which guide data collection, and cover the following areas: stewardship, health financing, service delivery, human resources, pharmaceuticals, and ealth information systems. [publisher’s description]

Dissatisfied with centralized approaches to delivering local public services, a large number of countries are decentralizing responsibility for these services to lower- level, locally elected governments. The results have been mixed. This chapter provides a framework for evaluating the benefits and costs, in terms of service delivery, of different approaches to decentralization, based on relationships of accountability between different actors in the delivery chain. Moving from a model of central provision to that of decentralization to local governments introduces a new relationship of accountability—between national and local policymakers—while altering existing relationships, such as that between citizens and elected politicians.

Provider payment methods are important to consider any time a government or a payor wants to improve the efficiency and the quality of health services with the use of its funds. Changes in provider payment methods are often pivotal to broader health reform measures to contain costs and use existing resources effectively, and also to improve quality of care and equitable financial access to care. [author’s description]

Incentives that affect worker performance may be modified by system change. Attention to both financial and non-financial incentives can make health care delivery more effective. [author’s description]

Nigeria has one of the largest stocks of human resources for health (HRH) in Africa. However, great disparities in health status and access to health care exist among the six geo-political zones, and between rural and urban areas. This assessment measures the size, skills mix, distribution, and growth rate of HRH in the public health sector in Nigeria. The assessment also quantifies the increase in HRH requirements in the public health sector necessary for reaching key PEPFAR targets and the health Millennium Development Goals. The findings are based on a survey conducted in April-May 2006 in 290 public health facilities representing all levels of care (primary, secondary, and tertiary).

People caught in crisis situations have crucial reproductive health needs. The needs of pregnant women are most urgent. Complications of labor and delivery can be life-threatening when women lack adequate care. Risk for HIV/AIDS, other STIs, and unwanted pregnancy increases, particularly when disorder provides cover for rape and other sexual coercion. Health care providers understand people’s needs and have experience meeting them, but few have worked in humanitarian relief.

Contraceptive provision in many settings continues to be based on outdated medical information, unproven theoretical concerns, and provider biases. Studies have found that in some developing countries 25-50% of women seeking contraceptives are refused services until they are menstruating. Coupled with effective training, checklists can be important tools for health care workers at various levels to apply the latest WHO medical eligibility criteria and guidelines for contraceptive use.

Networks of private providers can be highly effective in reaching women with Family Planning/Reproductive Health (FP/RH) services Advantages: service delivery points are already in place, often financially sustainable, and have excess capacity. Private midwives provide 46% of all contraceptive use in Indonesia. A “linking organization” is key to link providers, identify incentives, develop a plan to meet service objectives and broker training, supplies, quality, and outreach to customers. [author’s description]

Private health care plays a central role in health-care provision in many developing countries hat have a high burden of TB. It is therefore encouraging that public-private partnerships (PPM) are being set up in various countries around the world to explore possible interaction between the national TB programs and other partners in the fight against TB. The objective of this review was to use the published literature to asses the range of providers included in PPMs for their ability to provide case-detection services for the vulnerable. [abstract]

Over the past four decades there has been a trend for pharmacy practice to move away from its original focus on medicine supply towards a more inclusive focus on patient care. The role of the pharmacist has evolved from that of a compounder and supplier of pharmaceutical products towards that of a provider of services and information and ultimately that of a provider of patient care. This introductory handbook sets out a new paradigm for pharmacy practice.

Women health workers have been vital in improving the health of women and children in Pakistan. Inspired by its neighbor’s experience, Afghanistan is embarking on a similar program to encourage women to work in the health sector. [author’s description]

The goal of this project was to assist health system managers and policy makers develop policies and strategies to recruit and retain human resources in the homecare sector and have a satisfied, healthy workforce. Researchers worked in partnership with the agencies and the unions representing workers in the agencies to examine the effects of work and work environments on homecare workers’ emotional, mental, and physical health and intention to leave their workplaces. [executive summary]