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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]

Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. This study presents a unique exploration of how the factors affect the performance of primary reproductive health providers (nurse-midwives) in two regions of Armenia. [from abstract]

This paper presents a case study of an intervention (the lunch allowance scheme) instituted in Uganda to improve retention and motivation of health workers. The study traces the scheme’s evolution, assesses its impact on the brain drain of health professionals (medical doctors and nurses), and identifies difficulties encountered and lessons learned. [abstract]

Ghana is undergoing health sector reforms aimed at achieving greater equity of access to services, improved efficiencies in resource utilization, development of wider linkages with communities and other partners, as well as improved quality of health services. These reforms have strong influences on issues of human resources development, deployment and motivation. [from abstract]

Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients. Productivity is a significant indicator of professional development within any professional group, including nurses. The human resource element has been identified as the most important factor affecting productivity. This research aimed to explore nurses’ perceptions and experiences of productivity and human resource factors improving or impeding it. [from abstract]

The aim of the code of practice is to promote high standards of practice in the international recruitment and employment of healthcare professionals. [author’s description]

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]

As a key contribution toward increasing human capacity in national health systems, the Capacity Project is hosting a series of Human Resources for Health (HRH) Action Workshops. The initial workshop—held in Johannesburg in partnership with the United Nations Development Programme/Southern Africa Capacity Initiative (UNDP/SACI)—facilitated the exchange of knowledge and best practices in planning, developing and supporting the health workforce.

The three and one-half day workshop brought together 38 HRH leaders from 11 countries (Kenya, Lesotho, Malawi, Namibia, Rwanda, Sudan, South Africa, Swaziland, Tanzania, Uganda and Zambia).

This document is a combined Human Resources Development Plan and Human Resources Strategic Plan for the health and social welfare sector of Lesotho. The Development Plan is presented in Chapters 2 through 5, and the Strategic Plan is presented in Chapter 6. The essential difference between the two is that the HR Development Plan represents a technical assessment of the total labor supply and training requirements for the sector in the absence of any budget or production constraints. It reflects a technical assessment of what is needed and what should be produced and financed if we faced no constraints.

The difficulty of ensuring an adequate and appropriate distribution of health services, together with increasing financial pressures in the public sector, are forcing many countries to consider using more rigorous methods for determining staffing levels in the health facilities. The Workload Indicators of Staffing Need (WISN) method is one such method. It uses a form of activity analysis (activity standards), together with measures of utilisation and workload to determine staffing requirements. The method provides a vehicle for assessing localised staffing needs that is believable and which at the same time is sharply different to historic methods.

The National Human Resource Plan is a national guideline for all stakeholders. It outlines broad issues whilst taking the lead in some areas in order to facilitate the resolution of some of the chronic systemic challenges facing the health system. In implementing this plan, all stakeholders will be required to adapt to the guidelines expressed here. It is envisaged that there will be a measure of variation between the provinces, because each province must take into consideration the prevailing conditions and demands on its human resource capacity to plan objectively.

This report presents findings from a nationwide Expenditure Tracking and Service Delivery Survey implemented in Mozambique between August and October 2002. The study focuses on the primary health care system, which is frequently the only source of health care for most Mozambicans. The report covers a broad set of issues, including institutional context, budget management, cost recovery, allocation and distribution of drugs, human resources, infrastructure and equipment, and service outputs. [from abstract]

This study assessed the impact of management training in the performance of managers from agencies in Bangladesh delivering primary healthcare services. [from abstract]

This study indicates that healthcare professionals are using mostly clinical handover meetings, seminars and workshops for their continued professional development (CPD). There is need to improve access to relevant professional journals. The regulatory or licensing boards for healthcare professionals in Malawi should seriously consider mandatory CPD credits for re-certification. [author’s description]

This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options. [from abstract]

This is the fourth of a series of policy briefs produced by the Community Health Department of the Aga Khan Health Service in Kenya. It focuses on a number of issues related to the management of health facilities: the rational for decentralisation of health services, the role of the community in the management of health facilities, the membership of local management committees, selection criteria and, finally, the involvement of local politicians.

These briefs are primarily intended for directors and managers of community-based health care programmes — whether working within ministries of health, international donor agencies or non-government organisations.

These briefs are primarily intended for directors and managers of community- based health care programmes—whether working within ministries of health, international donor agencies or non-government organizations. This brief takes up a number of likely questions about the management functions of the nurses in charge of small, local health facilities:

• How prepared are “nurses in charge” for carrying out administrative and management functions?
• How should they relate to the new management committees?
• What additional training do they need?
• What are the lessons from the Kwale project—lessons about the training of nurses—that can be applied elsewhere?
  

This paper combines the literature on public health, on economics of health and on economics of technological innovation to discuss the peculiarities of labour in the health care sector. The health care system has a distinctive characteristic from other economic sectors: it is the intersection between social welfare and innovation systems. The relationship between technological innovation and cost in the health care sector is surveyed. Finally, the Brazilian case is discussed as an example of a developing country. The peculiarities of labour in the health care sector suggest the need to recognize the worth of sectoral labour and to cease to treat it separately.

The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa.

QAP implemented the first randomized control trial to measure the impact of accreditation in a developing country setting and reports its findings in this Operations Research Results report. The central issue to the report addresses the extent to which accreditation, known to favorably impact measurable indicators relating to the quality of care, actually improves patient outcomes. While exploring this issue, the report also sheds light on the importance of careful planning and communication in implementing complex research and would serve as a guide to others in undertaking similar efforts.

This paper aims to summarize strategies to solve inequitable distribution of human resources for health (HRH) between urban and rural areas, by using four decades of experience in Thailand as a case study for analysis. [from abstract]

Public-Private health sector Interactions (PPI) are on the increase in South Africa. However, there are few mechanisms for the two sectors to routinely engage with each other. Such mechanisms are necessary to allow all stakeholders to understand better the motivations of, and the challenges that face, each sector and are a key part of the process of building trust between the sectors. The overall purpose of PPIs, and therefore of engagement between the public and private sectors, is to strengthen the overall health system for the benefit of all South Africans. [author’s description]

The overall objective of this paper is to provide some insights into the effects of the HIV epidemic on human capital in sub-Saharan Africa through a discussion of some of the factors that are operating. It is not intended as a compendium of data on the problem but aims instead to provide an analytical framework for understanding the policy and programming issues. There is an analysis of the impact on the public services in Malawi, a detailed presentation of the impact on education and health and a discussion of issues relating to the measurement of the impact on different productive sectors and the role of different social partners in adjusting to, and managing, the impact.

Health services in the UK are benefiting from the collapse of health services in some of the poorest countries of the world due to the widespread and increasing migration of health professionals. Children in these countries are unable to obtain the most basic health services and many die as a consequence. Research summarised in this briefing reveals that current UK policy in this area is ineffective in tackling this inequality. Using Ghana as a case study, it sets out a range of practical suggestions for how the UK Government should respond. [From author]

This report is an attempt to systematically document and evaluate the state of the health workforce in Africa. It draws on academic published literature (which is limited), the WHO statistical database (which is incomplete and only sporadically updated), studies of bilateral donors, national documents, and newspaper articles. The report shows clearly that for more than a decade HR issues have received very little attention. [from foreword]

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]

In recent months, the debate over foreign workers in the UK has become more heated. While the government argues that more foreign workers will raise growth, protectionists insist that foreign workers are robbing British citizens of jobs. A different question is also asked: how can Africa develop if the brightest and best are leaving? The debate runs a serious risk of trivialising what is a complex set of issues. [from author]

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]

This article describes the validation of an instrument to measure work group climate in public health organizations in developing countries. The instrument, the Work Group Climate Assessment Tool, was applied in Brazil, Mozambique, and Guinea to assess the intermediate outcomes of a program to develop leadership for performance improvement. [from abstract]

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]