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Epidemiological data indicate elevated psychosocial health risks for physicians, e. g., burnout, depression, marital disturbances, alcohol and substance abuse, and suicide. The purpose of this study was to identify psychosocial health resources and risk factors in profession-related behaviour and experience patterns of medical students and physicians that may serve as a basis for appropriate health promoting interventions. [from abstract]

Irrational drug use is contributed by many factors including care providers giving wrong drug information to patients. Dispensing staff in private pharmacy shops play a significant role in pharmaceutical management and provision of relevant information to clinicians and patients, enhancing the improvement of rational medicine use. This report offers an evaluation/staff assessment of pharmacist knowledge in a situation where they function as health workers in dispensing and prescribing medications. [adapted from introduction]

Increased interest in parasite-based malaria diagnosis has led to increased use of rapid diagnostic tests (RDTs), particularly in rural settings. The scarcity of health facilities and trained personnel in many sub-Saharan African countries means that limiting RDT use to such facilities would exclude a significant proportion of febrile cases. Use of RDTs by volunteer community health workers (CHWs) is one alternative, but most sub-Saharan African countries prohibit CHWs from handling blood, and little is known about CHW ability to use RDTs safely and effectively. [adapted from introduction]

This version of Voices discusses the Capacity Project’s work with the Ministry of Health in Southern Sudan to strengthen its ability to plan for and manage the health workforce. [adapted from author]

Research has identified that skilled nurses working in rural and remote locations are crucial for the provision of maternity care to rural parturient women. This study considered the experiences of rural nurses and their contributions to maternity care in rural and remote settings and in the small towns where women might be referred for care surrounding childbirth. [from introduction]

The main objective of this study was to assess the role of traditional birth attendants and the quality of their services in contributing to the reduction of maternal deaths in Malawi. [from abstract]

There has been little research on HIV incidence or prevalence among hospital staff worldwide, and even less on modes of transmission among those infected. Recent evidence from South Africa suggests that HIV prevalence among health care personnel may not differ greatly from the general population. This evaluation study describes the significant effect of HIV morbidity and mortality among the workers in Zambia’s health care system. [adapted from introduction]

JHPIEGO has been focused on improving the quality and availability of reproductive health and family planning services for slum residents, both by targeting the facility-based health care providers and the community members who access these services. This document outlines several lessons that have been learned from this experience. [adapted from author]

In developing countries, postabortion care (PAC) programs are frequently available only in urban or regional health facilities, placing rural women at greater risk for mortality and morbidity from complications because they lack access to services. This technical brief evaluates efforts to decentralize PAC activities in Senegal and Tanzania that show PAC can be safely and successfully decentralized with services capably provided by mid-level personnel in health centers, dispensaries, and some health posts when providers are trained and supervised and equipment and supplies are available.

This Voices discusses the experiences of nurse hired through the Emergency Hiring Plan in Kenya in providing family planning services, and the importance of confidentiality in the successful provision of these services.

These reports demonstratre that non-physician clinicians and nurses can take over many of the tasks in providing HIV care and treatment (including ART) in some resource-limited settings. [from author]

In the space of just a few years, close to 300,000 people with HIV have been put onto ART in Ethiopia and Malawi - two of the countries most severely affected by the human resources for health crisis. But while some might suggest that such a rapid scale-up could only have come at the expense of other general health services, Ethiopia and Malawi performed this remarkable feat using HIV/AIDS funding and technical support to launch ambitious and comprehensive human resource plans to strengthen their health sectors overall. [from author]

Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). [from abstract]

This article compares the quality, quantity and distribution of tuberculosis physicians, laboratory staff, community health workers and nurses in Nigeria and Kyrgyzstan, and highlights implications for (re)training tuberculosis workers in developing countries. [from abstract]

The objectives of this paper are to highlight the situation of health workers in Pacific and Asian countries to gain a better understanding of the contributing factors to health worker motivation, dissatisfaction and migration; examine the regional and global evidence on initiatives to retain a competent and motivated health workforce, especially in rural and remote areas; and suggest ways to address the shortages of health workers in Pacific and Asian countries by using incentives. [from abstract]

Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy. Because in the current system it takes one to two years to fill vacant positions, even when funding is available, an emergency approach was needed to fast-track the hiring and deployment process. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model that would mobilize 830 additional health workers.

The report aims to document the present health workforce in the country in order to find out their strengths and weaknesses and put forward recommendations for improvement. It lays special emphasis on the profile and density of healthcare providers, quality of services provided by selected groups of providers, training, and production and future challenges for healthcare providers. [adapted from author]

Prior to implementing male circumcision as a public health measure against the spread of HIV, the feasibility, safety and costs of the procedure within target countries should be evaluated to understand what measures need to be taken to ensure access to safe, affordable voluntary circumcision services. The aims of this study were to assess variation and safety of male circumcision practices, as well as resource and training needs related to the procedure, in a community that has been practicing circumcision traditionally for many generations. [from introduction]

Thousands of community workers are helping Ethiopia to deliver primary health-care services to people living in rural areas. However, critics say that the training these workers receive is not adequate for them to attend many of the health problems they encounter. [from introduction]

This article describes the achievements of 11 Sudanese-Canadian physicians who completed medical training and returned to Southern Sudan to practice. Few internationally educated physicians are prepared to return to a homeland as challenging as Southern Sudan; this goes against the globally entrenched flow of physicians migrating from developing to developed countries. [from introduction]

This report describes three health system developments introduced by the Rwandan government that are improving these barriers to care

Most children undergoing surgery in Kenya are anaesthetised by clinical officers or anaesthetists with minimal training in paediatric anaesthesia. This article details the statistics of how this personnel shortage impacts anaesthesia delivery. [from introduction]

This presentation discusses the current climate and prospects for health partnerships between the private and public sectors in Africa. [from presentation]

This presentation discusses the various aspects of private providers as they pertain to contracting for health services. [from presentation]

This book considers the topic of scaling up with a focus on ways to increase the impact of health service innovations that have been tested in pilot or experimental projects so as to benefit more people and to foster policy and program development on a lasting, sustainable basis.

Chapter 8 of this book describes an innovative educational approach to capacity building and scaling up reproductive health services in Latin America. It explains how the capacity to provide innovative training was scaled up in public sector reproductive health services in Brazil, Bolivia and Chile. [from introd

Rural nurses describe the nature of their practice as being embedded in working as a team where belonging is central to the success of the team and the individual nurse. As a result they form close professional and personal ties. The challenge for nursing students is to develop a sense of belonging to the rural hospital team so that preceptorship is successful. The objective of this article is to describe the cultural theme of a sense of belonging that nursing students develop during a rural hospital preceptorship. [adapted from abstract]

The researchers conclude that given the HRH crisis, ART delivery models requiring much less doctor time need to be developed. Overall, there is a need to shift tasks from medical doctors to nurses and from nurses to community health workers. In particular, the patients themselves need to play an important role in the delivery of ART. The outcomes of the various scenarios are predicted. [from author]

In South Africa, first-contact primary care is delivered by nurses in small clinics and larger community health centres (CHC). CHCs also employ doctors, who often work in isolation from the nurses, with poor differentiation of roles and little effective teamwork or communication. Worcester CHC, a typical public sector CHC in rural South Africa, decided to explore how to create more successful practice teams of doctors and nurses.

Community-based education (CBE) was developed thirty years ago in response to the maldistribution of physicians and subsequent inequity of health care services across geographical areas in developed and developing countries. Several medical schools in Nigeria report adopting CBE. This study seeks to identify and describe the CBE programs in accredited Nigerian medical schools and to report students’ assessments of the knowledge and skills gained during their community-based educational experience. [from abstract]

Evaluations of Community Health Worker programs consistently document improvements in health, yet few articles clearly describe the roles of Community Health Workers (CHWs) from the CHWs’ perspective. This article presents the CHWs’ points of view regarding the various roles they played in a community-based participatory research (CBPR) project, Poder es Salud/Power for Health in Portland, Oregon, including their roles as community organizers and co-researchers. [introduction]