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To tackle problems of staff shortage and maldistribution, in 2003 the Government of the Republic of Zambia in partnership with the Royal Netherlands Government embarked on a Pilot Zambian Health Workers Retention Scheme (ZHWRS) for health professionals. The scheme had as first objective to replace the Dutch doctors, working under the bilateral agreement between Zambia and the Netherlands. A regular review process was included as part of the scheme. This report is from the Midterm review that took place in January 2005. [from introduction]

In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity.

Because the demand for health services outstrips the available resources, priority setting is one of the most difficult issues faced by health policy makers, particularly those in developing countries. The objective of this paper is to describe priority setting in a teaching hospital in Uganda and evaluate the description against an ethical framework for fair priority setting processes. [from abstract]

The aim of this interventional study was to assess, document and improve the Patient-held Record System in the Emtshezi Subdistrict. The study began in 1998 and was conducted using a Quality Assurance Cycle, which focuses on systems and processes and encourages a team approach to problem solving and quality improvement. [from abstract]

In South Africa, the distribution of doctors is skewed in favour of the urban areas, but it is not uncommon to find many peri-urban facilities in short supply of doctors. In 1997, the South African government introduced compulsory community service (CS) to address this uneven distribution of doctors in the country. The CS doctors posted to the Letaba-Sekororo hospital complex in Limpopo Province refused to take up their appointments for various reasons, ranging from lack of supervision to poor basic infrastructure. This study is one of the earliest conducted to understand the perceptions of hospital managers on the impact of the national community service on the health service. [publisher’s description]

There is growing interest in the migration of doctors from Africa to developed nations. Little attention has been made in understanding the flow of doctors into African countries. The objective of this article is to describe the nationality, country of primary qualification as a doctor and specialties of doctors registered in Malawi in 2003. [from abstract]

This strategy paper takes stock of “best practice” experiences in supporting communities in their response to HIV/AIDS in several countries in Africa. It draws lessons from Burkina Faso, Côte d’Ivoire, Guinea, Malawi, Nigeria, and Tanzania and sheds light on methods that a growing number of organizations and individuals use to foster behavior change among people living in rural areas. The success stories presented in this paper prove that it is both possible and promising to implement HIV/AIDS programs that include several components and multiple sectors at the community level. [from forwa

This study examines the relationship between medical practice and type of clinic ownership in HeBei province in the People’s Republic of China. The objective was to find out whether the kind of clinic ownership affects health care delivery patterns and access to health care. The study was carried out between 1995 and 2000 by a team of researchers from China, Israel and the Netherlands. [from preface]

NORAD commissioned this study in order to learn how the human resource challenge currently is being addressed in Tanzania. A second aim of the study was to identify knowledge gaps for the development of evidence-based human resource strategies in Tanzania. [from introduction]

This presentation discusses the AMRN role of strengthening nurses and midwives in their responses to HIV/AIDS by improving their knowledge and skills in evidence based practice, research, counseling, advocacy and education. Included is information about the magnitude of the HIV/AIDS problem and some strategies that AMRN has used to address the problem through nurses and midwives.

This report presents findings from Phase 3 of an assessment of the human resources implications of HIV/AIDS services scale-up in Rwanda. It focuses on the staffing implications and associated costs of HIV/AIDS services scale-up. By documenting current staffing levels and the level of effort necessary to provide HIV/AIDS services, Phase 3 of the study analyzes how many full-time equivalent (FTE) staff will be needed, and at what costs, if the Government of Rwanda is to meet its HIV/AIDS service delivery objectives. The human resources projections are based on data gathered during Phases 1 and 2 of the study.

This Kenya assessment is part of a multicountry initiative to provide data and options to policymakers and donors amidst for building the capacity of health care systems in low resource countries through recruitment, training, and deployment of public and private health workers. The assessments look at how human resource (HR) policy and workload planning can address personnel shortages, specifically, gross imbalances across urban and rural areas and among personnel categories, including doctors, nurses, pharmacists, and lab technicians. [adapted from author]

The Health Management Information System (HMIS) in Kwale District, Coast Province is Kenya’s first computerised district-level HMIS. A joint effort of the Ministry of Health and the Community Health Department of the Aga Khan Health Service, Kenya, the system uses simple, user-friendly software developed by Data Dynamics Limited to collect and analyse data from local health facilities.

AIDS-related stigma and discrimination is a pervasive problem worldwide. People living with HIV/AIDS (PLHA) in India, as elsewhere, face stigma and discrimination in a variety of contexts, including the household, community, workplace, and health care setting. Research in India has shown that stigma and discrimination against HIV-positive people and those perceived to be infected are common in hospitals and act as barriers to seeking and receiving critical treatment and care services (UNAIDS 2001). Recognizing the need to move beyond documentation of the problem, three New Delhi hospitals; SHARAN, an Indian NGO; and the Horizons Program, with support from the National AIDS Control Organisation (NACO), carried out an operations research project to develop and test responses to hospital-based stigma and discrimination against people living with HIV/AIDS.

The handbook is a resource collection of information sheets and participatory activities for NGOs working on HIV/AIDS who want to work towards a greater involvement of people living with HIV (GIPA) in their work. It aims at sensitising NGOs, building individual skills and organisational capacities so that NGO management, staff and volunteers can discuss and plan together in a participatory way how to meaningfully involve people living with HIV in their organisation. [from introduction]

This issue of the HST Update contains articles on: overview of nursing in South Africa, transforming nursing education towards primary health care, problems in nursing today, nursing summit charters a way forward, placement of nurses, nurse training in Mount Frere health district, and the quest for rational drug use.

In order to identify potentially effective models of home-based care (HBC) within which paediatric palliative care could be integrated, and to identify critical aspects requiring strengthening, the NMCF commissioned an in-depth evaluation of three NGOs that have been supported through the Goelama Program. The objectives of the evaluation were: to evaluate the current capacity of the three HBC projects to provide paediatric palliative care as a component of overall HBC - this focused on the overall management of the projects, as well as the competencies of carers to provide both general HBC and palliative care to children; To explore the possibilities for strengthening the provision of paediatric palliative care as an integrated component of HBC; and to explore the role of home-based carers and HBC projects in the provision of ART to children. [author’s description]

The primary objective of the study was to identify organisations/institutions that provide HIV and AIDS services at the sub-district level, the range of services they provide and their funding sources. This in turn will inform sub-district and district management teams of the progress and impact of services provided and furnish them with tools to monitor the performance and activities on NGOs in their sub-districts and districts. It is hoped that the report will serve as a baseline for ongoing monitoring of the country’s response to the epidemic. Data was collected through self-administered questionnaires, staff interviews and record reviews.

This presentation was part of the Planning, Developing and Supporting the Health Workforce: Human Resources for Health Action Workshop. It briefly discusses the background and some issues for consideration about Malawi’s plan to retain and recruit health workers.


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This presentation was part of the Planning, Developing and Supporting the Health Workforce: Human Resources for Health Action Workshop. It gives an overview of the Southern Africa Capacity Initiative (SACI) Framework, provides examples of SACI applications and discusses the Africa HRH agenda.


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This presentation was part of the Planning, Developing and Supporting the Health Workforce: Human Resources for Health Action Workshop. It discusses the review of 11 country HR assessments including: Malawi, Lesotho, Ethiopia, Zambia, Botswana, Swaziland, Mozambique, The Gambia, Ghana and Tanzania. It identifies the challenges faced, the implementation, technical inputs, and the process expertise.

This presentation is from a Capacity Project sponsored interactive workshop to consider fresh perspectives on supportive supervision, exploring alternative approaches to the standard visiting-supervisor model from within and outside the international health care sector.

Maldistribution of human resources for health is a worldwide phenomenon and may appear in different dimensions. The first and greatest concern is the inequitable distribution, particularly of high level professionals like doctors, both among countries in the world and within each country. [author’s description]

The Government of Ghana has adopted the WHO focused antenatal care (ANC) package in a move to improve access, quality and continuity of ANC services to pregnant women. As part of these efforts, the Government has exempted fees for ANC clients. The main objective of this study, undertaken by Noguchi Memorial Institute for Medical Research in collaboration with the Ghana Health Service (GHS), FRONTIERS, and with USAID funding, was to examine the extent to which adaptation of the package influenced quality of care received by pregnant women and its acceptability to both providers and clients. The study used a policy analysis and a situation analysis in ten intervention clinics in which the package had been introduced and four comparison clinics.

To promote the health and survival of mothers and babies, Kenya has adapted the WHO goal-oriented Antenatal Care (ANC) package, popularly known as focused ANC (FANC). The Ministry of Health (MOH) has designed new guidelines for ANC services, placing emphasis on refocusing antenatal care, birth planning and emergency preparedness, and the identification, prevention and management of life threatening complications during pregnancy and childbirth. ANC visits are now used as an entry point for a range of other services, thus promoting comprehensive integrated service delivery. A major challenge, however, is whether the Kenyan health care system can cope with the implementation of this package.

This report is the result of the meeting of the 47th Directing Council and 58th session of the Regional Committee in Washington DC. It is a summary of actions and proposals for a plan of action on human resources for health in the Americas submitted for the consideration of the Directing Council. This document summarizes the activities carried out to date in the countries and in the Governing Bodies. It provides an overview of the situation and the predominant trends in the Region, as well as a vision of the technical proposals and agreements for activities that are being developed.

Few countries in Latin America have experienced in such a short period the shift from a socialist government and centrally planned economy to a liberal market economy as Nicaragua. The impact of such a change in the health field has been supported by the quest for reform of the health system and the involvement of external financial agencies aimed at leading the process. However, this change has not been reflected in the planning of human resources for health.

The objective of this article is to explore the type of private practice supplementary income-generating activities of public sector doctors in the Portuguese-speaking African countries, and also to discover the motivations and the reasons why doctors have not made a complete move out of public services. [objective]

The Quality Assurance Project investigated how job aids could increase compliance with guidelines for the Integrated Management of Childhood Illness (IMCI) in cooperation with the Zambia Central Board of Health beginning in 1999. One of the first countries to introduce IMCI, Zambia had a large number of IMCI-trained providers, and several IMCI job aids were already in use: a chartbook, recording form, poster, and mother card.

The involvement of district-level workers in local-level practical approaches to mainstreaming gender is central to facilitating change and informing health strategies. There are very few practical examples of mainstreaming gender in health, especially at the lower levels of the health sector. One approach is to build the capacity of staff to conduct and respond to gender analysis. [author’s description]