Americas & Caribbean

Beginning in 1992, JHPIEGO worked in close collaboration with the Bolivia Ministry of Health (MOH) to develop an integrated family planning/reproductive health (FP/RH) training network throughout the country. The focus of the assistance was the establishment of nine national training centers (NTCs) for inservice training conducted by physician-nurse teams and located at departmental maternity hospitals in departmental capitals. By 2000, the government of Bolivia and other stakeholders had shifted the training emphasis to preservice education efforts.

Many NGOs providing reproductive health (RH) services are facing reductions in donor funding, requiring them to generate more of their own resources. Prosalud, CIES and APSAR, Bolivian NGOs, wanted to build skills in costing and market research to support efforts to improve financial sustainability. Staffs attended a one-week workshop, followed by implementation of three operations research (OR) studies designed to reinforce skills and generate information for decisionmaking. The Prosalud and CIES studies included the calculation of unit cost per service; measurement of client willingness to pay (WTP) higher prices for services, and a market segmentation assessment in selected areas where Prosalud clinics are located.

This paper describes the experiences of three types of programs (government, reproductive health NGO, and women’s health NGO) in Kenya, India, and Guatemala that integrate gender in their work and examines how they integrate gender into programs that improve quality of care and access to care. It should be emphasized that this report does not document whether gender integration results in higher quality and access, but rather documents how gender integration can take place. [author’s description]

This document aims to facilitate the development of quality-oriented health sector reforms by providing a clear conceptual framework that can serve as a roadmap for policymakers and senior managers. By taking advantage of opportunities to integrate quality assurance activities into health sector reforms, healthcare leaders can maximize the effectiveness of reform and move toward optimizing health outcomes for the citizens of Latin America and the Caribbean. [author’s description]

Human resources become increasingly relevant in this context. Health human resource (HHR) is currently experiencing a three-fold problem, which encompasses old issues, together with the effects of reform, and the consequences of globalisation. This includes the workforce crisis in nursing which, facing all kinds of difficulties, requires complex in-depth analysis, synergies and alliances in order to ensure quality nursing services.

Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada? [author’s description]

This cross-sectional study was carried out in four states that were selected according to geopolitical and administrative criteria to identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers. The report discusses the effect of decentralization on health service providers and community involvement. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. [adapted from author]

The objective of this study was to describe the profile of community health workers - health promoters, traditional birth attendants and traditional healers - in rural Quechua communities from Ayacucho, Peru.

To explore the extent, characteristics, incentives, effects and possible regulation of private medical practice in public facilities this study undertook a cross sectional quantitative

Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization — the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization.

Both the advocates and the detractors of decentralization are probably wrong. A thoughtfully designed process of decentralization is not likely to radically improve a health system, nor is it likely to severely disrupt the system. We have evidence that a well-designed decentralization can improve equity of allocations and may have other positive effects such as increased funding of promotion and prevention. Its influence over efficiency and quality is not as clear. These guidelines suggest some mechanisms which can be effective in the design and implementation of decentralization.

This comparative study evaluates the implementation of decentralization of health systems in three Latin American countries: Chile, Bolivia, and Colombia. In terms of the relationship between decentralization and system performance in general, the findings support the conclusion that both the die-hard detractors and the fervent advocates for decentralization are wrong. Decentralization appears to be improving some indicators of equity, such as a tendency toward similar per capita expenditures for wealthier and poorer municipalities, and to be associated with increased and more equitable per capita spending on promotion and prevention.

The objective was to examine whether decentralization has improved health system performance in the State of Ceara, north-east Brazil. Decentralization was associated with improved performance, but only for 5 of our 22 performance indicators. Moreover, in the multiple regression, decentralization explained the variance in only one performance indicator; indicators for informal management and political culture appeared to be more important influences. However, some indicators for informal management were themselves associated with decentralization but not any of the political culture indicators.

The International Labour Office (ILO), the International Council of Nurses (ICN), the World Health Organization (WHO) and Public Services International (PSI) launched in 2000 a joint programme in order to develop sound policies and practical approaches for the prevention and elimination of violence in the health sector. When the programme was first established and information gaps were identified, it was decided to launch a number of country studies as well as cross-cutting theme studies and to conclude by drafting guidelines to address workplace violence in the health sector.

This paper addresses the problem of wastage of the qualified labor force, which takes place both during the education process and when trained personnel try to find jobs in the local market. Reducing wastage at both the educational and labor levels should improve the capacity of social investment, thereby increasing the capacity of the health system as a whole to provide services, particularly to those populations who are most in need. [from abstract]

This pilot study focused on self-identified factors of nursing students who expressed an interest in rural practice post-graduation. The sample included students from the USA and Canada, who were enrolled in graduate and undergraduate programs of nursing, and were attending an international rural nursing conference. [From abstract]

Functioning health services are key to making the community of New Orleans livable again. Conversely, a livable community is key to attracting a stable healthcare workforce to New Orleans. Hurricane Katrina forced the entire healthcare workforce to evacuate the City of New Orleans and a large majority of these workers have since found jobs elsewhere, such as in neighboring parishes and Texas. This brief summarizes policy options to create and maintain a healthcare workforce, as well as options to bridge the transition from the current situation to the point at which the interventions will show an effect.

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 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]

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]

Whilst the issue of international migration of health workers is sometimes presented as a one-way linear ‘brain drain,’ the dynamics of international mobility, migration and recruitment of health workers are complex.

This review examines the systemic and individual causes of multiple job holding (MJH) and evidence on its prevalence. MJH should be seen as resulting initially from underlying system-related causes. These include overly ambitious efforts by governments to develop and staff extensive delivery systems with insufficient resources. Governments have tried to use a combination of low wages, incentives, exhortations to public service, and regulation to develop these systems.

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.

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 departure of a large proportion of the most competent and innovative individuals from developing nations slows the achievement of the critical mass needed to generate the enabling context in which knowledge creation occurs. To favourably modify the movement and distribution of global talent, developing countries must implement bold and creative strategies that are backed by national policies.

This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States.

This document summarizes the human resources management situation in the region, its determinants, and the projects for its development. To promote improvements in the human resources management function as part of the sectoral changes under way at the national and regional level, the Pan American Health Organization is proposing a series of strategies, actions, and operational tools through the Observatory of Human Resources in Health Sector Reform initiative. [adapted from author]

This report was commissioned by OECD to examine the evidence on role change and delegation from physicians to advanced practice nurses (APN), nurse practitioners and nurses in other advanced roles in the hospital setting and primary care. The report has three components: a literature review, an assessment of country responses to an OECD questionnaire, and two more detailed country case studies, on England and the US. [author’s description]