Sub-Saharan Africa

The critical shortage of qualified health professionals, especially in the developing world, leaves patients without access to care for even the most basic health issues. In this video, created by the Health Rights Advocacy Forum (HERAF) and PHR, health workers at Mbagathi District Hospital in Kenya talk about how they rise to the challenges they face every day. [from author]

This study contends that increasing coverage of skilled delivery care and achieving the full implementation of Tanzania’s Focused Antenatal Care Package in Ngorongoro depends upon improved training and monitoring of health care providers, and greater family participation in antenatal care visits. [adapted from abstract]

This article describes a health management delivery program in which north and south institutions collaborated to integrate classroom and field-based training in health management and to transfer the capacity for sustaining management development in Liberia. [adapted from abstract]

Gaps in the midwifery tutors’ knowledge on comprehensive abortion care (CAC) have resulted in most midwives in Ghana not knowing the legal indications under which safe abortion care can be provided, and lacking the skills and competencies for CAC services. The aim of this study is to assess the capacity and willingness of midwifery tutors to teach contraception, post abortion care and legal termination in Ghana. [from abstract]

This paper reports on a research study to investigate the introduction of new information management strategies intended to promote an informational approach to management at the operational health service level in low-income countries. It aims to understand the process taking place when externally developed training materials, which are intended to strengthen health management information systems, are introduced to potential users in an east African country. [from author]

Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. [from abstract]

The focus of this study is to assess the level of migration expectation among health care professionals and to determine some of the factors which have pushed - and are likely to continue to push - them to seek employment outside Ghana. [from introduction]

This article evaluates a training initiative that has been established to help address the problem of skills shortage in pharmaceutical management in East Africa. [adapted from abstract]

The need for documenting how the AIDS epidemic is affecting the health care personnel has long been recognized. In the specific case of Tanzania which already has a Health Sector HIV/AIDS Strategy it is imperative to have information on how the health system and the health personnel who are expected to spearhead the implementation of that strategy are being affected. This can guide preventive and remedial measures to ensure that the capacity of the system and its personnel for the effective implementation of the Strategy is not unduly compromised. [from author]

This paper reviews available research evidence that links medical students’ characteristics with human resource imbalances and the contribution of medical schools in perpetuating an inequitable distribution of the health workforce. [from abstract]

While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. [from abstract]

This study evaluated two models of routine HIV testing of hospitalized children in a high HIV-prevalence resource-constrained African setting. Both models incorporated task shifting, or the allocation of tasks to the least-costly, capable health worker. [from abstract]

In 2008, Malawi piloted the distribution of depo-medroxy progesterone acetate (DMPA), an injectable contraceptive, to the community by Health Surveillance Assistants. This report presents lessons learned during the initial implementation, from gaining stakeholder buy-in to curriculum development, and the initial three months after the training and implementation roll-out. [from abstract]

This study focused on a trained health workforce in Northern Uganda. The retention of specifically-trained staff 12-15 months after attending training was examined, as was the relevance and usefulness of the training as perceived by the health workers. [from abstract]

This article posits that out-migration of health workers is not a critical contributor to health workforce shortages in Nigeria’s rural and remote areas and that more important factors include: contraction of government health spending as a percentage of GDP despite deteriorating health conditions, public health management systems that operate by default rather than by design, spartan living conditions outside urban areas, inadequate training of appropriate cadres of health staff, limited facilities and medications for effective delivery of clinical services, and burnout of overworked and unde

This study assessed the knowledge of maternity unit operatives at the primary and secondary levels of care about the concept of emergency obstetric care and investigated the contents of antenatal care counseling services they delivered to clients. It also described the operatives’ preferred strategies and practices for promoting safe motherhood and averting maternal mortality in south-west Nigeria. [from abstract]

In this study, we aimed to determine the cost and cost-effectiveness of involving health extension workers in tuberculosis treatment in Southern Ethiopia. This paper presents an ancillary cost-effectiveness analysis of data from a randomized control trial. [adapted from introduction]

This study presents evaluation findings of two different programs targeting private medicine retailers for malaria control in Kenya. Key components of this evaluation were measurement of program performance, including coverage, knowledge, practices, and utilization based on spatial analysis. [from abstract]

This study evaluated whether the provider-initiated HIV testing and counseling approach increased HIV testing amongst patients with a new episode of sexually transmitted infection, as compared to standard voluntary counseling and testing at the primary care level in South Africa, a high prevalence and low resource setting. [from abstract]

This successful program highlights how improving HIV care strengthened the primary health care system and validates several critical areas for task shifting that are being considered by other countries in the region, including nurse-driven ART for adults and children, and lay counsellor supported testing and counselling, adherence and case management. [from abstract]

This article uses the realist evaluation method to determine the effect of human resource management on hospital performance using a regional facility in Ghana.

This report documents the efficiency of the Learning for Performance approach in the implementation of new pre-service reproductive health/family planning and child health training modules aimed at local health technicians working in Northern Mali. [adapted from introduction]

The Capacity Project used the Learning for Performance (LFP) approach to develop the family planning (FP), HIV/AIDS and gender components included in the competency-based A1 nursing and midwifery pre-service curricula. LFP was also used to adapt the Rwanda national FP curriculum to an on-the-job training approach. This study documents the implementation of the and the lessons learned from its application in preservice education and in-service training in Rwanda. [from summary]

In direct response to the country’s human resources for health needs, the Capacity Project helped to develop the capacity of the district hospital clinical workforce to expand access to a full range of quality family planning methods through a pilot vasectomy in-service training program for physicians and nurses at two district hospitals. [adapted from introduction]

This evaluation presents the results of a Kenyan emergency hiring plan (EHP) to quickly hire, train and deploy workers to high-need areas. The report presents the tracked hiring, training and deployment of all new hires compared to identified gaps. It also contains facility statistics and new hire and coworker feedback in a sample of ten facilities at baseline and every six months for period of three years. [adapted from summary]

The Capacity Project worked to strengthen HRIS in several low-resource countries to assist decision-makers and human resources managers in identifying and responding to critical gaps in HRH. The findings and recommendations in this report cover the Capacity Project’s implementation of HRIS in Swaziland, Rwanda and Uganda. [from summary]

In September 2005, a pilot program of nurse-centered antiretroviral treatment (ART) prescription was launched in three rural primary health centers in Rwanda. We retrospectively evaluated the feasibility and effectiveness of this task-shifting model using descriptive data. [from abstract]

In Mozambique, a country with a high HIV burden and a staggering workforce deficit, the Ministry of Health looked to past experience in workforce expansion to rapidly build ART delivery capacity, including reliance on existing nonphysician clinicians (NPC) to prescribe ART and dramatically increasing the output of NPC training. [from abstract]

The objectives of this study include documenting the role of the private for-profit sector in voluntary counseling and testing (VCT) service delivery; establishing whether there are significant differences in the quality of VCT services, particularly in counseling and referral practices, between public, private for-profit, NGO, and mission providers; measuring key VCT service statistics at facilities within each sector; and identify best practices from each sector. [adapted from introduction]

HIV scale-up has triggered innovations in nurse training, task shifting, retention, and scope of practice that need not remain HIV specific. Lessons learned in the context of HIV have the potential to enhance nursing practice and human resources for health more generally, strengthening South Africa’s health systems and improving access to effective health services. [from abstract]