Sub-Saharan Africa

This issue of Voices describes the Capacity Project’s work on the health management information system (HMIS) in Uganda including an assessment of the HMIS performance and support in setting standards for using it effectively.

The availability and distribution of an appropriate eye care workforce are fundamental to reaching the goals of “VISION 2020: The right to sight”, the global initiative for the elimination of avoidable blindness. The objectives of the study were to determine the availability and distribution of human resources for eye care delivery in Enugu Urban, south-eastern Nigeria. [from abstract]

An interview with health development expert Dr. Peter Ngatia about 'brain drain' and its impact on health in Africa. [from introduction]

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A joint pilot program was launched at the primary health care level in Lesotho through which nurses were trained and empowered to assume high levels of clinical responsibility for HIV care, including ART. This nurse-driven, community-supported model of care has proven to be successful in delivering quality HIV/AIDS and TB services integrated into existing primary health care structures for a population living in remote, rural areas. [from summary]

This report is the result of a rapid assessment conducted to better understand the current and potential market for family planning products and services in the private health sector in Senegal, as well as to provide recommendations to strengthen the private health sector. [adapted from executive summary]

This report describes field experiences with task shifting in Lusaka, Zambia, where a large public-sector ART program has enrolled over 71,000 HIV-infected adults and children across 19 program sites. It advocates a comprehensive, three-pronged approach to task-shifting that comprises training, on-site clinical mentoring, and continuous quality assurance. A structured approach is important so that clinical care is not compromised when clinical duties are initially shifted to less specialized health professionals. [from introduction]

The health sector has prepared this 5 year strategy in for developing a 5 year strategic plan for all sectors in Sudan. The purpose of this policy document is to provide a framework for the health system reform and sustainable development. It stipulates as well the most important health priorities to be addressed during the coming five years (2007-2011). [from introduction]

This document profiles the Sudan Health System, detailing the resources it employs the and the challenges it faces.

This strategy was prepared in response to the national government initiative of developing a 25-year strategic plan for all sectors in Sudan. The purpose of this policy document is to give a framework for health systems and services development from 2003-2027. It provides a road map for identifying key priority areas and defining the context within which the health system will perform. The strategy will provide a guide for policy makers and service providers to achieve the future vision. [from introduction]

This strategic work plan for HRH in Sudan is introduced with the aim of guiding the efforts and further work in developing human resource plans at different levels of the health system in a comprehensive approach that considers all dimensions of HRH. The plan also defines the issues and priorities and suggests strategic actions to revive and improve HR policies, planning, production and management systems. [from executive summary]

This commentary article is focused on encouraging debate and discussion as to how health care professionals in the developed world might wish to re-think the relationship with colleagues in other health care environments and consider how to work together on a theme of two-way shared learning rather than one-way aid. [adapted from abstract]

The human resources crisis in Africa is especially acute in the public health field. This paper describes the innovative aspects of the distance education program at the School of Public Health of the University of the Western Cape, South Africa. Strategies are proposed for scaling up such a program to meet the growing need in this essential area of health human resource capacity development in Africa. [adapted from abstract]

Ethiopia does not have a sufficient health care workforce to meet the population’s demand for services and the burden of disease. The objective of this project was to assess the usefulness and feasibility of collecting key participant and training information for monitoring and planning of HIV/AIDS services. This paper describes a project that uses training data to follow up with providers after training to assess whether they are still working in HIV/AIDS-related services. [adapted from introduction]

Health care workers in developing countries continue to lack access to basic, practical information to enable them to deliver safe, effective care. This paper provides the first phase of a broader literature review of the information and learning needs of health care providers in developing countries. [from abstract]

This article provides an overview of how new research in India and Nigeria offers innovative strategies to improve health care provider performance.

This policy brief explores the major challenges facing Kenya in the implementation of their Integrated Management of Childhood Illness strategy and looks at why it is failing to fulfill its potential to improve health care and reduce child mortality. [adapted from introduction]

The health worker shortage in sub-Saharan Africa derives from many causes, yet the dynamics of entry into and exit from the health workforce in many of these countries remain poorly understood. This limits the capacity of national governments and their international development partners to design and implement appropriate intervention programmes. This paper provides some of this information through the first systematic estimates of health worker inflow and outflow in selected sub-Saharan African countries. [adapted from introduction]

This study involves the development and evaluation of training materials for provider-initiated HIV counseling and testing, HIV prevention and integrated primary HIV care and support for use by health care workers involved in the care of patients with TB at the primary health care clinic level in the Democratic Republic of Congo. [adapted from abstract]

This study aims to undertake a national assessment of existing district management structures, competencies and current training programmes in order to inform a national strategy and plan to strengthen district management capacity to ensure effective delivery of primary health care in South Africa. [from introduction]

Tanzania is implementing the Integrated Management of Childhood Illness (IMCI), developed by the WHO and UNICEF to improve the management of child health at the primary care level in order to reduce child mortality in low and middle income countries. Workers in health facilities are trained in a structured IMCI case management course. IMCI also advocates the strengthening of the health system to facilitate practice of the skills acquired by health workers, as well as calling for improvement of household and community practices related to child health. [from executive summary]

Ethiopia suffers from an acute shortage of health workers at every level, and rural areas in which 85% of the population live have been particularly chronically under-served. The Ministry of Health chose to focus on community level provision, initiating the Health Extension Programme in 2004. This is outlined in the current Health Sector Development Plan, which focuses on both human resource development and the construction and rehabilitation of facilities. [adapted from introduction]

Currently, a wide variety of community health workers are active in many antiretroviral treatment delivery sites. This article investigates whether present community health worker programmes for antiretroviral treatment are taking into account the lessons learnt from past experiences with community health worker programmes in primary health care and to what extent they are seizing the new antiretroviral treatment-specific opportunities. [from abstract]

A Health Management Information System (HMIS) can be a powerful tool to make health care delivery more effective and far more efficient. This paper describes how an HMIS can also be used for organisational development and reports on the experiences of the HMIS programme of the Uganda Catholic Medical Bureau (UCMB) in Uganda. [from abstract]

The Mothers’ Support Group empowers mothers and mother-to-be to access peer-based support and make linkages to services such as family planning, infant-feeding, counseling, nutriotional guidance, antiretroviral therapy, prevention of mother-to-child transmission and health institutional delivery. [from author]

Insufficient attention has been paid to understanding what determines the performance of health workers and how they make labor market choices. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia. We describe performance problems identified by both health users and health workers participating in the focus group discussions including absenteeism and shirking, pilfering drugs and materials, informal health care provision and illicit charging, and corruption.

Health facility assessments are being increasingly used to measure and monitor indicators of health workforce performance, but the global evidence base remains weak. The World Health Organization coordinated a series of facility-based surveys using a common approach in six countries: Chad, Cote d’Ivoire, Jamaica, Mozambique, Sri Lanka and Zimbabwe. The objectives were to inform the development and monitoring of human resources for health policy within the countries; and to test and validate the use of standardized facility-based human resources assessment tools across different contexts.

This presentation covers the state of the health workforce in Ethiopia and defines the crisis in health worker coverage including numerous charts and staistics that track the decline in the number of doctors.

East African countries have in the recent past experienced a tremendous increase in the volume of antiretroviral drugs. Capacity to manage these medicines in the region remains limited. Makerere University established a network of academic institutions to build capacity for pharmaceutical management in the East African region. The initiative includes institutions from Uganda, Tanzania, Kenya and Rwanda and aims to improve access to safe, effective and quality-assured medicines for the treatment of HIV/AIDS, TB and Malaria through spearheading in-country capacity.

The results of this survey shed light on several aspects of problems faced by reproductive health services regarding provider performance, equipment and supplies in facilities and laboratories, availability of medicine, initial staff qualification and in-service training, and supervision of health care providers. The results will serve as a guide for monitoring and evaluation of maternal and child health programs, reproductive health programs, HIV/AIDS programs, and other infectious diseases programs. [from preface]

The study assessed knowledge and practice of health care providers on current concepts on malaria prophylaxis in pregnancy. [from abstract]