Sub-Saharan Africa

This report details the impact of Pathfinder Interational’s community-based approach to reproductive health and family planning in Ethiopia.

This article is an overview of the major HRH issues facing the health system in Zambia, including out-migration, an outdated medical-training infrastructure, faulty government management, and the effects of HIV/AIDS.

This editorial describes the widespread recruitment of health workers from sub-Saharan Africa to developed nations by recruiting agencies. The authors describe international efforts to criminalize this practice and express concern at the continued practice of recruitment.

This article outlines the challenges facing the surgical workforce in Africa. Funding priorities in Africa typically favor infectious diseases, and surgery and perioperative care have been neglected, even though essential surgical care at district hospitals is more cost effective than some other highly prioritized interventions, such as antiretroviral therapy for HIV. There is a need to integrate surgical and anesthetic training programs so health personnel, particularly in rural areas, can treat the full range of diseases appropriate to that level of care. [adapted from author]

This article investigates pay structures for health workers in the public sector in sub-Saharan Africa; the adequacy of incomes for health workers; the management of public- and private-sector pay; and the fiscal and macroeconomic factors that impinge on pay policy for the public sector. The study finds that pay and income of health workers varies widely, whether between countries, by comparison with cost of living, or between the public and private sectors. To optimize the distribution and mix of health workers, policy interventions are needed. Fiscal constraints to increased salaries might need to be overcome in many countries, and non-financial incentives improved. [adapted from summary]

To understand how the private health sector might better complement Africa’s public health systems, we studied the health care sectors of 45 sub-Saharan African countries. The findings suggest opportunities for private enterprise to help improve the region’s woefully poor health outcomes.

The original purpose of the ADHA scheme was to compensate doctors for hours worked beyond the standard 40 hours per week or 160 hours per month. This study investigated how the scheme impacted a number of human resources (HR) factors associated with health worker recruitment, deployment, retention and performance - specifically, how the significantly higher income levels resulting from the ADHA scheme influenced job satisfaction, motivation, workplace climate and the relationship between clinical and administrative staff, as well as productivity. The study provides a detailed chronology of the ADHA scheme and explores lessons learned from the way in which the GOG implemented and administered the scheme.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It covers the imbalance in physician deployment in Ethiopia and the lottery system for ensuring coverage in rural areas.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It reviews a study of how Rwanda, faced with constrained fiscal conditions, has implemented innovative reforms to create fiscal space for human resources and to make these resources more responsive to needs through an analysis of budget documents and policy and regulation changes and key informant interviews. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study to identify the level of satisfaction and intent to stay among health workers and effort to develop strategies to improve retention. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study done to analyze health worker perceptions of renumeration and determine the factors that affect the mobility of the health workforce in Burkina Faso

This presentation was given at the First Forum on Human Resources for Health in Kampala. It discusses the Zambia Health Workers Retention Scheme, an incentive program targeting key health worker cadres primarily in rural district to decrease attrition rates of critical service providers. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It details a study done to assess the feasibility and interest among stakeholders in the Netherlands, UK and US in facilitating recruitment and placement of foreign health care professionals to work in public sector health care in South Africa. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It outlines the micro-economics of health worker behaviour and discusses a study done to evaluate migration in Ghana.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It discusses the key features of the Problem-Based Learning/Community-Based Education and Service innovations to the health curricula at Makerere University, why they implemented these improvements and the benefits they have seen from the program.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It discusses training Clinical Officers, a cadre of mid-level health professionals, as a method of filling the health worker gap in a post-conflict area.

The main aim of the study was to estimate how much clinician-time that malaria exacts on Malawi’s Ministry of Health resources. It estimates the proportion of finances that anti-malarial medications exact on the country’s health budget and determines whether the Malawi public health sector had adequate human resources to provide treatment. [adapted from author]

The general aim of this paper is to add to the limited research on family caregivers, and specifically to enable a better understanding of the actual experience of providing care for ill adults within the home in the context of HIV/AIDS, using qualitative research findings from a KwaZulu-Natal study. [from author]

This study focused on the positive traits and strategies exhibited by high-performing facilities to determine how to improve performance at average and low-performing sites. [from author]

This publication provides information on the medical dialogue, a method formulated to address the recommendation for collaboration between biomedical practitioners and traditional healers and the integration of traditional medicine into public health care to respond to AIDS. [adapted from author]

In an initiative to collate experiences on management development in low resource settings, WHO carried out case studies to explore management development approaches and how these impacted managerial and service delivery performance. [adapted from author]

This article examines one new element of non-government provision in Tanzania: small-scale independent midwifery practices. Because of their location and emphasis on personalized care, small-scale independent practices run by retired midwives could potentially increase rates of skilled attendance at delivery at peripheral level. [from author]

The Capacity Project is applying an integrated strategy to strengthen family planning (FP) and reproductive health. The project is helping the Ministry of Health develop the capacity of the clinical workforce to provide a full range of FP methods and services at 13 hospitals and 146 health centers. [adapted from author]

In order to gain an understanding of the total health workforce in Swaziland, The Capacity Project worked with senior leaders of the Ministry of Health and Social Welfare to develop a program to strengthen the country’s human resources information systems. [from author]

This study explores the views of nursing students in Uganda to assess their views on professional practice options and their intentions to migrate to wealthier countries. The surveys show that most students would like to work outside of Uganda. The authors conclude that nursing schools may want to recruit students desiring work in rural areas or public practice to lead to a more stable workforce in Uganda. [adapted from author]

One of the most significant challenges in fighting the AIDS epidemic in Southern Africa is securing the health care workforce to deliver care in settings where the manpower is already in short supply. The authors produced a demand-driven staffing model based on treatment protocols for HIV-positive patients that adhere to Mozambican guidelines.

This study evaluated the skills and competency levels of hospital managers in South Africa to determine whether there are any significant differences between managers in the public and private sectors. The results show that managers in the private sector perceived themselves to be significantly more competent than their public sector colleagues in most of the management facets. Public sector managers were also more likely than their private sector colleagues to report that they required further development and training. [adapted from abstract]

It has been shown that, internationally, medical students of rural origin are more likely to practice in a rural area after graduation, but this has not been demonstrated in South Africa before. This study aimed to investigate the career choices of medical graduates of rural origin in the South African context, and to determine what proportion of rural origin students are currently practicing in a rural area. [from abstract]

This paper addresses the influence of the HIV/AIDS epidemic on the health workforce. An overview of the impact of HIV/AIDS on health systems is provided, with a focus on developing countries. Other topics include the impact of HIV/AIDS on morbidity and mortality among staff in Africa; the impact of HIV/AIDS on workforce motivation, performance and migration; and future staffing scenarios and potential obstacles. [adapted from author]

This report describes opportunities for engaging and supporting a well managed and effectively regulated private sector to improve the region’s health. This report highlights the critical role the private sector can play in meeting health care needs in Sub-Saharan Africa. It also identifies policy changes that governments and international donors can make to enable the private sector to take on an ever more meaningful role in closing Africa’s health care gap. [adapted from publisher]