Sub-Saharan Africa

The objective of this study was to quantify staff requirements in primary health care facilities in South Africa through an adaptation of the WHO workload indicator of staff needs tool. The results show that the application of an adapted WHO workload tool identified important human resource planning issues. [adapted from abstract]

This article discusses the gaps exist between the potential of health systems and their actual performance. Best practices from various countries are discussed. The author concludes that the crisis can be tackled if there is global rsponsibility, political will, financial commitment and public-private partnership for country-led and country-specific interventions that seek solutions beyond the health sector. [adapted from abstract]

The 2006 Tanzania Service Provision Assessment Survey provides detailed information on the availability and quality of facility infrastructure, resources, and management systems, and on services for child health, family planning, maternal health (antenatal and delivery care), and selected infectious diseases, namely sexually transmitted infections and tuberculosis. The survey also provides information on the capacity of health facilities to provide quality HIV/AIDS services. [adapted from abstract]

In order to highlight the driving forces determining the international allocation of medical personnel, the cases of four countries (the Philippines and South Africa as source countries, and Saudi Arabia and the United Kingdom as destination countries) are examined. The paper concludes that changes in demand generated in major destination countries determine the international allocation of medical personnel at least in the short run. [from abstract]

Faith-based organizations are a key link in the sustainability of accessible health services. In many African countries, they have been providing health care for over 60 years and in some, such as Kenya, for a century or more.

Providing contraceptive services at VCT centers is an opportunity to prevent unintended pregnancies among clients whose needs may not be met through traditional family planning services. Operations research in Kenya suggests that integrating family planning into VCT services is feasible and acceptable. An integration intervention improved providers’ discussions about fertility desires and contraceptive methods with clients, without compromising the length of client-provider interaction or client waiting time.

Staff shortages could harm the provision and quality of health care in Uganda and therefore staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace. Results from interviews and surveys show that HIV/AIDS is an important contextual factor that impacts working conditions in various ways.

Twelve percent of the adult population in Malawi is estimated to be HIV infected and 15% to 20% of these are in need of life saving antiretroviral therapy. Using data on the total number of patients on highly active antiretroviral treatment (HAART) and estimates of the number of health professionals required to deliver HAART, researchers set out to determine the human resources requirements for HAART scale-up in Malawi. Results show that the human resources requirements are significant and that Malawi is using far fewer human resources than would be expected based on past studies. [adapted

This brief describes the Capacity Project’s work with health workforce planning using HRIS in Rwanda.

This paper examines recent experiences in Zambia, and Ethiopia that illustrate why policy matters for developing the private health sector and underscoring the need for rational regulatory policies and practices. [author’s description]

This study examines the opinions of health professionals about the capacity and performance of the ‘tecnico de cirurgia’, a surgically trained assistant medical officer in the Mozambican health system. Particular attention is paid to the views of medical doctors and maternal and child health nurses. [from abstract]

In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers’ competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. [abstract]

This edition focuses on the role of the private sector, a part of the health system that has not previously been accorded extensive coverage in the SAHR. The contrast between the public and private sectors remains stark in many facets and the deepening inequity is cause for profound concern. The significance of the private sector cannot be underestimated both with regard to its potential contribution to the health and well-being of this country’s people, as well as its role in drawing resources (financial and human) from the public sector.

The nurse is the single most important frontline health worker. Without nurses the clinics, community health centres and hospitals cannot function. It is therefore critical that nurse education and the supply of nurses form an integral part of transformation of health services in South Africa. According to the Department of Health there is a need to significantly increase the production of all categories of nurses in order to fulfil the requirements of South Africa. Attracting new recruits to the profession is an integral part of increasing production. It is for this reason that a study was undertaken to assess the attitudes of school leavers towards taking up nursing as a profession, and the reasons for these attitudes.

The objectives of the study were to assess the extent to which CHW deployment has been addressing important health priorities; document success stories and lessons, identify champions; understand the range of ways that CHW programmes have evolved in South Africa and compile recommendations and lessons learned to improve practice. [from executive summary]

In both Asia and Latin America, community-based health workers have been trained in safe injection techniques and routinely provide injectable contraception. However, the African continent still resists this service delivery mechanism with the rationale that it is unsafe for clients to receive injections from paramedical personnel. This argument is weakening, however, as non-reusable syringes become the norm and with the recent development of a checklist, based on the latest WHO Medical Eligibility Criteria, for safe provision of DMPA by community-based agents.

In [Tanzania’s] response to HIV, the Ministry has deemed its shortfall in human resources for health (HRH) as an emergency. To begin to address this gap, the Ministry is expanding antiretroviral therapy services through an Emergency Hiring Program that will bring 365 new health workers to 25 underserved districts in two phases. The first phase, now underway, will place 176 new hires in 19 districts. [author’s description]

This study conducted structured interviews with 204 health care providers in three public hospitals in Dar es Salaam, Tanzania, to evaluate the prevalence of stigma and discrimination among providers toward people living with HIV/AIDS (PLWHAs) and the factors associated with stigmatizing attitudes. Information on HIV/AIDS-related knowledge, perceived risk of infection, willingness to care, and availability of protective gear was also obtained. [from executive summary]

This is an exploratory descriptive study that examined migration of locally trained doctors from Ghana using graduates of the country’s first medical school as a proxy. The objectives of the study were to describe trends in the loss of medical personnel to emigration and the influence this has on human resources planning, including forecasting of staff supply and requirements. It was also to provide some information towards the development of strategies to counteract such losses. [from abstract]

The migration of health professionals from developing countries in general, and sub-Saharan African countries in particular, has become the subject of considerable theoretical and case study research attention in international migration and human resources for health (HRH) literature. This report is a review of all available literature on the costs and benefits of the migration of health workers from East and Southern African (ESA) countries to developed nations. [from executive summary]

In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one’s country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health.

The disparity is staggering. Africa bears one-quarter of the burden of disease around the world yet has barely 3 percent of all health workers. Millions of people across the continent thus suffer needlessly because they cannot obtain medical care from trained personnel. In sub-Saharan Africa, where the crisis is most acute, fully 820,000 additional doctors, nurses, and midwives are needed to provide even the most basic health services. To meet this shortfall, most of the region’s countries would have to increase the size of their health workforce by 140 percent. [author’s description]

Health care providers play a crucial role in determining access to reproductive health services and their influence is likely to be heightened in delivering services to HIV-infected women. We examined the attitudes of health care policy makers and providers towards reproductive decision- making among HIV-infected individuals. [from abstract]

Home-based management of malaria (HMM) is promoted as a major strategy to improve prompt delivery of effective malaria treatment in Africa. The published literature was searched for studies that evaluated the health impact of community- and home-based treatment for malaria in Africa. [from abstract]

This paper reports the findings at baseline in a multi-phase project that aimed at reducing maternal mortality in a local government area of South-West Nigeria. The objectives were to determine the availability of essential obstetric care services and to assess the quality of existing services. The first phase of this interventional study, which is the focus of this paper, consisted of a baseline health facility and needs assessment survey using instruments adapted from the United Nations guidelines. [from abstract]

In responding to the goal of rapidly increasing access to antiretroviral treatment (ART), the government of Botswana undertook a major review of its health systems options to increase access to human resources, one of the major bottlenecks preventing people from receiving treatment. In mid-2004, a team of government and World Health Organization (WHO) staff reviewed the situation and identified a number of public sector scale up options. The team also reviewed the capacity of private practitioners to participate in the provision of ART. Subsequently, the government created a mechanism to include private practitioners in rolling out ART.

Malaria is a major cause of illness and death in Nigeria, and a significant drain on its economy and the poor. Yet most Nigerians do not obtain appropriate treatment for malaria, and depend on informal private providers for anti-malarial drugs (AMDs), largely through patent medicine vendors (PMVs). This study seeks to better understand the role played by PMVs in the provision of AMDs in Nigeria, and to explore ways to improve the regulation and delivery of AMDs. [from summary]

The study was carried out to evaluate short term effects of one to one educational intervention approach, conducted with 40 drug sellers in order to improve the private sector’s practices, compliance and performance in using the national treatment guidelines for malaria and other common childhood (diarrhoea, acute respiratory tract infection-ARI) illnesses in Kibaha district-Tanzania. [from abstract]

In parts of rural Africa, where conflict and neglect have destroyed any remnants of a functioning health system, there is one long-running public-health programme that is not only surviving but thriving—by capitalising on communities’ desires to help themselves. [author’s description]

This report summarises the results of a study of health worker satisfaction, working conditions and intent to continue working in the health sector in Uganda. The findings point to the importance of a number of factors that contribute to satisfaction and intent to stay, including differences by cadre, gender, age, sector (public or non-profit) and location. The results suggest several policy strategies to strengthen human resources for health in Uganda. [from abstract]