Sub-Saharan Africa

The report, in its first part, destroys three common myths regarding the private health care sector in Africa and discusses how to engage the private sector effectively. It provides examples of successful public-private partnerships and highlights some of the trends in these types of partnerships. [adapated from executive summary]

The World Bank commissioned the Center for Development Communication (CDC) to develop a communication strategy to help boost public-private partnerships in the African continent. CDC consulted with key informants and stakeholders identified by the World Bank’s Public-Private Partnerships (PPP) working group in order to develop a stakeholder analysis to help inform the larger communication strategy. This report summarizes the results of that consultation. [from executive summary]

Both financial and nonfinancial factors influenced the tenure and job satisfaction of nurses at public maternity services in South Africa. Surveys suggest that strong management and fully equipped facilities could help redress staff turnover. [author’s description]

In this paper, we aim to quantify the contribution of international health volunteers (IHVs) to the health workforce in sub-Saharan Africa and to explore the perceptions of health service managers regarding these volunteers. [from abstract]

This case study was conducted to impart a thorough understanding of the Tumaini Home-Based Care Program model and to document lessons learned that could be applied to other initiatives. While the Tumaini program addresses the needs of both people living with HIV and AIDS (PLHA) as well as OVC, the case study focuses particular attention on specific services and program impact for OVC. The program goals were to provide care and support to OVC; to provide care and support to PLHA; Tumaini: Home-Based Care and to build the capacity of local organizations to provide sustainable HBC services. [from

The objective [of this report is] to describe the development, initial findings, and implications of a national nursing workforce database system in Kenya. [from abstract]

The health worker crisis is particularly acute in rural and hard to reach areas, where 80% of the population in Africa live. The resultant low capacity at the peripheral level of the health system is a crucial barrier to good health. AMREF believes that developing capable, motivated and supported health workers at all levels of the health system is essential in ensuring the delivery of accessible and effective health care across Africa… This briefing draws on AMREF’s experience to look at three key issues: the importance of appropriate training, task-shifting to lower cadres of worker, and training and supporting community health workers (CHW) in order to bring health care closer to communities.

Coping strategies have, in some countries, become so prevalent that it has been widely assumed that the very notion of civil services ethos has completely – and possibly irreversibly – disappeared. This paper describes the importance and the nature of pilfering of drugs by health staff in Mozambique and Cape Verde, as perceived by health professionals from these countries. Their opinions provide pointers as to how to tackle these problems. [from abstract]

While the availability and use of trained midwives can shape the quality of care received in pregnancy and childbirth, a number of other underlying health systems structures and processes are important. The management of health workforces, the mix of public and private provision and the impact of reforms affect quality of care across countries…[This study] examined how the structure and operation of a health system influences maternal health care provision and outcomes in Bangladesh, Russia, South Africa and Uganda. [author’s description]

Sub-Saharan Africa has the worst rate of maternal ill-health in the world. Maternal deaths occur partly because health systems are inadequately staffed to deal effectively with birth complications. How can maternal health human resources be managed better to ensure that all women, especially in poor, rural areas, can access good quality maternal health care? [author’s description]

The importance of human resources in health systems needs not to be over-emphasised. Expenditure on health workers forms a significant proportion of total health expenditure in many countries. In order to effectively implement cost-effective interventions, health workers must have the appropriate skills, competencies, training and motivation to do so. However, current evidence suggests that health systems in developing countries are understaffed and exhibit maldistribution of health workers. Health workers are generally demotivated and less productive due to inappropriate incentive environment.

For long now, doctors in Uganda have been complaining that their terms of service, particularly remuneration, are not commensurate with the years that they spend training and the amount of work that they do. This issue has persistently been raised at several fora over the years but with no definite resolution. But how should doctors be paid? This paper attempts to answer this question. In the developed world, policy makers attempt to answer the question of cost containment. In Uganda, due to limited financial resources, the overriding question is where will the extra resources to adequately pay doctors be found? [from introduction]

Uganda has been successful in implementing the national “Health Management Information System” (HMIS). Disease surveillance reports and monitoring of key output indicators within the health sector seem to be the areas with the most remarkable advance. But little mention has been made on the importance of the use of information for monitoring performance indicators and for management/decision making purposes. The existing HMIS makes this possible.

At the inception of Uganda’s second 5-year Health Sector Strategic Plan (HSSP II), this paper traces the history of the public - private partnership for health (PPPH) in Uganda, giving its justification and mandate. It also gives its current state of the art, outlining the successes scored, the challenges still faced in its implementation and current efforts being made to make it comprehensively institutionalized. [abstract]

The Health Sector Strategic Plan (HSSP) aims to ensure access to basic health care by the Ugandan population. This requires availability of well-trained health professionals. This study demonstrates that the Private-Not-For-Profit Health Training Institutions - the majority in Uganda - have remained grossly under-funded, which poses a threat to achievement of the HSSP. It is recommended that government increases and guarantees its support to these Health Training Institutions as a way of maintaining quality of health worker training. [from abstract]

The study whose summary is presented here tried to compare the attrition rates in three Private Not For Profit and three Government General Hospitals in West Nile Region over a period of five years. It also examined the destination to which the health professionals were lost, the source of the new staff that replaced those lost by the hospitals, the reasons for attrition as perceived by the existing staff in the hospitals, what kept some of the staff working for longer period than others who chose to leave, and the incentives that were in place for attraction and retention of health professionals in these hospitals.

In Yumbe District of north-western Uganda, Village Health Teams (VHT) have been established in line with the national strategy for community involvement in health. The Yumbe VHT programme has won an award for innovative support to strengthening decentralisation. This paper reviews aspects of the programme outlining its successes and challenges.

A goal of the health management information system (HMIS) is to provide reliable, comprehensive information about the health system to health managers, to enable them take decisions that will improve the services provided to the consumers. This study assessed the utilisation of HMIS data for decision making at the grassroots level in Bufumbira East Health Sub-District (HSD) of Kisoro District. [from abstract]

South Africa has a serious shortage of human and financial resources to provide primary healthcare services especially in the historically under-served areas. It is a tedious task to carry out healthcare delivery for the masses without rationalizing human resources in the form of re-allocation and re-deployment of healthcare personnel. This study aimed to establish the level of adequacy and efficiency of nursing staff in the former Transkei region. The study was carried out in the child and family welfare clinic of the Umtata General Hospital. [from abstract]

IMCI was launched in Uganda in June 1995 and has so far been implemented in most districts. However, reports indicate that counselling is poorly performed and that health providers find IMCI counselling the most difficult component to implement. The study was carried out to assess IMCI-trained health providers’ counselling of caregivers and to determine factors that facilitate or constrain counselling. [from abstract]

This study was carried out to document the current situation regarding continued or in-service training opportunities amongst healthcare workers serving in government (public) health centres within Blantyre District Health office. Knowledge of such a situation would better inform health personnel trainers, professional regulatory bodies, the Ministry of Health and international agencies to design appropriate intervention programs towards professional development of healthcare personnel. [from introduction]

A scarcity of trained medical personnel impedes Uganda’s ability to deliver healthcare effectively. The role of the Clinical Officer (CO) was established to assist the provision of primary healthcare to rural communities. The primary aim of this study was to explore the role that the CO performs in delivery of primary and secondary healthcare in Uganda. A secondary aim was to determine the resources and facilities that are available to COs in order to carry out these duties. A further aim was to determine the confidence of COs at performing surgical and obstetric procedures. [from introducti

The study investigated the relationship between gender and knowledge, attitude and practice of infection control among oral health care workers in the management of patients with HIV/AIDS in Osun State of Nigeria. It was a cross-sectional survey using 85 oral Health care workers enlisted in the public dental health clinics. [from abstract]

The objective of this study was to explore knowledge, attitudes and practices of health workers in Mulago hospital towards domestic violence prevention and management, especially violence during pregnancy. Many respondents had poor knowledge of domestic violence management or prevention. Though they believed counseling survivors was necessary, none of the in-depth interviewees had counseling skills or had ever referred patients or survivors for such counseling.

Stigma and discrimination are widely recognized as factors that fuel the HIV/AIDS epidemic. Uganda’s success in combating HIV/AIDS has been attributed to a number of factors, including political, religious and societal engagement and openness – actors that combat stigma and assist prevention efforts. Our study aimed to explore perceptions of Uganda-based key decision-makers about the past, present and optimal future roles of FBOs in HIV/AIDS work, including actions to promote or dissuade stigma and discrimination. [from abstract]

A cross-sectional study was carried out in Mkuranga District of Tanzania with the aim of comparing the ability of trained and untrained traditional birth attendants (TBAs) in identifying women with danger signs for developing complications during pregnancy and childbirth as well as their referral practices. Study findings revealed that majority of the TBAs (86.5%) had not received any training. Trained TBAs were more knowledgeable on danger signs during pregnancy and childbirth and were more likely to refer women with complications to a health facility, compared to untrained TBAs. The authors recommend that in resource constrained countries like Tanzania and especially in remote rural areas, TBAs should be trained on early identification of mothers with obstetrical complications and on their prompt referral to health facilities that can provide emergency obstetric care.

A significant proportion of people in Nigeria seek medical care primarily in the “for profit” private sector. The complexity of managing HIV and AIDS has led to debates on whether care should only be restricted to trained and accredited experts in HIV care. This research studied the knowledge and practices of physicians in private practice in two Nigerian states on the management of patients with HIV/AIDS using an anonymous self-administered questionnaire eliciting knowledge and attitudinal information. This is to ascertain their preparedness to manage HIV positive patients. [from abstract]

The Traditional Birth Attendants (TBAs) Survey in Swaziland was undertaken between March 27th 1996 and April 8th 1996. The objective of the survey was to generate reliable information regarding activities of TBAs in Swaziland. The survey was conducted in 25 Chiefdoms sampled out of a total of 206 Chiefdoms registered in Swaziland. [from abstract]

In order to identify reasons clinicians in Malawi might not offer HIV testing to patients, a cross-sectional descriptive postal census with telephone and fax follow-up was conducted. Proportions were calculated for each reason given for not offering HIV testing. Multiple logistic regression was used to determine whether responses differed by demographic characteristics. The five most common reasons for not offering HIV testing were: inadequate training in HIV counselling; perception that the patient is not ready; no indication; testing facilities unavailable; and insufficient time.

The quality and quantity of health care services delivered by the Malawi public health system is severely limited, due to, among other things the shortage of adequate numbers of trained health care workers. In order to suggest policy changes and implement corrective measures, there may be need to describe the perceptions of the legislature on how they perceive as the cause of the problem, which could be the solutions and an evaluation of those solution. In this paper, I present the finding from a qualitative study of Hansards (official verbatim record of parliamentary speeches) analysed by discourse analysis.