Sub-Saharan Africa

The African Region continues to experience loss of a sizeable number of highly skilled health professionals (physicians, nurses, dentists and pharmacists) to Australia, North America and European Union. Past attempts to estimate cost of migration were limited to education cost only and did not include the lost returns from investment. The objective of this study was to estimate the social cost of emigration of doctors and nurses from the African Region to the developed countries. [from abstract]

Very little information is available on the extent to which the private health sector is involved in clinical management of HIV/AIDS in Nigeria. This study assessed the potentials and existing capacity of 15 private health facilities in Nassarawa state for clinical management of HIV/AIDS. [from abstract]

This report describes a performance needs assessment of family planning and other health care providers in three regions of Guinea. Its purpose was to identify performance gaps or problems and determine the most appropriate interventions to improve providers’ performance and clients’ and communities’ access to and use of long-term and permanent methods of contraception (LTPMs)—specifically, male and female sterilization and the intrauterine device (IUD). [adapted from author]

As strides are made in the prevention and treatment of HIV, it is important to take advantage of opportunities to expand and integrate reproductive health services. Integration is an approach that uses a client visit as an opportunity to address other health and social needs beyond those that prompted the current health visit.

Given the very limited health infrastructure and resources and the need to provide a palliative care service to about one percent of the population each year, community and home-based care is viewed as the key to responding to these needs. Some countries have already developed strong home-based care networks in coordination with the PHC system to respond to the HIV/AIDS epidemic. Palliative care, as part of the continuum of care of HIV/AIDS, cancer and other chronic conditions can be integrated into this existing network. [author’s description]

Significant numbers of African-trained health workers migrate every year to developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon. The population of Sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. [from introduction]

The overall objective of this study is to evaluate the capacity as well as the performance of the health facilities (HF) and community associations (community health workers associations (CHW), traditional birth attendant associations (TBA) and associations of people living with HIV (PLWHA), operating in the Gisagara (formerly Kibilizi) District. [from summary]

This article discusses the cost-effectiveness of a recent programme that involved training shopkeepers and community mobilisation for treating childhood fevers in the rural Kilifi District in Kenya. The programme offered workshops for shopkeepers on appropriate treatment for malaria in young children and also ran community information activities, with impact maintained through refresher training and monitoring. [author’s description]

Occupational stress and burnout merit concern in South Africa as the severity and intensity of the HIV epidemic is often perceived as overwhelming, leaving many caregivers with intense feelings of hopelessness and despair. This study explores and describes the experiences, feelings and perceptions of South African caregivers working in various capacities (healthcare, counselling and teaching) in the HIV/AIDS field. [from abstract]

In southern Africa, rapid out-migration of health professionals is compounding the problems of health systems already faced with budget constraints and the impacts of HIV/AIDS. The authors outline a program of research on how Canada and the international community might address the negative impacts of the brain drain. [abstract]

Achieving the health Millennium Development Goals will require a significant scaling up of health service delivery in many countries. The number of competent managers will also have to be scaled up at the same time – managers are an essential resource for ensuring that priority needs are met and resources are used effectively. This study describes various management strengthening activities in 3 countries – South Africa, Togo and Uganda. [from executive summary]

Hospice Africa Uganda introduced palliative medicine to Uganda in 1993 with enough funds to support a team of three clinicians for three months. Training in the medical and nursing schools was introduced in 1994. Since then, Uganda has achieved the three essential components of an effective public health strategy. It has also been the first country to have palliative care described as an essential clinical service and to change the law to allow nurses and clinical officers who complete special training in palliative medicine at Hospice Uganda to prescribe morphine. Palliative care is spreading throughout the districts of Uganda, ensuring that morphine will be available to everyone who needs it. [adapted from publisher’s description]

The study sought to assess the knowledge of health-care providers about HIV/AIDS, determine the potential for discrimination in the provision of services based on patients’ HIV sero-status and review the factors that may contribute to such attitude. [from abstract]

Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania. [abstract]

This is a guideline to replicate and scale-up a human resources promising practice documented by the Capacity Project for outsourcing human resources services (HRS) to obtain a rapid increase and deployment of the health workforce, making HIV services available in a short period of time, especially in underserved areas.

This guideline is for human resources planners and managers in the health sector and sets out the steps required to extend the health workforce by incorporating lay workers (field officers), especially in the delivery of antiretroviral therapy (ART) to home-based clients.

Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries… Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes. [summary]

This report evaluates the success of a program to improve family planning services in Malawi. It discusses the importance of community-based distribution, i.e. mobile clinics and community health workers, to the success of family planning in the country since so much of the population is rural.

This report evaluates the BHAPP project including an analysis of its service and communication activities for outreach and capacity strengthening of personnel in 23 health centers to diagnose and treat STIs and use STI case management as a referral point for HIV testing. It also discusses the effectiveness of the project’s policy work at the central level.

The objective of this study was to assess whether adding a training intervention for clinic staff to the usual DOTS strategy (the internationally recommended control strategy for tuberculosis (TB)) would affect the outcomes of TB treatement in primary care clinics with treatemet success rates below 70%. [from abstract]

This report is the result of a regional meeting held March 17-19 in Arusha, Tanzania and presents the regional context for work on migration and retention; an overview of the current situation, integrating evidence from background papers and country experiences; and summarizes the discussions held on follow-up work on migration and retention. [adapted from introduction]

This report outlines information from a literature review and field research pertaining to the key differences and similarities between the hospice ICHC model and other home-based care models used in South Africa; reviews the core elements of the ICHC model; and highlights best practices of the model. [adapted from introduction]

This report presents the finding from an study to determine the impact of HIV/AIDS on the public sector in Malawi. Section E, 3 establishes the impacts of HIV/AIDS on the Ministry of Health and Population and on health workers including statistics of attrition by occupational category in the health sector, morbidity and absenteesim, vacancy levels. It also analyzes effect on health worker workload, discusses the impact on productivity and performance, the financial implications, impact on service provision, and institutional vulnurability to HIV/AIDS.

A growing body of evidence suggests that the quality of a health system depends greatly on highly motivated health workers who are satisfied with their jobs, and therefore stay at their stations and work. This paper reviewed evidence from published and grey literature on the use of non-financial incentives for health worker retention in sixteen countries in east and southern Africa. [adapted from author]

The development of the delivery of reproductive health services is continually confronted by challenges from a changing environment, an important element of which is health sector reform, in particular decentralization, which is being undertaken by most governments in Africa. The general objective of this research is to make health sector decentralisation more effective in the development of appropriate reproductive health services. In Chapter 8 human resource management and development as it has been affected by decentralization is discussed. [adapted from introduction]

Although the [critical shortage of health care workers] is not new, recent international efforts to vaccinate children and to fight HIV/AIDS, malaria, tuberculosis, and other diseases have brought it into sharper focus. The worker shortage derives from a combination of underproduction, internal maldistribution, and emigration of trained workers (“brain drain”). Fortunately, many African countries have begun attacking the problem by implementing innovative programs that may serve as models for other countries. Once effective pilot programs have been identified, scaling up will be the next hurdle: programs that are found to work on a small scale or in a particular environment may not be easy to expand or replicate.

This paper reports the findings of the PET/QSDS pertaining to human resources for health in Zambia. The Public Expenditure Tracking and Quality of Service Delivery survey (PET/QSDS) was undertaken in mid-2006 to provide quantitative assessment of the state of health service delivery in the country. One component of the survey focused on the management of health personnel, including staff availability, vacancy, absenteeism, and tardiness; staff turnover; staff workload, use of time, and morale; and staff salary and benefits. [from introduction]

Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors. [abstract]

The goal of this policy is to help management and staff minimize the risk of TB transmission in health care facilities and other facilities where the risk of transmission of TB may be high due to high prevalence of both diagnosed and undiagnosed TB such as prisons.

Malawi has a critical human resources problem particularly in the health sector. The College of Medicine (COM)is the only medical school. For senior staff it heavily depends on expatriates. We explore to what extent a brain drain took place among the COM graduates by investigating their professional development and geographical distribution.