Sub-Saharan Africa

One of the challenges of continuing professional development (CPD) is to ensure that members of the medical profession maintain and improve the competencies in medical practice. CPD is an evolving system and different countries in Africa are at different levels of development. This article focuses on the developments and challenges of CPD among medical and dental practitioners in Africa. [abstract]

This is a summary report from the Africa Health Workforce Observatory meeting held September 26-29, 2006, at the ECSA headquarters in Arusha, Tanzania. The meeting focused on developing mechanisms to create up-to-date and reliable information that enables evidence-based decision making for HRH. [adapted from author’s description]

This study evaluates an intervention to raise healthcare provider morale and retention. Two different incentives-cash and a trophy, awarded to facilities rather than individuals-were tested in two districts. The program was implemented district-wide. Health centers and other small health facilities competed for the awards and were scored on the basis of management system indicators. Interviews with staff in both districts measured the effect of the awards on staff motivation and satisfaction. [publisher’s description]

This report examines the workforce issues surrounding HIV/AIDS service delivery. At the request of the Government of Rwanda, data were collected on current health sector staffing and from 20 public and private facilities of various sizes and characteristics on the time required to provide HIV/AIDS services and the quality of those services. The report presents data relative to the numbers of clients needing different types of HIV/AIDS services, providers’ degree of compliance with service delivery standards, and the time it takes to provide services.

South African citizens have experienced many inequalities and these have extended to the health care setting. one of the major challenges that needs to be addressed is the accessibility and availability of health care and specialized medical services in rural areas in South Africa. Telemedicine is a potential solution to address some of the challenges within health care in a developing country like South Africa. This article looks at the experiences of developing and implementing a telemedicine solution. [abstract]

Addressing the current state of human resources in health, the paper highlights the critical situation of the health workforce in sub-Saharan Africa. It examines the most recent workforce statistics and trends, including geographical distribution. The factors that have and are influencing the availability of human resources are briefly reviewed, focusing on the workforce motivation, the serious brain drain of health professionals, and the increasing impact of HIV/AIDS.

The most pressing challenge to achieving universal access to highly active anti-retroviral therapy (HAART) in sub-Saharan Africa is the shortage of trained personnel to handle the increased service requirements of rapid roll-out. Overcoming the human resource challenge requires developing innovative models of care provision that improve efficiency of service delivery and rationalize use of limited resources. We conducted a time-series intervention trial in two HIV clinics in central Mozambique to discern whether expanding the role of basic-level nurses to stage HIV-positive patients using CD4 counts and WHO-defined criteria would lead to more rapid information on patient status (including identification of HAART eligible patients), increased efficiency in the use of higher-level clinical staff, and increased capacity to start HAART-eligible patients on treatment.

Effective teamwork between doctors and clinical nurse practitioners (CNP) is essential to the provision of quality primary care in the South African context. The Worcester Community Health Centre (CHC) created dedicated practice teams offering continuity of care, family-orientated care, and the integration of acute and chronic patients. The teams depended on effective collaboration between the doctors and the CNPs. This inquiry focuses on the question of how more effective teams of doctors and clinical nurse practitioners offering clinical care could be created within a typical CHC. [adapted f

This chapter aims to determine the current demand for medical practitioners and nurses in South Africa by looking at the number of positions that are filled and the number that are currently vacant. It attempts to determine the number of medical practitioners and nursing positions that will be required until 2011, establishes the expected output from higher education over the next ten years, and determines the gap between supply and demand of health professionals. [adapted from introduction]

This study documents the contribution made by religion and religious entities to the struggle for health and wellbeing in Zambia and Lesotho, in a context dominated by poverty, stressed public health systems and the HIV/AIDS pandemic. By mapping and understanding these Religious Health Assets (RHAs), the study calls for a greater appreciation of the potential they have for the struggle against HIV/AIDS and for universal access and offers recommendations for action by both public health and religious leaders at all levels.

The African continent is facing 25% of the world’s morbidity rate with only 3% of its healthcare personnel. This is the result of years of neglect and underinvestment by African governments and the international community, plus harsh IMF restraints on nations’ budgetary expeditures. [author’s descripton]

This article discusses the issue the brain drain of doctors to more developed countries and Ghana’s efforts to supply an adequate health workforce in the face of this problem.

This consultation was convened jointly by the Global Health Workforce Alliance, the World Health Organization and the Swedish International Development Agency to discuss issues relating to the current crisis in human resources for health. The objectives of the Consultation were: to provide information on the global and regional crisis in human resources for health and propose activities based on the main recommendations of the World Health Report 2006; to share experiences in human resources for health, including issues related to priority programmes such as HIV/AIDS in the countries represented; and to present the African Human Resources for Health Platform and discuss possible solutions to the alleviation of the crisis in the African region.

This Praxis Note provides an overview of the impact of HIV/AIDS on the Malawi health care system and on the organisational capacity of Mulanje Mission Hospital. It describes the experiences and lessons learnt from a capacity building program designed to address capacity deficits and erosion caused by HIV/AIDS attrition. Less emphasis was placed on external training courses and increasing attention given to short-course inputs and distance learning. [from introduction]

This presentation gives an outline of the current challenges and opportunities for HRH in the Sub-Saharan Africa AIDS crisis, some possible solutions, key messages and ways forward.

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Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers responses to the changes in their working environments by taking a realistic evaluation approach. [abstract]

A seven-point framework was used to analyze retention strategies in four countries: Uganda, the United Kingdom, Canada, and Thailand. This framework draws upon available country data and includes GDP and investment in health, mix of private/public investment, international migration, health policy frameworks, countrywide strategies, provincial/regional strategies, and professional associations/regulatory bodies. Comparison of the countries demonstrated that progress has been made in nurse retention. [from executive summary]

The migration of health professionals trained in Africa to developed nations has compromised health systems in the African region. The financial losses from the investment in training due to the migration from the developing nations are hardly known. Developing countries are losing significant amounts of money through lost investment of health care professionals who emigrate. There is need to quantify the amount of remittances that developing nations get in return from those who migrate. [from abstract]

This article describes a survey of health workers and traditional birth attendants (TBAs) which was carried out in 2005 in two regions of Ghana. The objective of the survey was to ascertain the impact of the introduction of a delivery fee exemption scheme on both health workers and those providers who were excluded from the scheme (TBAs).

The loss of human resources through migration of professional health staff to developed countries usually results in a loss of capacity of the health systems in developing countries to deliver health care equitably. Migration of health workers also undermines the ability of countries to meet global, regional and national commitments…

This study describes the work of the Choose to Care initiative of the Catholic Church in Southern Africa which began in 2000. It shows that effective scaling-up of programmes in the response to HIV does not necessarily have to be the expansion of a single central service. Working through the diocesan and parish system,…the Catholic Church scaled up service provision by the replication of smaller scale programmes rooted in and responsive to the needs expressed by local communities in this five-country area.

This paper addresses an important practical challenge to staff management. We use a case study based on semi-structured interview data to explore the steps that Namibia, a country facing severe health problems that include an alarmingly high AIDS infection rate, has taken to manage its health workers. [from abstract]

This resource paper uses a simple framework to provide an analytical review of human resources for health (HRH) strategic plans that have been generated over the last few years by countries in sub-Saharan Africa that are faced with an HRH crisis. The author collected and analyzed HRH strategic plans for the following countries: Eritrea, Kenya, Lesotho, Malawi, South Africa, Swaziland and Zambia. The paper explores some of the key dynamics and steps in the evolution of these plans, including the plan development process and content, implementation bottlenecks and the frequency with which the plans are reviewed or evaluated.

The 2006 Review seeks to provide a South African perspective on prevailing international public health issues, and in particular provides an opportunity to reflect on progress to achieving the Millennium Development Goals many of which are linked to maternal and child health. It also seeks to stimulate debate and critical discourse, to provide a platform for assessing progress and to identify key gaps and opportunities for future action that is realistic and sustainable. [from foreword]

This presentation details a program to implement and evaluate the feasibility, acceptability, effectiveness and cost of two models of integration of HIV prevention information, and routine offer of provider initiated counselling and testing for HIV into family planning (FP) services in 18 health facilities in North West Province, South Africa. [adapted from abstract]

To maximize program impact with current resources, integration of Family Planning into existing HIV/AIDS programs is a very cost effective and an excellent point of entry. This is a study of an intervention program focused on initiating and also strengthening existing integration of FP into functional VCT, ART and PMTCT sites. The intervention encompassed an orientation on integration benefits to heads of health facilities; identification of challenges of integration and drawing of plan of action on how to overcome the challenges and improve integration.

The purpose of the study is to obtain information on the level of workplace violence in the health sector in South Africa. In particular this study examines the extent of workplace violence, factors that may contribute to violence and explore the most suitable strategies and appropriate policies to prevent and address violence in the workplace. [introduction]

This report results from a research project on violence against health care providers in selected health care units in Maputo city. The main objective of this work was to analyse the level of violence which existed in the hospitals of Maputo city, identifying the factors and forms of struggle or prevention of these events. [from introduction]

While the scale of the [health worker shortage] crisis is huge, solutions do exist. Many countries and communities around the world have begun to develop and implement innovative initiatives to sustain and build the health workforce. Several such examples are highlighted here. They address such issues as retention in rural areas, AIDS treatment for health workers, and the deployment of paraprofessionals to extend health care access deeper into communities. Many of these examples focus on rural areas, which typically have only a fraction of the number of health workers as urban areas due to more difficult living conditions, social and professional isolation, and weaker health infrastructure. [publisher’s description]

The Public Private Partnership in Health (PPPH) is an element of Uganda’s Health Sector Strategic Plan II. The private sector includes not-for-profit providers, for-profit providers called private health practitioners (PHPs), and traditional and complementary medicine providers. A representative sample of facilities was selected and surveyed to provide in-depth information on PHP facilities, which could be extrapolated to the national database. The survey collected information from 359 facilities on facility ownership, human resources, staff employment in other facilities, infrastructure and equipment, health services provided including in-depth information on HIV/AIDS services, drug availability, health management information systems, financial management procedures, and registration and organizational affiliation.