Sub-Saharan Africa

Home-based care (HBC) for HIV/AIDS is increasingly looked to as a more accessible and affordable alternative to more costly inpatient care, both for patients who are unable to travel to or pay for inpatient care as well as for governments that must fund inpatient facilities. Partners for Health Reformplus estimated the cost of HBC for HIV in Rwanda, based on a sample of eight programs offering care in early 2004. The sample comprised facility- and community-based programs. Both types of program implement the medical care recommended in the Ministry of Health guidelines for HBC. [from abstract]

There is a growing acknowledgment of the importance of the continuum of care and support services to people living with HIV/AIDS outside of health facilities. Greater reliance on communities to provide care and support to people living with HIV/AIDS as well as non-complex maintenance and adherence support for treatment of those who are under antiretroviral treatment is seen as a way to alleviate the burden placed on traditional health systems in countries highly affected by HIV/AIDS. This report presents findings from the field-test of the Partners for Health Reformplus guidelines developed for costing home-based care (HBC) programs, with cases drawn from nine HBC programs in Uganda.

This paper describes the specific policy measures that the Zimbabwean government has recently implemented to try to improve health sector performance, and promote higher levels of motivation amongst public sector health care workers. The overall reform package is to include financial reforms (user fees and social insurance), strengthening of health management, liberalization and regulation of the private health sector, decentralization, and contracting out. Unfortunately, the process of reform implementation in Zimbabwe and the government’s poor communication with workers, combined with a conflict between local cultures and the measures being implemented, has undermined the potentially positive effect of reforms on health worker motivation.

A potentially effective strategy for bringing early, appropriate and low cost treatment of malaria closer to the home is through the use of community health workers. The objective of this study was to determine peoples’ stated and actual preferences for different strategies for improving the timeliness and appropriateness of treatment of malaria before and after the implementation of a community health workers strategy in their community. [from abstract]

The medical brain drain has been described as rich countries looting doctors and nurses from developing countries undermining their health systems and public health. However this brain-drain might also be seen as a success in the training and export of health professionals and the benefits this provides. This paper illustrates the arguments and possible policy options by focusing on the situation in one of the poorest countries in the world, Malawi. [author’s description]

This review of the South African Health Information System (HIS) maps essential health-related information, discusses the District Health Information System, details the current status of the HIS and the challenges the HIS faces.

The HIPC/PRSP process is intended to be a major instrument for achieving improved service delivery for poor people Crucially, improved service delivery depends on having the right professional, technical and other human resources in the right place at the right time. This review examined for 6 African countries, the country based poverty reduction strategy paper (PRSP) documentation and the associated World Bank/IMF HIPC documentation for human resources for health content. These documents were supplemented with other relevant country documents such as health strategies.

This case study describes how five Integrated Management of Childhood Illness (IMCI) trainers and supervisors conducted an assessment of provider knowledge and skill to carry out IMCI at 38 facilities in two districts in Kenya. [author’s description]

The objectives of the study were to identify exemplary medical and nurse practitioners in primary health care, to document their practices and perceptions with regard to their community involvement, to analyse the common themes arising from the findings, and to present recommendations based on the findings. The lack of a clearly defined role in the community outside of the clinical role that deals with the individual patient who presents for care is discussed in relation to the policy of the primary health care approach. The concept of community-oriented primary care provides a framework for a more systematic approach to community engagement, and this study serves as a basis for further research into the subject.

This paper discusses how Mozambique coped with the health system needs in terms of specialized doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. The Ministry of Health (MOH) managed to make up for its severe scarcity of specialist MDs especially through contracting expatriate technical assistance.

This study was implemented as part of the EQUINET theme work on Human Resources for Health coordinated by Health systems Trust. The study set out to explore and describe the influence of conditions of service on the movement and retention of the health professionals in Namibia. It is a qualitative study targeting mainly professional nurses, doctors, social workers and health inspectors at both operational and managerial levels, in public and private sectors. [from executive summary]

Universal Basic Precautions (UBP) are not well understood nor implemented by health professionals, though crucial in HIV/AIDS prevention. UBP refers to the prevention of transmission of blood borne pathogens like HIV through strict respect by health workers of rules concerning care and nursing. The objectives of this study were to find out knowledge and attitudes of medical personnel doctors in the Department of Surgery of the Korle Bu Teaching Hospital to HIV transmission and to find out their current practices of UBP in surgery.

The integration of HIV-prevention activities into care has received little attention within or outside formal healthcare settings. The contribution of community home-based care services in facilitating disclosure of HIV status and reducing stigma have also not been described. This study examines the community impact of an integrated community home-based care (ICHC) programme on HIV-prevention efforts and disclosure of status. Quantitative data was collected from 363 people living with HIV (PLHIV) and 1 028 members of their micro-communities. [from abstract]

This study investigates the experiences of informal caregivers of people living with HIV in two semi-rural communities in South Africa. It is argued that a thorough understanding of how home-based care undermines the physical health and psychological wellbeing of already vulnerable women is crucial for informing policies on home-based care. Thus, there is a need to incorporate gender perspectives when planning and implementing home-based care programs. [from abstract]

In 1993, Uganda began decentralization of its health care sector to the district and subdistrict levels. Its objectives were to increase local revenue for health service provision, in part through user fees; involve the consumers in the management of their health care services; and integrate all providers, including non-governmental organizations, missions, and non-traditional providers, into the care delivery system. The increased revenues and consumer participation was expected to improve quality and increase utilization of services. With a focus on maternal and child health (MCH) services, this study used statistical data and interviews with local health administrators and physicians to assess how the reform policies have been implemented and how they have impacted MCH service provision and utilization.

The purpose of this technical effort by the Partnerships for Health Reform was to assess various issues, problems, and opportunities facing the University Teaching Hospital (UTH) in Zambia. This review serves to catalyze and provide input for the development of an effective strategic plan for the UTH and Zambia’s health services in general. Findings from this review provide a basis for recommendations on how to effectively address these issues in order to improve management and, ultimately, positively affect efficiency, quality, equity, and sustainability of services. [from abstract]

Nigeria has one of the largest stocks of human resources for health (HRH) in Africa. However, great disparities in health status and access to health care exist among the six geo-political zones, and between rural and urban areas. This assessment measures the size, skills mix, distribution, and growth rate of HRH in the public health sector in Nigeria. The assessment also quantifies the increase in HRH requirements in the public health sector necessary for reaching key PEPFAR targets and the health Millennium Development Goals. The findings are based on a survey conducted in April-May 2006 in 290 public health facilities representing all levels of care (primary, secondary, and tertiary).

This document was presented at the ECSA Workforce Observatory Meeting in Arusha and describes an initiative in Malawi to provide regularly updated HRH information through an HRIS system including the current problems with collecting data, the steps to create the initiative and the indicators they will need.

The Quality Assurance Project (QAP) has developed and twice tested a computer-based version of the Integrated Management of Childhood Illness (IMCI) training course. Earlier testing had shown that the computer-based training (CBT), which takes six days, was as effective as the 11-day training traditionally used to teach healthcare providers to use IMCI. This report describes more recent testing of the CBT, which is available on CD-ROM.

Facilitator-led training of 20 healthcare providers in IMCI requires 11 days of lectures/practice and 6 facilitators, while the QA Project’s computer-based training requires 9 days and 4 facilitators. This study compared the cost-effectiveness of the two methods and found that both courses had equal effects on participants’ knowledge and skills, and retention after three to four months. The computer course was about 25 percent less expensive, excluding the cost of developing the software and for the computers used in the training. [publisher’s description]

This study examines the relationship between IMCI compliance and three cost issues: the length of client-provider consultations, treatment drugs, and workload. The setting was 26 health clinics in Niger, the only developing country setting where QA was implemented before IMCI. [publisher’s description]

The research described in this report investigated whether facility-based teams that had been trained and coached to develop and implement improvements in performance of the Integrated Management of Childhood Illness (IMCI) algorithm through problem-solving teams would improve case management. The study compared 21 facilities with teams and 14 without, all in rural facilities in Kenya.

This report presents data on in-hospital care for childbirth and obstetrical emergencies in 14 hospitals. This report examines intervals between critical events

This report presents the results from Rwanda for the of the Quality Assurance Project’s three Safe Motherhood Studies: competence of skilled birth attendants, the enabling environment for skilled attendance at birth, and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility. The Rwanda study focused on an urban referral (tertiary care) hospital with an active maternity department, two mid-sized referral (secondary care) hospitals, and four health centers. [publisher’s description]

As part of the African Growth and Opportunitues Forum, this paper addresses how African businesses are responding to the HIV/AIDS crisis. It is imperative that businesses take immediate action to lessen the economic and social consequences of HIV/AIDS. If they take action, businesses can ensure that economic initiatives, such as the African Growth and Opportunities Act (AGOA) will succeed in stimulating economic growth in Africa. While both the public and private sector should have HIV/AIDS policies and programs, this paper addresses only the private business sector response to the epidemic. However, many of the actions, best practices, and conclusions discussed in this paper are also applicable to public sector policies and programs.

This working paper is from the African regional consultative meeting on human resources for health (HRH) in Brazzavile, Congo. It describes the issues in health systems and HRH in the region and outlines the strategies and actions required for improvement. The document also discusses the Observatory of Health Human Resources for Africa, which was proposed as a cooperative network initiative among the countries and different partners of the region to produce the information and knowledge necessary for improving human resources policy decisions, and to share the country experiences in order to improve human resource development in the health services. [adapted from author]

Ensuring the availability of essential drugs and using them appropriately are crucial if limited resources for health care are to be used optimally. While training of health workers throughout Zimbabwe in drug management (including stock management and rational drug use) resulted in significant improvements in a variety of drug use indicators, these achievements could not be sustained, and a new strategy was introduced based on the supervision of primary health care providers.

This paper reports on research investigating the health management information system (HMIS) implementation process in Uganda, utilizing the diffusion of innovation and dynamic equilibrium organizational change models.

Various constraints are being experienced in the health delivery systems, namely weak health infrastructure, limited tools, inadequate human resource capacity, limited public financing to the health sector as a whole (and not only to disease specific programs), poor management and planning and lack of integrated health systems and misapplication of human, technical and financial resources. In order to improve health in Africa, inequalities to health service access between and within countries should be addressed within the health system. [author’s description]

The document aims to analyse the health system in Sudan, to identify the new challenges brought about by the new context, and on this basis to present a post-conflict strategic framework for the health sector. Chapter 3 presents an overview of the health sector. Available data on infrastructures and human resources indicate wide inequality across states in resource availability.