Sub-Saharan Africa

Through its Safe Motherhood Research Program, the Quality Assurance Project carried out three studies to explore issues regarding competence of skilled birth attendants, the elements that contribute to an enabling environment and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility in countries with high maternal mortality ratios.

These reports review Rwanda’s healthcare staffing, documents practices and levels of effort in providing HIV/AIDS services, and calculates staffing needs for scale-up. It also discusses such issues as training, management, supervision, job satisfaction, and staff motivation and incentives. [publisher’s description]

This report presents findings from Phase 1 of an assessment of the human resources implications of HIV/AIDS services scale-up in Rwanda. Services covered include voluntary counseling and testing, prevention of mother-to-child transmission, and care and treatment, including lab services and drug dispensing. It reports the number and types of staff employed at public and private healthcare sites, estimates the number providing HIV/AIDS services, and identifies employment practices that could facilitate or hinder the human resources scale-up.

This report discusses care provided to 245 women during labor, delivery, and immediate postpartum and their newborns during immediate postpartum. The quality of care for different tasks (e.g., monitoring fetal heart rate) is presented by country, by hospital type, and overall. The report details performance on recommended tasks and should inform program managers and providers in finding similar weaknesses in their own care delivery systems. Report includes 21 data tables and the data collection instrument for observations. [publisher’s description]

Case management maps (CMMs) are a type of job aid: a sheet of paper with information that guides healthcare providers in treating patients. Each patient has his or her own condition-related CMM, which is maintained in the patient’s chart or on the wall near the patient’s hospital bed to inform providers of the treatment protocol, what treatment was provided when and by whom, what to do should a critical event occur, etc. This report describes a study that implemented two CMMs that were introduced about a year apart in a 500-bed hospital where such job aids had not previously been used.

This study sought to better understand how to sustain provider compliance with standards, using local (Mali) standards (on care for fever and structural quality). The intervention had two parts: a self-assessment instrument that providers used weekly to assess their performance with a feverish client and a review of that performance by a colleague who had observed the consultation. The study found that when used regularly, such an intervention can have a significant effect on compliance.

Research on the Integrated Management of Childhood Illness (IMCI) shows that it is a scientifically sound way to treat sick children, but ways to ensure that it is implemented properly are lacking. This 1997-98 study examined and compared three implementation approaches: structured feedback of performance data, structured feedback of performance data where quality improvement (QI) teams were in place, and the formal World Health Organization training in districts with QI teams.

HIV/AIDS mainstreaming has traditionally been equated with adjusting programs to be more relevant to beneficiaries affected by HIV/AIDS. Bitter experience is demonstrating, however, that civil society organizations (CSOs) are not immune to the impacts of AIDS within their own organizations. Few local CSOs are responding adequately to this threat, partly because they simply do not know the extent of these costs. This paper suggests how CSOs in sub-Saharan Africa can build organizational resilience in order to survive the loss of valuable staff, time and money that HIV/AIDS will cause. It also concludes with practical recommendations for their donors in how they can move beyond being concerned bystanders. [publisher’s description]

The Gender Policy Guidelines have been established in order to support the Department of Health in meeting not only its constitutional commitment to promoting gender equity and equality, but also its own commitments to equity, meeting the needs of those who have been previously marginalized and improving its productivity and quality of care within the health services.

There is no doubt that one of the most effective ways of improving quality of health care at district level, is by means of clinic supervision. To that end, the Clinic Supervisor’s Manual is being used to implement supervision throughout health districts in South Africa. This booklet is a simple tool which guides the effective use of the Clinic Supervisor’s Manual in addition to guiding the day to day activities involved in supervision towards successful and improved outcomes.

This resolution, enacted by the Department of Health in South Africa, details the management and conditions of an allowance designed to attract and retain health workers in rural areas.

The Integrated Management of Childhood Illness (IMCI) strategy seeks to reduce [childhood] deaths through three main components: improving the skills of health workers, improving health systems an improving family and community practices. IMCI has been shown to be associated with improved quality of care, which should result in improved health outcomes. However, concern about the costs of implementing IMCI had been given as a reason why some countries have not adopted it on a large scale. It is important, therefore, to assess whether IMCI does, in practice, cost more than routine care for children who are less than 5 years old, and if so, by how much…Here we present results from the cost components of the MCE study in the United Republic of Tanzania.

Accurate, detailed and up-to-date manpower data is a prerequisite for human resource management. This technical brief describes how the Ministry of Health conducted a human resource mapping exercise of all public health staff in Kenya, and discusses the implications of the findings. The aim is to demonstrate the many practical uses of human resource data. [adapted from author]

To tackle problems of staff shortage and maldistribution, in 2003 the Government of the Republic of Zambia in partnership with the Royal Netherlands Government embarked on a Pilot Zambian Health Workers Retention Scheme (ZHWRS) for health professionals. The scheme had as first objective to replace the Dutch doctors, working under the bilateral agreement between Zambia and the Netherlands. A regular review process was included as part of the scheme. This report is from the Midterm review that took place in January 2005. [from introduction]

Because the demand for health services outstrips the available resources, priority setting is one of the most difficult issues faced by health policy makers, particularly those in developing countries. The objective of this paper is to describe priority setting in a teaching hospital in Uganda and evaluate the description against an ethical framework for fair priority setting processes. [from abstract]

The aim of this interventional study was to assess, document and improve the Patient-held Record System in the Emtshezi Subdistrict. The study began in 1998 and was conducted using a Quality Assurance Cycle, which focuses on systems and processes and encourages a team approach to problem solving and quality improvement. [from abstract]

In South Africa, the distribution of doctors is skewed in favour of the urban areas, but it is not uncommon to find many peri-urban facilities in short supply of doctors. In 1997, the South African government introduced compulsory community service (CS) to address this uneven distribution of doctors in the country. The CS doctors posted to the Letaba-Sekororo hospital complex in Limpopo Province refused to take up their appointments for various reasons, ranging from lack of supervision to poor basic infrastructure. This study is one of the earliest conducted to understand the perceptions of hospital managers on the impact of the national community service on the health service. [publisher’s description]

There is growing interest in the migration of doctors from Africa to developed nations. Little attention has been made in understanding the flow of doctors into African countries. The objective of this article is to describe the nationality, country of primary qualification as a doctor and specialties of doctors registered in Malawi in 2003. [from abstract]

This strategy paper takes stock of “best practice” experiences in supporting communities in their response to HIV/AIDS in several countries in Africa. It draws lessons from Burkina Faso, Côte d’Ivoire, Guinea, Malawi, Nigeria, and Tanzania and sheds light on methods that a growing number of organizations and individuals use to foster behavior change among people living in rural areas. The success stories presented in this paper prove that it is both possible and promising to implement HIV/AIDS programs that include several components and multiple sectors at the community level. [from forwa

NORAD commissioned this study in order to learn how the human resource challenge currently is being addressed in Tanzania. A second aim of the study was to identify knowledge gaps for the development of evidence-based human resource strategies in Tanzania. [from introduction]

This presentation discusses the AMRN role of strengthening nurses and midwives in their responses to HIV/AIDS by improving their knowledge and skills in evidence based practice, research, counseling, advocacy and education. Included is information about the magnitude of the HIV/AIDS problem and some strategies that AMRN has used to address the problem through nurses and midwives.

This report presents findings from Phase 3 of an assessment of the human resources implications of HIV/AIDS services scale-up in Rwanda. It focuses on the staffing implications and associated costs of HIV/AIDS services scale-up. By documenting current staffing levels and the level of effort necessary to provide HIV/AIDS services, Phase 3 of the study analyzes how many full-time equivalent (FTE) staff will be needed, and at what costs, if the Government of Rwanda is to meet its HIV/AIDS service delivery objectives. The human resources projections are based on data gathered during Phases 1 and 2 of the study.

This Kenya assessment is part of a multicountry initiative to provide data and options to policymakers and donors amidst for building the capacity of health care systems in low resource countries through recruitment, training, and deployment of public and private health workers. The assessments look at how human resource (HR) policy and workload planning can address personnel shortages, specifically, gross imbalances across urban and rural areas and among personnel categories, including doctors, nurses, pharmacists, and lab technicians. [adapted from author]

The Health Management Information System (HMIS) in Kwale District, Coast Province is Kenya’s first computerised district-level HMIS. A joint effort of the Ministry of Health and the Community Health Department of the Aga Khan Health Service, Kenya, the system uses simple, user-friendly software developed by Data Dynamics Limited to collect and analyse data from local health facilities.

This issue of the HST Update contains articles on: overview of nursing in South Africa, transforming nursing education towards primary health care, problems in nursing today, nursing summit charters a way forward, placement of nurses, nurse training in Mount Frere health district, and the quest for rational drug use.

In order to identify potentially effective models of home-based care (HBC) within which paediatric palliative care could be integrated, and to identify critical aspects requiring strengthening, the NMCF commissioned an in-depth evaluation of three NGOs that have been supported through the Goelama Program. The objectives of the evaluation were: to evaluate the current capacity of the three HBC projects to provide paediatric palliative care as a component of overall HBC - this focused on the overall management of the projects, as well as the competencies of carers to provide both general HBC and palliative care to children; To explore the possibilities for strengthening the provision of paediatric palliative care as an integrated component of HBC; and to explore the role of home-based carers and HBC projects in the provision of ART to children. [author’s description]

The primary objective of the study was to identify organisations/institutions that provide HIV and AIDS services at the sub-district level, the range of services they provide and their funding sources. This in turn will inform sub-district and district management teams of the progress and impact of services provided and furnish them with tools to monitor the performance and activities on NGOs in their sub-districts and districts. It is hoped that the report will serve as a baseline for ongoing monitoring of the country’s response to the epidemic. Data was collected through self-administered questionnaires, staff interviews and record reviews.

This presentation was part of the Planning, Developing and Supporting the Health Workforce: Human Resources for Health Action Workshop. It briefly discusses the background and some issues for consideration about Malawi’s plan to retain and recruit health workers.


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This presentation was part of the Planning, Developing and Supporting the Health Workforce: Human Resources for Health Action Workshop. It gives an overview of the Southern Africa Capacity Initiative (SACI) Framework, provides examples of SACI applications and discusses the Africa HRH agenda.


To view this presentation, you must have either Microsoft PowerPoint or download the free PowerPoint Viewer.

This presentation was part of the Planning, Developing and Supporting the Health Workforce: Human Resources for Health Action Workshop. It discusses the review of 11 country HR assessments including: Malawi, Lesotho, Ethiopia, Zambia, Botswana, Swaziland, Mozambique, The Gambia, Ghana and Tanzania. It identifies the challenges faced, the implementation, technical inputs, and the process expertise.