Sub-Saharan Africa

In an effort to understand the flows of funds throughout the health system, the Government of Rwanda (GoR) conducted, for the second time, a National Health Accounts (NHA) estimation. NHA is an internationally recognized tool for measuring health expenditures in a comprehensive manner — one that includes the public, private and donor sectors. By doing so, NHA offers a financial perspective on who is paying for health care, who is managing health care funds and their allocation, and where the funds are going — by type of provider and service. In short, NHA aims to inform policymakers on resource flows for the entire health system so as to assist in making good policy decisions and averting potentially adverse ones.

QAP implemented the first randomized control trial to measure the impact of accreditation in a developing country setting and reports its findings in this Operations Research Results report. The central issue to the report addresses the extent to which accreditation, known to favorably impact measurable indicators relating to the quality of care, actually improves patient outcomes. While exploring this issue, the report also sheds light on the importance of careful planning and communication in implementing complex research and would serve as a guide to others in undertaking similar efforts.

This study explored the factors that motivate lay volunteers to join tuberculosis (TB) control programmes in high burden but resource-limited settings. [adapted from abstract]

This report attempts to provide a comprehensive assessment of health outcomes and of the health sector performance in targeting the poor. The report is guided by the Poverty Reduction Strategy Framework on health, nutrition and population and poverty. It also uses the frameworks on accountability and service provision from the World Development Report 2004: Making Services Work for Poor People. The report builds upon a vast literature on the health sector in Uganda and uses available data from surveys and the health information system for its analysis. It provides an in depth examination of inequalities in health outcomes, health behavior and practices and of health system performance and financing from the equity perspective.

This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options. [from abstract]

This study was carried out in order to determine factors that may facilitate the poor retention of registered nurses in the Malawian public health sector.

This review examines the systemic and individual causes of multiple job holding (MJH) and evidence on its prevalence. MJH should be seen as resulting initially from underlying system-related causes. These include overly ambitious efforts by governments to develop and staff extensive delivery systems with insufficient resources. Governments have tried to use a combination of low wages, incentives, exhortations to public service, and regulation to develop these systems.

This report emanates from the results of a study that examined the impact of HIV/AIDS on the public and private health facilities in South Africa, and outlines the subsystems that are affected. Both public and private sector health facilities have reported an increase in the number of patients seeking clinical care for people living with HIV/AIDS, leading to increased admissions to medical and pediatric wards and increased workloads. This study addresses these issues and makes recommendations for managing the HIV/AIDS case load. [from author]

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels. [from abstract]

As a key contribution toward increasing human capacity in national health systems, the Capacity Project is hosting a series of Human Resources for Health (HRH) Action Workshops. The initial workshop—held in Johannesburg in partnership with the United Nations Development Programme/Southern Africa Capacity Initiative (UNDP/SACI)—facilitated the exchange of knowledge and best practices in planning, developing and supporting the health workforce.

The three and one-half day workshop brought together 38 HRH leaders from 11 countries (Kenya, Lesotho, Malawi, Namibia, Rwanda, Sudan, South Africa, Swaziland, Tanzania, Uganda and Zambia).

This report examines whether Zambia’s hospital accreditation program improved health outcomes and other indicators. Performed after an accreditation program had been launched in about 40 hospitals, the evaluation examined eight indicators of healthcare quality at hospitals that had and had not been exposed to the accreditation program.

The National Human Resource Plan is a national guideline for all stakeholders. It outlines broad issues whilst taking the lead in some areas in order to facilitate the resolution of some of the chronic systemic challenges facing the health system. In implementing this plan, all stakeholders will be required to adapt to the guidelines expressed here. It is envisaged that there will be a measure of variation between the provinces, because each province must take into consideration the prevailing conditions and demands on its human resource capacity to plan objectively.

An annual review done against the priorities set in the South Africa Health Sector Strategic Framework, 1999 to 2004, and in the Strategic Plan of the National Department for 2003/04 to 2005/06. Section 2 is devoted to Human Resource Management Data.

This paper illustrates that the way human resources for health (HRH) are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers.

This report presents findings from a nationwide Expenditure Tracking and Service Delivery Survey implemented in Mozambique between August and October 2002. The study focuses on the primary health care system, which is frequently the only source of health care for most Mozambicans. The report covers a broad set of issues, including institutional context, budget management, cost recovery, allocation and distribution of drugs, human resources, infrastructure and equipment, and service outputs. [from abstract]

These briefs are primarily intended for directors and managers of community- based health care programmes—whether working within ministries of health, international donor agencies or non-government organizations. This brief takes up a number of likely questions about the management functions of the nurses in charge of small, local health facilities:

• How prepared are “nurses in charge” for carrying out administrative and management functions?
• How should they relate to the new management committees?
• What additional training do they need?
• What are the lessons from the Kwale project—lessons about the training of nurses—that can be applied elsewhere?
  

African public health care systems suffer from significant brain drain of its health care professionals and knowledge as health workers migrate to wealthier countries. In this paper, the brain drain is defined as both a loss of health workers (hard brain drain) and unavailability of research results to users in Africa (soft brain drain).

The overall objective of this paper is to provide some insights into the effects of the HIV epidemic on human capital in sub-Saharan Africa through a discussion of some of the factors that are operating. It is not intended as a compendium of data on the problem but aims instead to provide an analytical framework for understanding the policy and programming issues. There is an analysis of the impact on the public services in Malawi, a detailed presentation of the impact on education and health and a discussion of issues relating to the measurement of the impact on different productive sectors and the role of different social partners in adjusting to, and managing, the impact.

Donor funds may be inadequate to support the growing demand for services provided by community-based distribution (CBD) programs. One solution may be to reduce the remuneration of CBD agents, but this approach may lower their productivity. Programs also need to consider reducing other costs, including those for supervision and training. The cost per agent visit—including costs associated with payments to agents and to supervisors and the costs of training—was calculated for three CBD programs in Tanzania. The output measure was visits in which contraceptives were provided or referrals made for family planning services.

Health services in the UK are benefiting from the collapse of health services in some of the poorest countries of the world due to the widespread and increasing migration of health professionals. Children in these countries are unable to obtain the most basic health services and many die as a consequence. Research summarised in this briefing reveals that current UK policy in this area is ineffective in tackling this inequality. Using Ghana as a case study, it sets out a range of practical suggestions for how the UK Government should respond. [From author]

Zambia’s recently developed hospital accreditation program is a major component of ongoing health sector reforms that have taken place in the country during the last decade. Although Zambia previously had several processes in place for evaluating hospital performance, comprehensive performance standards had not been developed and quality measurement was not standardized.

This study indicates that healthcare professionals are using mostly clinical handover meetings, seminars and workshops for their continued professional development (CPD). There is need to improve access to relevant professional journals. The regulatory or licensing boards for healthcare professionals in Malawi should seriously consider mandatory CPD credits for re-certification. [author’s description]

This report is an attempt to systematically document and evaluate the state of the health workforce in Africa. It draws on academic published literature (which is limited), the WHO statistical database (which is incomplete and only sporadically updated), studies of bilateral donors, national documents, and newspaper articles. The report shows clearly that for more than a decade HR issues have received very little attention. [from foreword]

Traditionally, training institutions have in the main adopted the training programmes of rich countries. Graduates from these programmes have not usually been suitably adapted to the needs of the communities where the vast majority of people live. As such, their practice has not been based on an appropriate consideration of the social determinants of health. Graduates have offered services which have neglected key aspects of people’s living and working circumstances and lifestyles as well as the health implications of economic policies. [from abstract]

There has been a lively debate in the media about working conditions in rural South African Hospitals, with a particular focus on staffing and quality of care. From a medical perspective, it has been stated that poorly equipped and managed hospitals, inappropriate training and an excessive workload are significant contributors to the problem. This study was conducted to investigate the experiences of medical practitioners in performing their professional duties in rural district hospitals in the Western Cape. [from abstract]

The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care.

The purpose of this strategy is to guide the planning, management and development of human resources for health in Eritrea for the period 2006 - 2014. Whilst much progress has been made with the staffing of the health services in the health sector, there is still more work to be done. There is a general shortage of health professionals, particularly amongst more highly skilled groups. Although geographic distribution is relatively good compared to many countries in Africa, there are still health stations and health centres that are under-staffed. There is a major shortage of midwives, exacerbating the high rate of maternal mortality. [from author]

The core objective of the plan is national, comprehensive treatment and care for HIV/AIDS with equal access to services, long-term commitment, improvement of Rwanda’s general health services infrastructure beyond HIV/AIDS, and financial transparency. The approach for implementation will involve service integration with existing health system infrastructure, community mobilization, linkage between treatment and care and prevention, multi-country procurement economies of scale, and rapid scale-up and iterative learning based on a collaboratives model.

A cautiously optimistic appraisal of the Tanzania Health Interventions Project (TEHIP) in Tanzania, which was designed to test the proposition that mortality and morbidy rates in developing countries could be significantly reduced even with modest resources if health care funding was allocated to cost-effective health interventions more in line with the prevailing local burden of disease. [from preface]

This brief report describes four different accreditation programs in South Africa: one is nationwide and addresses hospitals; the second accredits privately financed healthcare programs; the third is a provincial program accrediting all public healthcare facilities, and the fourth assesses clinics providing adolescent reproductive health. This operations research study interviewed stakeholders of the South Africa healthcare system to elicit their views of the best possible options for South Africa and of the strengths and weaknesses of the four existing programs. [author’s description]