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Nursing Brain Drain from India

In response to recent findings regarding migration of health workers out of Africa, we provide data from a survey of Indian nurses suggesting that up to one fifth of the nursing labour force may be lost to wealthier countries through circular migration. [abstract]

Human Resources for Health at the District Level in Indonesia: the Smoke and Mirrors of Decentralization

The objective of this article is to determine the stock of human resources for health in 15 districts, their service status and primary place of work. It also assesses the effect of decentralization on management of human resources and the implications for the future. [from abstract]

China's Barefoot Doctor: Past, Present and Future

This document discusses China’s long struggle with rural coverage for health care through the barefoot doctors program, which was introduced as a national policy focused on quickly training paramedics to meet rural needs. [adapted from author]

Costs of Eliminating Critical Shortages in Human Resources for Health

This presentation was part of the WHO-OECD Hosted Dialogue on migration and other
health workforce issues in a global economy. It discusses the cost of providing the minimum number of health workers for developing countries in terms of increasing the production of health workers, taking into account the diversity and competencies of health workers, and augmenting financial rewards and improving the working environment. [adapted from author]

What about the Health Workers? Improving the Work Climate at Rural Facilities in Kenya

In health facilities across Kenya, many workers are struggling to do their jobs in less-than-ideal conditions. Work climate issues such as poor working environments, unfriendly colleagues, disorganized facility functions and ineffective supervision have been hindering workers’ performance and productivity and contributing to low retention. [from author]

Improving Efficiency: Assessing Efficiency in Service Delivery

In recent years, some efforts have been made at developing systems for assessing performance and generating information to assist in the distribution of resources in the health sector. However, most of these measurements have focused on the implementation of services and the intermediate steps that determine how inputs are transformed into outputs. This document uses available information to estimate the cost of providing service and workload analysis in order to provide a picture of efficiency in the delivery of services. [from introduction]

Accelerating Reproductive and Child Health Program Impact with Community-Based Services: the Navrongo Experiment in Ghana

This report concludes that assigning nurses to community locations where they provide basic curative and preventive care substantially reduces childhood mortality and accelerates progress towards attainment of the child survival MDG. The research in Navrongo demonstrates that affordable and sustainable means of combining nurse services with volunteer action can accelerate attainment of both the International Conference on Population and Development agenda and the MDGs. [from summary]

Maternal Mortality Update 2006 - Expectation and Delivery: Investing in Midwives and Others with Midwifery Skills

This document reviews the issues around midwives and others with midwifery skills: who they are, what they do and how to scale up professional attendance at all births. It also includes case studies of midwifery initiatives. [adapted from summary]

Midwifery in the Community: Lessons Learned

This report documents experiences and lessons from the First International Forum on Midwifery in the Community related to training and scaling-up the midwifery workforce.

Towards MDG5: Scaling up the Capacity of Midwives to Reduce Maternal Mortality and Morbidity

Urgent support to increase the numbers and skills of midwives would save the lives of 5 million women, prevent 80 million illnesses and disabilities from pregnancy or childbirth and save the lives of countless newborns. The goal of this workshop is to contribute to that agenda, and respond to the global focus on human resources for health. [from executive summary]

Investing in Midwives and Others with Midwifery Skills to Save the Lives of Mothers and Newborns and Improve Their Health

This guidance note is designed for countries seeking to scale up midwifery services, especially at the community level. It outlines in detail the action required by policy-makers and program managers to effect change at country level and scale up midwifery capacity, specifically in poor and hard-to-reach areas.

Health Worker Densities and Immunization Coverage in Turkey: a Panel Data Analysis

Increased immunization coverage is an important step towards fulfilling the Millennium Development Goal of reducing childhood mortality. Recent cross-sectional and cross-national research has indicated that physician, nurse and midwife densities may positively influence immunization coverage. However, little is known about relationships between densities of HRH and vaccination coverage within developing countries and over time. This study examines HRH densities and coverage of the Expanded Program on Immunization (EPI) in Turkey from 2000 to 2006. [from abstract]

Implementing a Community-Based Tuberculosis Program in the Omaheke Region of Namibia: Nurses' Perceived Challenges

The purpose of this survey was to identify nurses' perceived challenges in implementing a community-based TB program in the Omaheke region of Namibia. The HIV pandemic has increased the number of TB patients and increased nurses' workloads, aggravating the burden of TB as a resurgent disease in this region. In order to implement a successful community-based TB program, the patient-related, access-related and knowledge-related challenges, perceived by the nurses, need to be addressed effectively. [from abstract]

How Can Optimal Skill Mix be Effectively Implemented and Why?

This policy brief describes steps towards the determination and implementation of an optimal skill mix within a health system, including definition of the skill mix and how to achieve clarity regarding the key policy problems for which it is envisioned as a solution. [from executive summary]

Role of Community-Based Surveillance in Health Outcomes Measurement

A community health planning and service strategy was started in Ashanti region in 2001 with the intention of improving geographic access to comprehensive health care. The region used community-based surveillance as an entry point. The implementation process and health outcomes were tracked and evaluated after a year. [from summary]

Emergency Medical Services

This resource is a chapter from Disease Control Priorities in Developing Countries. Despite the best efforts of primary care providers and public health planners, not every emergency is preventable. Actual provision of emergency care may range from delivery using trained emergency professionals to delivery by laypeople and taxi drivers. Developing strategies to meet the range of needs posed by such diverse circumstances will require innovation and a reorientation of public health planning. [from introduction]

Retention of Health Care Workers: Countries' Experiences - Swaziland

This presentation details the issues of migration and retention in Swaziland.

Using Human Resource for Health Data: Health Policy and Program Planning Examples from Four African Countries

Imbalances in quantity and quality of human resources for health (HRH) are increasingly recognized as perhaps the most critical impediment to achieving health outcome objectives in most African countries. However, reliable data on the HRH situation is not readily available. Some countries have hesitated to act in the absence of such data; other countries have not acted even when data are available while others have moved ahead in spite of the lack of reliable information. This paper addresses the issue of data use for HRH policy-making. [from summary]

Perceived Educational Value and Enjoyment of a Rural Clinical Rotation for Medical Students

It is well-recognised that medical students whose training exposure is largely limited to tertiary-level training hospitals may be inappropriately equipped to deal with the most relevant health issues affecting rural communities. This article evaluated the perceived educational value of a 2 week clinical rotation undertaken by senior undergraduate medical students at rural district hospitals and health care centers in the Western Cape Province, South Africa. [from abstract}

Drawing on Data: Effective Decision-Making for the Health Workforce

The Capacity Project has been helping to strengthen human resources information systems (HRIS) in several African countries, and many of the systems are now able to produce useful reports about the health workforce. [from author]

Primary Health Care Delivery Models in Rural and Remote Australia: a Systematic Review

This is the first study to systematically review the available published literature describing innovative models of comprehensive primary health care (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993-2006). The study aimed to describe what health service models were reported to work, where they worked and why. [from abstract]

Data Demand and Information Use in the Health Sector: A Conceptual Framework

This publication provides a framework for health and information professionals, as well as stakeholders, for improving the use of information to guide policymaking, program design, management, and service provision in the health sector in developing countries. [adapted from introduction]

Effective Scale-Up: Avoiding the Same Old Traps

Despite progress in developing more effective training methodologies, training initiatives for health workers continue to experience common pitfalls that have beset the overall success and cost-effectiveness of these programs for decades. These pitfalls are now seen as aggravating the current crisis in human resources for health and impeding the effective scale-up of training and the potential impact of promising strategies such as task shifting to address health worker shortages.

Programme Evaluation Training for Health Professionals in Francophone Africa: Process, Competence Acquisition and Use

While evaluation is, in theory, a component of training programmes in health planning, training needs in this area remain significant. Improving health systems necessarily calls for having more professionals who are skilled in evaluation. This article describes a four-week course taken by two cohorts of health professionals from 11 francophone African countries. We discuss how the course came to be, its content, its teaching processes and the master’s programme results for students. [from abstract]

Measuring Inequalities in the Distribution of Health Workers: the Case of Tanzania

The overall human resource shortages and the distributional inequalities in the health workforce in many developing countries are well acknowledged. However, little has been done to measure the degree of inequality systematically. This paper describes and measures health worker distributional inequalities in Tanzania on a per capita basis; and it suggests and applies additional health care needs indicators in the measurement of distributional inequalities. [adapted from abstract]

Retention Strategies for Swaziland's Health Sector Workforce: Assessing the Role of Non-Financial Incentives

This country study in Swaziland thus sought to map and assess incentives for retaining heath workers, particularly non-financial incentives. Specifically it sought to identify existing policies and measures for incentives for retention of health workers, their relevance to current factors driving exit and retention, and propose inputs for guidelines for introducing and managing incentives for health worker retention to maximize their positive impact. [from summary]

Issue Brief: Increasing the Role of the Private Health Sector

In sub-Saharan Africa, the private health sector ranges from traditional healers, pharmacies, and shopkeepers selling health care products, to nonprofit and for-profit clinics and hospitals. There are a variety of reasons people use the private health sector including convenience, perceived quality, confidentiality, or because nothing else is available. Moreover, private health care in sub-Saharan Africa is not just for the rich. Africans of all socioeconomic backgrounds turn to the private sector for their health care needs. [from author]

Central America Field Epidemiology Training Program (CA FETP): a Pathway to Sustainable Public Health Capacity Development

The Central America Field Epidemiology Training Program (CA FETP) is a public health capacity-building training programme aimed at developing high-caliber field epidemiologists at various levels of the public health system. The curriculum is competency-based, and is divided into a three-tiered training pyramid that corresponds to the needs at the local, district and central levels of the health system.[adapted from abstract]

Experience of Virtual Leadership Development for Human Resource Managers

Strong leadership and management skills are crucial to finding solutions to the human resource crisis in health. Health professionals and human resource (HR) managers worldwide who are in charge of addressing HR challenges in health systems often lack formal education in leadership and management. The Virtual Leadership Development Program is a web-based leadership development program that combines face-to-face and distance learning methodologies to strengthen the capacity of teams to identify and address health challenges and produce results. [adapted from abstract]

Vietnamese-Born Health Professionals: Negotiating Work and Life in Rural Australia

The two main objectives of this study were to examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse and identify key coping strategies used by them when in working in the rural context. [from abstract]