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This resulted in a collection of papers with very different viewpoints and formats, reflecting the different professional and geographical backgrounds of the participants. First a set of papers describes the performance of health personnel in a number of countries and attempts to improve it. A second part looks more closely at the various coping strategies health care workers, medical and paramedical, clinical and managerial, actually apply to deal with difficult working and living conditions.

Published lessons learned from high HIV prevalence countries suggest that there are several key lessons available for any organisation that wishes to embark on an internal HIV/AIDS policy development process. This report contains first-hand experience by the Dutch Ministry of Foreign Affairs on its HIV/AIDS policy development process, plus comparative examples from various organisations. [from executive summary]

This report presents the finding from an study to determine the impact of HIV/AIDS on the public sector in Malawi. Section E, 3 establishes the impacts of HIV/AIDS on the Ministry of Health and Population and on health workers including statistics of attrition by occupational category in the health sector, morbidity and absenteesim, vacancy levels. It also analyzes effect on health worker workload, discusses the impact on productivity and performance, the financial implications, impact on service provision, and institutional vulnurability to HIV/AIDS.

A growing body of evidence suggests that the quality of a health system depends greatly on highly motivated health workers who are satisfied with their jobs, and therefore stay at their stations and work. This paper reviewed evidence from published and grey literature on the use of non-financial incentives for health worker retention in sixteen countries in east and southern Africa. [adapted from author]

This is the first in a series of three papers that examines the financing of services in developing countries. This paper focuses on external assistance in the form of aid and debt cancellation to finance the recruitement, training and salaries of health and education workers. It also discusses the factors that contribute to the critical shortage of these workers and explores some approaches to scaling-up the recruitment of health workers and teachers. [adapted from author]

The development of the delivery of reproductive health services is continually confronted by challenges from a changing environment, an important element of which is health sector reform, in particular decentralization, which is being undertaken by most governments in Africa. The general objective of this research is to make health sector decentralisation more effective in the development of appropriate reproductive health services. In Chapter 8 human resource management and development as it has been affected by decentralization is discussed. [adapted from introduction]

Violence in the social services work place in general, and the developmental services in particular, has increased in the last several years. Findings from an ethnographic study suggests that new, lean forms of work organization remove opportunities to use or learn many of the tacit or practice skills workers previously used to keep themselves and their clients safer in the work place. This article describes many of these skills and the new management schemes that remove the possibility to develop or transmit these praxis skills.

To objective of this article was to determine the prevalence and nature of workplace violence against nurses, how nurses deal with such aggression; and to identify the risk factors related to violence in the hospital environment. [author’s description]

This study was done to determine the prevalence of experiences with physical violence and psychological violence that health staff have had in the workplace in Jamaica, and to identify factors associated with those experiences of violence. [from abstract]

Workplace violence is one of the most complex and dangerous occupational hazards facing nurses working in today’s health care environment. This article includes critiques of the conceptual, empirical, and policy progress of the past decade, a discussion of the need for methodologically rigorous intervention effectiveness research, and a description of a joint-labor management research effort aimed at documenting a process to reduce violence in a state mental health system. [from abstract]

The purpose of this policy and guidelines is to ensure that in all violent incidents, appropriate action is consistently taken to protect health service staff, patients and visitors, and health service property from the effects of such behaviour. The guidelines are provided as a reference tool and should be used to develop local policies and procedures that reflect the intent of this document, and that are specifically targeted at and adapted to local workplace cultures, situations and needs. [from introduction]

The incidence and severity of occupational violence varies across health care occupations because risk factors differ between locations and according to job tasks. Patterns of violence also vary because some health workplaces adopt improved prevention. This discussion paper provides an overview of some of the strategies that may reduce the incidence and severity of occupational violence. [adapted from author]

Strategies to prevent and manage violence and aggression in the health care setting have become a primary health and safety issue. A series of vignettes are provided to highlight key elements in developing a program for preventing behavioural violence and aggression in a tertiary hospital. Key components of the program include staff education and training, risk assessment and management practices, the use of patient contracts and policy development. The program aims to integrate and balance occupational health and safety obligations to staff with the duty of care owed to patients. [abstract]

The guides in this toolkit are intented to be used to facilitate a broad discussion of the elements and conditions that underpin the concept of informed and voluntary decision making, help users assess the status of sexual reproductive health decision making in a given program by identifying the challenges and supporting factors at the individual/community, service-deliver, and policy levels, and to help users plan strategies to strengthen supports for clients’ reproductive health decision making.

Although the [critical shortage of health care workers] is not new, recent international efforts to vaccinate children and to fight HIV/AIDS, malaria, tuberculosis, and other diseases have brought it into sharper focus. The worker shortage derives from a combination of underproduction, internal maldistribution, and emigration of trained workers (“brain drain”). Fortunately, many African countries have begun attacking the problem by implementing innovative programs that may serve as models for other countries. Once effective pilot programs have been identified, scaling up will be the next hurdle: programs that are found to work on a small scale or in a particular environment may not be easy to expand or replicate.

This paper reports the findings of the PET/QSDS pertaining to human resources for health in Zambia. The Public Expenditure Tracking and Quality of Service Delivery survey (PET/QSDS) was undertaken in mid-2006 to provide quantitative assessment of the state of health service delivery in the country. One component of the survey focused on the management of health personnel, including staff availability, vacancy, absenteeism, and tardiness; staff turnover; staff workload, use of time, and morale; and staff salary and benefits. [from introduction]

Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors. [abstract]

International medical graduates (IMGs) have been a valuable resource for the United States physician workforce, and their contribution to the United States workforce is likely to increase. This article describes the historical trends and compare the characteristics of IMGs to United States medical graduates in the United States. It also recommends that policymakers consider the consequences for both the United States and source countries. [adapted from abstract]

The goal of this policy is to help management and staff minimize the risk of TB transmission in health care facilities and other facilities where the risk of transmission of TB may be high due to high prevalence of both diagnosed and undiagnosed TB such as prisons.

Malawi has a critical human resources problem particularly in the health sector. The College of Medicine (COM)is the only medical school. For senior staff it heavily depends on expatriates. We explore to what extent a brain drain took place among the COM graduates by investigating their professional development and geographical distribution.

This news article presents a study in Uganda that found HIV-positive Ugandans are twice as likely to quit antiretroviral therapy (ART) if they also use traditional herbal medicine. It suggests that the integration of traditional healers into modern medical practice needs to be handled more cautiously and that rather than shunning traditional healers, the solution is to work closely with them. [adapted from author]

West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes and consequences of the migration. We conducted interviews and focus groups with faculty, administrators (deans and provosts), students and post-graduate residents in six medical schools in Ghana and Nigeria. In addition to the migration push and pull factors documented in previous literature, we learned that there is now a well-developed culture of medical migration.

This conference aimed to address the global health care workforce shortage: what has been done and what steps are still needed to solve this critical problem. The meeting linked research, policy and action for global human resources for health. [publisher’s description]

Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration. [from abstract]

There is growing concern globally at the current flows of nurse migration, particularly from low-income to middle and high-income countries. Recruitment practices of many countries such as Ireland are thought to be fuelling this rate of migration. This paper aims to establish the perceptions and opinions of those involved in the recruitment process on their role in recruitment and the effects recruitment has on both source and destination countries. [from abstract]

This article assesses interventions aimed at improving family planning mechanisms and reviewing the problem-solving processes to build an effective monitoring system of the interventions at the local level of the overall system of the Ministry of Health and Family Welfare of the Government of Bangladesh. [adapted from author]

World health statistics 2007 presents the most recent health statistics for WHO’s 193 Member States. This third edition includes a section with 10 highlights of global health statistics for the past year as well as an expanded set of 50 health statistics. [publisher’s description] The section on Health Workforce Statistics gives a breakdown of the total number and density by population for the 193 member countries.

While publications like the World Health Report have described general approaches that can be taken to improve the human resources for health (HRH) situation at the country level, there is a relative paucity of more detailed documentation that describes promising practices that would be useful to HRH leaders and practitioners. As a result, USAID’s Africa Bureau commissioned a study to identify and document promising practices in a way that takes into account the context of the practice, describes lessons learned and puts forth potential implications for replication in other countries. The intent of the promising practices study is to “serve as a practical and much needed resource for governments, partners and donors in promulgating policies and approaches that have successfully mitigated the negative effects of the health workforce crisis.” After consultation within USAID, it was decided that the study would focus on promising practices in four African countries: task shifting in Ghana and Uganda, improving retention in Malawi, and increasing recruitment and rapid deployment in Namibia.

This brief discusses Capacity’s experience with partnering with faith-based organizations (FBO), the critical role these organizations play in improving Africa’s health workforce and some challenges to working with FBOs.

The report of the Africa Working Group (Joint Learning Initiative) is in 4 main parts covering a situation analysis, opportunities that arise and the preconditions for effective strategies.