Journal Articles

We reviewed published literature that outlines the principles of quality assurance in higher education from various institutions worldwide. Using this information, we designed a handbook that outlines the quality assurance principles in a simple and practical way. This was intended to enable institutions, even in developing countries, to adapt these principles in accordance with their local resource capacity. We subsequently pilot-tested this handbook at one of the sites in Ghana. [from abstract]

While the recruitement of rural doctors is steadily rising, there is concern about their long-term retention. In response, an orientation course for recently established rural doctors was set up in 2003, based on a training needs assessment. This paper draws lessons from this experience, focusing on processes and mechanisms operating in the relation between training and retention in rural practice. [adapted from author]

This article reports on an initiative in a rural New Zealand community to meet the need for after hours care. First contact for patients is with a community nursing team operating from the local health centre, complemented by on-call advice from GPs and GP clinics twice daily at weekends. The article reports on the demand for after hours services generated by a geographically defined community in New Zealand. [from introduction]

After a curriculum review, Makerere University’s longstanding traditional curriculum was converted to a problem based learning curriculum with a focus on Community Based Education and Service (COBES). As a component of COBES, radiography, medical, nursing, dentistry and pharmacy students are sent to community health facilities where they are expected to participate in community services and other primary healthcare activities.

There is increasing consensus that training programmes should focus on know-how instead of know-all. IntraHealth International’s Learning for performance: a guide and toolkit for health worker training and education programs offers a step-by-step, customizable approach designed to develop the right skills linked to job responsibilities. Using Learning for Performance yields more efficient training that focuses on what is essential for health workers to do their jobs and on effective learning methods.

Health worker retention is critical for health system performance and a key problem is how best to motivate and retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of financial and non-financial incentives on motivation and retention. [from abstract]

The recruitment of health care practitioners from developing to developed countries is an important topic in global health ethics. This paper examines the emergence of the debate over what is now popularly called the “Brain Drain” – the migration of physicians from developing to developed countries and between industrialized nations. [adapted from abstract]

Health professionals face the duality of the professional and the organizational systems, each of which has its own distinct values, principles and expectations. This study presents organizational and professional commitment concepts and their relations in the context of the health sector. [adapted from introduction]

This article suggests that India’s maternal mortality rate is so high due to political, administrative and managerial issues such as the lack of exclusive midwifery training and professional midwives. [adapted from author]

The theory of planned behaviour states that attitudinal variables such as job satisfaction only have an indirect effect on retention whereas intentions have a direct effect. This study tests for the direct and indirect effects of job satisfaction of nurses during the 3 years after qualification. [adapted from abstract]

This article profiles three leaders from Afghanistan, South Africa, and Southern Sudan who have made a significant difference in those countries’ HR situations. By taking a comprehensive approach and working in partnership with stakeholders, these leaders demonstrate that strengthening health workforce planning, management, and training can have a positive effect on the performance of the health sector. [from author]

Shortages and maldistibution of physicians in northern Ontario, Canada, have been a longstanding issue. This study seeks to document, in a chronological manner, the introduction of programs intended to help solve the problem by the provincial government over a 35-year period and to examine several aspects of policy implementation, using these programmes as a case study. [from abstract]

This paper analyzes China’s current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold difference. Over the past decade there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce.

Epidemiological data indicate elevated psychosocial health risks for physicians, e. g., burnout, depression, marital disturbances, alcohol and substance abuse, and suicide. The purpose of this study was to identify psychosocial health resources and risk factors in profession-related behaviour and experience patterns of medical students and physicians that may serve as a basis for appropriate health promoting interventions. [from abstract]

Irrational drug use is contributed by many factors including care providers giving wrong drug information to patients. Dispensing staff in private pharmacy shops play a significant role in pharmaceutical management and provision of relevant information to clinicians and patients, enhancing the improvement of rational medicine use. This report offers an evaluation/staff assessment of pharmacist knowledge in a situation where they function as health workers in dispensing and prescribing medications. [adapted from introduction]

Increased interest in parasite-based malaria diagnosis has led to increased use of rapid diagnostic tests (RDTs), particularly in rural settings. The scarcity of health facilities and trained personnel in many sub-Saharan African countries means that limiting RDT use to such facilities would exclude a significant proportion of febrile cases. Use of RDTs by volunteer community health workers (CHWs) is one alternative, but most sub-Saharan African countries prohibit CHWs from handling blood, and little is known about CHW ability to use RDTs safely and effectively. [adapted from introduction]

Research has identified that skilled nurses working in rural and remote locations are crucial for the provision of maternity care to rural parturient women. This study considered the experiences of rural nurses and their contributions to maternity care in rural and remote settings and in the small towns where women might be referred for care surrounding childbirth. [from introduction]

The main objective of this study was to assess the role of traditional birth attendants and the quality of their services in contributing to the reduction of maternal deaths in Malawi. [from abstract]

In this paper we review the current situation of human resources for maternal health as well as the problems that they face. We propose seven key areas of work that must be addressed when planning for scaling up human resources for maternal health in light of MDG5, and finally we indicate some advances recently made in selected countries and the lessons learned from these experiences. [from abstract]

This article summarizes the Joint Learning Initiative report that analyzes the global workforce, which proposes mobilization and strengthening of human resources for health is central to combating health crises in some of the world’s poorest countries and for building sustainable health systems in all countries. [adapted from author]

These reports demonstratre that non-physician clinicians and nurses can take over many of the tasks in providing HIV care and treatment (including ART) in some resource-limited settings. [from author]

This article defines the concept of task shifting, outlines the World Health Organization’s “Treat, Train, Retain’s” recommendations and guidelines on task shifting, gives case study examples of how task shifting can be used, defines the remaining barriers and suggests the conditions necessary for the success of task shifting.

In the space of just a few years, close to 300,000 people with HIV have been put onto ART in Ethiopia and Malawi - two of the countries most severely affected by the human resources for health crisis. But while some might suggest that such a rapid scale-up could only have come at the expense of other general health services, Ethiopia and Malawi performed this remarkable feat using HIV/AIDS funding and technical support to launch ambitious and comprehensive human resource plans to strengthen their health sectors overall. [from author]

Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). [from abstract]

The evidence base for strategies and interventions for newborn care in community settings has substantially improved, with a range of interventions that can be potentially packaged for delivery at different times during pregnancy, childbirth, and after birth, through various health-care providers. More recently, efficacy trials in representative rural settings have added to the evidence base. Such studies used innovative approaches with community health workers and varied preventive and treatment interventions. [from author]

This article compares the quality, quantity and distribution of tuberculosis physicians, laboratory staff, community health workers and nurses in Nigeria and Kyrgyzstan, and highlights implications for (re)training tuberculosis workers in developing countries. [from abstract]

There is good evidence and compelling logic to support the principle of task shifting

The objectives of this paper are to highlight the situation of health workers in Pacific and Asian countries to gain a better understanding of the contributing factors to health worker motivation, dissatisfaction and migration; examine the regional and global evidence on initiatives to retain a competent and motivated health workforce, especially in rural and remote areas; and suggest ways to address the shortages of health workers in Pacific and Asian countries by using incentives. [from abstract]

Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy. Because in the current system it takes one to two years to fill vacant positions, even when funding is available, an emergency approach was needed to fast-track the hiring and deployment process. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model that would mobilize 830 additional health workers.

Improving the capacity of developing countries to respond to emerging diseases and especially influenza pandemics is essential to reduce both transmission around the globe and the human toll of outbreaks in the developing world. Investing in this capacity in developing countries is thus increasingly seen as a shared concern within the global community. [from introduction]