Documents & Reports

The study found that about half of the deliveries in Malawi are not assisted by a skilled attendant. It seems that there is a severe and long standing problem with retaining midwives. Therefore, close monitoring of the retention problem is advisable. The research found that the two main forms of losses are that the midwives die or they go abroad. Possible ways of mitigating the loss through emigration could be to continue efforts in enforcing codes of practice on international recruitment in recipient countries.

The numbers of health professionals joining the brain drain has reached a peak in recent years in apparent response to huge demands emanating from the developed countries. The brain drain of professionals, combined with the health crisis, threatens the entire development process in Africa. The crisis in health intensifies with the advent of the HIV/AIDS crisis. The loss of health workers simply serves to worsen a dire situation.

The brain-drain may not be stoppable, but it may be manageable. There is a great deal more that developed countries should be doing to support collapsing health systems in poorer countries and improving incentives for health staff to stay. [From author]

A human rights framework provides a formal and explicit way to examine the different social, political and economic problems that both give rise to, and result from, international migration, in particular inequality. It also allows clear and explicit articulation of where the obligation to do something about these human rights impacts lies under international human rights law, together with migration of health workers; and ensures that any improvements in the right to health are achieved without any express limitation of any other rights, including freedom of movement and rights in work.

This paper should be read in association with its companion paper on migration and human rights (Bueno de Mesquita and Gordon 2005). Our aims are conceptual and agenda-setting. In essence, we argue that current policy responses to migration of health professionals from low income developing countries underestimate the pressures and misidentify the reasons for rising migration, overestimate the impact of recruitment policies on migration flows while ignoring unintended side effects, and mis specify the ethical dilemmas involved.

The purpose of these Guidelines is to assist Member Countries in strengthening the management of their nursing and midwifery workforce and, through this, to assist in strengthening health care delivery and strategies for improving health. In particular, they aim to assist Member Countries by assisting them to effectively manage nursing and midwifery issues, including the problems of continuing shortage and maldistribution of nursing and midwifery personnel along with an inappropriate skill mix. [from introduction]

The main aim of these guidelines is to support countries in the Human Resource Development and management process of assessing the human resource for health situation, policy and plan development with the view of achieving some level of comprehensiveness and consistency country level. The guidelines will discuss HRH processes, situation analysis, policy and plan development with reference to the overall context of national health policies and strategies. These guidelines describe how to formulate, develop, review HRH situations, policies and plans with the flexibility necessary for each country context.

This paper represents one of three components of a larger study examining health worker motivation in two hospitals in the Hashemite Kingdom of Jordan. The goal of this in-depth analysis was to assess which motivational determinants seemed to most influence outcomes of the motivational process. Using self administered, quantitative questionnaires to workers and supervisors, data were collected on 506 workers in two Jordanian hospitals. Motivational outcomes were measured in terms of what workers do (performance), what they feel (affective motivation, such as satisfaction and commitment) and what they think (cognitive motivation).

Health worker motivation has the potential to have a large impact on health systems performance, yet little is known about the key determinants and outcomes of motivation in developing and transition countries. This study, conducted in Jordan and Georgia focused on the individual determinants and outcomes of the worker’s motivational process. A wide range of psychometric scales was used to assess individual differences, perceived contextual factors and motivational outcomes (feelings, thoughts and behaviors). Although the two countries have very different cultural and socio-economic environments, many similarities existed among key determinants between the two countries.

This report is the result of a two-year project. The aim of the project was to examine the crucial issue of nursing shortages and identify priority areas for intervention. Five priority areas of intervention for ICN and nursing were identified: Macroeconomic and health sector funding policies; Workforce policy and planning, including regulation; Positive practice environments and organisational performance; Recruitment and retention, addressing in-country maldistribution, and out-migration; and Nursing leadership.

Measuring, managing and improving organisational performance are key considerations for individuals and teams charged with the responsibility for leading and managing NHS organisations. These are issues that are addressed by this resource, which has been developed specifically to support managers and leaders of NHS organisations to identify and act upon signs of performance decline and failure. [from executive summary]

This document is designed as a resource to support the 10 High Impact HR Changes as outlined in “A National Framework to Support Local Workforce Strategy Development.” These include: support and lead effective change management; develop effective recruitment, good induction and supportive management; develop shared service models and effective use of IT; manage temporary staffing costs; promote staff health and manage sickness absence; promote job and service re-design; develop and implement appraisal; involve staff and work in partnership to develop good employee relations; champion good peop

The main objective of the Ministry of Health (MOH) certification program, which will be called the Health Worker Certification System (HWCS), is to achieve a standard level of quality provided by all health workers. To achieve this level of quality it is critical that the skills of each health worker by certified through a competency-based test. This system of testing will require that all training of health workers in the future be focused on combining knowledge acquisition with hands-on competency based skills, rather than just didactic training. Refresher training and recertification will also be required in order to ensure a basic level of quality.

An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research and programme implementation. The Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources, and cultural institutions for supporting community-based primary health care.

A number of ART projects are trying to tackle the HRH problematic by delegating certain tasks from medical doctors to other cadres. While this task-shifting is certainly an important step, we contend that it will not be enough for scaling up ART in the high HIV-prevalence countries with the most severe HRH shortages. In the present report we argue that an altogether different approach to HIV/AIDS care and treatment might be required for overcoming the HRH bottleneck. [from summary]

There have been reported shortages in both the regulated and unregulated workforce in New Zealand, in particular of medical practitioners, nurses in primary care, mental health professionals, allied and primary health professionals, Māori and Pacific practitioners, and support workers. There is also an ongoing issue of a maldistribution of workers between rural and urban locations. In the future, the constraints on labour supply in New Zealand will necessitate a much greater focus on growing the health workforce and improving the performance and productivity of the available workforce.

Credentialing of health care providers, facilities and educational institutions is an integral component in building and sustaining robust HRH systems. This technical brief examines the characteristics and potential advantages of credentialing mechanisms and common challenges faced in implementing them in low-resource settings. [from author]

A Village Development Committee Orientation organized to allow representatives of different organizations to discuss and identify causes of low coverage and high drop-out in their community. Special emphasis was placed on monitoring the immunization drop-out rate of each health facility. Indicators for VDCs have improved in 2003, and Parsa District is now regarded as one of the highest performing districts in the region.

Australia is experiencing workforce shortages across a number of health professions despite a significant and growing reliance on overseas trained health workers. The shortages are even more acute in rural and remote areas. It is critical to increase the efficiency and effectiveness of the available health workforce, and to improve its distribution. This report describes the Australian government’s objectives of developing a more sustainable and responsive health workforce while maintaining a commitment to high quality and safe health outcomes. A set of national workforce objectives are also proposed.

Shortages of skilled health workers occur in most countries in the world, and most significantly in countries where education levels are relatively high. Migration has tended to be at some cost to relatively poor countries where the costs of production are considerable and losses are not compensated. The costs of global mobility are thus unevenly borne by the poorer source countries and the benefits are concentrated in the recipient countries. Since migration cannot be ended, and source countries have only limited scope for substantial policy change that will improve the number and status of health workers in the home countries, the onus has increasingly shifted towards the role of recipient countries in ensuring that, if migration is to continue, then it be more equitable and that there be adequate compensation for losses incurred in source countries.

The appealing, modern websites of the private agencies specializing in the recruitment of health care professionals for Western markets invite the loggers-on to explore a myriad of opportunities. So fierce is the competition to secure scarce health care professionals that private recruitment agencies stage promotional events and aggressive recruitment campaigns in supplying countries, tripping over each other to attract suitable candidates. How did the shortages of health care professionals become so acute, and how did international migration come to be viewed as one of the solutions to the problem?

To explore the extent, characteristics, incentives, effects and possible regulation of private medical practice in public facilities this study undertook a cross sectional quantitative

There are four types of health providers at present in China. These are defined in terms of differences in ownership. Private practice in the health sector was reintroduced from 1980, when China began its economic reform from a planned economy to a market economy. Dual practice (DP) is quite common and a major concern from the point of view of health policy-making as little is known about it. The aim of this study was to describe policies and regulations of DP, the current situation, its impact on access to services and physician behaviour, and to provide evidence for future policy decisions.

All decentralization initiatives require making changes in the structure of the agency or organization, which means making changes in how the work gets done. It means developing new management systems, training staff in the skills that they will need to perform in their new roles, designing or modifying service delivery systems, and developing strategies for enhancing the long-term sustainability of the program.

Both the advocates and the detractors of decentralization are probably wrong. A thoughtfully designed process of decentralization is not likely to radically improve a health system, nor is it likely to severely disrupt the system. We have evidence that a well-designed decentralization can improve equity of allocations and may have other positive effects such as increased funding of promotion and prevention. Its influence over efficiency and quality is not as clear. These guidelines suggest some mechanisms which can be effective in the design and implementation of decentralization.

This comparative study evaluates the implementation of decentralization of health systems in three Latin American countries: Chile, Bolivia, and Colombia. In terms of the relationship between decentralization and system performance in general, the findings support the conclusion that both the die-hard detractors and the fervent advocates for decentralization are wrong. Decentralization appears to be improving some indicators of equity, such as a tendency toward similar per capita expenditures for wealthier and poorer municipalities, and to be associated with increased and more equitable per capita spending on promotion and prevention.

The general argument for decentralizing health care is the potential for improved service quality and coverage. This note raises the issues to consider if decentralization is to bring about beneficial results. A table summarizes a general framework for assigning responsibilities to central and local levels, while the rest of the note outlines a series of issues to consider. [From author]

In issuing this statement, WHO, ICM and FIGO are advocating for skilled care during pregnancy, childbirth and the immediate postnatal period. This statement is especially aimed at countries in which the coverage of skilled attendance at birth is below 85%. The statement defines clearly who is a skilled attendant, what skills she/he should have and how she/he should be trained and supported. Thus a skilled attendant is an accredited health professional

Specific programs for selected diseases are an important component of the national and international health agenda. But in many developing countries, such programs fail to reach their full potential because of either insufficient implementation capacity or the lack of an integrated approach. For disease control programs to work, attention must be paid to human resources management.

This paper explores human resources constraints with regards to specific disease control programs, and provides an inventory of strategies to overcome these constraints. The paper is an edited version of the report on the meeting of the working group “Priority Diseases,” one of the seven working groups of the Joint Learning Initiative. The Joint Learning Initiative was set up to explore strategies to improve health services delivery through human resources management. [Publisher’s description]

The number of health workers employed is an indicator of a country’s ability to meet the health care needs of its people, especially the poorest and most vulnerable. Resource-constrained countries committed to the Millennium Development Goals are facing up to the reality that shortages and uneven distribution of health workers threaten their capacity to tackle the HIV/AIDS pandemic, as well as the resurgence of tuberculosis and malaria. Worker shortages are linked to three factors: 1) decreasing student enrollment in health training institutions, 2) delays or freezes in the hiring of qualified professionals and 3) high turnover among those already employed.