Briefs

This technical brief discusses the shortage of human resources for health (HRH) that threatens the health care delivery system in many countries, particularly in Africa; and promising practices to strengthen HRH including: workforce planning, task shifting, strengthening HR information and management systems, promoting retention and gender equity, and establishing partnerships. [adapted from author]

Leaders of the University of Belize’s Faculty of Nursing and Allied Health had a vision. Their country has the third highest HIV prevalence in the region, after Haiti and Guyana, yet it lacked an effective system for training providers in counseling and testing. As faculty members, they dreamed of establishing a national training center that would provide the latest resources and trainings for both students and providers. [from author]

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]

To help build the health workforce, the Capacity Project assisted Uganda’s Ministry of Health to craft and implement a comprehensive agenda for human resources for health… Improved human resources information systems (HRIS) will help the Ministry to plan for recruitment, training and retention of health professionals. [from author]

Credentialing of health care providers, facilities and educational institutions is an integral component in building and sustaining robust human resources for health (HRH) systems. The credentialing mechanisms

What effect does the increased number of Malawians living with HIV/AIDS have on the public health sector? To address this question, the Commonwealth Regional Health Community Secretariat (CRHCS) and Malawian researchers from the Ministry of Health and Population (MoHP), with support from the U.S. Agency for International Development, Bureau for Africa, undertook an assessment to explore the effects of HIV/AIDS on the health workforce. [author’s description]

Contraceptive provision in many settings continues to be based on outdated medical information, unproven theoretical concerns, and provider biases. Studies have found that in some developing countries 25-50% of women seeking contraceptives are refused services until they are menstruating. Coupled with effective training, checklists can be important tools for health care workers at various levels to apply the latest WHO medical eligibility criteria and guidelines for contraceptive use. The pregnancy, combined oral contraceptive (COC), depot-medroxyprogesterone acetate (DMPA), and intrauterine device ( IUD) checklists allow health care workers to avoid medical barriers and better provide methods of contraception.

A comparison showed that two models for teaching maternal care skills to providers resulted in similarly modest improvements in knowledge and performance. However, maternal care skills remained weak overall. Training should incorporate the best elements of the two approaches while seeking improvements in basic knowledge of maternal care. [author’s description]

Today’s health professionals are inappropriately trained to address the health of the public, particularly the large proportion who are disadvantaged; they are also maldistributed by specialty and geography. Health disparities exist worldwide, but are of crisis proportions in developing countries where the magnitude of health problems far outstrips the available meager resources. Community-based education has the potential to train service providers, educators and researchers who can assist communities to identify their priority health needs and to implement feasible, affordable and sustainable interventions.

While the availability and use of trained midwives can shape the quality of care received in pregnancy and childbirth, a number of other underlying health systems structures and processes are important. The management of health workforces, the mix of public and private provision and the impact of reforms affect quality of care across countries…[This study] examined how the structure and operation of a health system influences maternal health care provision and outcomes in Bangladesh, Russia, South Africa and Uganda. [author’s description]

People caught in crisis situations have crucial reproductive health needs. The needs of pregnant women are most urgent. Complications of labor and delivery can be life-threatening when women lack adequate care. Risk for HIV/AIDS, other STIs, and unwanted pregnancy increases, particularly when disorder provides cover for rape and other sexual coercion. Health care providers understand people’s needs and have experience meeting them, but few have worked in humanitarian relief. By learning more and being prepared, family planning providers and managers - whether at the community level or internationally-could help in several ways.

This research brief presents results from a cost analysis of an adolescent reproductive health intervention that found that using community health workers was less expensive than using doctors for provision of reproductive health services to young women. [from publisher]

Credentialing is a means of assuring quality and protecting the public by confirming that individuals, programmes, institutions or products meet agreed standards. Credentialing is becoming increasingly important as health systems strive to address issues of public safety and quality services. [author’s description]

The aim of this Kwik Skwiz is to introduce and contextualise cross-site visits, consider their benefits and costs and finally to assist others in planning cross-site visits, while sharing lessons on what contributes to and what detracts from a successful visit. Cross-site visits are a very effective means of sharing lessons between districts and may still prove to be one of the most useful and effective methods.

In developing countries, postabortion care (PAC) programs are frequently available only in urban or regional health facilities, placing rural women at greater risk for mortality and morbidity from complications because they lack access to services. This technical brief evaluates efforts to decentralize PAC activities in Senegal and Tanzania that show PAC can be safely and successfully decentralized with services capably provided by mid-level personnel in health centers, dispensaries, and some health posts when providers are trained and supervised and equipment and supplies are available. [adap

Evidence Update is a two-page summary of a Cochrane Review of healthcare interventions relevant to people in low-income and middle income-countries. This issue reviews whether lay health workers improve health care delivery and health care outcomes.

Under the ENABLE Safe Motherhood Core Initiative, CEDPA/India collaborated with the Community Aid and Sponsorship Program on the Safe Motherhood Initiative to reduce maternal death by showing women, their families and their communities how to prepare for a safe delivery, to identify pregnancy-related complications at their onset, and to seek medical help immediately. [publisher’s description]

NGOs that provide basic health care to the poor must become less dependent on donor support by diversifying their funding. The NGO Service Delivery Program (NSDP), a USAID-funded health care program in Bangladesh, is working with NGOs to find corporate sponsorship. [publisher’s description]

There are substantial differences in the working lives of women and men and this affects their occupational safety and health (OSH). The Community strategy on health and safety at work has mainstreaming, or integrating, gender into occupational safety and health activities as an objective. To support this, the Agency has produced a report examining gender differences in workplace injury and illness, gaps in knowledge and the implications for improving risk prevention. This factsheet summarizes the main findings. [adapted from publisher’s description]

The involvement of district-level workers in local-level practical approaches to mainstreaming gender is central to facilitating change and informing health strategies. There are very few practical examples of mainstreaming gender in health, especially at the lower levels of the health sector. One approach is to build the capacity of staff to conduct and respond to gender analysis. [author’s description]

Birth spacing — the practice of timing the interval between births — is recognized as a significant health-improving and life-saving measure for mothers and children. This brief discusses PSI’s programs to promote birth spacing including managing franchised networks of doctors and clinics

This paper summarizes the outcome of a workshop to examine National Health Service workforce supply and demand. [from abstract]

This is the fourth of a series of policy briefs produced by the Community Health Department of the Aga Khan Health Service in Kenya. It focuses on a number of issues related to the management of health facilities: the rational for decentralisation of health services, the role of the community in the management of health facilities, the membership of local management committees, selection criteria and, finally, the involvement of local politicians.

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 organisations.

Health workers are at the core of health systems everywhere. Where there are health worker shortcomings, health systems suffer, resulting in insurmountable preventable deaths and disease. Such is the case now in sub-Saharan Africa where the health worker shortageof over 1 million is truly the bottleneck in AIDS care delivery. [author’s description]

Many health service managers are familiar with the problem of absenteeism in district hospitals. It affects the running of the hospital and can seriously compromise the quality of care which patients receive. For the purpose of this Kwik-Skwiz absenteeism is defined as staff taking time off that has not been scheduled or staff taking more leave than is necessary or reasonable. Clearly there are many legitimate reasons for taking sick or other types of leave. It is often debatable how much leave is reasonable. It often depends on the pattern and circumstances, rather than the actual total amount of leave that an individual takes. Managers have a responsibility to balance the rights and needs of individual staff members, with the needs of the hospital. High levels of absenteeism, both on the part of individuals or in the whole hospital, are often symptomatic of underlying problems. Addressing these issues can result in lower absenteeism levels that benefits staff, managers and patients. [author’s description]

Accurate, detailed and up-to-date manpower data is a prerequisite for human resource (HR) management. This Technical Brief describes how the Ministry of Health (MoH), with support from HLSP, conducted a human resource mapping exercise of all public health staff in Kenya, and discusses the implications of the findings. The aim is to demonstrate the many practical uses of human resource data – data which is not too complex to collect. [abstract]

The HRH Framework provides a pathway for governments and health managers to develop a comprehensive plan for addressing the critical shortage of health staff in HIV/AIDS and health services in general. [author’s description]

Liverpool Associates in Tropical Health has been teaching, researching and consulting in HRH throughout the changing global and country contexts for almost two decades. This overview paper highlights the changes that we have observed over time, in both the attention paid to workforce issues and the types of activities that we have seen. [from author]

Over the last two decades, health sector reform in many countries has been characterized by spirited efforts to bring down costs and reduce gaps in coverage. Various approaches to decentralization and public-private partnerships have been introduced, but there has been hardly any attempt to understand or address the human resources (HR) aspects and implications of such structural changes. This technical brief synthesizes findings from recent publications to help promote general understanding among the various HRM actors, especially advocates and practitioners in developing countries. [from aut

The objective of this paper is to contribute to a better understanding of the issues related to imbalance through a critical review of its definition, nature and measurement techniques, as well as the development of an analytical framework. [author’s description]