Sub-Saharan Africa

This report details the findings of the Forum on Engaging the Private Sector in Child Health held in Uganda in 2005. It discusses the potential of private providers and the private sector as a resource for improving community health outcomes. [from executive summary]

Task shifting should not be viewed as a panacea for the human resources challenges facing sub-Saharan Africa. Rather, it must be part of an overall strategy that includes measures to increase, retain, and sustain health staff. [from author]

Two crises dominate the health sectors of sub-Saharan African countries: those of human resources and of HIV. There is considerable variation in the extent to which these two phenomena affect sub-Saharan countries, with a few facing extreme levels of both. This paper reviews the continent-wide situation with respect to this double burden before considering the case of Malawi in more detail. [from abstract]

Growing awareness of the need for improved accommodation between health systems and priority health programs is now prompting health systems to actively adopt measures that can help integrate and maximize the impact of Global Health Initiatives. At the same time, the Global Health Initiatives are starting to make a more active investment in systems strengthening. A concerted global effort is now required if the world is to take full advantage of these opportunities. This presentation discusses the impact of the US President Emergency Plan for AIDS relief (PEPFAR) on human capacity development regarding current global, regional and country experiences. [from presentation description]

This presentation outlines a program desingned to train midwifery tutors and midwives to reduce maternal mortality.

This article builds on a recent publication on the capacity of the existing health workforce in Africa to expand through increasing production of its non-physician clinicians and by suggesting that there are four further issues to be urgently addressed if NPCs are to realize their full potential. [adapted from author]

This note discusses challenges and options in scaling up the production of skilled health workers and strengthening the health professions educational capacity of the countries in crisis, particularly in Africa. [from introduction]

The Canadian health care system is one of the places where push comes to pull in terms of attracting health care professionals from sub-Saharan Africa. The authors call this "the perverse subsidy": the costs of training these professionals are paid for by "poorer people in poorer countries." The pull to Canada is equally a push from Africa. Reflections on a pilot study on a labour mobility issue that is equally a question of conscience. [from author]

Within the Southern African prevention of mother to child transmission (PMTCT) programmes, counsellors talk with pregnant mothers about a number of interrelated decisions and behaviour changes. Current counselling has been characterised as ineffective in eliciting behaviour change and as adopting a predominantly informational and directive approach. Motivational interviewing (MI) was chosen as a more appropriate approach to guide mothers in these difficult decisions, as it is designed for conversations about behaviour change. MI has not previously been attempted in this context. This paper reflects on how MI can be incorporated successfully into PMTCT counselling and what lessons can be learnt regarding how to conduct training with counsellors.

This editorial describes the widespread recruitment of health workers from sub-Saharan Africa to developed nations by recruiting agencies. The authors describe international efforts to criminalize this practice and express concern at the continued practice of recruitment.

This article outlines the challenges facing the surgical workforce in Africa. Funding priorities in Africa typically favor infectious diseases, and surgery and perioperative care have been neglected, even though essential surgical care at district hospitals is more cost effective than some other highly prioritized interventions, such as antiretroviral therapy for HIV. There is a need to integrate surgical and anesthetic training programs so health personnel, particularly in rural areas, can treat the full range of diseases appropriate to that level of care. [adapted from author]

This article investigates pay structures for health workers in the public sector in sub-Saharan Africa; the adequacy of incomes for health workers; the management of public- and private-sector pay; and the fiscal and macroeconomic factors that impinge on pay policy for the public sector. The study finds that pay and income of health workers varies widely, whether between countries, by comparison with cost of living, or between the public and private sectors. To optimize the distribution and mix of health workers, policy interventions are needed. Fiscal constraints to increased salaries might need to be overcome in many countries, and non-financial incentives improved. [adapted from summary]

To understand how the private health sector might better complement Africa's public health systems, we studied the health care sectors of 45 sub-Saharan African countries. The findings suggest opportunities for private enterprise to help improve the region's woefully poor health outcomes.

This paper addresses the influence of the HIV/AIDS epidemic on the health workforce. An overview of the impact of HIV/AIDS on health systems is provided, with a focus on developing countries. Other topics include the impact of HIV/AIDS on morbidity and mortality among staff in Africa; the impact of HIV/AIDS on workforce motivation, performance and migration; and future staffing scenarios and potential obstacles. [adapted from author]

This report describes opportunities for engaging and supporting a well managed and effectively regulated private sector to improve the region’s health. This report highlights the critical role the private sector can play in meeting health care needs in Sub-Saharan Africa. It also identifies policy changes that governments and international donors can make to enable the private sector to take on an ever more meaningful role in closing Africa’s health care gap. [adapted from publisher]

This article discusses the gaps exist between the potential of health systems and their actual performance. Best practices from various countries are discussed. The author concludes that the crisis can be tackled if there is global rsponsibility, political will, financial commitment and public-private partnership for country-led and country-specific interventions that seek solutions beyond the health sector. [adapted from abstract]

This report provides inforation on the potential establishment of regulatory bodies for allied health professionals in the ECSA region. It introduces the concept of regulation and the traditional methods of regulation, discusses the contextual issues, outlines five possible regulatory models, provides some draft model legislative provisions to regulate AHPs, and describes how to establish and implement a regional body. [adapted from author]

There is a growing interest for more and better cooperation between the public and private sector in the field of health care delivery, particularly in the developing world. This document discusses the need for coopertation, its benefits and some of the challeges in implementing it. [adapted from authors]

The migration of health professionals from developing countries in general, and sub-Saharan African countries in particular, has become the subject of considerable theoretical and case study research attention in international migration and human resources for health (HRH) literature. This report is a review of all available literature on the costs and benefits of the migration of health workers from East and Southern African (ESA) countries to developed nations. [from executive summary]

In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one’s country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health. [

The disparity is staggering. Africa bears one-quarter of the burden of disease around the world yet has barely 3 percent of all health workers. Millions of people across the continent thus suffer needlessly because they cannot obtain medical care from trained personnel. In sub-Saharan Africa, where the crisis is most acute, fully 820,000 additional doctors, nurses, and midwives are needed to provide even the most basic health services. To meet this shortfall, most of the region’s countries would have to increase the size of their health workforce by 140 percent. [author's description]

Home-based management of malaria (HMM) is promoted as a major strategy to improve prompt delivery of effective malaria treatment in Africa. The published literature was searched for studies that evaluated the health impact of community- and home-based treatment for malaria in Africa. [from abstract]

In parts of rural Africa, where conflict and neglect have destroyed any remnants of a functioning health system, there is one long-running public-health programme that is not only surviving but thriving—by capitalising on communities' desires to help themselves. [author's description]

In much of sub-Saharan Africa, a significant portion of the population lives in rural areas, leaving many women with limited access to clinic-based family planning services. Thus CBD of contraceptives remains an important service delivery mechanism in this region. The primary aim of this study was to assess the safety, quality, and feasibility of Depo-Provera provision by community reproductive health workers.

This report provides an overview of the public health situation across the 46 Member States of the African Region of the World Health Organization. The report charts progress made to date in fighting disease and promoting health in the African Region. It reviews the success stories and looks at areas where more efforts are needed to improve people’s health. [author's description] Chapter 6 includes a discussion of the human resources for health crisis and approaches to filling the gap as well as health information systems.

Health workers attending overseas universities may be less likely to return home. One response is to improve course provision and professional updating opportunities in-country. Leeds Metropolitan University, with funding from the Commonwealth Scholarships Commission under their distance learning initiative, runs a tailor-made MSc Public Health (Environmental Health and Health Promotion) in Zambia, for nurse tutors, clinical officers and environmental health workers. Using locally relevant curricula, with community-based, student centred, problem-solving approaches, retention may be improved. This paper will discuss how the course is delivered in Zambia, how the partnership developed such as to enable effective delivery of the course, and how sustainable learning can be achieved in a developing country in partnership with a UK University. [from abstract]

This edition covers topics such as: migration of skilled health workers, investing in human resources for health, strengthening human resources for health in Africa, and the economic cost of health professionals brain drain in the African region. [author's description]

Experience has shown that governments have different kinds of HRH policies, strategies and plans even when they are within the overall context of national health policies and strategies. This document provides guidance on the process with proposals of content for three basic HRH documents: situation analysis, policy, and strategic plan. [from foreword]

By measuring the ability and actual practice of a sample of clinicians in Tanzania and examining the terms of employment for these clinicians, we show that both ability and motivation are important to quality.