HRH Interventions

All long-term care agencies struggle to find and keep sufficient, reliable, and skilled staff capable of meeting client needs and providing great quality care. This workbook offers 12 concrete steps to guide agencies in developing excellent recruitment, selection and retention practices—the three key elements necessary to manage long-term care organizations successfully. [from introduction]

This presentation was part of the 2006 Global Health Mini-University. A key approach to address the global shortage of healthcare providers is to improve the productivity of existing workers, thereby improving the quality and coverage of services. Improving the work environment and task shifting of health functions to different cadres of providers are two promising interventions that are being used for this purpose. This session will describe and discuss these and some of the other innovative solutions to enhance the capacity and productivity of the current workforce and to build coherence into the management of human resources for stronger health systems. [publisher's description]

This article discusses the potential contribution of community health workers to child survival rates. Several trials show substantial reductions in child mortality, particularly through case management of ill children by these types of community interventions. However, community health workers require focussed tasks, adequate remuneration, training, supervision, and the active involvement of the communities in which they work. This article discusses the need for evaluation of programmes for community health workers. [from summary]

The issue of The Manager focuses on designing and improving a package of HIV-related services using a conceptual framework called the Functional Service Delivery Point. The framework can help managers to identify the characteristics that make HIV-related services functional and to deliver these services with strong community and management support. [from editor]

This paper summarizes the importance of improving maternal and reproductive health, the progress made to date and lessons learned, and the major challenges confronting programs today. The paper highlights the progress that some countries, including very poor ones, have made in reducing maternal mortality, but cautions that progress in many countries remains slow. Relying on evidence from the most recent research and survey information, the paper also analyzes the key determinants and evidence on effective interventions for attaining the maternal health MDG. [from abstract]
Section 3 dis

When GHARP set out to recruit new service providers [for preventing mother-to-child transmission], it faced a dilemma. Due to the limited supply of health workers in Guyana, the project needed to avoid recruiting health care providers already working for the MOH. Hiring existing health workers away from their jobs would simple reshuffle the distribution of health workers, rather than add new ones. To address the problem, GHARP staff decided to recruit retired nurses to fill the positions. [from author's description]

Poverty and limited health services in rural Africa present barriers to adherence to antiretroviral therapy that necessitate innovative options other than facility-based methods for delivery and monitoring of such therapy. We assessed adherence to antiretroviral therapy in a cohort of HIV-infected people in a home-based AIDS care programme that provides the therapy and other AIDS care, prevention, and support services in rural Uganda. [author's description]

Many Nigerian children with malaria are treated at home. Treatments are mostly incorrect, due to caregivers' poor knowledge of appropriate and correct dose of drugs. A comparative study was carried out in two rural health districts in southwest Nigeria to determine the effectiveness of a guideline targeted at caregivers, in the treatment of febrile children using chloroquine. [from abstract]

A scarcity of trained medical personnel impedes Uganda’s ability to deliver healthcare effectively. The role of the Clinical Officer (CO) was established to assist the provision of primary healthcare to rural communities. The primary aim of this study was to explore the role that the CO performs in delivery of primary and secondary healthcare in Uganda. A secondary aim was to determine the resources and facilities that are available to COs in order to carry out these duties. A further aim was to determine the confidence of COs at performing surgical and obstetric procedures. [from introducti

This report discusses the impacts of malaria on business. It reviews the academic literature on the impacts of malaria on economies and businesses, presents data from survey on the business impacts of malaria, discusses the actions the private sector can take to combat malaria, and reviews examples of business malaria programs. The final section makes some recommendations for businesses considering engagement in malaria control. [adapted from author]

This paper, which was prepared as background for the Working Group on Performance Based Incentives, looks at a particular type of financing intervention that has been applied in several different ways around the world to address the joint problems of underutilization and low quality of health services. The focus is on demand- and supply-side financial and material (examples: food, travel vouchers) incentives that can be used to improve utilization and quality of ambulatory health care services, especially for the poor. [from introduction]

This issue of the HST Update contains articles on: overview of nursing in South Africa, transforming nursing education towards primary health care, problems in nursing today, nursing summit charters a way forward, placement of nurses, nurse training in Mount Frere health district, and the quest for rational drug use.

In 1996, the REWARD Project identified a need for effective interventions to increase women’s communication about reproductive health among themselves and with their husbands. Project staff formed women’s groups, called Communication Action Groups (CAGs), in three rural districts. The project provides group leaders with training on communication, leadership, group dynamics, condom use, condom negotiating skills, and HIV/AIDS and sexually transmitted infections (STIs). This study was designed to evaluate the effectiveness of the CAG program so that achievements and problems could be identified and program activities strengthened.

The community approach to improving public health has been produced for community nurses who want an insight into community development practice used in nursing. The publication provides a framework and resources for nurses to use as a tool to begin to develop their own local initiatives. [from introduction]

Most South Asian governments have concentrated on emulating a Western style of healthcare service, with the result that an elite few are overmedicalised whereas the majority are neglected. However, community participation in the development of local health services could provide a solution. [abstract]

Given the very limited health infrastructure and resources and the need to provide a palliative care service to about one percent of the population each year, community and home-based care is viewed as the key to responding to these needs. Some countries have already developed strong home-based care networks in coordination with the PHC system to respond to the HIV/AIDS epidemic. Palliative care, as part of the continuum of care of HIV/AIDS, cancer and other chronic conditions can be integrated into this existing network. [author's description]

This pre-tested and peer-reviewed curriculum focuses on the knowledge and skills necessary for providing holistic CHBC for people living with HIV/AIDS, transferring knowledge and skills to caregivers and CHBC clients, and mobilizing communities around HIV/AIDS prevention, care, treatment, and support. The trainer's guide includes comprehensive units that cover topics from HIV basics, communication skills, nursing care, nutrition, positive living, family planning, HIV prevention, ART, to community mobilization.
The illustrated handbook provides community health workers with a practical user-friendly tool that can be used as reference material and for skills transfer to clients and caregivers. [publisher's description]

This document provides a systematic framework for establishing and maintaining community home-based care (CHBC) in resource-limited settings for people with HIV/AIDS and those with other chronic or disabling conditions.

The integration of HIV-prevention activities into care has received little attention within or outside formal healthcare settings. The contribution of community home-based care services in facilitating disclosure of HIV status and reducing stigma have also not been described. This study examines the community impact of an integrated community home-based care (ICHC) programme on HIV-prevention efforts and disclosure of status. Quantitative data was collected from 363 people living with HIV (PLHIV) and 1 028 members of their micro-communities. [from abstract]

In a rural village in India, newborn deaths have been halved not by neonatologists or high-tech interventions but by local villagers trained in simple life-saving practices. Some experts, however, are sceptical about whether this strategy can work everywhere. [from author]

This document presents estimates of the number and proportion of children who will lose one or both parents in 23 countries heavily affected by HIV/AIDS. The report also presents the view that solutions can be found only through coordinated efforts to support, strengthen, and multiply coping strategies among the families and communities on the front lines of the pandemic. The COPE (Community-based Options for Protection and Empowerment) program is a promising example of how this can be done. Human resources challenges are also addressed. [adapted from author]

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]

The main objections to the use of [antiretroviral therapies] in less-developed countries have been their high cost and the lack of health infrastructure necessary to use them. We have shown that it is possible to carry out an HIV treatment programme in a poor community in rural Haiti, the poorest country in the western hemisphere.

In 1996 an act of Parliament created the Ghana Health Service (GHS) as an extra-ministerial agency that is outside the civil service, freeing the health sector to change, innovate, and reform health care operations in Ghana. This flexibility enables the GHS to utilize research for guiding innovation with research activities. The GHS has adopted a model for community-based service delivery known as the Community-based Health Planning and Services (CHPS) Initiative. CHPS is an integral part of the current Ghana Health Service Five Year Programme of Work and represents the health sector component of the national poverty alleviation programme.

Community-based Health Planning and Services (CHPS) initiative as a strategy to deliver community level service is a key health system reform for the Health Sector in general and the Ghana Health Service in particular. If the health sector is to achieve the Health Millennium Development Goals’ in Ghana, then there is the need for a drastic shift in the paradigm of service provision. CHPS provides us with a vehicle for making this paradigm shift so as to deliver community level service by engaging communities in taking decisions concerning their own health and recognizing that the primary producers of health are the individuals within households – especially mothers.

Outline of the community-based health planning and services (CHPS) initiative developed by the Ghana Health Services, as an enhanced Close to Client (CTC) System. CHPS aims to provide accessible primary health care to all communities of Ghana, by enabling District Health Management Teams throughout Ghana to develop approaches to community health care that are consistent with local traditions, sustainable with available resources, and compatible with prevailing needs. This article discusses, step by step, the processes involved in managing, planning, coordinating, and monitoring the CHPS initiative.

The emphasis of the COPHIA program is the provision of home-based care and support services by multi-purpose community-based health workers to vulnerable households in the geographic focus areas that are coping with the burden of caring for seriously ill family members or caring for orphans and vulnerable children. The COPHIA community-based health workers, with the support of clinical and non-clinical supervisors, provide the direct physical and emotional care and support services to PLWHA and orphans and vulnerable children in the project catchment area with the support of trained primary caregivers.

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]

Guidance for integrated postpartum care at the community/household level that reduces maternal and newborn mortality and encourages health in the immediate postpartum period is lacking. This report identifies and summarizes descriptive and research studies of existing community-based postpartum programs which provide counseling and services along with education on self-care. The literature review identified three models of community-base postpartum care: home visits by professional health care providers, home visits by community workers and home visits by community workers with referral or health facility support.