Middle East & North Africa

In Egypt there is increasingly strong political support for health sector reform including a widespread recognition that a working information system is necessary to undertake and monitor this reform. This paper assesses the role of USAID technical support to help build health management information systems in Egypt. The major objectives of the report are to: identify constraints to building the necessary information systems, identify and describe available resources, determine the most constructive role for the technical assistance element of the initiative, recommend a development strategy, and outline necessary resources.

It has become urgent for health agencies and related public services to collaborate, and for all health professionals to become knowledgeable about disaster preparedness. Crisis management, which has become more prevalent for many organizations, is an important strategic initiative for nursing, helping them provide the infrastructure to respond effectively to emergencies and unpredictable events. It is important in today's world that hospital and nursing organizations develop a strategic system to handle disaster situations. [from abstract]

The directory enlists all available data on the institutes that award at least a bachelor degree in any of the health professions in the countries of the Eastern Mediterranean Region.

A substantial number of patients with psychiatric disorders consult primary care physicians for comprehensive health care; however, the diagnosis and effective treatment of psychiatric disorders are deficient in primary health care. The aim of this intervention study is to assess the pre- and post-psychiatric training knowledge of primary care physicians. [from abstract]

The 2004 Egypt Service Provision Assessment (ESPA 2004) survey was designed to collect informationon the provision of reproductive health and child health services in Egypt in order to complement the information obtained through the 2003 Egypt Interim Demographic and Health Survey. The ESPA 2004 collected information on the preparedness of health facilities in Egypt to provide high quality care to clients seeking services for family planning, maternal health, child health, and sexually transmitted infections. A representative sample of 659 clinics of all types of facilities, in both government and nongovernmental organization facilities, was assessed. The survey included, in addition to the resources of the facilities, interviews with service providers, observations of consultations between the providers and clients, and interviews with clients after they were served. The information included in this report is important for identifying areas of intervention that will help improve the quality of family planning, maternal health, and child health services provided to clients. [preface]

The main objective of this study was to determine the perceptions of Iranian nurse educators and students regarding the evaluation of teaching effectiveness in university-based programs. [from abstract]

This report presents results from the Egypt Health Care Providers Surveys, the objectives of which were to: provide a comprehensive picture of all sources of health care services; provide policy relevant data on critical issues for health sector reform; and create a database on health care providers for use by the Ministry of Health and Population in developing policy reform proposals. Five separate surveys were conducted on health care institutions, private clinics, pharmacies, dayas (traditional birth attendants), and other practitioners. The sample of 10,048 providers was developed from a complete enumeration of all health care providers in sampling areas and data from the 1986 national census.

As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income countries. As an illustrative case of international migration of physicians, we evaluated the current number and historical trends of Lebanese medical graduates in the US, and compared their characteristics to those of US medical graduates and other international medical graduates. [abstract]

This short documentary film chronicles the four year journey, initially funded by USAID’s Office of Population, that the governorate of Aswan, Egypt embarked upon to develop greater leadership within all levels of its health care staff. The video shows an innovative process that develops leaders at all levels, including the front lines of health care, to identify challenges and work in teams to overcome obstacles and achieve service improvements. In their own words, doctors, nurses, and outreach workers of hospitals and clinics throughout the region, tell the story of how they became empowered and what they did to improve health results in family planning and maternal child health. Participants share how they worked to improve health care services and indicators in their own communities and expand the program to health units throughout the region using only the resources at hand. [publisher’s description]

This report was developed to outline broad strategy, create a common vision for developing a new core health information system, and describe specific technical development tasks in detail. The new information system must be designed from the top down based on information demand. This should focus development on clear data collection and processing priorities, eliminate collection of unused data, and produce an efficient and relevant system. Information demand is being generated and defined by developing and testing an Executive Information System (EIS), beginning with a very limited set of key indicators and drawing data from the existing HIS.

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.

The objectives of this paper are to: lay out the facts on what we know about the HRH for EMR countries; generate and interpret evidence on the relationship between HRH and health status indicators for LMICs and middle and high income countries (MHICs) in the context of EMR; identify and analyze the information gaps and provide forward thinking by identifying priorities for research and policy. [abstract]

The authors argue that health for all is not achievable in most countries without health sector reform that incorporates a process of coordinated health and human resources development. They examine the situation in countries in the Eastern Mediterranean Region of the World Health Organization.

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).

Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients. Productivity is a significant indicator of professional development within any professional group, including nurses. The human resource element has been identified as the most important factor affecting productivity. This research aimed to explore nurses’ perceptions and experiences of productivity and human resource factors improving or impeding it. [from abstract]

Although adequate knowledge about HIV infection and effective antitransmission measures, such as taking universal precautions in the handling of blood and other body fluids, are important factors in minimizing the risk of HIV transmission in the healthcare setting, little has been reported on the knowledge of nurses with regard to HIV infection and their attitude toward patients with AIDS in Iran. The aim of the present study was to assess these matters. [author’s description]

A questionnaire survey was conducted on 50 primary health care physicians in Iraq to assess their knowledge and identify misperceptions about breastfeeding. Basic knowledge about the main processes of breastfeeding was good (when to start feeding, frequency of feeding, relactation, importance of psychological factors), but there were deficiencies in their ability to deal with some practical problems related to breastfeeding. Steps for improving the knowledge and training are addressed. [from abstract]

This research study was undertaken to test the feasibility, acceptability, and effectiveness of two models of integrating family planning services with postabortion services.

In this study, the overall job satisfaction of medical laboratory scientist graduates of one Kuwaiti University was examined in relation to the environment and organizational features of their places of employment. [from abstract]

This review examines the systemic and individual causes of multiple job holding (MJH) and evidence on its prevalence. MJH should be seen as resulting initially from underlying system-related causes. These include overly ambitious efforts by governments to develop and staff extensive delivery systems with insufficient resources. Governments have tried to use a combination of low wages, incentives, exhortations to public service, and regulation to develop these systems. In many countries, these strategies are not sufficient to outweigh the motivations of and incentives faced by individual health workers in mixed public private labour markets.

The migration of doctors and nurses from Africa to rich countries has raised fears of an African medical brain drain. But empirical research on the issue has been hampered by lack of data. How many doctors and nurses have left Africa? Which countries did they leave? Where have they settled? As part of a larger study of the consequences of the international migration of African health professionals, we compiled a database of the cumulative bilateral net flows of African-born physicians and nurses to the nine most important destination countries. It is the first database of net bilateral migration flows specific to a skilled profession collected systematically for a large number of developing countries.

One Million More presents some of the interventions, debates, discussions and conclusions of a conference held in London from 21–22 March 2006. The conference was organised to create a stimulating and interactive forum to discuss the crisis in human resources for health, in an effort to influence national, regional and international policies for the promotion of sustainable skills capacity in Africa and to engage the African diaspora in innovative, practical steps to move the agenda forward. [author’s description]

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The process of health system reform in Egypt has brought an increased need for improved processes of monitoring and evaluation of health sector activities. This report outlines the existing Ministry of Health and Population “Inspection and Evaluation” unit, as well as other agencies involved in health care monitoring, in terms of duties, staffing, and issues that the organizations need to examine and resolve. It goes on to describe three options for handling monitoring and evaluation in the future. [from abstract]

While previous Egyptian studies have identified provider practices contributing to maternal mortality, none has focused on neonatal care. This report details a survey of reported practices of birth attendants. As well, 217 recently-delivered mothers in rural areas of three governorates were interviewed about antenatal, intrapartum and postnatal care they received. [from abstract]

The objective of this study was to assess the supply of physicians in Lebanon in 1998, with an assessment of their practice patterns and capacity building. [from abstract]

Nurses are expected to empower their clients, but they cannot do so if they themselves feel powerless. They must become empowered before they can empower others. This paper is an attempt to clarify the concept of power in nursing. It also presents a model describing the factors affecting nurse empowerment. [from abstract]

Under its existing primary care strategy-universal access to comprehensive primary care through government and public sector delivery and financing of services-Egypt has made substantial progress in some aspects of primary care in recent decades. Deficiencies exist, however, particularly in routine provision of care to individuals and families by public providers, in disparities of care that exist across regions and socio-economic groups, and in prospects for the sector to respond well to emerging health challenges. This report suggests a new role for government and new approaches, including separating financing of services from their provision and reorganization and integration of care delivery.

This report describes how the war in Iraq and its aftermath continue to have a disastrous impact on the physical and mental health of the Iraqi people, and the urgent measures needed to improve health and health services. It assesses the current state of the health system, including the impact of insecurity, and the workforce, supplies, medicines and equipment it lacks. It also looks at health information and health policy in Iraq. The report ends with conclusions and recommendations, exploring what needs to happen now in Iraq and what lessons can be learned. [adapted from author]

The aim of this paper is to review the share of the medical sector in the higher education enhancement project fund (HEEPF), its outcomes, sustainability, and to provide recommendations for keeping the momentum of reform pursuit in the future. [from abstract]

In order to highlight the driving forces determining the international allocation of medical personnel, the cases of four countries (the Philippines and South Africa as source countries, and Saudi Arabia and the United Kingdom as destination countries) are examined. The paper concludes that changes in demand generated in major destination countries determine the international allocation of medical personnel at least in the short run. [from abstract]