Americas & Caribbean

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]

This paper describes the application of activity-based costing (ABC) to calculate unit costs for a healthcare organization in a developing country. It also describes the ways in which these calcualtions can provide information for improving the efficiency and quality of healthcare services. [from abstract]

This report summarizes key results of the evaluation of a distance learning course in the Standard Days Method. This course responds to a growing demand for low-cost options to training for family planning service providers. This option was considered as a potentially useful alternative to traditional class-room training, which can be both costly and time-consuming. [adapted from abstract]

The objective was to examine whether decentralization has improved health system performance in the State of Ceara, north-east Brazil. Decentralization was associated with improved performance, but only for 5 of our 22 performance indicators. Moreover, in the multiple regression, decentralization explained the variance in only one performance indicator; indicators for informal management and political culture appeared to be more important influences. However, some indicators for informal management were themselves associated with decentralization but not any of the political culture indicators.

The 2005 Barbados HIV/AIDS Service Provision Assessment (Barbados HSPA) survey report provides baseline information on the capacity of the formal public health sector in Barbados to provide both basic and advanced level HIV and AIDS services and the availability of recordkeeping systems for monitoring HIV and AIDS care and support. Within the Caribbean region, there is a concern for the recent training of health professionals who provide HIV and AIDS services, for health worker attitudes towards people living with HIV (PLHIV) and for patient movement within the region. The Barbados HSPA captured information on these region-specific indicators in addition to the standard HSPA indicators.

The peculiarities of the scattered small states of the Caribbean region call for a model of training practitioners that is effective, relevant and sustainable. Distance education (DE) as an approach offers advantages that meet some of the challenges inherent in training family physicians for the region. This paper examines some of these challenges and shows where DE is being used to structure delivery of the programme. In particular, the need for context-specific training, managing time strictures and the cost issues of training are discussed. [from abstract]

This data creates a profile of the nursing workforce, which is useful for projecting trends and estimating future requirements. At the corporate level, longitudinal examination over a series of years would demonstrate the relationship between the characteristics of the nursing workforce and the overall requirements for patient care. At the unit level, the data is helpful to examine human resource needs and fluctuations in the workforce characteristics. A human resource profile has many data elements and results from the input of a variety of sources and requires high standards of data entry and management.

Understanding the supply and utilization of nurses is critical to maintaining an effective community health system. There has to be sufficient staff and a work environment that builds on the existing strengths of community health nursing to meet emerging needs. This report provides a demographic profile of community health nurses (CHNs) in Ontario and identifies enablers that support optimal practice of their competencies. [from executive summary]

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]

Significant numbers of African-trained health workers migrate every year to developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon. The population of Sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. [from introduction]

This report marks the culmination of the Nursing Sector Study. The five year study consisted of two phases, and examined the nursing workforce for all three regulated nursing professions in Canada. Phase I, which concluded in December 2004, examined the state of nursing human resources in Canada. The objective of Phase II was to develop a pan-Canadian nursing human resource (HR) strategy in consultation with government and non-government stakeholders that built on the findings and recommendations presented at the completion of Phase I. [from executive summary]

This best practice guideline focuses on nursing teams and processes that foster healthy work environments. The focus for the development of this guideline was collaborative practice among nursing teams with the view that this may be a first stage in a multi-staged process that could eventually result in interprofessional guidelines. A healthy work environment for nurses is a practice setting that maximizes the health and well being of nurses, quality patient outcomes and organizational performance. Effective nursing teamwork is essential to the work in health care organizations. [from purpose]

This paper examines the experience with using various incentives to motivate and retain community health workers (CHWs) serving primarily as volunteers in child health and nutrition programs in developing countries.

In 1986 the authors conducted a survey examining the performance of health promoters in Pucallpa, Peru, three years after an initial Danish project for training and supervising those promoters ended. The survey found that some two-fifths of the promoters were still active, that increased stress had been placed on curative tasks, and that the promoters appeared to have had their greatest impact in the areas of vaccination coverage and increased use of the available public health care service. No significant changes were found in the affected population’s treatment of diarrhea or improvement of drinking water quality.

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.

This study provides initial information about current nursing issues that have arisen as a result of health care reform initiatives. Regardless of differences in service models or phases of health sector reform implementation, in all the countries the participating nurses identified many common themes, trends, and changes in nursing practice. The driving forces for change and their intensity have been different in the five countries. Nurses maintain their core values despite increased work stress and greater patient care needs in all the countries as well as economic crises in the Latin American countries.

This paper combines the literature on public health, on economics of health and on economics of technological innovation to discuss the peculiarities of labour in the health care sector. The health care system has a distinctive characteristic from other economic sectors: it is the intersection between social welfare and innovation systems. The relationship between technological innovation and cost in the health care sector is surveyed. Finally, the Brazilian case is discussed as an example of a developing country. The peculiarities of labour in the health care sector suggest the need to recognize the worth of sectoral labour and to cease to treat it separately.

This overview paper highlights the key messages and issues presented in the country reports submitted by national nurses’ associations (NNAs) at the 12th International Council of Nurses (ICN) Workforce Forum held in Copenhagen 25-26 September 2006. Participating NNAs submitted written reports on major agenda items: environmental scan; outsourcing; alliances; occupational health and safety; private sector for profit health enterprises; positive practice environments; and future options. [from introduction]

The intent of the report is to stimulate creative discussions among [British Colubia’s] health system stakeholders about opportunities for coordinated action on employee and workplace health. The best available evidence suggests that the scope and depth of workplace health challenges today require solutions that go beyond traditional workplace health promotion programs.

The question guiding the paper is: “What are the key ingredients of a high-quality work environment in Canada’s health care sector and how can this goal be achieved?” Synthesizing insights from a variety of research streams, the paper identifies many ingredients needed to create a high-quality workplace. We take a multidisciplinary and holistic approach, which complements other research initiatives on health human resources. [from abstract]

This text presents the context and background, the methodology and some of the main results of the regional consultation on the critical challenges for human resources in health in the Americas. This consultation hopefully documents how the countries in the Americas are facing the main challenges to the development of the health workforce. The main results and suggestions by the actors consulted with regard to the role of international cooperation in the countries of the Region are presented, so that the countries and international agencies can better formulate common strategies of development and strengthening of the work force in health.

The story of the international nurse in the U.S. workforce is generally one of perserverance - not only in obtaining a visa and a state license, but in adjusting to living and working in the United States. [author’s description]

This article describes the experience of Guatemalan students at Cuba’s Latin American Medical School. The students’ education emphasizes health problems and diseases characterizing the epidemiological situation in their home country and in-depth courses in disaster management, as well as clinical experience in Guatemala. [adapted from author]

The world’s 1,691 medical schools and 5,492 nursing schools are not producing enough graduates to cover the massive global deficit of doctors, nurses, and midwives. One scaling-up initiative addressing these critical shortages is Cuba’s Latin American Medical School. This article describes those efforts. [adapted from introduction]

Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization — the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization.

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 viewpoint presented throughout this document tries to analyze political aspects which are normally not considered in order to understand the execution and results of health policies. In this case, we are interested in understanding the link between the decentralization process and three aspects of the human resource policy: distribution, regulation and management. Our focus, however, attempts to document the processes, more than the results, since these will have to manifest themselves during the coming years. The scientific value of documenting the process allows us to identify explicit and hidden links between the actors in this process, which are strong determinants of the final results.

This study explored nurse staffing decision-making processes, supports in place for nurses, nursing workload being experienced, and perceptions of nursing care and outcomes in Canada. A number of key themes emerged from the study that can form the basis for policy and practice changes related to determining appropriate workload for nursing in Canada. These include the use of staffing principles and frameworks, nursing workload measurement systems, nurse-to-patient ratios, and the need for uptake of evidence related to nurse staffing. [adapted from abstract]

This paper begins by clarifying the terms shortage and underserviced. Provincial and federal programs for underserviced areas in Ontario are then described and considered in terms of their relevance to nursing. A discussion of the issues associated with policies addressing shortage and underserviced areas follows. The paper concludes with recommendations for change. The importance of making funding decisions based on a clear understanding of relevant concepts and models is emphasized. [introduction]

Preparing health workers to confront the HIV/AIDS epidemic is an urgent challenge in Haiti. There is a critical shortage of doctors, leaving nurses as the primary care providers for much of the population. Haiti’s nurses play a leading role in HIV/AIDS prevention, care and treatment. However, they do not receive sufficient training at the pre-service level to carry out this important work. The Ministry of Health and Population collaborated with the International Training and Education Center on HIV to create a competency-based HIV/AIDS curriculum to be integrated into the the national schools