Eastern Europe & Central Asia

This retrospective study assessed the effects of pre- and post-training programme for healthcare professionals about breastfeeding. [from abstract]

This report describes highlights from the Doctors We Trust Project in St. Petersburg and the Together We Are Stronger Project in Kaliningrad. Both projects focused onthe limitations of health care for vulnerable groups in St. Petersburg and Kaliningrad. The key strategy was to build cooperative links between government agencies and NGOs, uniting those who control public medical facilities and those who work most closely with vulnerable populations. The goal was to strengthen the NGOs’ capacity to provide care, while helping the governmental sector and medical personnel better understand and respond to the needs of people living with HIV and AIDS (PLHA) and other vulnerable groups.

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]

This paper represents the second phase of a larger study examining health worker motivation in two hospitals in Tbilisi, Georgia. The overall objective of the 360 degree assessment was to begin to identify the major organizational, situational, and individual factors associated with health worker motivation, and to better understand how major constituencies (i.e., managers, supervisors, workers, and patients) perceive the hospital/work environment. Specific objectives of this study component were to: assess congruence between managers, supervisors and workers on perceptions of hospital goals; compare perceptions of hospital and worker characteristics among types of workers (physician, nurse, other) and levels of respondents (managers, supervisors, workers, patients); and identify possible factors for stimulating good performance and possible interventions for enhancing motivation.

The difficulty of ensuring an adequate and appropriate distribution of health services, together with increasing financial pressures in the public sector, are forcing many countries to consider using more rigorous methods for determining staffing levels in the health facilities. The Workload Indicators of Staffing Need (WISN) method is one such method. It uses a form of activity analysis (activity standards), together with measures of utilisation and workload to determine staffing requirements. The method provides a vehicle for assessing localised staffing needs that is believable and which at the same time is sharply different to historic methods.

JHPIEGO has been working since 1991 to support the development of a national integrated clinical training system used for both family planning/reproductive health (FP/RH) preservice education and inservice training in Turkey. In summary, this project has made substantial gains in meeting the USAID/Turkey results package from the Strategic Objective, Increased Utilization of FP/RH Services, through Intermediate Result 2, Expansion of High Quality FP/RH Services in the Public and Private Sectors, and two Sub-Results-2.1 Increased Availability of Postpartum and Postabortion FP Services and 2.3 Improved Job Performance of Health Providers, Trainers, and Administrators. It has been successful in assisting the MOH, medical institutions, and midwifery schools to establish a national, integrated training system capable of sustaining high-quality preservice education programs for interns and midwives. The inservice training system that has been established will support the MOH in their effort to expand FP/RH training to other provinces in coming years. The preservice education system will support all university-based midwifery school students by strengthening their FP/RH and maternal health skills as they progress toward their degree. [adapted from publisher]

Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. This study presents a unique exploration of how the factors affect the performance of primary reproductive health providers (nurse-midwives) in two regions of Armenia. [from abstract]

This report assesses the business development needs, particularly financial and training, of private health care providers and distributors of reproductive health and family planning products and services in Romania. [adapted from author]

This study analyzes the Lithuanian family physician (FP) workforce to determine if an adequate supply of FPs will be available in the future to take over emerging tasks. The authors conclude that despite the rapid expansion of the FP workforce during the last fifteen years, forecasts of supply and demand indicate that the number of FPs in 2015 will not be sufficient. [adapted from author]

Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of each health care system and of reform and policy initiatives in progress or under development. [publisher’s description] Each report contains a section on human resources for health including an overview of the situation and specific health workforce statistics.

The paper outlines a conceptual framework that integrates the key strategies that must be addressed and linked if policy-makers are to create the kinds of health care system to which the citizens of [central and eastern Europe and Eurasia] are entitled. It examines how financing, coordinated service delivery and quality measures matter independently, and it highlights the need to interweave them effectively with citizen and community participation mechanisms and a far-reaching concern for public health. It also reviews the complex issues that hinder or help the implementation of reforms and suggests how an understanding of context, stakeholders and capacity will be critical to delivering change.

The ILO Sectoral Activities Department initiated an explorative research project on health worker mobility in Europe with focus on CEE countries. The purpose of the project was to explore and document current knowledge and information available in order to establish the current status, and identify both preliminary trends as well as information gaps and the need for further action. The project contained two main components: a literature review to provide an overview on the state of the migration discussion in Europe, complemented by initial research in selected countries for obtaining country-based insight on information available.

This report presents an overview of the policy implications of the international migration of health workers in Europe, based on case studies conducted in five countries – Estonia, Germany, Lithuania, Poland and the United Kingdom – and draws on information from other WHO European Region countries, such as Israel and Latvia. [from introduction]

This paper represents the first phase of a larger study examining health worker motivation in two hospitals in Tbilisi, Georgia. The paper analyzes the context within which health workers are located and describes historic trends in the position of health workers and the current efforts to reform the health sector. It also provides a detailed analysis of work conditions and organizational features of the two study hospitals. [from abstract]

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.

This paper describes major directions of the reform thought by the Ministry of Health of Georgia to rationalize the hospital sector. It reviews the reform directions in the environmental context, and attempts to provide some quantitative and qualitative indicators to characterize the reform process and its impact. The discussion addresses the issues of granting autonomy to hospitals, exposure of hospitals to the market, social functions of the hospitals, and improved accountability of hospital facilities. The implications of the reform on HRD are analyzed. The final section of the paper summarizes the lessons learned from the Georgian experience.

Georgia’s health care system underwent dramatic reform after gaining independence in 1991. The decentralization of the health care system was one of the core elements of health care reform but reports suggest that human resource management issues were overlooked. The Georgian national immunization program was affected by these reforms and is not functioning at optimum levels. This paper describes the state of human resource management practices within the Georgian national immunization program in late 2004. [from abstract]

This is a report of a Workshop organised by the WHO Regional Office for Europe, with the objectives of building the evidence base for Human Resources for Health (HRH) in Europe by identifying the key policy questions that policy makers face in HRH, agreeing upon an agenda for development of options, and undertaking further validation of the WHO HQ/HRH framework. The workshop allowed further exploration of the framework and validation for theEuropean region; and, with the participation of policy makers, enabled the identification of thekey HRH issues/policy questions for the region, and identification of initial priorities for building capacity and action.

Though reforms in the health sector have recently been common around the world, their success has, for a variety of reasons, been mixed. The paper aims to examine and explain the importance of human resources (HR) to the success or failure of health reforms using case studies from Russia, Zambia and the United Kingdom. [from abstract]

The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia. [from abstract]

This book examines some of the major challenges facing health care professions in Europe and the potential responses to these challenges. The authors document how health care systems in Europe are confronting existing challenges in relation to the health workforce and identify the strategies that are likely to be most effective in optimizing the management of health professionals in the future. [from publisher]

This document attempts to review the HRH situation in the WHO European Region. Section 2 addresses the problems associated with varying definitions to ensure a common understanding of the issues involved. In section 3, a number of key methodological issues (the relevance of HRH, education, management, regulation, etc.,) are analyzed. Section 4 summarizes the key HRH facts and figures for the region. In conclusion, section 5 describes the way forward and the main EURO policy proposals for supporting member states in this complex sphere. [author’s description]

This report presents findings of an in-depth study into the determinants and outcomes of health worker motivation in two hospitals in Tbilisi, Georgia. The study aimed to compare ratings of different motivational determinants between different types of workers and test associations between motivational determinants and various outcomes of the motivational process. A total of 473 workers at the two hospitals completed a structured survey instrument consisting largely of psychometric tools adapted from similar work in the US. [from abstract]

This article presents the results of a 2002 social audit of the health sector of three Baltic States. Comparisons were made of perceptions, attitudes and experience regarding unofficial payments in the health services of Estonia, Latvia and Lithuania. The findings can serve as a baseline for interventions and to compare each country’s approach to health service reform in relation to unofficial payments. [adapted from abstract]

Human resources management in health often encounters problems related to workforce geographical distribution. The aim of this study was to investigate the internship workplace preferences of final-year medical students and the reasons associated with their choices. [from abstract]

This report is the outcome of a seminar held in Brussels on 15th June 2004. The aims of the seminar were firstly to share information on gender and occupational safety and health (OSH) issues, including a gender-sensitive approach in OSH and how gender can be mainstreamed into OSH, and secondly to facilitate discussion and debate among EU and national authorities, social partners and experts on how to take forward gender issues in OSH. It includes proposals for taking forward gender issues in OSH. [Publisher’s description]

This paper looks at reproductive health and family planning programs in the Eastern Europe and Eurasian region. It includes: a methodology to analyze the RH/FP market; an overview of opportunities and constraints to the private sector region; a description of current practices in the region that foster a greater private sector role in the provision of FP services and products; and recommendations for leveraging and maximizing private sector contribution to RH/FP goals. [adapted from author]

The aim of the present study was to examine available human medical resources in primary care and identify possible inequalities regarding the distribution of general practitioners in Albania between 2000 and 2004.

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.

Incentives such as P4P can be very powerful in their effects. Caution in their design and deployment is essential. However, ignoring their potential would be unwise, as they offer the possibility of improving value for money for taxpayers and patients. The first section of the paper will review evidence of common provider problems in all health care systems and their implications for introducing a P4P system. This will be followed by a review of P4P reforms in the United Kingdom and United States in particular. [from author]