Sub-Saharan Africa

The Government of Ghana has adopted the WHO focused antenatal care (ANC) package in a move to improve access, quality and continuity of ANC services to pregnant women. As part of these efforts, the Government has exempted fees for ANC clients. The main objective of this study, undertaken by Noguchi Memorial Institute for Medical Research in collaboration with the Ghana Health Service (GHS), FRONTIERS, and with USAID funding, was to examine the extent to which adaptation of the package influenced quality of care received by pregnant women and its acceptability to both providers and clients. The study used a policy analysis and a situation analysis in ten intervention clinics in which the package had been introduced and four comparison clinics.

To promote the health and survival of mothers and babies, Kenya has adapted the WHO goal-oriented Antenatal Care (ANC) package, popularly known as focused ANC (FANC). The Ministry of Health (MOH) has designed new guidelines for ANC services, placing emphasis on refocusing antenatal care, birth planning and emergency preparedness, and the identification, prevention and management of life threatening complications during pregnancy and childbirth. ANC visits are now used as an entry point for a range of other services, thus promoting comprehensive integrated service delivery. A major challenge, however, is whether the Kenyan health care system can cope with the implementation of this package.

This study was carried out to document the current situation regarding continued or in-service training opportunities amongst healthcare workers serving in government (public) health centres within Blantyre District Health office. Knowledge of such a situation would better inform health personnel trainers, professional regulatory bodies, the Ministry of Health and international agencies to design appropriate intervention programs towards professional development of healthcare personnel. [from introduction]

This report will review the critical elements of quality assessment in Section 1. In the second section it will review the National Health Insurance Fund Act requirements for accreditation and the current means of registering and evaluating health providers. What is needed in accreditation, the options for Tanzania, and the potential problems there may be with accreditation. The final section provides practical guidance for implementing a short-term and longterm strategy for accreditation of NHIF providers and more broadly for all Tanzanian providers. Appendix A provides a practical tool: An Accreditation Survey Instrument for Hospitals.

The focus of McKinsey’s research effort is on the HRH constraint, faced by many
developing countries, in absorbing development aid and scaling up urgently
needed health programs. HRH in this context is defined as the health workers
at the front line of healthcare service delivery. The field work necessary to
diagnose the problem and identify possible solutions has been initiated in
Tanzania. We believe these findings, accounting for certain differences, will be
broadly applicable to several developing countries.

The causes of brain drain are complex and interrelated, involving social, political, and economic factors. The necessary responses will therefore be varied and cover an array of areas. Drawing on growing interest and scholarship, Physicians for Human Rights (PHR) proposes this plan of action for addressing brain drain and the unequal distribution of health personnel within countries, recommending actions by high-income countries, African governments, WHO, international financial institutions, private businesses, and others. [author’s description]

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]

This paper addresses an important practical challenge to staff management. We use a case study based on semi-structured interview data to explore the steps that Namibia, a country facing severe health problems that include an alarmingly high AIDS infection rate, has taken to manage its health workers. [from abstract]

This presentation was part of the International Conference on Global Health session, “Answering the Call: Innovations in Human Resources by African Faith-Based Organizations.” From the perspective of the Uganda Catholic Medical Bureau experience, the presentation discusses why the private not-for-profit sector is important in service provision and training; why nurses are in the midst of the human resource crisis; obastacles to increasing the training capacity; and what the PNFP health training institutions are doing to address their weaknesses. [adapted from author]

South Africa has a serious shortage of human and financial resources to provide primary healthcare services especially in the historically under-served areas. It is a tedious task to carry out healthcare delivery for the masses without rationalizing human resources in the form of re-allocation and re-deployment of healthcare personnel. This study aimed to establish the level of adequacy and efficiency of nursing staff in the former Transkei region. The study was carried out in the child and family welfare clinic of the Umtata General Hospital. [from abstract]

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]

This paper examines the employment preferences of public sector registered nurses working in Malawi and identifies the range and relative importance of the factors that affect their motivation. The research was designed in the light of the Malawi government’s programme to address the shortage of health workers, which is based on salary top-ups as a means of increasing employee motivation and reducing high rates of attrition. This policy has been adopted despite relatively little quantitative exploration into the employment preferences of health workers in developing countries. This study aims to provide a clearer picture of the preferences of registered nurses about different aspects of their employment, and the factors that might persuade them to continue in the profession within their home country.

Countries in Africa are facing a public health meltdown as hundreds of public health workers succumb to the AIDS pandemic or are fleeing the region in search of better pay. As well, the healthcare infrastructure is well below the required standard with rural communities in some nations struggling to cope. [from article]

This presentation was part of the ECSA Workforce Observatory Meeting in Arusha. It describes the Africa Health Workforce Observatory as a cooperative initiative and partnership (public sector, NGO/ CSOs, academy, professional associations, international & subregional organizations, development partners) to improve human resources development through promoting and facilitating evidence-based policy-making. The presentation details the benefits and some of the functions of the Observatory such as: country monitoring and information; research and analysis; sharing and dissemination; promoting national and intercountry networking; and capacity building for HRH. [author’s description]

The purpose of this document is to provide Africa 2010’s strategy for strengthening regional and local capacity for adopting effective policies and innovations to improve the health status of Africans. [from introduction]

The African continent is facing 25% of the world’s morbidity rate with only 3% of its healthcare personnel. This is the result of years of neglect and underinvestment by African governments and the international community, plus harsh IMF restraints on nations’ budgetary expeditures. [author’s descripton]

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]

The starting point for this online database was a comprehensive health workforce survey conducted by the WHO Regional Office for Africa in collaboration with WHO department of human resources for health in Geneva in 2004/2005. All 46 member states of the African Region have contributed to this data collection. The data base presented here is the best available information base on the health workforce in the African Region to date and it will be continuously updated. Data is provided for 23 different types of health care cadres, both as total numbers and densities per 1000 population. For many health care cadres, additional data e.g.

Paper presented at the AAU Conference of Rectors, Vice Chancellors and Presidents of African Universities, 2003. The paper examines the situation of HIV/AIDS globally, and in Africa. The central message of the paper is that higher education institutions must develop a comprehensive HIV prevention programme which runs through and drives each of the following: HIV/AIDS policy and strategy development; developing culturally appropriate prevention messages; tackling socio-economic factors; establishing partnerships; sustaining awareness and education; challenging denial and stigma; situating prevention in a community context; linking care to prevention; rigorous scientific reflection.

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.

Various constraints are being experienced in the health delivery systems, namely weak health infrastructure, limited tools, inadequate human resource capacity, limited public financing to the health sector as a whole (and not only to disease specific programs), poor management and planning and lack of integrated health systems and misapplication of human, technical and financial resources. In order to improve health in Africa, inequalities to health service access between and within countries should be addressed within the health system. [author’s description]

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels. [from abstract]

This study documents the contribution made by religion and religious entities to the struggle for health and wellbeing in Zambia and Lesotho, in a context dominated by poverty, stressed public health systems and the HIV/AIDS pandemic. By mapping and understanding these Religious Health Assets (RHAs), the study calls for a greater appreciation of the potential they have for the struggle against HIV/AIDS and for universal access and offers recommendations for action by both public health and religious leaders at all levels. Through respectful engagement these assets have the potential to increase in strength and value and become more effective in the long-term sustainability, recovery and resilience of individuals, families and communities. [publisher’s description]

Family Medicine training and assessment is becoming more formalized and developed in South Africa. Assessment of competency in relation to clinical skills can involve observation in the clinical setting, but is more usually assessed in an examination. Summative assessment of family physician’s clinical skills now usually includes an Objective Structured Clinical Examination (OSCE). Standardisation of the OSCE is required to define the pass mark above which a candidate performs at the level expected of a family physician. [from abstract]

This case study describes how five Integrated Management of Childhood Illness (IMCI) trainers and supervisors conducted an assessment of provider knowledge and skill to carry out IMCI at 38 facilities in two districts in Kenya. [author’s description]

The Quality Assurance Project investigated how job aids could increase compliance with guidelines for the Integrated Management of Childhood Illness (IMCI) in cooperation with the Zambia Central Board of Health beginning in 1999. One of the first countries to introduce IMCI, Zambia had a large number of IMCI-trained providers, and several IMCI job aids were already in use: a chartbook, recording form, poster, and mother card. The study proceeded in three stages: an initial assessment of job aid usage in 1999, the design and introduction of a new IMCI job aid (called “new outpatient department book” or “NOPD book”) that also served as the patient record, and a second assessment of job aid usage in 2000 after introduction of the NOPD book.

The study was carried out to evaluate short term effects of one to one educational intervention approach, conducted with 40 drug sellers in order to improve the private sector’s practices, compliance and performance in using the national treatment guidelines for malaria and other common childhood (diarrhoea, acute respiratory tract infection-ARI) illnesses in Kibaha district-Tanzania. [from abstract]

Very little information is available on the extent to which the private health sector is involved in clinical management of HIV/AIDS in Nigeria. This study assessed the potentials and existing capacity of 15 private health facilities in Nassarawa state for clinical management of HIV/AIDS. [from abstract]

This assessment establishes the link between service quality and initial training by examining the skill retention of 2 cohorts of service providers who participated in a family planning (FP) training program in Kenya during 1994–1995. The following two questions were considered: 1) Do providers use the skills in which they were trained? 2) Is the length of time after the course concludes related to whether trained providers retain their new skills? [publisher’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]