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This paper focuses on lessons learned about building quality improvement into service delivery programs. Addressed to the program leaders and donor agencies that allocate resources for service delivery programs, the paper offers guidance on the actions that must take place to improve the quality of reproductive health and child survival programs. This guidance is based on the field experiences of members of the Management and Supervision Subcommittee of the MAQ Initiative. [publisher’s description]

This paper explores the implications and impact of knowledge management on family planning and reproductive health care. Using case studies and illustrative vignettes, the paper highlights the experiences of a number of developing country family planning/reproductive health organizations in integrating knowledge management tools and strategies to improve work processes and outcomes. [publisher’s description]

Using all of the tools in the document will provide a comprehensive assessment of skills and service delivery. Each tool, however, may be used separately or combined with others to create a document appropriate for the content of a specific maternal and newborn health training course. [author’s description]

This document aims to facilitate the development of quality-oriented health sector reforms by providing a clear conceptual framework that can serve as a roadmap for policymakers and senior managers. By taking advantage of opportunities to integrate quality assurance activities into health sector reforms, healthcare leaders can maximize the effectiveness of reform and move toward optimizing health outcomes for the citizens of Latin America and the Caribbean. [author’s description]

There is compelling evidence for the success of the “rural pipeline” (rural student recruitment and rurally based education and professional training) in increasing the rural workforce. The nexus between clinical education and training, sustaining the health care workforce, clinical research, and quality and safety needs greater emphasis in regional areas.

The medical workforce shortage and efforts to maintain the safety and quality of health services are putting acute pressure on the profession. Task transfer or role substitution of medical services is mooted as a potential solution to this pressure. This has the potential to drastically transform the profession. How task transfer will evolve and change medicine depends on the vision and leadership of the profession and a flexible pragmatism that safeguards quality and safety and places patient priorities above those of the profession. [from abstract]

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

In Thailand, family practice was developed primarily through a small number of self-styled family practitioners, who were dedicated to this professional field without having benefited from formal training in the specific techniques of family practice. In the context of a predominantly hospital-based health care system, much depends on their personal motivation and commitment to this area of medicine. The purpose of this paper is to compare the responsiveness, degree of patient-centredness, adequacy of therapeutic decisions and the cost of care in 37 such self-styled family practices, i.e. practices run by doctors who call themselves family practitioners, but have not been formally trained, and in 37 conventional public hospital outpatient departments (OPDs), 37 private clinics and 37 private hospital OPDs.

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.

This paper examines various aspects of the nursing and midwifery workforce in Africa, looking at education and supply systems; recruitment, retention and motivation and career systems. It further investigates attrition from migration and HIV/AIDS, as well as other factors and makes some recommendations on how to move forward using examples of experiences from countries. These experiences, albeit on a small scale, show promise of good results after being scaled up. [author’s description]

Human resources become increasingly relevant in this context. Health human resource (HHR) is currently experiencing a three-fold problem, which encompasses old issues, together with the effects of reform, and the consequences of globalisation. This includes the workforce crisis in nursing which, facing all kinds of difficulties, requires complex in-depth analysis, synergies and alliances in order to ensure quality nursing services.

Recruiting and keeping the right staff are key challenges for health policy-makers. The performance and quality of a health system ultimately depend on the quality and motivation of health human resources. Therefore, recruitment and retention problems should be appropriately addressed, as nursing staff shortages and low motivation are likely to have adverse effects on the delivery of health services and the outcome of care. The main objective of this paper is to examine how to develop and retain a motivated nursing workforce. [author’s description]

This document summarises underlying evidence and issues related to good human resource management (HRM)in the health sector with reference to: (a) indicators of performance and measurement of nursing outcomes; (b) performance issues related to individuals and teams; and (c) employee engagement, commitment and organisational citizenship behaviour (OCB). There are two key themes: What are the interventions and indicators associated with good HRM outcomes, and how can these be measured? [author’s description]

The safety of heath care workers (HCWs) who take care of people with HIV/AIDS and other infectious diseases is of paramount importance. Occupational transmission of blood borne infections is not regarded as a common problem in developed country settings, but this is not the case in resource poor countries where the incidence and impact of such exposures is under-reported and is now becoming appreciated as an important risk factor for HCWs.

Many countries have experimented with alternative ways of paying providers of health care services. This paper illustrates different methods, suggests some of the theoretic advantages and limitations of each, and provides a general theoretical framework for evaluating alternatives. Over the last two decades, new and more sophisticated payment systems have evolved, with a broadening of units of payment and setting of payments prospectively. The authors discuss the international experience of a number of payment systems, both traditional and more recently developed, including line-item budgeting, salary, fee-for-service, per diem, case-mix adjusted per episode, global budgets and capitation.

In the majority of low and middle-income countries, the private sector presents significant opportunities for expanding the reach of essential child health services and products. Through better coordination with the private sector, governments and donors can improve the availability, quality, and effectiveness of child health services…This document assesses the current importance, and potential, of the private sector in contributing to child health. [author’s description]

Health care labor is central to managing and delivering health services. Because recruitment and retention policies are key issues for purchasers, gaining insights into labor-purchasing mechanisms may permit them to be addressed more effectively. This paper is intended to provide a brief introduction to health care labor purchasing and the mechanisms through which it can have an impact on the delivery of health services and on health system performance. A framework is developed to foster understanding of health labor purchasing mechanisms. [abstract]

Planning for the efficient and effective delivery of health care services to meet the health needs of the populations is a significant challenge. Globally policy makers, educators, health service researchers, leaders of unions and professional associations, and other key stakeholders struggle with the best way to plan for a workforce to fulfill the health needs of populations.

This review of experience in accreditation and external quality assessment systems was produced at the request of the UK Department for International Development in India. The purpose of this review is to describe where External Quality Assessment fits in the broader set of levers that exist for engaging with health care providers and organisations in developing countries in order to improve quality and affordability of care.

This paper reviews some experiences of social agencies contracting with the private sector to provide health care services. It focuses on the capacity of this mechanism to improve access to services by the poor. The term private sector is used to cover both for-profit and not-for-profit providers of health services. The paper draws on these experiences to suggest some lessons and basic guidelines for contracting. [author’s description]

This case study provides details of a partnership that emerged in Georgia following the initiation of health sector reforms in 1995. It mainly focuses on describing the details of how and why the public purchaser contracted a non-governmental provider to deliver a set of health services in Georgia. The case study is discussed with proper attention to the context within which this arrangement developed. The nature of the services provided was paediatric cardio-surgery, which can hardly be considered a basic essential health service.

This literature review provides a short summary on some specified features of the training systems which are in place in developing countries (mainly low income Africa and Asia) which supply key workers into the health and education sectors. [author’s description]

The recent UN Millennium Project (UNMP) report recommended as a ‘quick win’ a massive training of community-based workers. This review examines the evidence to support or reject the hypothesis that investment in community workers can only impact on health outcomes with parallel investments in trained health workers and health systems. [author’s description]

This review paper…looks at strategies that have been undertaken to increase the productivity of health workers. It examines the evidence to support or reject the hypothesis that short term training, incentives, better equipment, supplies and conditions and other things can be employed that improve outputs and health outcomes without increasing the numbers of health workers. The review provides an overview of key aspects and options for improving productivity, with country illustrative examples. [author’s description]

It is becoming increasing important that policymakers be aware of health worker motivation and it’s impact on health sector performance. Health care delivery is highly labor-intensive, and service quality, efficiency, and equity are all directly mediated by workers’ willingness to apply themselves to their tasks. While resource availability and worker competencies are essential, decision makers should know that they are not sufficient in themselves to ensure desired worker performance. Worker performance is also dependent on workers’ level of motivation stimulating them to come to work regularly, work diligently, and be flexible and willing to carry out the necessary tasks.