Evaluations & Reviews

Staff Training and Ambulatory Tuberculosis Treatment Outcomes: a Cluster Randomized Controlled Trial in South Africa

The objective of this study was to assess whether adding a training intervention for clinic staff to the usual DOTS strategy (the internationally recommended control strategy for tuberculosis (TB)) would affect the outcomes of TB treatement in primary care clinics with treatemet success rates below 70%. [from abstract]

Study of Health Human Resources in Nova Scotia 2003

This report provides a comprehensive picture of HRH in Nova Scotia, a snapshot of the number of people working in each health occupation and health care setting; education and training characteristics; age, gender and other demographics, and wokplace injury and illness informatio.

Creating Healthy Health Care Workplaces in British Columbia: Evidence for Action

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.

Integrated Community-Based Home Care (ICHC) in South Africa

This report outlines information from a literature review and field research pertaining to the key differences and similarities between the hospice ICHC model and other home-based care models used in South Africa; reviews the core elements of the ICHC model; and highlights best practices of the model. [adapted from introduction]

Human Resource Management and HIV/AIDS: a Study Among Share-Net Members

Published lessons learned from high HIV prevalence countries suggest that there are several key lessons available for any organisation that wishes to embark on an internal HIV/AIDS policy development process. This report contains first-hand experience by the Dutch Ministry of Foreign Affairs on its HIV/AIDS policy development process, plus comparative examples from various organisations. [from executive summary]

Review of Non-Financial Incentives for Health Worker Retention in East and Southern Africa

A growing body of evidence suggests that the quality of a health system depends greatly on highly motivated health workers who are satisfied with their jobs, and therefore stay at their stations and work. This paper reviewed evidence from published and grey literature on the use of non-financial incentives for health worker retention in sixteen countries in east and southern Africa. [adapted from author]

Physical and Psychological Violence in Jamaica's Health Sector

This study was done to determine the prevalence of experiences with physical violence and psychological violence that health staff have had in the workplace in Jamaica, and to identify factors associated with those experiences of violence. [from abstract]

State of Human Resources for Health in Zambia: Findings from the Public Expenditure Tracking and Quality of Service Delivery Survey, 2005/06

This paper reports the findings of the PET/QSDS pertaining to human resources for health in Zambia. The Public Expenditure Tracking and Quality of Service Delivery survey (PET/QSDS) was undertaken in mid-2006 to provide quantitative assessment of the state of health service delivery in the country. One component of the survey focused on the management of health personnel, including staff availability, vacancy, absenteeism, and tardiness; staff turnover; staff workload, use of time, and morale; and staff salary and benefits. [from introduction]

Postoperative Outcome of Caesarean Sections and Other Major Emergency Obstetric Surgery by Clinical Officers and Medical Officers in Malawi

Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors. [abstract]

Help Wanted: Confronting the Health Care Worker Crisis to Expand Access to HIV/AIDS treatment: MSF Experience in Southern Africa

This report focuses on the impact of human resource shortages witnessed by MSF teams in four southern African countries - Lesotho, Malawi, Mozambique, and South Africa. While the focus is largely on nurses in rural areas, it should be acknowledged that health staff is lacking across the spectrum - from doctors to laboratory technicians to pharmacists - at all levels of care. In all these cases the need for access to ART, as well as other health needs, is outstripping human resource capacity. [from introduction]

Transition to Skilled Birth Attendance: Is There a Future Role for Trained Traditional Birth Attendants?

This document provides a brief history of training of traditional birth attendants (TBAs), summary of evidence for effectiveness of TBA training, and consideration of the future role of trained TBAs in an environment that emphasizes transition to skilled birth attendance. [adapted from abstract]

Community-Based Postpartum Care: an Urgent Unmet Need

Guidance for integrated postpartum care at the community/household level that reduces maternal and newborn mortality and encourages health in the immediate postpartum period is lacking. This report identifies and summarizes descriptive and research studies of existing community-based postpartum programs which provide counseling and services along with education on self-care. The literature review identified three models of community-base postpartum care: home visits by professional health care providers, home visits by community workers and home visits by community workers with referral or health facility support.

Effect of Community Nurses and Health Volunteers on Child Mortality: the Navrongo Community Health and Family Planning Project

This report presents the child mortality impact of a trial of primary healthcare service delivery strategies in rural Ghana. After adjustment for sociodemographic factors, underfive mortality in areas with village-based community-nurse services fell by 16 percent during the five years of program implementation compared with mortality before the intervention. [from abstract]

Documentation and Assessment of the Reproductive and Child Health Alliance (RACHA) Program: an External Assessment

This assessment evalutes the RACHA program in Cambodia which was intended to strengthen the capacity and sustainability of the public and private sectors to deliver quality reproductive health and child survival services. The five technical intervention areas were birth spacing, STD/HIV prevention, safe motherhood, childhood diarrhoeal diseases and micronutrient deficiences. One of the key intermediate results identified within these areas was inproved human resource capacity to address these issues. [adapted from author]

Multisectoral Responses to HIV/AIDS: A Compendium of Promising Practices from Africa

This document brings together the promising practices identified by the PVO community. Our definition of promising is purposefully broad to include the many ideas and experiences of different organizations that seem likely to combat HIV/AIDS successfully. [from foreword]

Mapping Capacity in the Health Sector: a Conceptual Framework

This paper aims to review current knowledge and experiences from ongoing efforts to monitor and evaluate capacity building interventions in the health sector in developing countries.

Social Franchising of Sexual and Reproductive Health Services in Honduras and Nicaragua

This document outlines the outcome of three franchising projects implemented by Partners of Marie Stopes International (MSI) in Honduras and Nicaragua. The projects were designed to pilot full and partial social franchising models as part of an initiative to test and develop alternative forms of delivering quality sexual and reproductive health (SRH) services by a non government organisation (NGO). [abstract]

Providing Doorstep Services to Underserved Rural Populations: Community Health Officers in Ghana

Through its Community-Based Health Planning and Services (CHPS) initiative, Ghana has deployed more than 310 auxiliary nurses in 53 of the country’s most deprived districts. These nurses, who receive two years of training and the title Community Health Officer (CHO), are part of an innovative approach that shifts staff from low-impact static health centers with limited outreach to high-impact mobile community-supported services. CHOs provide doorstep services to underserved rural populations and have improved access to health services for nearly one million Ghanaians (each CHO serves an average of 4,500 people), resulting in substantial improvements in community health.

Global Health Partnerships: the UK Contribution to Health in Developing Countries

This report sets out many stories of individual and National Health Service partnerships working to improve health and share learning. Already the UK has an impressive record and reputation on international development, in health and in other areas. But to get the best out of all the enthusiasm and the work that is being done, the report identifies a need for better coordination and more strategic partnerships, and makes recommendations for improvement. [from foreword]

Understanding Nurse Emigration: Final Report

TURP was commissioned to investigate the extent of nurse emigration and to suggest why this is happening. This report draws out the findings of the research conducted by TURP, and also uses information from newspaper reports. [introduction]

Health Personnel in Southern Africa: Confronting Maldistribution and Brain Drain

The report provides evidence of inadequate ratios of personnel to population for key skilled health personnel, and a maldistribution of personnel along three different axes, between: public and private heath sectors, urban and rural areas and tertiary and primary levels of the health system. It describes the exodus of healthcare workers from areas of poverty and low socio-economic development, to more highly developed areas. [from executive summary]

Introducing Client-Centered Reproductive Health Services in a Pakastani Setting

Typically, provider–client interactions are brief, and providers often behave condescendingly toward clients. As a result, clients are unable to express their concerns or describe the limitations they face in trying to implement the providers’ suggested course of action. A training intervention was developed for providers that focused on addressing the problems inherent in this dynamic. This research was undertaken to assess whether providers in the experimental area delivered services in a different manner than they had prior to the training intervention. [adapted from author]

Home and Community-Based Health Care for Mothers and Newborns

Recent efforts to improve maternal health have focused on skilled attendants and emergency care at health facilities. Skilled birth attendants and access to emergency obstetric care are essential to saving mothers lives. In developing countries, 60 million women give birth at home without skilled care and with high maternal and neonatal mortality. Nearly all essential newborn care can be provided safely, effectively, and at a low cost at the household level. The same is true for care of the mother, and many effective interventions can be implemented at the household and community level that will save mothers’ lives.

Strategic Management of the Health Workforce in Developing Countries: What Have We Learned?

The study of the health workforce has gained in prominence in recent years, as the dynamic interconnections between human resource issues and health system effectiveness have come into sharper focus. This paper reviews lessons relating to strategic management challenges emerging from the growing literature in this area. [from abstract]

Capacity Building in an AIDS-Affected Health Care Institution: Mulanje Mission Hospital, Malawi

This Praxis Note provides an overview of the impact of HIV/AIDS on the Malawi health care system and on the organisational capacity of Mulanje Mission Hospital. It describes the experiences and lessons learnt from a capacity building program designed to address capacity deficits and erosion caused by HIV/AIDS attrition. Less emphasis was placed on external training courses and increasing attention given to short-course inputs and distance learning. [from introduction]

Health System Innovations in Central America: Lessons and Impact of New Approaches

Ensuring high performance of health care delivery systems is a challenge facing all governments. Dealing with the incentive problems underlying public health care delivery to improve productivity, quality, and performance is a common theme of health sector reforms in many countries. However, the impact of these reforms is often hard to establish. This book presents a series of case studies of health systems innovations by the Central American republics in the 1990s. The cases have a common theme of efforts to improve specific aspects of health system performance through the introduction of innovative and alternative financial, organizational, or delivery models…The case studies in this book report on the results of these experiences, encompassing a range of issues from the expansion of primary care to the use of public-private partnerships and the establishment of a social security-financed delivery system.

Retention Strategies for Nursing: a Profile of Four Countries

A seven-point framework was used to analyze retention strategies in four countries: Uganda, the United Kingdom, Canada, and Thailand. This framework draws upon available country data and includes GDP and investment in health, mix of private/public investment, international migration, health policy frameworks, countrywide strategies, provincial/regional strategies, and professional associations/regulatory bodies. Comparison of the countries demonstrated that progress has been made in nurse retention. [from executive summary]

Establishing Referral Networks for Comprehensive HIV Care in Low-Resource Settings

Strengthening access to a range of HIV-related services for those in need and promoting communication among service providers requires a formalized referral network of providers. However, little information about how to create these networks and few standardized tools to facilitate effective network functioning are available. This document aims to describe several models of referral networks and to provide tools and instructions that can be adapted to different settings.

International Recruitment of Nurses: United Kingdom Case Study

This paper assesses the reasons for recent growth in recruitment of registered nurses from other countries to the United Kingdom (UK). It aims to examine trends in inward recruitment of nurses to the UK, assess the impact of free mobility of registered nurses in the European Union from a UK perspective, examine the impact of the introduction of ethical guidelines on international recruitment of nurses to the UK, and explore the reasons why registered nurses are internationally mobile. [from introduction]

Quality of Care Management Center in Nepal: Improving Services with Limited Resources

This working paper evaluates th success of the Quality of Care Management Center in Nepal and highlights the fact that even in resource-poor settings, quality of care in health service delivery can be achieved. This model for a quality of care center that provides timely, appropriate, and ongoing support to clinical facilities may be especially useful in countries where centralized systems are in place for allocation of resources or where maintenance and supply capacity is limited to central locations.