Sub-Saharan Africa

This background study to the World Health Report 2006 is an attempt to provide a preliminary analysis of inflow and outflow patterns of health service providers in sub-Saharan Africa. The analysis is limited only to three types of health workers—doctors, nurses and midwives—and to countries in the region with critical shortages of health workers. [from publisher]

The Capacity Project has made specific technical contributions to shape and advance the human resources management professional development agenda at the global, regional and country level since 2005. This brief describes the rationale, process, methodology and some of the results of key approaches that the Project and its collaborating partners developed and implemented in sub-Saharan Africa. [from author]

This paper documents the impact of the AIDS crisis on non-AIDS related health services in fourteen sub-Saharan African countries. [from introduction]

One of the main barriers to surgical care in resource-limited settings is the shortage of trained health workers. A number of approaches are being employed to overcome this shortage including the mobilization of non-physician clinicians to perform surgical and anesthetic tasks. This paper discusses some of the experiences of surgical task shifting to date, and outlines lessons from task shifting in the delivery of HIV/AIDS care in sub-Saharan Africa. [adapted from abstract]

The delegation of tasks from one cadre to another has been used in many countries for decades. However, rapidly increasing care needs and accelerating human resource crises in Africa have given task shifting new prominence and urgency. This commentary argues that task shifting holds great promise, but that any long-term success of task shifting hinges on serious political and financial commitments. [adapted from abstract]

The regional guidelines for implementing the SDNM in the African Region are to accelerate action at country level. The guidelines also provide both a framework for WHO action to support countries in improving the quality of nursing and midwifery services, and a guide for action at national and local levels. Possible priority actions have been proposed to countries to facilitate strengthening of nursing and midwifery services at national and local levels. [from foreword]

This presentation describes perspectives on the out-migration of health professionals in Africa.

This document details the efforts of the Christian Health Association to strengthen sub-Saharan Africa’s national health sectors by mitigating the the HR shortage. [adapted from executive summary]

This toolkit is an interactive, client-friendly approach for improving counseling on family planning and prevention, detection, and treatment of sexually transmitted infections (STIs) including HIV. It includes a training of trainers guide that supervisors and others can use to train health care facility directors and service providers on how to use the BCS+ for counseling family planning clients. [from publisher]

An interview with health development expert Dr. Peter Ngatia about 'brain drain' and its impact on health in Africa. [from introduction]

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Health care workers in developing countries continue to lack access to basic, practical information to enable them to deliver safe, effective care. This paper provides the first phase of a broader literature review of the information and learning needs of health care providers in developing countries. [from abstract]

The health worker shortage in sub-Saharan Africa derives from many causes, yet the dynamics of entry into and exit from the health workforce in many of these countries remain poorly understood. This limits the capacity of national governments and their international development partners to design and implement appropriate intervention programmes. This paper provides some of this information through the first systematic estimates of health worker inflow and outflow in selected sub-Saharan African countries. [adapted from introduction]

Currently, a wide variety of community health workers are active in many antiretroviral treatment delivery sites. This article investigates whether present community health worker programmes for antiretroviral treatment are taking into account the lessons learnt from past experiences with community health worker programmes in primary health care and to what extent they are seizing the new antiretroviral treatment-specific opportunities. [from abstract]

The already inadequate health systems of sub-Saharan Africa have been badly damaged by the emigration of their health professionals. This article suggests some practical measures to address the situation. [adapted from summary]

To build instructors’ capacity and address the knowledge gaps, the Capacity Project partnered with East, Central and Southern Africa Health Community and Africa’s Health in 2010 to deliver a week-long workshop on Contemporary Issues in Family Planning for midwifery tutors in Kenya, Tanzania and Uganda. [from author]

This article measured the productivity of cataract surgeons in Africa and assesses the factors that predict high productivity among surgeons in general. [adapted from abstract]

Non-state providers (NSP) of healthcare, whether philanthropic or commercial, exist outside the public sector. Research by the London School of Hygiene and Tropical Medicine found evidence that NSPs provide the majority of primary contacts with the health system in all six countries, except possibly South Africa. [from author]

This study cuts across countries and quantifies the range of service provision types and mechanisms used by sub-Saharan companies that are diverse in terms of size, industry, and national origin. The study results systematically quantify which services are actually being offered, and how companies actually finance those services. The study also explores some motivators for offering workplace services and assesses why certain services and financing mechanisms are used predominantly by large companies. [from summary]

Imbalances in quantity and quality of human resources for health (HRH) are increasingly recognized as perhaps the most critical impediment to achieving health outcome objectives in most African countries. However, reliable data on the HRH situation is not readily available. Some countries have hesitated to act in the absence of such data; other countries have not acted even when data are available while others have moved ahead in spite of the lack of reliable information. This paper addresses the issue of data use for HRH policy-making. [from summary]

While evaluation is, in theory, a component of training programmes in health planning, training needs in this area remain significant. Improving health systems necessarily calls for having more professionals who are skilled in evaluation. This article describes a four-week course taken by two cohorts of health professionals from 11 francophone African countries. We discuss how the course came to be, its content, its teaching processes and the master’s programme results for students. [from abstract]

In sub-Saharan Africa, the private health sector ranges from traditional healers, pharmacies, and shopkeepers selling health care products, to nonprofit and for-profit clinics and hospitals. There are a variety of reasons people use the private health sector including convenience, perceived quality, confidentiality, or because nothing else is available. Moreover, private health care in sub-Saharan Africa is not just for the rich. Africans of all socioeconomic backgrounds turn to the private sector for their health care needs. [from author]

We reviewed published literature that outlines the principles of quality assurance in higher education from various institutions worldwide. Using this information, we designed a handbook that outlines the quality assurance principles in a simple and practical way. This was intended to enable institutions, even in developing countries, to adapt these principles in accordance with their local resource capacity. We subsequently pilot-tested this handbook at one of the sites in Ghana. [from abstract]

Increased interest in parasite-based malaria diagnosis has led to increased use of rapid diagnostic tests (RDTs), particularly in rural settings. The scarcity of health facilities and trained personnel in many sub-Saharan African countries means that limiting RDT use to such facilities would exclude a significant proportion of febrile cases. Use of RDTs by volunteer community health workers (CHWs) is one alternative, but most sub-Saharan African countries prohibit CHWs from handling blood, and little is known about CHW ability to use RDTs safely and effectively. [adapted from introduction]

Most children undergoing surgery in Kenya are anaesthetised by clinical officers or anaesthetists with minimal training in paediatric anaesthesia. This article details the statistics of how this personnel shortage impacts anaesthesia delivery. [from introduction]

This presentation discusses the current climate and prospects for health partnerships between the private and public sectors in Africa. [from presentation]

This presentation discusses the various aspects of private providers as they pertain to contracting for health services. [from presentation]

The researchers conclude that given the HRH crisis, ART delivery models requiring much less doctor time need to be developed. Overall, there is a need to shift tasks from medical doctors to nurses and from nurses to community health workers. In particular, the patients themselves need to play an important role in the delivery of ART. The outcomes of the various scenarios are predicted. [from author]

This report details the findings of the Forum on Engaging the Private Sector in Child Health held in Uganda in 2005. It discusses the potential of private providers and the private sector as a resource for improving community health outcomes. [from executive summary]

Task shifting should not be viewed as a panacea for the human resources challenges facing sub-Saharan Africa. Rather, it must be part of an overall strategy that includes measures to increase, retain, and sustain health staff. [from author]

Two crises dominate the health sectors of sub-Saharan African countries: those of human resources and of HIV. There is considerable variation in the extent to which these two phenomena affect sub-Saharan countries, with a few facing extreme levels of both. This paper reviews the continent-wide situation with respect to this double burden before considering the case of Malawi in more detail. [from abstract]