Sub-Saharan Africa

Confidentiality or Continuity? Family Caregivers’ Experiences with Care for HIV/AIDS

The overall objective of this study was to analyse the challenges which family caregivers encountered in home-based care when they tried to access medical treatment for home-based AIDS patients in the context of confidentiality and limited medical care. [from abstract]

Non-Physician Clinicians in Sub-Saharan Africa

This article builds on a recent publication on the capacity of the existing health workforce in Africa to expand through increasing production of its non-physician clinicians and by suggesting that there are four further issues to be urgently addressed if NPCs are to realize their full potential. [adapted from author]

Scaling Up Health Workforce Production: a Concept Paper Towards Implementation of World Health Assembly Resolution WHA59.23

This note discusses challenges and options in scaling up the production of skilled health workers and strengthening the health professions educational capacity of the countries in crisis, particularly in Africa. [from introduction]

Perverse Subsidy: Canada and the Brain Drain of Health Professionals from Sub-Saharan Africa

The Canadian health care system is one of the places where push comes to pull in terms of attracting health care professionals from sub-Saharan Africa. The authors call this the perverse subsidy: the costs of training these professionals are paid for by poorer people in poorer countries. The pull to Canada is equally a push from Africa. Reflections on a pilot study on a labour mobility issue that is equally a question of conscience. [from author]

Reflections on the Training of Counsellors in Motivational Interviewing for Programmes for the Prevention of Mother to Child Transmission of HIV in Sub-Saharan Africa

Within the Southern African prevention of mother to child transmission (PMTCT) programmes, counsellors talk with pregnant mothers about a number of interrelated decisions and behaviour changes. Current counselling has been characterised as ineffective in eliciting behaviour change and as adopting a predominantly informational and directive approach. Motivational interviewing (MI) was chosen as a more appropriate approach to guide mothers in these difficult decisions, as it is designed for conversations about behaviour change. MI has not previously been attempted in this context. This paper reflects on how MI can be incorporated successfully into PMTCT counselling and what lessons can be learnt regarding how to conduct training with counsellors.

Should Active Recruitment of Health Workers from Sub-Saharan Africa be Viewed as a Crime?

This editorial describes the widespread recruitment of health workers from sub-Saharan Africa to developed nations by recruiting agencies. The authors describe international efforts to criminalize this practice and express concern at the continued practice of recruitment.

Africa's Neglected Surgical Workforce Crisis

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]

Salaries and Incomes of Health Workers in Sub-Saharan Africa

This article investigates pay structures for health workers in the public sector in sub-Saharan Africa; the adequacy of incomes for health workers; the management of public- and private-sector pay; and the fiscal and macroeconomic factors that impinge on pay policy for the public sector. The study finds that pay and income of health workers varies widely, whether between countries, by comparison with cost of living, or between the public and private sectors. To optimize the distribution and mix of health workers, policy interventions are needed. Fiscal constraints to increased salaries might need to be overcome in many countries, and non-financial incentives improved. [adapted from summary]

How Private Health Care Can Help Africa

To understand how the private health sector might better complement Africa’s public health systems, we studied the health care sectors of 45 sub-Saharan African countries. The findings suggest opportunities for private enterprise to help improve the region’s woefully poor health outcomes.

Impact of HIV/AIDS on the Health Workforce in Developing Countries

This paper addresses the influence of the HIV/AIDS epidemic on the health workforce. An overview of the impact of HIV/AIDS on health systems is provided, with a focus on developing countries. Other topics include the impact of HIV/AIDS on morbidity and mortality among staff in Africa; the impact of HIV/AIDS on workforce motivation, performance and migration; and future staffing scenarios and potential obstacles. [adapted from author]

Business of Health in Africa: Partnering with the Private Sector to Improve People's Lives

This report describes opportunities for engaging and supporting a well managed and effectively regulated private sector to improve the region’s health. This report highlights the critical role the private sector can play in meeting health care needs in Sub-Saharan Africa. It also identifies policy changes that governments and international donors can make to enable the private sector to take on an ever more meaningful role in closing Africa’s health care gap. [adapted from publisher]

Inequities in the Global Health Workforce: the Greatest Impediment to Health in Sub-Saharan Africa

This article discusses the gaps exist between the potential of health systems and their actual performance. Best practices from various countries are discussed. The author concludes that the crisis can be tackled if there is global rsponsibility, political will, financial commitment and public-private partnership for country-led and country-specific interventions that seek solutions beyond the health sector. [adapted from abstract]

Costs and Benefits of Health Worker Migration from East and Southern Africa (ESA): a Literature Review

The migration of health professionals from developing countries in general, and sub-Saharan African countries in particular, has become the subject of considerable theoretical and case study research attention in international migration and human resources for health (HRH) literature. This report is a review of all available literature on the costs and benefits of the migration of health workers from East and Southern African (ESA) countries to developed nations. [from executive summary]

Exodus of Health Professionals from Sub-Saharan Africa: Balancing Human Rights and Societal Needs in the Twenty-First Century

In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one’s country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health.

Addressing Africa's Health Workforce Crisis

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]

Impact of Home-Based Management of Malaria on Health Outcomes in Africa: a Systematic Review of the Evidence

Home-based management of malaria (HMM) is promoted as a major strategy to improve prompt delivery of effective malaria treatment in Africa. The published literature was searched for studies that evaluated the health impact of community- and home-based treatment for malaria in Africa. [from abstract]

Community Workers Key to Improving Africa's Primary Care

In parts of rural Africa, where conflict and neglect have destroyed any remnants of a functioning health system, there is one long-running public-health programme that is not only surviving but thriving—by capitalising on communities’ desires to help themselves. [author’s description]

Community-Based Distribution of Depo-Provera: Evidence of Success in the African Context

In much of sub-Saharan Africa, a significant portion of the population lives in rural areas, leaving many women with limited access to clinic-based family planning services. Thus CBD of contraceptives remains an important service delivery mechanism in this region. The primary aim of this study was to assess the safety, quality, and feasibility of Depo-Provera provision by community reproductive health workers.

African Regional Health Report: the Health of the People

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.

Model of ODL to Address Educational Needs of Health Workers in Africa

Health workers attending overseas universities may be less likely to return home. One response is to improve course provision and professional updating opportunities in-country. Leeds Metropolitan University, with funding from the Commonwealth Scholarships Commission under their distance learning initiative, runs a tailor-made MSc Public Health (Environmental Health and Health Promotion) in Zambia, for nurse tutors, clinical officers and environmental health workers. Using locally relevant curricula, with community-based, student centred, problem-solving approaches, retention may be improved. This paper will discuss how the course is delivered in Zambia, how the partnership developed such as to enable effective delivery of the course, and how sustainable learning can be achieved in a developing country in partnership with a UK University. [from abstract]

Crisis in Human Resources for Health in the African Region

This edition covers topics such as: migration of skilled health workers, investing in human resources for health, strengthening human resources for health in Africa, and the economic cost of health professionals brain drain in the African region. [author’s description]

Policies and Plans for Human Resources for Health: Guidelines for Countries in the WHO African Region

Experience has shown that governments have different kinds of HRH policies, strategies and plans even when they are within the overall context of national health policies and strategies. This document provides guidance on the process with proposals of content for three basic HRH documents: situation analysis, policy, and strategic plan. [from foreword]

Getting Clinicians to Do Their Best: Ability, Altruism and Incentives

By measuring the ability and actual practice of a sample of clinicians in Tanzania and examining the terms of employment for these clinicians, we show that both ability and motivation are important to quality.

Migration of Nurses from Sub-Saharan Africa: A Review of Issues and Challenges

This paper was commissioned to identify and review reports, documents and data relating to nursing workforce dynamics in sub-Saharan Africa with the objective of analyzing, synthesizing, and presenting key information on nurse migration in the region. It reviews trends and impact of nurse migration derived from previously published work by various groups and reports to the High Level Forum on the millennium development goals on the human resources crisis. [from abstract]

Consultative Meeting on Strengthening the Role of Colleges of Medicine in the Production of Health Workers in the WHO African Region

This meeting discussed the role of medical schools in the process of development and implementation for national health policies and plans, the need for medical education reforms to respond to national health challenges within the context of global and regional health strategies, the way forward for enhancing the capacity of medical schools to produce adequate human resources for health, and the formulation of recommendations for regular institutional evaluation. [adapted from executive summary]

African Atlas of the Health Workforce

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.

Trends and Opportunities in Public-Private Partnerships to Improve Health Service Delivery in Africa

The report, in its first part, destroys three common myths regarding the private health care sector in Africa and discusses how to engage the private sector effectively. It provides examples of successful public-private partnerships and highlights some of the trends in these types of partnerships. [adapated from executive summary]

Building Support for Public Private Partnerships for Health Service Delivery in Africa: Critical Issues for Communication: Results from a Stakeholder Consultation

The World Bank commissioned the Center for Development Communication (CDC) to develop a communication strategy to help boost public-private partnerships in the African continent. CDC consulted with key informants and stakeholders identified by the World Bank’s Public-Private Partnerships (PPP) working group in order to develop a stakeholder analysis to help inform the larger communication strategy. This report summarizes the results of that consultation. [from executive summary]

Contribution of International Health Volunteers to the Health Workforce in Sub-Saharan Africa

In this paper, we aim to quantify the contribution of international health volunteers (IHVs) to the health workforce in sub-Saharan Africa and to explore the perceptions of health service managers regarding these volunteers. [from abstract]

People First: African Solutions to the Health Worker Crisis

The health worker crisis is particularly acute in rural and hard to reach areas, where 80% of the population in Africa live. The resultant low capacity at the peripheral level of the health system is a crucial barrier to good health. AMREF believes that developing capable, motivated and supported health workers at all levels of the health system is essential in ensuring the delivery of accessible and effective health care across Africa… This briefing draws on AMREF’s experience to look at three key issues: the importance of appropriate training, task-shifting to lower cadres of worker, and training and supporting community health workers (CHW) in order to bring health care closer to communities.