Documents & Reports

These revised and expanded guidelines aim to help [national nursing associations], nursing and midwifery personnel, nurse managers, employers and others to address the educational needs and ethical responsibilities of nursing and midwifery personnel in reducing transmission of HIV/AIDS, HBV, HCV and tuberculosis; develop strategies for a safer work environment and increased protection for nursing and midwifery personnel; and address the socioeconomic welfare issues related to the health care needs, compensation and financial security of HIV-positive nursing and midwifery personnel.

This document highlights the potential advantages and perils of career moves and migration for nurses, describes some of the main nurse migration trends and establishes a list of critical questions as an ethical framework for nurse recruitment. [adapted from author]

Nurses are increasingly working overtime. Nurses’ overtime (mandatory or voluntary) has been used as a measure to reduce the impact of the critical shortage of nurses and/or the downsizing of nursing departments in both private and public health facilities. However, the increasing amount of overtime threatens nurses’ ability to provide safe and individualised care for patients. [author’s description]

Healthcare systems worldwide are stressed by limited resources and increasing demands on their services. Nurses, as the largest group of healthcare professionals, have experienced significant changes in their work life and environment as systems have tried to meet these challenges. As workloads become more substantial and the number of nurses per patient diminishes, patients and healthcare workers across the globe are put increasingly at risk. [introduction]

This guidance was developed to help staff of the ACQUIRE Project understand and explain to counterparts and field partners the improvement approaches and tools used by ACQUIRE. ACQUIRE brings together partners with proven, effective approaches to improving provider performance and the quality of services and to mobilizing communities to drive improvements in health care: performance improvement, quality improvement, and participatory learning and action.

Home-based care (HBC) for HIV/AIDS is increasingly looked to as a more accessible and affordable alternative to more costly inpatient care, both for patients who are unable to travel to or pay for inpatient care as well as for governments that must fund inpatient facilities. Partners for Health Reformplus estimated the cost of HBC for HIV in Rwanda, based on a sample of eight programs offering care in early 2004. The sample comprised facility- and community-based programs. Both types of program implement the medical care recommended in the Ministry of Health guidelines for HBC. [from abstract]

This paper describes the specific policy measures that the Zimbabwean government has recently implemented to try to improve health sector performance, and promote higher levels of motivation amongst public sector health care workers. The overall reform package is to include financial reforms (user fees and social insurance), strengthening of health management, liberalization and regulation of the private health sector, decentralization, and contracting out. Unfortunately, the process of reform implementation in Zimbabwe and the government’s poor communication with workers, combined with a conflict between local cultures and the measures being implemented, has undermined the potentially positive effect of reforms on health worker motivation.

This paper reports the experiences of primary care reform in the Zhezkazgan region of Kazakhstan. After the collapse of the Soviet regime, Kazakhstan undertook a radical program of reform to restructure the health sector, making primary care the centerpiece of their health reform agenda. The reforms included the creation of independent family group practices financed on a capitation basis directly from the Ministry of Health, allowing free choice of primary care providers through open enrollment, and creating a non-governmental primary care physician association. This program has had remarkable success in improving motivation among primary health care workers.

This paper offers a conceptual framework for considering the many layers of influences upon health worker motivation. It suggests that worker motivation is influenced not only by specific incentive schemes targeted at workers, but also by the whole range of health sector reforms which potentially affect organizational culture, reporting structures, channels of accountability, etc.

Family planning and other health care organizations in developing countries increasingly must do more with the same resources, and sometimes with fewer. Reorganizing work processes offers one common-sense way to help staff members at all levels cope with growing demands. [author’s description]

This paper provides a brief overview of some programs and issues related to the use of technology and distance education to train community health workers in frontier areas. Issues include the use of consistent definitions, the appropriate technology format for the learner and access to that technology, cultural competency /proficiency of faculty, support for faculty and students, and the assurance of quality. [from executive summary]

This report was developed to outline broad strategy, create a common vision for developing a new core health information system, and describe specific technical development tasks in detail. The new information system must be designed from the top down based on information demand. This should focus development on clear data collection and processing priorities, eliminate collection of unused data, and produce an efficient and relevant system.

This report presents results from the Egypt Health Care Providers Surveys, the objectives of which were to: provide a comprehensive picture of all sources of health care services; provide policy relevant data on critical issues for health sector reform; and create a database on health care providers for use by the Ministry of Health and Population in developing policy reform proposals. Five separate surveys were conducted on health care institutions, private clinics, pharmacies, dayas (traditional birth attendants), and other practitioners. The sample of 10,048 providers was developed from a complete enumeration of all health care providers in sampling areas and data from the 1986 national census.

In Egypt there is increasingly strong political support for health sector reform including a widespread recognition that a working information system is necessary to undertake and monitor this reform. This paper assesses the role of USAID technical support to help build health management information systems in Egypt.

The purpose of this technical effort by the Partnerships for Health Reform was to assess various issues, problems, and opportunities facing the University Teaching Hospital (UTH) in Zambia. This review serves to catalyze and provide input for the development of an effective strategic plan for the UTH and Zambia’s health services in general. Findings from this review provide a basis for recommendations on how to effectively address these issues in order to improve management and, ultimately, positively affect efficiency, quality, equity, and sustainability of services. [from abstract]

Dissatisfied with centralized approaches to delivering local public services, a large number of countries are decentralizing responsibility for these services to lower- level, locally elected governments. The results have been mixed. This chapter provides a framework for evaluating the benefits and costs, in terms of service delivery, of different approaches to decentralization, based on relationships of accountability between different actors in the delivery chain. Moving from a model of central provision to that of decentralization to local governments introduces a new relationship of accountability—between national and local policymakers—while altering existing relationships, such as that between citizens and elected politicians.

Provider payment methods are important to consider any time a government or a payor wants to improve the efficiency and the quality of health services with the use of its funds. Changes in provider payment methods are often pivotal to broader health reform measures to contain costs and use existing resources effectively, and also to improve quality of care and equitable financial access to care. [author’s description]

Incentives that affect worker performance may be modified by system change. Attention to both financial and non-financial incentives can make health care delivery more effective. [author’s description]

People caught in crisis situations have crucial reproductive health needs. The needs of pregnant women are most urgent. Complications of labor and delivery can be life-threatening when women lack adequate care. Risk for HIV/AIDS, other STIs, and unwanted pregnancy increases, particularly when disorder provides cover for rape and other sexual coercion. Health care providers understand people’s needs and have experience meeting them, but few have worked in humanitarian relief.

Contraceptive provision in many settings continues to be based on outdated medical information, unproven theoretical concerns, and provider biases. Studies have found that in some developing countries 25-50% of women seeking contraceptives are refused services until they are menstruating. Coupled with effective training, checklists can be important tools for health care workers at various levels to apply the latest WHO medical eligibility criteria and guidelines for contraceptive use.

Networks of private providers can be highly effective in reaching women with Family Planning/Reproductive Health (FP/RH) services Advantages: service delivery points are already in place, often financially sustainable, and have excess capacity. Private midwives provide 46% of all contraceptive use in Indonesia. A “linking organization” is key to link providers, identify incentives, develop a plan to meet service objectives and broker training, supplies, quality, and outreach to customers. [author’s description]

This document was presented at the ECSA Workforce Observatory Meeting in Arusha and describes an initiative in Malawi to provide regularly updated HRH information through an HRIS system including the current problems with collecting data, the steps to create the initiative and the indicators they will need.

This study examines the relationship between IMCI compliance and three cost issues: the length of client-provider consultations, treatment drugs, and workload. The setting was 26 health clinics in Niger, the only developing country setting where QA was implemented before IMCI. [publisher’s description]

This report is from a workshop on HRD for mental health in Pacific island countries. The objectives of the workshop were to evaluate the mental health training needs and resources in the Pacific island countries; to achieve consensus on guiding principles in the developmenet of national mental health education and training programs in the local context; and to identify mechanisms to support countries in developing and strengthening mental health training programs. [from summary]

This speech contends that a well performing workforce is the most critical determinant of the performance of services. Well functioning infrastructures and equipment do not serve if the people who deliver the services are not there (be it that there are none available, that they are absent from work, or that they are on strike). Well trained health workers, without the appropriate tools and supplies cannot do much either. And even when all ingredients are there, if workers are not motivated, services underperform. Advocacy to convince policy and decision-makers, as well as international agencies and donors to do something to improve the performance of the health workforce (HW) has been fervent these last 3-4 years, and it has been quite successful.

A group of individuals with expertise in areas such as TB control, human resources (HR) development and health systems (Annex 1) participated in a Consultation on HR Development for TB Control convened jointly by WHO and the Rockefeller Foundation and held at WHO headquarters in Geneva on 27 and 28 August 2003. This report summarizes the results of the consultation and the recommendations presented to the Second ad hoc Committee on the TB Epidemic.

This working paper is from the African regional consultative meeting on human resources for health (HRH) in Brazzavile, Congo. It describes the issues in health systems and HRH in the region and outlines the strategies and actions required for improvement. The document also discusses the Observatory of Health Human Resources for Africa, which was proposed as a cooperative network initiative among the countries and different partners of the region to produce the information and knowledge necessary for improving human resources policy decisions, and to share the country experiences in order to improve human resource development in the health services. [adapted from author]

These job satisfaction surveys are tools intended to gain feedback from providers who have stayed in their positions, providers who have changed jobs and managers in district and facility level health centers in order to measure satisfaction with working conditions.

The response to AIDS depends largely on people who are themselves getting sick and dying. This is why there is now a need for more targeted interventions to support these health workers, enable them to deliver good care and keep them in their positions. [author’s description]

This note provides a brief overview of the scope and nature of health workforce challenges in low-income countries; provides a simple framework for organizing the analysis of problems and responses; and outlines possible priority actions at country and international level.