Stakeholders

This paper examines the potential roles and responsibilities of professional obstetrical and midwifery associations in addressing the tragedy of maternal deaths. We examine the successes and challenges of obstetrical and midwifery associations and encourage the growth and development of active associations to address maternal mortality within their own borders. [abstract]

This paper aims to provide an overview of the current evidence and opinion of the workforce implications of regulation, competency development and role definition. These three elements are inextricably linked to each other and are fundamental to the practice of nursing in today’s environment. [from introduction]

As the private sector plays an increasingly critical role in the delivery of reproductive health/family planning (RH/FP) services, donors and public health ministries are turning their attention to business arrangements that offer the potential to increase access to high-quality priority health services. Private provider networks hold the promise of cost effectively expanding the scale of private practice, and are increasingly being considered as a way to achieve national public health objectives.

There is currently much debate about the role Global Health Initiatives (GHI) should play in strengthening health systems. There is increasing realization that without more support to help countries build health system capacity, the resources mobilized by GHIs are unlikely to reach their full potential. This paper argues that health-system strengthening requires improving capacity in critical components of health systems in order to get more equitable and sustained improvement across health services and outcomes. This paper discusses these critical components, including human resource development within the broader context of health system strengthening. [adapted from author]

The NGOs that comprise the USAID-funded NGO Service Delivery Program must control costs in order to improve their cost recovery rates. Costs associatied with high staff turnover are an important variable operating expense. An NSDP study of staff turnover has produced interesting findings contributing to new staff retention strategies. [introduction]

NGOs that provide basic health care to the poor must become less dependent on donor support by diversifying their funding. The NGO Service Delivery Program (NSDP), a USAID-funded health care program in Bangladesh, is working with NGOs to find corporate sponsorship. [publisher’s description]

This report focuses on HIV/AIDS home and community care projects and programs that have been able to scale up or reach out, and in doing so have brought an improved quality of life to people living with or affected by HIV/AIDS. The initiatives are widely spread geographically, with five from Africa, two from Asia, and one from Latin America. The final chapter of this report revisits some of the main lessons learned through the practices, and examines both commonalities and differences. [adapted from author]

This report discusses the impacts of malaria on business. It reviews the academic literature on the impacts of malaria on economies and businesses, presents data from survey on the business impacts of malaria, discusses the actions the private sector can take to combat malaria, and reviews examples of business malaria programs. The final section makes some recommendations for businesses considering engagement in malaria control. [adapted from author]

This case study documents Indonesia’s family planning experience with a view to understanding the factors and conditions that led to the remarkable growth in the private sector’s role in delivering family planning services. [from abstract]

The paper outlines a conceptual framework that integrates the key strategies that must be addressed and linked if policy-makers are to create the kinds of health care system to which the citizens of [central and eastern Europe and Eurasia] are entitled. It examines how financing, coordinated service delivery and quality measures matter independently, and it highlights the need to interweave them effectively with citizen and community participation mechanisms and a far-reaching concern for public health. It also reviews the complex issues that hinder or help the implementation of reforms and suggests how an understanding of context, stakeholders and capacity will be critical to delivering change.

This paper reviews the experiences of franchising and discusses the opportunities and implications for governments and donors of franchising for HIV and AIDS services. [from author]

This report identifies innovative approaches countries are using to address the shortages of health care workers and describes efforts to achieve long-term sustainability. [author’s description]

This report describes global progress on the “3 by 5” (Treating 3 million by 2005: making it happen) project in scaling up access to [HIV/AIDS] antiretroviral therapy and outlines the areas in which important progress has been made and lessons learned. It also outlines the remaining challenges and roadblocks to treatment access. [author’s description]

Chapter 2 (Strengthening Health Systems) provides an overview of HRH related approaches and progress.

During the past few years, a number of key donor programs have scaled up their global response to the crisis of HIV and AIDS… The goal of this paper is to begin a discussion among donors, international and local NGOs, and multilateral and U.S. government representatives on how to effectively engage indigenous partners and transfer much-needed resources. [from preface]

This study aims to examine the range of impacts the [HIV/AIDS] pandemic has had on selected NGO partners of Oxfam operating in South Africa, Zambia, and Zimbabwe, and to make recommendations useful to NGOs, including Oxfam, donors, and policy-makers based on its results. [author’s description]

The purpose of this paper is to begin to develop consensus about key challenges and effective strategies in working with the non-state sector to achieve public health goals. [Author’s description]

This paper evaluates structural quality of hospital care in the context of an evaluation of contracting out district hospital services in South Africa. Three contractor hospitals, run by a private company and paid by public purchasers to provide district hospital care to a rural catchment population, were matched with three adjacent public hospitals and three private hospitals serving largely insured patients. A structured instrument was used to provide a quantitative measure of structural quality. Private hospitals scored highest overall, followed by public and then contractor hospitals.

As a key contribution toward increasing human capacity in national health systems, the Capacity Project is hosting a series of Human Resources for Health (HRH) Action Workshops. The initial workshop—held in Johannesburg in partnership with the United Nations Development Programme/Southern Africa Capacity Initiative (UNDP/SACI)—facilitated the exchange of knowledge and best practices in planning, developing and supporting the health workforce. The three and one-half day workshop brought together 38 HRH leaders from 11 countries (Kenya, Lesotho, Malawi, Namibia, Rwanda, Sudan, South Africa, Swaziland, Tanzania, Uganda and Zambia). Almost all of the participants are senior HRH directors or practitioners working at the operational level within the Ministry of Health in their respective countries. Two representatives from faith-based organizations also attended.

We report on income generation and work mix among 100 civil servants who manage public health services in developing countries. Their salary puts these managers among the better-off in their countries. However, 87% of the respondents complement their salaries with other income-generating activities.

This article considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. [adapted from abstract]

Action is underway to increase access to antiretroviral drugs, especially in countries with high rates of HIV. The role of private providers is largely ignored, although they are an important source of care for stigmatizing diseases in many poor countries. Evidence is emerging that antiretroviral drugs are leaking into formal and informal private markets. Uncontrolled use of drugs in the private sector will lead to rapid development of HIV resistance. Countries require guidance and support from international policy makers and pharmaceutical companies to implement strategies for working with private providers.

As a key contribution toward increasing human capacity in national health systems, the Capacity Project is hosting a series of Human Resources for Health (HRH) Action Workshops. The initial workshop—held in Johannesburg in partnership with the United Nations Development Programme/Southern Africa Capacity Initiative (UNDP/SACI)—facilitated the exchange of knowledge and best practices in planning, developing and supporting the health workforce.

The three and one-half day workshop brought together 38 HRH leaders from 11 countries (Kenya, Lesotho, Malawi, Namibia, Rwanda, Sudan, South Africa, Swaziland, Tanzania, Uganda and Zambia).

The Human Resource Management (HRM) Assessment Tool offers a method for assessing what an organization’s Human Resource Management system consists of and how well it functions. The HRM Assessment Tool helps users to develop strategies to improve the human resource system and make it as effective as possible. It can also serve as a basis for focusing discussions, brainstorming, and strategic planning. It is designed to be used in public and private-sector health organizations.

Countries in the Europe and Eurasia region are facing a significant and expanding HIV/AIDS epidemic that is largely concentrated among particularly vulnerable populations. A window of opportunity exists to respond effectively to the epidemic and to halt its spread, both within and beyond vulnerable populations. However, available evidence indicates that this opportunity is being missed. One explanation for this is that significant barriers exist within the region’s health systems that prevent rapid scale–up of effective HIV/AIDS programs.

This study seeks to examine these barriers and ways they can be overcome.

This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce.

A technical consultation on imbalances in the health workforce was held in Ottawa, Ontario, Canada, from 10 to 12 March 2002. The discussions focused on the following main themes: the rationale for WHO’s work on imbalances in the health workforce; developing a conceptual framework for defining imbalances in the health workforce; identifying sources of data required for optimal monitoring of imbalances; and identifying areas for further research. [author’s description]

We develop a principal-agent model to analyze how the behavior of a physician in the
public sector is affected by his activities in the private sector. We show that the physician will have incentives to over-provide medical services when he uses his public activity as a way of increasing his prestige as a private doctor. The health authority only benefits from the physician’s dual practice when it is interested in ensuring a very accurate treatment for the patient. Our analysis provides a theoretical framework in which some actual policies implemented to regulate physicians’ dual practice can be addressed.

The report presents findings from a baseline survey of 155 primary health care facilities (dispensaries, with and without maternity units) that was carried out in Uganda in the latter part of 2000. The analysis compares service delivery performance in three ownership categories: government, private for-profit, and private nonprofit. Among the topics it explores at the facility level are staffing, availability of drugs and other inputs, remuneration, outputs, and financing. The findings are highly relevant for public policy in Uganda and in other countries in Africa that are undertaking civil service reform and promoting private-public partnerships in health care.

The present report deals with health financing issues in Malawi and analyzes trends in health expenditures in the 1990s, along with the prospects for improving resource mobilization, allocation and use in the health sector of that country. This review highlights the need to further prioritize the activities under the Malawi National Health Plan so that the plan will be a basis for government policy and budgetary commitments and also an instrument to marshal and orchestrate donor support to the sector. [from foreword]

Provides an overview of a new budgeting approach in Mauritania, developed by the Ministry of Health on the basis of an analysis of the health problems of poor people, their difficulties in accessing health care, and the shortcomings of the health systems in serving them. The document shows how such analysis can inform the budgeting process and reorient public expenditures in the health sector. Budgeting health services in Mauritania have shifted from a line item approach towards performance based programs with specific indicators of success identified both program and region wide. [from author