Americas & Caribbean

This text presents the context and background, the methodology and some of the main results of the regional consultation on the critical challenges for human resources in health in the Americas. This consultation hopefully documents how the countries in the Americas are facing the main challenges to the development of the health workforce. The main results and suggestions by the actors consulted with regard to the role of international cooperation in the countries of the Region are presented, so that the countries and international agencies can better formulate common strategies of development and strengthening of the work force in health.

This presentation focuses on the work MSH has done in Nicaragua, where leadership has been used as the key to address many of the challenges faced by the health sector, using a systems approach. [author’s description]

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Many countries in Latin America and the Caribbean have too many specialists and too few primary care providers and community health workers. These countries need to overhaul their training and payment practices to address this imbalance, say human resources experts. [author’s description]

Many women choose to use traditional birth attendants in Guatemala to deliver their babies - a fact that can’t be ignored, according to local public-health officials. They hope a new culturally sensitive approach to training traditional birth attendants will help improve their quality of care and save lives. [adapted from author]

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.

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]

This report marks the culmination of the Nursing Sector Study. The five year study consisted of two phases, and examined the nursing workforce for all three regulated nursing professions in Canada. Phase I, which concluded in December 2004, examined the state of nursing human resources in Canada. The objective of Phase II was to develop a pan-Canadian nursing human resource (HR) strategy in consultation with government and non-government stakeholders that built on the findings and recommendations presented at the completion of Phase I. [from executive summary]

This best practice guideline aims to identify and describe: leadership practices that result in healthy outcomes for nurses, patients/clients, organizations and systems; system resources that support effective leadership practices; organizational culture, values and resources that support effective leadership practices; personal resources that support effective leadership practices; and anticipated outcomes of effective nursing leadership. [author’s description]

This report calls for provincial governments to take a closer look at the way they hire doctors, nurses and other health professionals from developing countries. Canada has always relied on newcomers to help deal with shortages in this field, but increasingly these professionals are coming from developing countries, especially from Africa and Asia, which have staffing shortages and critical health problems of their own.

This report is intended to generate discussion and direct future initiatives aimed at improving the current nationwide shortage of nurses. It is a review, analysis, and discussion of six major research documents on Canadian nursing human resource issues produced during the last five years. The questions this report sets out to answer are: What are the fundamental issues behind nursing human resource challenges? What solutions and strategies have been put forward to address them? What areas are being addressed? What areas have not been addressed and why? [from executive summary]

This yearly profile is a summary of statistics about the nursing workforce in Canada, Denmark, Germany, Iceland, Ireland, Japan, New Zealand, Norway, Sweden, UK and USA.

The objective of the country case studies consists in showing country-specific evidence and practical solutions concerning workplace violence in the health sector. By summarising existing information and analysing newly obtained information the study aims to identify risk factors as well as best practices of anti-violence interventions in the given socio-cultural context. This work will serve as a basis for the formulation of guidelines for prevention and coping strategies targeting issues of workplace violence in the health sector. [author’s description]

The present study reviews and analyses major known national guidelines and strategies for prevention and management of workplace violence. The purpose is to get a detailed picture of strategies recommended, a better knowledge on existing guidance for employers and employees. Another objective is to obtain information on the implementation processes and the impact of the reviewed guidelines. Identification of good practices as well as gaps shall serve as a basis for lessons learnt for the development of future guidance materials.

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]

Nurses have assumed management positions in many health institutions. To properly accomplish the demands of this role, it is important that they be competent in both management and leadership. For appropriate performance, knowledge of management and supervision styles is a priority. Therefore, the goal of this investigation is to identify the nurse manager’s knowledge regarding management and leadership.

The objective of this study was to examine associations between management training of physician executives and their leadership styles, as well as effectiveness in achieving disease management goals. [author’s description]

This case study describes how healthcare providers in Nicaragua worked together to improve the quality of obstetric care at their health centers and posts. They began by measuring the extent to which staff performed according to standards. Once aware of the quality gaps, they formed QI teams and used rapid team problem solving to implement quality improvements so that healthcare providers could perform according to obstetric standards. Continuous monitoring shows their success in meeting the standards and improving health outcomes. [author’s description]

Since 1994, Brazil has developed a primary care system based on multidisciplinary teams which include not only a physician and a nurse, but also 4-6 lay community health workers. Yet relatively few investigations have examined its effectiveness, especially in contrast with that of the traditional multi-specialty physician team approach it is replacing, or that of other existing family medicine approaches placing less emphasis on lay community health workers. The main objective of the study is to evaluate the quality of care offered to adults through different models of care currently present.

The goal of this project was to assist health system managers and policy makers develop policies and strategies to recruit and retain human resources in the homecare sector and have a satisfied, healthy workforce. Researchers worked in partnership with the agencies and the unions representing workers in the agencies to examine the effects of work and work environments on homecare workers’ emotional, mental, and physical health and intention to leave their workplaces. [executive summary]

In this setting, physicians were already making site visits to clinics to monitor technical standards of care. An intervention was designed to reinforce doctors’ interpersonal communication (IPC) training. Under the intervention, doctors received IPC job aids, self-assessment forms, and tape recorders. They taped themselves during consultations and assessed their skills from the recordings, using the forms and in consultation with their supervisors. The self-assessment form and the supervisor assessment form were modified to be reproduced in this report. [publisher’s description]

The article analyzes the practice of physicians and nurses working on the Family Health Program. A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams’ work agenda to their routine labour activities. [abstract]

This paper describes the application of activity-based costing (ABC) to calculate unit costs for a healthcare organization in a developing country. It also describes the ways in which these calcualtions can provide information for improving the efficiency and quality of healthcare services. [from abstract]

This report presents data on in-hospital care for childbirth and obstetrical emergencies in 14 hospitals. This report examines intervals between critical events

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.

This study provides initial information about current nursing issues that have arisen as a result of health care reform initiatives. Regardless of differences in service models or phases of health sector reform implementation, in all the countries the participating nurses identified many common themes, trends, and changes in nursing practice. The driving forces for change and their intensity have been different in the five countries.

Even though the situation of human resources in health varies between the countries of the Region of the Americas, all of them are confronted by deep imbalances in the availability, composition, and distribution of the work force. These imbalances can be present as acute shortages of health personnel, chronic and persistent problems of inappropriate distribution of the work force with regard to needs, or inequities in composition of health providers in relation to the population served.

This report discusses care provided to 245 women during labor, delivery, and immediate postpartum and their newborns during immediate postpartum. The quality of care for different tasks (e.g., monitoring fetal heart rate) is presented by country, by hospital type, and overall. The report details performance on recommended tasks and should inform program managers and providers in finding similar weaknesses in their own care delivery systems. Report includes 21 data tables and the data collection instrument for observations. [publisher’s description]

This publication is a companion document to the Workforce Trends of Regulated Nurses in Canada series of publications. The Workforce Trends series organizes and presents data by nursing profession, with separate publications for each of the licensed practical nurse (LPN), registered nurse (RN) and registered psychiatric nurse (RPN) workforces. This publication, in contrast, organizes and presents data by province or territory.

This report is the result of the meeting of the 47th Directing Council and 58th session of the Regional Committee in Washington DC. It is a summary of actions and proposals for a plan of action on human resources for health in the Americas submitted for the consideration of the Directing Council. This document summarizes the activities carried out to date in the countries and in the Governing Bodies. It provides an overview of the situation and the predominant trends in the Region, as well as a vision of the technical proposals and agreements for activities that are being developed.

Few countries in Latin America have experienced in such a short period the shift from a socialist government and centrally planned economy to a liberal market economy as Nicaragua. The impact of such a change in the health field has been supported by the quest for reform of the health system and the involvement of external financial agencies aimed at leading the process. However, this change has not been reflected in the planning of human resources for health.