Eastern Europe & Central Asia

The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia. [from abstract]

This report assesses the business development needs, particularly financial and training, of private health care providers and distributors of reproductive health and family planning products and services in Romania. [adapted from author]

This paper looks at reproductive health and family planning programs in the Eastern Europe and Eurasian region. It includes: a methodology to analyze the RH/FP market; an overview of opportunities and constraints to the private sector region; a description of current practices in the region that foster a greater private sector role in the provision of FP services and products; and recommendations for leveraging and maximizing private sector contribution to RH/FP goals. [adapted from author]

This study analyzes the Lithuanian family physician (FP) workforce to determine if an adequate supply of FPs will be available in the future to take over emerging tasks. The authors conclude that despite the rapid expansion of the FP workforce during the last fifteen years, forecasts of supply and demand indicate that the number of FPs in 2015 will not be sufficient. [adapted from author]

This article presents the results of a 2002 social audit of the health sector of three Baltic States. Comparisons were made of perceptions, attitudes and experience regarding unofficial payments in the health services of Estonia, Latvia and Lithuania. The findings can serve as a baseline for interventions and to compare each country’s approach to health service reform in relation to unofficial payments. [adapted from abstract]

The migration of medical professionals as a result of the expansion of the European Union is cause for concern. But there is a significant lack of information available about this phenomenon. This study did a search of secondary databases about the presence of european doctors working abroad and a survey of professional organisations and regulators in countries of the European Union. [from abstract]

This retrospective study assessed the effects of pre- and post-training programme for healthcare professionals about breastfeeding. [from abstract]

The ILO Sectoral Activities Department initiated an explorative research project on health worker mobility in Europe with focus on CEE countries. The purpose of the project was to explore and document current knowledge and information available in order to establish the current status, and identify both preliminary trends as well as information gaps and the need for further action.

This report presents an overview of the policy implications of the international migration of health workers in Europe, based on case studies conducted in five countries – Estonia, Germany, Lithuania, Poland and the United Kingdom – and draws on information from other WHO European Region countries, such as Israel and Latvia. [from introduction]

Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of each health care system and of reform and policy initiatives in progress or under development. [publisher’s description] Each report contains a section on human resources for health including an overview of the situation and specific health workforce statistics.

Georgia’s health care system underwent dramatic reform after gaining independence in 1991. The decentralization of the health care system was one of the core elements of health care reform but reports suggest that human resource management issues were overlooked. The Georgian national immunization program was affected by these reforms and is not functioning at optimum levels. This paper describes the state of human resource management practices within the Georgian national immunization program in late 2004. [from abstract]

While the availability and use of trained midwives can shape the quality of care received in pregnancy and childbirth, a number of other underlying health systems structures and processes are important. The management of health workforces, the mix of public and private provision and the impact of reforms affect quality of care across countries…[This study] examined how the structure and operation of a health system influences maternal health care provision and outcomes in Bangladesh, Russia, South Africa and Uganda. [author’s description]

This case study examines the scale up of family planning services in Romania through primary care providers. It disucces the process, the challenges, the successful results and the lessons learned.

This case study examines the problem of workplace violence in the health sector of Bulgaria through consulting, examination and content analysis of the information and research available as well as conducting 6 focus groups and a confidential sociological survey. [adapted from author]

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.

In Albania, the PHRplus Project developed and tested a series of tools designed to introduce family medicine concepts and strengthen primary health care (PHC) services. PHC facility managers will find the toolkits useful reference materials when developing strategies and tools to improve quality of care and monitor and evaluate PHC strengthening efforts. This series comprises three toolkits: PHC Service Delivery Toolkit; PHC Quality Improvement (QI) Toolkit; and PHC Health Information Systems (HIS) Toolkit. [from abstract]

This document attempts to review the HRH situation in the WHO European Region. Section 2 addresses the problems associated with varying definitions to ensure a common understanding of the issues involved. In section 3, a number of key methodological issues (the relevance of HRH, education, management, regulation, etc.,) are analyzed. Section 4 summarizes the key HRH facts and figures for the region. In conclusion, section 5 describes the way forward and the main EURO policy proposals for supporting member states in this complex sphere. [author’s description]

This book examines some of the major challenges facing health care professions in Europe and the potential responses to these challenges. The authors document how health care systems in Europe are confronting existing challenges in relation to the health workforce and identify the strategies that are likely to be most effective in optimizing the management of health professionals in the future. [from publisher]

JHPIEGO has been working since 1991 to support the development of a national integrated clinical training system used for both family planning/reproductive health (FP/RH) preservice education and inservice training in Turkey.

This paper represents the second phase of a larger study examining health worker motivation in two hospitals in Tbilisi, Georgia. The overall objective of the 360 degree assessment was to begin to identify the major organizational, situational, and individual factors associated with health worker motivation, and to better understand how major constituencies (i.e., managers, supervisors, workers, and patients) perceive the hospital/work environment. Specific objectives of this study component were to: assess congruence between managers, supervisors and workers on perceptions of hospital goals; compare perceptions of hospital and worker characteristics among types of workers (physician, nurse, other) and levels of respondents (managers, supervisors, workers, patients); and identify possible factors for stimulating good performance and possible interventions for enhancing motivation.

To identify problems and barriers to [family planning] services specific to each district, to provide data that could assist with project implementation, and to allow determination of benchmarks and targets to measure success, the project started with a baseline assessment of facilities, providers, and community members in the five core districts. The objectives of the assessment were to evaluate factors contributing to the current use of FP services, including: the supply of FP in the public and private sectors: the availability and quality of facilities providing FP services, including the availability of contraceptive methods, IEC materials, and trained providers; and the demand for FP: the population’s knowledge of, attitudes toward, and practice of pregnancy prevention.

This case study provides details of a partnership that emerged in Georgia following the initiation of health sector reforms in 1995. It mainly focuses on describing the details of how and why the public purchaser contracted a non-governmental provider to deliver a set of health services in Georgia. The case study is discussed with proper attention to the context within which this arrangement developed. The nature of the services provided was paediatric cardio-surgery, which can hardly be considered a basic essential health service.

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 report is the outcome of a seminar held in Brussels on 15th June 2004. The aims of the seminar were firstly to share information on gender and occupational safety and health (OSH) issues, including a gender-sensitive approach in OSH and how gender can be mainstreamed into OSH, and secondly to facilitate discussion and debate among EU and national authorities, social partners and experts on how to take forward gender issues in OSH. It includes proposals for taking forward gender issues in OSH. [Publisher’s description]

Health worker motivation has the potential to have a large impact on health systems performance, yet little is known about the key determinants and outcomes of motivation in developing and transition countries. This study, conducted in Jordan and Georgia focused on the individual determinants and outcomes of the worker’s motivational process. A wide range of psychometric scales was used to assess individual differences, perceived contextual factors and motivational outcomes (feelings, thoughts and behaviors). Although the two countries have very different cultural and socio-economic environments, many similarities existed among key determinants between the two countries.

The aim of the present study was to examine available human medical resources in primary care and identify possible inequalities regarding the distribution of general practitioners in Albania between 2000 and 2004.

Human resources management in health often encounters problems related to workforce geographical distribution. The aim of this study was to investigate the internship workplace preferences of final-year medical students and the reasons associated with their choices. [from abstract]

The International Labour Office (ILO), the International Council of Nurses (ICN), the World Health Organization (WHO) and Public Services International (PSI) launched in 2000 a joint programme in order to develop sound policies and practical approaches for the prevention and elimination of violence in the health sector. When the programme was first established and information gaps were identified, it was decided to launch a number of country studies as well as cross-cutting theme studies and to conclude by drafting guidelines to address workplace violence in the health sector.

The difficulty of ensuring an adequate and appropriate distribution of health services, together with increasing financial pressures in the public sector, are forcing many countries to consider using more rigorous methods for determining staffing levels in the health facilities. The Workload Indicators of Staffing Need (WISN) method is one such method. It uses a form of activity analysis (activity standards), together with measures of utilisation and workload to determine staffing requirements. The method provides a vehicle for assessing localised staffing needs that is believable and which at the same time is sharply different to historic methods.

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.