Sub-Saharan Africa

The broad objective of this paper is to contribute to the retention of health workers in Malawi by providing an enhanced understanding of health workers’ coping strategies, together with the identification of possible strategies that could impact on their retention. [from author]

The African Church Health Associations’ Human Resources for Health Mini-Forum was held to re-energize the CHA’s human resources working group. The objectives of the forum were to: expand the HRH knowledge base; help develop a critical mass of faith-based HRH advocates; clarify the “Terms of Reference” for an HRH working group and plan for sustainability and next steps; and to generate action plans for HRH practices and identify technical assistance needs. [adapted from author]

Using Tanzania as a case study, this report advocates that the only effective means of really addressing the HRH challenge inpoor countries is to begin to immediately scale up training capacity, and that approach is relatively inexpensive when compared to its long-term benefits. [adapted from author]

The study documents the concerns of [People Living with AIDS] PLWHA, Community Health Workers (CHWs), primary care providers, and other stakeholders to inform Pathfinder’s support to national efforts to scale-up [Community Home-Based Care] CHBC. The proposed project aims to replicate Pathfinder’s successful CHBC model for PLWHA in other areas and improve access to HBC for more Tanzanians. [author’s description]

In Mozambique, [Health Alliance International] HAI has been working closely with the MOH for more than fifteen years to support the development and implementation of MOH programs in reproductive health, the response to HIV/AIDS, and malaria control… HAI works with the MOH to implement the nationally designed model of HIV care, and has supported the implementation of voluntary counseling and testing centers, prevention of mother-to-child transmission of HIV (PMTCT) PROGRAMS, and HIV treatment centers integrated into this public sector model of care. [publisher’s description]

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]

Ethiopia is currently one of the countries most seriously affected by HIV/AIDS, with the sixth highest number of infections in the world. This paper discusses how to combat this epidemic. As the country scales up HIV/AIDS services, increased attention is focused on identifying constraints to program expansion. One of the most important constraints is that of human resources. [from publisher’s abstract]

This report presents the findings of an independent Technical Review that focused on the promotion of Public Private Partnership for equitable provision of quality health services in Tanzania. [author’s description]

This article documents the experiences of the Catholic health network in Uganda and its umbrella organization, the Uganda Catholic Medical Bureau (UCMB) in making health services work for poor people. It demonstrates how the pro-poor ethos-derived from a longstanding tradition and the mission of “healing by treating and preventing diseases, with a preferential option for the less privileged”-supported by “soft” regulation and technical assistance from the umbrella organization can induce a process of change in a network of providers. [author’s description]

Horizons, in collaboration with CARE International and Family Health Trust, conducted a quasiexperimental intervention study to determine which care and support needs of people living with HIV and AIDS and their families could be met by trained youth, and to establish whether youth engaged in formalized care and support activities would increase their adoption of protective behaviors or reduce the stigma faced by members of AIDS-affected households.

The study was conducted in semi-urban and rural communities in two provinces of northern Zambia located 700 to 1,000 kilometers from Lusaka.

In response to the under-representation of female peer educators in the Geração BIZ Program (GBP), an adolescent sexual and reproductive health program in Mozambique, an operational research study was used to test new strategies for improving recruitment, participation, and retention of female peer educators. The study tested an intervention model to increase the involvement and performance of girls in the GBP.

The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland.

The study found that about half of the deliveries in Malawi are not assisted by a skilled attendant. It seems that there is a severe and long standing problem with retaining midwives. Therefore, close monitoring of the retention problem is advisable. The research found that the two main forms of losses are that the midwives die or they go abroad. Possible ways of mitigating the loss through emigration could be to continue efforts in enforcing codes of practice on international recruitment in recipient countries.

The numbers of health professionals joining the brain drain has reached a peak in recent years in apparent response to huge demands emanating from the developed countries. The brain drain of professionals, combined with the health crisis, threatens the entire development process in Africa. The crisis in health intensifies with the advent of the HIV/AIDS crisis. The loss of health workers simply serves to worsen a dire situation.

This paper should be read in association with its companion paper on migration and human rights (Bueno de Mesquita and Gordon 2005). Our aims are conceptual and agenda-setting. In essence, we argue that current policy responses to migration of health professionals from low income developing countries underestimate the pressures and misidentify the reasons for rising migration, overestimate the impact of recruitment policies on migration flows while ignoring unintended side effects, and mis specify the ethical dilemmas involved.

The main aim of these guidelines is to support countries in the Human Resource Development and management process of assessing the human resource for health situation, policy and plan development with the view of achieving some level of comprehensiveness and consistency country level. The guidelines will discuss HRH processes, situation analysis, policy and plan development with reference to the overall context of national health policies and strategies. These guidelines describe how to formulate, develop, review HRH situations, policies and plans with the flexibility necessary for each country context.

In Mali, operational research was conducted to identify the match between motivation and the range and use of performance management activities. The study showed that the main motivators of health workers were related to responsibility, training and recognition, next to salary. These can be influenced by performance management (job descriptions, supervisions, continuous education and performance appraisal).

The aim of this study was to explore the experiences of health workers working in the primary health care facilities in Kilimanjaro Region, Tanzania, in terms of their motivation to work, satisfaction and frustration, and to identify areas for sustainable improvement to the services they provide.

An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research and programme implementation. The Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources, and cultural institutions for supporting community-based primary health care.

This package includes Summary Document; Introduction to the Approach and Description of Facilitator Training; Facilitators’ Guide: Consultation I; and Facilitators’ Guide: Consultation II. The Community Problem Solving and Strategy Development (CPSSD) activities in Uganda have been designed to help health workers learn to work with communities, understand community perspectives about the services, and encourage community support and participation in the delivery of services, so that immunisation coverage is raised and sustained.

Zambian nurses have been greatly affected by the rise in the morbidity and mortality of nurses with TB. This article explains the impact of TB on the Zambian nursing workforce. Review of Zambian government programmes designed to address this health crisis and targeted interventions to reduce TB among nurses are offered. [abstract]

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.

This study reviews the experience of decentralization in four developing countries: Ghana, Uganda, Zambia and the Philippines. It uses two analytical frameworks to describe and compare the types and degrees of decentralization in each country. The first framework specifies three types of decentralziation: deconcentration, delegation and devolution. The second framework uses a principle agent approach and innovative maps of decision space to define the range of choice for different functions that is transferred from the centre to the periphery of the system. [from abstract]

This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. It draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. [from abstract]

The number of health workers employed is an indicator of a country’s ability to meet the health care needs of its people, especially the poorest and most vulnerable. Resource-constrained countries committed to the Millennium Development Goals are facing up to the reality that shortages and uneven distribution of health workers threaten their capacity to tackle the HIV/AIDS pandemic, as well as the resurgence of tuberculosis and malaria. Worker shortages are linked to three factors: 1) decreasing student enrollment in health training institutions, 2) delays or freezes in the hiring of qualified professionals and 3) high turnover among those already employed.

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.

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 objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa.

The goal of this article is to evaluate the current status of human resources quality, availability and distribution in Northern Tanzania in order to provide emergency obstetric care services to specific districts in this area. It also discusses the usefulness of distribution indicators for describing equity in the decision-making process. [from abstract]

This is the fourth of a series of policy briefs produced by the Community Health Department of the Aga Khan Health Service in Kenya. It focuses on a number of issues related to the management of health facilities: the rational for decentralisation of health services, the role of the community in the management of health facilities, the membership of local management committees, selection criteria and, finally, the involvement of local politicians.

These briefs are primarily intended for directors and managers of community-based health care programmes — whether working within ministries of health, international donor agencies or non-government organisations.