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Model for Analysis, Systemic Planning and Strategic Synthesis for Health Science Teaching in the Democratic Republic of the Congo

The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care.

Skill Mix in the Health Care Workforce: Reviewing the Evidence

This paper discusses the reasons for skill mix among health workers being important for health systems. It examines the evidence base, identifies its limitations, summarizes the main findings from a literature review, and highlights the evidence on skill mix that is available to inform health system.

National Health Accounts Rwanda 2002

In an effort to understand the flows of funds throughout the health system, the Government of Rwanda (GoR) conducted, for the second time, a National Health Accounts (NHA) estimation. NHA is an internationally recognized tool for measuring health expenditures in a comprehensive manner — one that includes the public, private and donor sectors. By doing so, NHA offers a financial perspective on who is paying for health care, who is managing health care funds and their allocation, and where the funds are going — by type of provider and service. In short, NHA aims to inform policymakers on resource flows for the entire health system so as to assist in making good policy decisions and averting potentially adverse ones.

Selecting and Applying Methods for Estimating the Size and Mix of Nursing Teams: A Systematic Review of the Literature Commissioned by the Department of Health

The aims of this summary and the main report are to help make sense of the complex and uncertain world of nursing workforce planning and to make better decisions about cost-effective numbers and mixes of nurses. Consequently, five commonly used workforce planning methods are reviewed and described: 1. Professional judgement approach, 2. Nurses per occupied bed method, 3. Acuity-quality method, 4. Timed-task/activity approaches, and 5. Regression-based systems. [From introduction]

Technical Consultation on Imbalances in the Health Workforce: Report of the Consultation

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]

International Recruitment of Health Workers to the UK: A Report for DFID: Final Report

Whilst the issue of international migration of health workers is sometimes presented as a one-way linear ‘brain drain,’ the dynamics of international mobility, migration and recruitment of health workers are complex.

Integrated Management of Adolescent and Adult Illness: Interim Guidelines for First-Level Facility Health Workers

The WHO IMAI guidelines support the rapid expansion of access to ART by supporting the shifts of key tasks to multi-purpose health workers at first-level facilities located in the community (health centres and clinics). By preparing nurses and clinical aids to provide acute care to adults, many opportunistic infections can be treated and the patient stabilized for ARV treatment without referral to district clinic. Management of patients near their home is important for equity and to achieve high levels of ARV adherence. [adapted from publisher’s description]

Health Information System: National Policy and Strategy

This document intends to provide a policy and strategic framework for management of health information, use of information in planning and management of health services and monitoring health sector performance. [from preface]

Ghana Community-Based Health Planning and Services Initiative for Scaling Up Service Delivery Innovation

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 paper reviews the development of the CHPS initiative, describes the processes of implementation and relates the initiative to the principles of scaling up organizational change which it embraces.

Review of Health Services Accreditation Programs in South Africa

This brief report describes four different accreditation programs in South Africa: one is nationwide and addresses hospitals; the second accredits privately financed healthcare programs; the third is a provincial program accrediting all public healthcare facilities, and the fourth assesses clinics providing adolescent reproductive health. This operations research study interviewed stakeholders of the South Africa healthcare system to elicit their views of the best possible options for South Africa and of the strengths and weaknesses of the four existing programs. [author’s description]

Imbalance in the Health Workforce

Imbalance in the health workforce is a major concern in both developed and developing countries. It is a complex issue that encompasses a wide range of possible situations. This paper aims to contribute not only to a better understanding of the issues related to imbalance through a critical review of its definition and nature, but also to the development of an analytical framework. [from abstract]

Human Resource Management (HRM) Rapid Assessment Tool for HIV/AIDS Environments: A Guide for Strengthening HRM Systems

The HRM-HIV Tool provides organizations with a participatory, rapid assessment tool for identifying an organization’s human resource management status and making concrete plans for improvements within HIV/AIDS environments. It has been used with both public and private organizations in Ghana, Kenya, Nigeria, and Tanzania. The tool conforms to principles of participation and self-determination that guide all of MSH’s training and technical assistance activities. [author’s description]

What is the Access to Continued Professional Education among Health Workers in Blantyre, Malawi?

This study indicates that healthcare professionals are using mostly clinical handover meetings, seminars and workshops for their continued professional development (CPD). There is need to improve access to relevant professional journals. The regulatory or licensing boards for healthcare professionals in Malawi should seriously consider mandatory CPD credits for re-certification. [author’s description]

Ghost Doctors: Absenteeism in Bangladeshi Health Facilities

The authors report on a study in which unannounced visits were made to health clinics in Bangladesh with the intention of discovering what fraction of medical professionals were present at their assigned post. This survey represents the first attempt to quantify the extent of the problem on a nationally representative scale. [from abstract]

Zambia's Hospital Accreditation Program Yields Important Lessons

Zambia’s recently developed hospital accreditation program is a major component of ongoing health sector reforms that have taken place in the country during the last decade. Although Zambia previously had several processes in place for evaluating hospital performance, comprehensive performance standards had not been developed and quality measurement was not standardized.

Human Resources for Emergency Obstetric Care in Northern Tanzania: Distribution of Quantity or Quality?

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]

Assessing Your Organization's Capacity to Manage Finances

This issue of The Manager offers financial and program managers—from headquarters to the service delivery level - reasons to assess their financial management systems and a method for performing this assessment. It introduces FIMAT, the Financial Management Assessment Tool, a step-by-step process and instrument for rapidly assessing budgeting, accounting, purchasing and other financial systems. It describes how managers can use their assessment results to develop detailed action plans that can be incorporated into their organization’s annual operation plans. [from author]

Utility of a Thematic Network in Primary Health Care: A Controlled Interventional Study in a Rural Area

UniNet is an Internet-based thematic network for a virtual community of users. It supports a virtual multidisciplinary community for physicians, focused on the improvement of clinical practice. This is a study of the effects of a thematic network such as UniNet on primary care medicine in a rural area, specifically as a platform of communication between specialists at the hospital and doctors in the rural area. [from abstract]

Effect of Performance-Related Pay of Hospital Doctors on Hospital Behaviour: A Case Study From Shandong, China

With the recognition that public hospitals are often productively inefficient, reforms have taken place worldwide to increase their administrative autonomy and financial responsibility. Reforms in China have been some of the most radical: the government budget for public hospitals was fixed, and hospitals had to rely on charges to fill their financing gap. Accompanying these changes was the widespread introduction of performance-related pay for hospital doctors, termed the “bonus” system. While the policy objective was to improve productivity and cost recovery, it is likely that the incentive to increase the quantity of care provided would operate regardless of whether the care was medically necessary.

Commonwealth Code of Practice for the International Recruitment of Health Workers

The Code develops a consensus approach to dealing with the problem of international recruitment of health workers, while remaining sensitive to the needs of recipient countries and the migratory rights of individual health professionals. The Code covers issues of transparency, fairness, mutuality of benefits, compensation/reparation/restitution, selection procedures, and registration. [Description from author]

Health Systems Strengthening and HIV/AIDS: Annotated Bibliography and Resources

Over the past few years, a united battle against HIV/AIDS has gained momentum worldwide. Non-governmental and community-based programs, national and international organizations—all are confronting the myriad of challenges posed by the HIV/AIDS pandemic. In an effort to provide policymakers, technical personnel, and other stakeholders comprehensive information on the costs of interventions and the impact of HIV/AIDS on health systems, PHRplus has prepared this annotated bibliography. The documents described focus on those aspects of the pandemic most related to the work of the project issues of economic impact, financing and resource allocation, costing, health system strengthening, scaling up antiretroviral therapy, surveillance systems, and program monitoring and evaluation.

Primary Health Care in Mozambique: Service Delivery in a Complex Hierarchy

This report presents findings from a nationwide Expenditure Tracking and Service Delivery Survey implemented in Mozambique between August and October 2002. The study focuses on the primary health care system, which is frequently the only source of health care for most Mozambicans. The report covers a broad set of issues, including institutional context, budget management, cost recovery, allocation and distribution of drugs, human resources, infrastructure and equipment, and service outputs. [from abstract]

Should Physicians' Dual Practice Be Limited? An Incentive Approach

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.

Contemporary Specificities of Labour in the Health Care Sector: Introductory Notes for Discussion

This paper combines the literature on public health, on economics of health and on economics of technological innovation to discuss the peculiarities of labour in the health care sector. The health care system has a distinctive characteristic from other economic sectors: it is the intersection between social welfare and innovation systems. The relationship between technological innovation and cost in the health care sector is surveyed. Finally, the Brazilian case is discussed as an example of a developing country. The peculiarities of labour in the health care sector suggest the need to recognize the worth of sectoral labour and to cease to treat it separately.

How Health Workers Earn a Living in China

The Chinese government has found it impossible to maintain uniform pay levels, particularly in the face of a radical devolution of its own financial management. Health workers have increasingly resorted to informal methods of earning an income. The government considers this to be unprofessional behavior and has used a combination of moral pressure and loss of professional privileges to discourage it.

Taking More than a Fair Share? The Migration of Health Professionals from Poor to Rich Countries

The author argues that the migration of physicians and other trained health professionals undermines the ability of developing countries to meet agreed Millennium Development Goals and creates untenable health conditions for the poorer sections of their populations.

Perceptions of Rural Women Doctors About Their Work

Recruitment and retention of medical staff are important issues in rural health. The aim of this study was to describe and understand the perceptions of women doctors working in rural hospitals in South Africa about their work. [from abstract]

Public Health Approach to Antiretroviral Treatment: Overcoming Constraints

Triple-drug combination antiretroviral (ARV) therapy has yielded remarkable results in affluent countries and some middle-income countries such as Brazil. Lessons can be learned from these examples, but this publication reviews the experiences of ARV programmes already underway in countries with very severe HIV epidemics but severely constrained resources, as in most of Africa and part of the Caribbean. The publication aims to show how some of the key policy issues for scaling up HIV/AIDS treatment have been dealt with and to identify common elements that should be considered by everyone seeking to provide HIV/AIDS care on a significant scale.

Training Works! What You Need to Know About Managing, Designing, Delivering and Evaluating Group-Based Training

What makes one training experience better than another? Effective training can help providers of family planning/reproductive health (FP/RH) services to improve their performance. This handbook summarizes the tasks that should be completed at each stage of training to ensure an effective training course.

Determining Skill Mix: Practical Guidelines for Managers and Health Professionals

This paper provides practical guidelines for managers and health professionals looking to skill mix as a potential solution to health service delivery problems. These guidelines emphasise the need to evaluate the problem, and examine the context, before deciding if skill mix is the answer. The guidelines are provided in the knowledge that skill mix is rarely examined in a pure theoretical sense by organisations. They have to adopt a pragmatic approach which takes account of the day-to-day realities of their priorities and resources. [abstract]