Journal Articles

Prior to implementing male circumcision as a public health measure against the spread of HIV, the feasibility, safety and costs of the procedure within target countries should be evaluated to understand what measures need to be taken to ensure access to safe, affordable voluntary circumcision services. The aims of this study were to assess variation and safety of male circumcision practices, as well as resource and training needs related to the procedure, in a community that has been practicing circumcision traditionally for many generations. [from introduction]

Thousands of community workers are helping Ethiopia to deliver primary health-care services to people living in rural areas. However, critics say that the training these workers receive is not adequate for them to attend many of the health problems they encounter. [from introduction]

This article describes the achievements of 11 Sudanese-Canadian physicians who completed medical training and returned to Southern Sudan to practice. Few internationally educated physicians are prepared to return to a homeland as challenging as Southern Sudan; this goes against the globally entrenched flow of physicians migrating from developing to developed countries. [from introduction]

This report describes three health system developments introduced by the Rwandan government that are improving these barriers to care

Rural nurses describe the nature of their practice as being embedded in working as a team where belonging is central to the success of the team and the individual nurse. As a result they form close professional and personal ties. The challenge for nursing students is to develop a sense of belonging to the rural hospital team so that preceptorship is successful. The objective of this article is to describe the cultural theme of a sense of belonging that nursing students develop during a rural hospital preceptorship. [adapted from abstract]

In South Africa, first-contact primary care is delivered by nurses in small clinics and larger community health centres (CHC). CHCs also employ doctors, who often work in isolation from the nurses, with poor differentiation of roles and little effective teamwork or communication. Worcester CHC, a typical public sector CHC in rural South Africa, decided to explore how to create more successful practice teams of doctors and nurses.

Community-based education (CBE) was developed thirty years ago in response to the maldistribution of physicians and subsequent inequity of health care services across geographical areas in developed and developing countries. Several medical schools in Nigeria report adopting CBE. This study seeks to identify and describe the CBE programs in accredited Nigerian medical schools and to report students’ assessments of the knowledge and skills gained during their community-based educational experience. [from abstract]

To date, traditional biomedical hospital-centered models of medical education have not produced physicians in quantities or with the competencies and commitment needed to meet health needs in poor communities worldwide. The Global Health Education Consortium conducted an initial assessment of selected medical education programs/schools established specifically to meet these needs.

Evaluations of Community Health Worker programs consistently document improvements in health, yet few articles clearly describe the roles of Community Health Workers (CHWs) from the CHWs’ perspective. This article presents the CHWs’ points of view regarding the various roles they played in a community-based participatory research (CBPR) project, Poder es Salud/Power for Health in Portland, Oregon, including their roles as community organizers and co-researchers. [introduction]

In this study, the overall job satisfaction of medical laboratory scientist graduates of one Kuwaiti University was examined in relation to the environment and organizational features of their places of employment. [from abstract]

India has traditionally had a bureaucratic approach to regulating its health service. Research suggests that this approach has failed to protect the interests of poor and vulnerable groups and has not gained the trust of providers or the public. So are there any other ways to make India’s health systems more accountable? [from author]

Preparing health workers to confront the HIV/AIDS epidemic is an urgent challenge in Haiti. There is a critical shortage of doctors, leaving nurses as the primary care providers for much of the population. Haiti’s nurses play a leading role in HIV/AIDS prevention, care and treatment. However, they do not receive sufficient training at the pre-service level to carry out this important work. The Ministry of Health and Population collaborated with the International Training and Education Center on HIV to create a competency-based HIV/AIDS curriculum to be integrated into the the national schools

Malawi is one of the poorest nations in the world, with some of the worst health worker to population ratios. Most health services are provided by clinical officers, medical assistants and enrolled nurses. The government has taken action to address the staffing shortfall, estimated at 15,000. [from author]

Contracting out public services is a way for governments to complement their own delivery of services. It is particularly effective for high risk or hard-to-reach populations that can be more effectively served by private groups. It can also contribute to more efficient delivery of primary health care. [from introduction]

Care for most women before, during and after delivery can be provided within a well equipped primary care setting. Since the 1980s Indonesia has attempted to improve women’s access to maternal health care by assigning professional midwives to each village. Despite an increase in the number of midwives, maternal mortality remains high compared to other countries with similar Gross Domestic Product per capita. [from introduction]

While previous Egyptian studies have identified provider practices contributing to maternal mortality, none has focused on neonatal care. This report details a survey of reported practices of birth attendants. As well, 217 recently-delivered mothers in rural areas of three governorates were interviewed about antenatal, intrapartum and postnatal care they received. [from abstract]

Neonatal mortality accounts for a high proportion of deaths in children under the age of 5 years in Bangladesh. This article describes a project for advancing the health of newborns and mothers implementing a community-based intervention package through government and non-government organisation infrastructures to reduce neonatal mortality. [from abstract]

Gender differences contribute to patients’ health and illness. However in current healthcare practices attention to gender differences is still underdeveloped. Recognizing these differences and taking them into account can improve the quality of care. In this study we aimed to investigate whether GPs’ gender sensitivity can be stimulated by a training program. [from abstract]

Swaziland has taken the lead in caring for overburdened health workers with the opening of the first Wellness Centre in Manzini for them and their families. This article reports on this innovative response to the deepening crisis in human resources for health in sub-Saharan Africa. [adapted from author]

In 2001 the Faculty of Medicine of the University of Gezira (FMUG) introduced the Integrated Management of Childhood Illness (IMCI) strategy into its medical curriculum. The emphasis was on pre-service training that addresses standard case management and the IMCI community component. This report presents the experience of FMUG in integrating such a training package into the medical curriculum. It explains the rationale for introducing the IMCI community component and the guiding principles for doing so.

Scaling up the implementation of new health care interventions can be challenging and demand intensive training or retraining of health workers. This paper reports on the results of testing the effectiveness of two different kinds of face-to-face facilitation used in conjunction with a well-designed educational package in the scaling up of kangaroo mother care. [from abstract]

The Tanzanian health system is currently undergoing major reforms. As part of this, a study was commissioned into the delivery of services and care at the Muhimbili National Hospital. One of the main components of this comprehensive study was to measure the extent to which workers in the hospital were satisfied with the tasks they performed and to identify factors associated with low motivation in the workplace. [from abstract]

This paper looks at the HRH crisis as experienced by the Uganda Catholic Medical Bureau network giving the trend, examining the reasons, the destinations of attritional cases and what the network is trying to do to improve human resource stability. [from abstract]

This article reports on the findings of a study into enrolled nurse (EN) to registered nurse (RN) transition in South Australian rural settings. Rural RNs are required to be multi-skilled generalists capable of providing a wide range of nursing services to a diverse range of clients. This frequently occurs in situations without medical or specialist assistance. The objective of this study was to gain an understanding of the EN to RN transition process within this unique context. [from abstract]

Although there is an emerging understanding of the stressors faced by rural physicians, little is known about the experience of care providers offering maternity care in low-resourced environments. This article considers the experience of rural maternity care providers from the perspective of the social risks they perceive are incurred by practicing in a low-resource environment. [from abstract]

Preparing nurse graduates for practice is challenging because of the diversity of skills expected of them. The objective of this study is to identify the attributes a rural community expect in new graduate nurses in order for them to provide quality care. [from abstract]

This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS) in England.Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. [from abstract]

A study of private-sector immunization services was undertaken to assess scope of practice and quality of care and to identify opportunities for the development of models of collaboration between the public and the private health sector. A questionnaire survey was conducted with health providers at 127 private facili¬ties; clinical practices were directly observed; and a policy forum was held for government representatives, private healthcare providers, and international partners. [from abstract]

The article presents a successful application in Mozambique of a leadership development program created by Management Sciences for Health. [from abstract]

Two crises dominate the health sectors of sub-Saharan African countries: those of human resources and of HIV. There is considerable variation in the extent to which these two phenomena affect sub-Saharan countries, with a few facing extreme levels of both. This paper reviews the continent-wide situation with respect to this double burden before considering the case of Malawi in more detail. [from abstract]