Little is known about the nonfinancial factors that influence South African health workers’ (HWs) choice of employer (public, private or nongovernmental organisation) or their choice of work location (urban, rural or overseas). To fill these gaps in the literature, researchers used a cross-sectional survey to gather data in 2009 in the province of KwaZulu-Natal. HWs in the public sector reported the poorest working conditions, as indicated by participants’ self-reports on stress, workloads, levels of remuneration, standard of work premises, level of human resources and frequency of in-service training. However, HWs in the NGO sector expressed a greater desire than those in the public and private sectors to leave their current employer. The authors call for innovative efforts to address the causes of HWs dissatisfaction and to further identify the nonfinancial factors that influence work choices of HWs. Policymakers must consider a broad range of nonfinancial incentives that encourage HWs to remain in the already overburdened public sector.
Human Resources
A baseline survey of 324 health workers in 64 primary healthcare facilities in two regions in Ghana found that the quality of care in health facilities was generally low. Most facilities did not have processes for continuous quality improvement and patient safety. Staff motivation appeared low, particularly in public facilities. Significant positive associations were found between staff satisfaction levels and working conditions and the clinic’s effort towards quality improvement and patient safety. The authors called for more comprehensive staff motivation interventions to be integrated into quality improvement strategies, especially in public health services where working conditions are perceived to be poor.
This report provides examples of professional and academic associations which work across three or more African countries, and which have some evidence of success. The author aims to identify the characteristics of these organisations which enable their success. Types of impact are varied, but are usually identified as strong membership, attendance at national or international meetings, awareness of the organisation in the wider sphere, dissemination and uptake of publications, and connection or influence on policy and policy-makers. The report particularly tries to draw out any impacts on governance in the wider public sphere, however, most of the indicators of success are input or output rather than outcome-focused, and do not identify broader social or policy change. The author emphasises the need for strongly committed individuals at the centre of the organisation, personal leadership, involvement of policy-makers and the quality of outputs. Independence and neutrality are seen as important values, allowing professional development free from politics.
Effective implementation and sustainability of quality laboratory programmes in Sub-Saharan Africa relies on the development of appropriate staff retention strategies, argue the authors of this paper. Assessing the factors responsible for job satisfaction and retention is key for tailoring specific interventions aiming at improving the overall impact of health programmes. They developed a survey to assess these factors among 224 laboratorians working in the laboratory programme the University of Maryland implemented in seven Sub-Saharan African countries. Lack of professional development was the major reason for leaving the previous job for 28% of interviewees who changed jobs in the past five years. Professional development/training opportunities was indicated by almost 90% of total interviewees as the most important or a very important factor for satisfaction at their current job. Similarly, regular professional development/opportunities for training was the highest rated incentive to remain at their current job by 80%. Laboratory professionals employed in the private sector were more likely to change jobs than those working in the public sector. The findings were used for developing specific strategies for human resources management, in particular targeting professional development, aiming at improving laboratory professionals within the University of Maryland laboratory programme and hence its long-term sustainability.
This study aimed to examine the links between human resources for health (HRH) and changes in health policy on user fees in Zimbabwe, with particular respect to reproductive, maternal and newborn health (RMNH). The authors used secondary data and small-scale qualitative fieldwork (key informant interview and focus group discussions) at national level and in one district in 2011. They found that past decades have seen a shift in the burden of payments onto households. Implementation of the complex rules on exemptions is patchy and confused. RMNH services are seen as hard for families to afford, even in the absence of complications. Health workers face challenges in managing demand, including from migration, and low pay. In four provinces they found that there are not enough doctors to provide more complex care, and only three provinces could provide skilled personnel for deliveries taking place in facilities. The authors argue that that there is a need to jointly address user fees that place financial burden on clients of RMNH services and to improve the terms and conditions of health staff.
This book was produced to support the policy dialogue on Human Resources for Health (HRH) in Ghana. Despite some recent successes, further improvements in health outcomes are in part hampered by the lack of skilled service providers, or human resources for health (HRH), particularly in rural areas, that prevent critical health services from being accessed and adequately delivered to those that need them most. To address the lack of information to guide the development of policies and programmes on HRH, the book aims to paint a comprehensive picture on HRH, consolidating new and existing evidence on some of the underlying determinants impacting stock, distribution and performance of health workers in Ghana, including health worker production and attrition, management and accountability structures, the capacity of health training institutions, and health worker compensation. As is made clear, any potential policies to improve the situation on HRH need to be well targeted, and take into account some of the fiscal and political challenges that are specific to the health labour market in Ghana. The book is intended to provide a basis for Ghanaian decision makers and external partners to dialogue on HRH and related policies, resulting in concrete HRH actions. More broadly, it will be of interest to all those working to improve HRH in Africa and beyond.
In this paper, the authors assess the gender-based distribution of Tanzania’s health workforce cadres. They conducted a secondary analysis of data collected in a cross-sectional health facility survey on health system strengthening, consisting of 815 health workers (HWs) from 88 randomly selected health facilities. Results showed that the mean age of the HWs was 39.7, with 75% women. The proportion of women among maternal and child health aides or medical attendants (MCHA/MA), nurses and midwives was 86%, 86% and 91%, respectively, while their proportion among clinical officers (COs) and medical doctors (MDs) was 28% and 21%, respectively. The authors conclude that the distribution of the Tanzania’s health cadres is dramatically gender skewed, a reflection of gender inequality in health career choices. MCHA/MA, nursing and midwifery cadres are large and female-dominant, whereas COs and MDs are fewer in absolute numbers and male-dominant. While a need for more staff is necessary for an effective delivery of quality health services, the authors call for adequate representation of women in highly trained cadres to enhance responses to some gender-specific roles and needs.
In this study, the authors explored the hypothesis that programmes initiated under unprecedented health investments from the US President's Emergency Plan for AIDS Relief have possibly facilitated the drain of healthcare workers from the public-health system in Uganda. They conducted a cross-sectional study between January and December 2010 to survey graduates, using in-person, phone or online surveys using email and social networks. The setting was rural: Mbarara University of Science and Technology (MUST) is one of three government supported medical schools in Uganda. The authors interviewed 85.4% (796) of all MUST alumni since the university opened in 1989, and they found 78% were physicians and 12% of graduates worked outside Uganda. Over 50% worked for an HIV-related non-governmental organisation (NGO) whether in Uganda or abroad. Graduates receiving their degree after 2005, when large HIV programmes started, were less likely to leave the country, but were more likely to work for an HIV-related NGO. The increase in resources and investment in HIV-treatment capacity is temporally associated with retention of medical providers in Uganda, the authors argue. External funds should be channelled to develop and retain healthcare workers in disciplines other than HIV and broaden the healthcare workforce to other areas, they recommend.
This qualitative assessment was undertaken to identify factors that influence motivation and job satisfaction of health surveillance assistants (HSAs) in Mwanza district, Malawi, in order to inform development of strategies to influence staff motivation for better performance. Seven key informant interviews, six focus group discussions with HSAs and one group discussion with HSAs supervisors were conducted in 2009. Data were supplemented by a district wide survey involving 410 households, which included views of the community on HSAs performance. The main satisfiers identified were team spirit and coordination, the type of work to be performed by an HSA and the fact that an HSA works in the local environment. Dissatisfiers were low salary and position, poor access to training, heavy workload and extensive job description, low recognition, lack of supervision, communication and transport. Managers and had a negative opinion of HSA perfomance, while the community was much more positive: 72.9% of all respondents had a positive view on the performance of their HSA. Activities associated with worker appreciation, such as performance management were not optimally implemented. The district level can launch different measures to improve HSAs motivation, including human resource management and other measures relating to coordination of and support to the work of HSAs.
This study describes the perspectives and engagement of key stakeholders in advancing critical regulatory and educational reform in east, central, and southern Africa (ECSA). Researchers surveyed 32 leading stakeholders from 13 ECSA countries with regard to task shifting and the challenges related to practice and education regulation reform. Most (72%) reported task shifting is practiced in their countries; however only 57% reported their national regulations had been revised to incorporate additional professional roles and responsibilities. They also reported different roles and levels of involvement with regard to nursing and midwifery regulation. The most frequently cited challenge impacting nursing and midwifery regulatory reform was the absence of capacity and resources needed to implement change. While guidelines on task shifting and recommendations on transforming health professional education exist, the authors argue that their study provides new evidence that countries in the ECSA region face obstacles to adapting their practice and education regulations accordingly. Stakeholders such as community nursing organisations, nursing associations, and academicians have varied and complementary roles with regard to reforming professional practice and education regulation.