human resources for health

Effective implementation of policies for expanding antiretroviral therapy (ART) requires a well-trained and adequately staffed workforce. Changes in national HIV workforce policies, health facility practices, and provider experiences were examined in rural Malawi and Tanzania between 2013 and 2017. In both countries, task-shifting and task-sharing policies were explicit by 2013. In facilities, the cadre mix of providers varied by site and changed over time, with a higher and growing proportion of lower cadre staff in the Malawi site. In Malawi, the introduction of lay counsellors was perceived to have eased the workload of other providers, but lay counsellors reported inadequate support. Both countries had guidance on the minimum numbers of personnel required to deliver HIV services. However, patient loads per provider increased in both settings for HIV tests and visits by ART patients and were not met with corresponding increases in provider capacity in either setting. Providers reported this as a challenge. Although increasing patient numbers bodes well for achieving universal antiretroviral therapy coverage, the quality of care may be undermined by increased workloads and insufficient provider training. Task-shifting strategies may help address workload concerns, but require careful monitoring, supervision and mentoring to ensure effective implementation.

The objective of this study was to examine job satisfaction, motivation and associated factors among nurses working in the public health facilities of Ethiopia, with the aim of improving performance and productivity in the health care system. From a random sample of 125 health facilities, 424 nurses were randomly selected for face-to-face interviews in all regions of Ethiopia. Overall, 60.8% of nurses expressed satisfaction with their job. Job satisfaction levels were significantly higher for female nurses, those older than 29  years and those who had over 10  years of work experience. Satisfaction with remuneration, recognition, professional advancement, features of the work itself, and nurses’ work experiences from 5 to 10  years were significantly associated with overall job satisfaction after controlling for other predictors. The study findings are signals for the Ministry of Health to strengthen the human resource management system and practices to improve nurses’ overall job satisfaction and motivation, especially among nurses with 5 to 10  years of experience on the job. Expanded recognition systems and opportunities for advancement are required to increase nurses’ job satisfaction and motivation. Equitable salary and fringe benefits are also needed to reduce their dissatisfaction with the job.

We examined how different training modalities have been employed and adapted in 12 countries to meet country-specific needs by a global pharmaceutical systems strengthening program in collaboration with a country’s Ministry of Health and local stakeholders. Case-based learning, practice and feedback, and repetitive interventions such as post-training action plan, supportive supervision and mentoring approaches are effective, evidence-based training techniques. In Ethiopia and Bangladesh, over 94% of respondents indicated that they have improved or developed skills or competencies as a result of the program’s training activities. Supportive supervision structures and mentorship have been institutionalized with appropriate management structures. National authorities have been sensitized to secure funding from domestic resources or from Global Fund grants for post-training follow-up initiatives. The Pharmaceutical Leadership Development Program is an effective, case-based training modality that motivates staff to develop quality-improvement interventions and solve specific challenges. Peer-to-peer learning mechanisms rather than traditional didactic methods was a preferred intervention among high level government officials both within country and between countries.

To provide the evidence to develop staffing norms for health facilities, the Workload Indicators of Staffing Need (WISN) tool of the World Health Organization (WHO) was adopted for assessing workload pressures to inform and improve human resource planning in facilities that provide HIV/AIDS services. This is a mixed methodology approach combining qualitative (separate group discussions for each OPC position) and secondary data extraction (number of patients/clinic from routine reports) in 23 outpatient clinics (OPCs) of Hai Phong City, Vietnam, from January-March 2014. The results showed that, with one exception, there is no shortage of manpower in the OPC system in Hai Phong. The pilot implementation of this toolkit for other HIV/AIDS service providers and other health care facilities could help calculate staff requirements, inform manpower planning, and help staff at health facilities develop job descriptions and plan their work accordingly.

Strong leadership and management skills are crucial to finding solutions to the human resource crisis in health. Health professionals and human resource (HR) managers worldwide who are in charge of addressing HR challenges in health systems often lack formal education in leadership and management. Management Sciences for Health (MSH) developed the Virtual Leadership Development Program (VLDP) with support from the United States Agency for International Development (USAID). The VLDP is a Web-based leadership development programme that combines face-to-face and distance-learning methodologies to strengthen the capacity of teams to identify and address health challenges and produce results. The USAID-funded Leadership, Management and Sustainability (LMS) Program adapted the VLDP for HR managers to help them identify and address HR challenges that ministries of health, other public-sector organizations and nongovernmental organizations are facing. Three examples illustrate the results of the VLDP for teams of HR managers: (1) the Uganda Protestant and Catholic Medical Bureaus; (2) the Christian Health Association of Malawi; and (3) the Developing Human Resources for Health Project in Uganda.

In developing countries, particularly in Africa, the provision of health services leans heavily towards today’s epidemics, including HIV and AIDS, malaria, tuberculosis and other infectious diseases. This calls for different approaches to the implementation of interventions from a public health perspective.

Background: In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision.

This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The third article presents a successful application in Mozambique of a leadership development program created by Management Sciences for Health (MSH).

Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy (ART).

As part of the special feature on leadership and human resources, Management Sciences for Health profiles three leaders who have made a significance difference in the HR situation in their countries.


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