Human Resource Crisis Research Articles

Health worker motivation in Africa: the role of non-financial incentives and human resource management tools.

BackgroundThere is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers.Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non-financial incentives. This study assesses the role of non-financial incentives for motivation in two cases, in Benin and Kenya.MethodsThe study design entailed semi-structured qualitative interviews with doctors and nurses from public, private and NGO facilities in rural areas. The selection of health professionals was the result of a layered sampling process. In Benin 62 interviews with health professionals were carried out; in Kenya 37 were obtained. Results from individual interviews were backed up with information from focus group discussions. For further contextual information, interviews with civil servants in the Ministry of Health and at the district level were carried out. The interview material was coded and quantitative data was analysed with SPSS software.Results and discussionThe study shows that health workers overall are strongly guided by their professional conscience and similar aspects related to professional ethos. In fact, many health workers are demotivated and frustrated precisely because they are unable to satisfy their professional conscience and impeded in pursuing their vocation due to lack of means and supplies and due to inadequate or inappropriately applied human resources management (HRM) tools. The paper also indicates that even some HRM tools that are applied may adversely affect the motivation of health workers.ConclusionThe findings confirm the starting hypothesis that non-financial incentives and HRM tools play an important role with respect to increasing motivation of health professionals. Adequate HRM tools can uphold and strengthen the professional ethos of doctors and nurses. This entails acknowledging their professionalism and addressing professional goals such as recognition, career development and further qualification. It must be the aim of human resources management/quality management (HRM/QM) to develop the work environment so that health workers are enabled to meet their personal and the organizational goals.

Can biomedical and traditional health care providers work together? Zambian practitioners' experiences and attitudes towards collaboration in relation to STIs and HIV/AIDS care: a cross-sectional study.

BackgroundThe World Health Organization's World health report 2006: Working together for health underscores the importance of human resources for health. The shortage of trained health professionals is among the main obstacles to strengthening low-income countries' health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs).The aim of this paper is to explore biomedical and traditional health practitioners' experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS.MethodsWe conducted a cross-sectional study in two Zambian urban sites, using structured questionnaires. We interviewed 152 biomedical health practitioners (BHPs) and 144 traditional health practitioners (THPs) who reported attending to patients with STIs and HIV/AIDS.ResultsThe study showed a very low level of experience of collaboration, predominated by BHPs training THPs (mostly traditional birth attendants) on issues of safe delivery. Intersectoral contacts addressing STIs and HIV/AIDS care issues were less common. However, both groups of providers overwhelmingly acknowledged the potential role of THPs in the fight against HIV/AIDS. Obstacles to collaboration were identified at the policy level in terms of legislation and logistics. Lack of trust in THPs by individual BHPs was also found to inhibit collaboration. Nevertheless, as many as 40% of BHPs expressed an interest in working more closely with THPs.ConclusionThere is indication that practitioners from both sectors seem willing to strengthen collaboration with each other. However, there are missed opportunities. The lack of collaborative framework integrating maternal health with STIs and HIV/AIDS care is at odds with the needed comprehensive approach to HIV/AIDS control. Also, considering the current human resources crisis in Zambia, substantial policy commitment is called for to address the legislative obstacles and the stigma reported by THPs and to provide an adequate distribution of roles between all partners, including traditional health practitioners, in the struggle against HIV/AIDS.

Training and HIV-Treatment Scale-Up: Establishing an Implementation Research Agenda

The provision of HIV treatment and care in resource-limited settings is expanding rapidly. Health-worker training is one of many factors critical to the rapid scale-up of high-quality care [ 1–6]. Large numbers of health workers require HIV training; yet, few countries have a comprehensive training plan, a clear assessment of ongoing training needs, a plan to operationalize training on a large scale, or adequate funds budgeted for training. In this setting, an extensive variety of HIV-related training programs have sprung up over the past few years. Unfortunately, there are limited data measuring their effectiveness, and there is no consensus about what constitutes effective training. Underlying the looming challenge in health-worker training, most resource-limited countries face a chronic shortage of trained health-care providers; chronic understaffing impedes the ability to adequately train health workers in HIV care. First, removing clinicians and nurses from active clinics for training purposes intensifies the strain on clinical care systems. Second, professional programs for physicians and other health workers are commonly lacking. For example, several countries in Africa and the Caribbean—including Botswana, Lesotho, and the Bahamas—do not have medical schools, and must send students outside of the country for basic professional training (see http://imed.ecfmg.org/main.asp; Table 1). Finally, trained workers (and potential recruits) commonly leave the public health sector for better compensation, benefits, working conditions, and job satisfaction found in other sectors and other countries—the “brain drain” phenomenon—further exacerbating the human resource crisis [ 7–12]. Table 1 Medical Schools in Selected Countries Faced with these challenges, and with the rapid pace of HIV-treatment expansion, few resource-limited countries have sufficient internal resources to address their training needs. As a result, most countries have collaborated with external partners to develop health-care-worker training programs, and/or to bring in expatriate specialists to provide training, at least in the initial phase of scale-up. Often, these training efforts are poorly coordinated with national training priorities, lack evidence to support their effectiveness, and are driven largely by foreign partners. As a result, many training redundancies exist alongside large, unmet training needs. We gathered information on global HIV training through a thorough review of the published peer-reviewed literature, internet sites, program reports related to training for HIV treatment in resource-limited countries, a survey of HIV training efforts in high-burden countries, and discussions with appropriate professionals in selected countries. Here, we review challenges and approaches to clinical HIV training, and suggest an agenda for implementation research—defined here as research into how proven interventions can be implemented to accelerate high-quality HIV-treatment scale-up—to address the question: what is the optimal approach to training the health workforce for an expanding HIV-treatment program in a resource-limited setting?

Disasters and dilemmas: aid agency recruitment and HRD in post-tsunami Sri Lanka1

This article examines the ethical dimensions and implications of recruitment and human resource development that face both local and international aid agencies operating in the context of an emergency response. Focusing on post-tsunami Sri Lanka it contends that, although the rapid proliferation of humanitarian organizations responding to the disaster created a boom in employment opportunities with international agencies, it also resulted in a human resource crisis for local ones and consequently the erosion of national emergency response capacities. It argues that the current recruitment and HRD practices of humanitarian organizations are insensitive to the disaster response needs of local agencies. It concludes with a call for international aid agencies to be more aware of the implications of their recruitment and HRD strategies in disaster-affected countries and recommends a number of ways in which practices could be improved to support, rather than diminish, local capacities.

Sustainability of long-term treatment in a rural district: The Lusikisiki model of decentralised HIV/AIDS care

No abstract available.

The health migration crisis: the role of four Organisation for Economic Cooperation and Development countries

The crisis of human resources for health that is affecting low-income countries and especially sub-Saharan Africa has been attributed, at least in part, to increasing rates of migration of qualified health staff to high-income countries. We describe the conditions in four Organisation for Economic Cooperation and Development (OECD) health labour markets that have led to increasing rates of immigration. Popular explanations of these trends include ageing populations, growing incomes, and feminisation of the health workforce. Although these explanations form part of the larger picture, analysis of the forces operating in the four countries suggests that specific policy measures largely unrelated to these factors have driven growing demand for health staff. On this basis we argue that specific policy measures are equally capable of reversing these trends and avoiding the exploitation of low-income countries' scarce resources. These policies should seek to ensure local stability in health labour markets so that shortages of staff are not solved via the international brain drain.

Nursing and midwifery: Millennium Development Goals and the global human resource crisis*

The World Health Organization Global Advisory Group for Nurses and Midwives and wider stakeholders met in May 2005 against a background of concern over the disappointing progress being made towards the Millennium Development Goals (MDGs). The meeting considered the urgent need to address human resource issues, particularly those related to nursing and midwifery, if the MDGs are to be achieved.

Health Systems and Access to Antiretroviral Drugs for HIV in Southern Africa: Service Delivery and Human Resources Challenges

Without strengthened health systems, significant access to antiretroviral (ARV) therapy in many developing countries is unlikely to be achieved. This paper reflects on systemic challenges to scaling up ARV access in countries with both massive epidemics and weak health systems. It draws on the authors' experience in southern Africa and the World Health Organization's framework on health system performance. Whilst acknowledging the still significant gap in financing, the paper focuses on the challenges of reorienting service delivery towards chronic disease care and the human resource crisis in health systems. Inadequate supply, poor distribution, low remuneration and accelerated migration of skilled health workers are increasingly regarded as key systems constraints to scaling up of HIV treatment. Problems, however, go beyond the issue of numbers to include productivity and cultures of service delivery. As more countries receive funds for antiretroviral access programmes, strong national stewardship of these programmes becomes increasingly necessary. The paper proposes a set of short- and long-term stewardship tasks, which include resisting the verticalisation of HIV treatment, the evaluation of community health workers and their potential role in HIV treatment access, international action on the brain drain, and greater investment in national human resource functions of planning, production, remuneration and management.

Policy patchwork hurts kids

Policy patchwork hurts kids

Wastage in the health workforce: some perspectives from African countries

BackgroundSub-Saharan Africa faces a human resources crisis in the health sector. Over the past two decades its population has increased substantially, with a significant rise in the disease burden due to HIV/AIDS and recurrent communicable diseases and an increased incidence of noncommunicable diseases. This increased demand for health services is met with a rather low supply of health workers, but this notwithstanding, sub-Saharan African countries also experience significant wastage of their human resources stock.MethodsThis paper is a desk review to illustrate suggestions that the way human resources for health (HRH) are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers. The paper suggests data types for use in measuring various forms of "wastage".Results"Direct" wastage – or avoidable increases in loss of staff through factors such as emigration and death – is on the rise, perhaps as a result of the HIV/AIDS epidemic. "Indirect" wastage – which is the result of losses in output and productivity from health professionals' misapplied skills, absenteeism, poor support and lack of supervision – is also common.HIV/AIDS represents a special cause of wastage in Africa. Deaths of health workers, fear of infection, burnout, absenteeism, heavy workloads and stress affect productivity.ConclusionThe paper reviews strategies that have been proposed and/or implemented. It suggests areas needing further attention, including: developing and using indicators for monitoring and managing wastage; enhancing motivation and morale of health workers; protecting and valuing the health worker with enhanced occupational safety and welfare systems; and establishing the moral leadership to effectively tackle HIV/AIDS and the brain drain.

COMMENTARY: Who will do the caesareans when there is no doctor? Finding creative solutions to the human resource crisis

The commitment of the 5th Millennium Development Goal (MDG5) is extremely far-reaching: to reduce the maternal mortality ratio by 75%by the year 2015. Of all MDGs this goal is the one least likely to be attained. This goal is particularly problematic because the levels of maternal mortality at the starting point 1990 suffer from a high degree of uncertainty. Under-reporting of maternal deaths was (and is) a very significant problem and numerous studies have shown this to be a serious problem whatever the setting. The finding of significant under-reporting in wealthy countries shows how difficult it is to assess the true maternal mortality ratio even when large amounts of funding are available. For countries with small budgets for health care the problem of under-reporting is even more marked making the baselines rates highly unreliable. (excerpt)

Calling All Leaders

ing leaders to create a forum to address the enormous challenges that face the profession now, and will continue to do so over the next several years. Many in the profession have been addressing these challenges, typically within the confines of the organizations that employ them. There has been no focused forum where nurse leaders themselves have an intellectual space for dialogue and planning, for harnessing their collective experience and wisdom unfettered by organizational policy or politics. Collective leadership in times of crisis can offer an array of solutions that, if implemented cohesively, can make a significant difference. One of the purposes of ACEN is to provide such a forum. As a beginning step, the Academy of Canadian Executive Nurses has expanded its membership to include nurses in leadership positions across a wide variety of settings. Nurse executives from academic health organizations are still the core members of ACEN but welcome the inclusion of deans, research chairs and government and NGO nurse leaders. The response to this membership initiative has been very positive. Nurse leaders have expressed a strong interest and commitment to working together. The challenges facing nursing and healthcare in Canada are not unfamiliar to those in leadership positions. The greatest of these is the health human resource (HHR) crisis, which will intensify over the next decade. The shortage of healthcare professionals, particularly nurses and physicians, has been the subject of provincial and national reports, research programs and media releases. It has been the subject of many government and stakeholder meetings, and a topic of discussion over a period of three or four years for the federal/provincial/territorial Advisory Committee on Health Delivery and Human Resources (ACHDHR). First ministers agreed to coordinate efforts in the planning and management of HHR. Calling All Leaders

Human resources for health: overcoming the crisis

In this analysis of the global workforce, the Joint Learning Initiative-a consortium of more than 100 health leaders-proposes that mobilisation and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world's poorest countries and for building sustainable health systems in all countries. Nearly all countries are challenged by worker shortage, skill mix imbalance, maldistribution, negative work environment, and weak knowledge base. Especially in the poorest countries, the workforce is under assault by HIV/AIDS, out-migration, and inadequate investment. Effective country strategies should be backed by international reinforcement. Ultimately, the crisis in human resources is a shared problem requiring shared responsibility for cooperative action. Alliances for action are recommended to strengthen the performance of all existing actors while expanding space and energy for fresh actors.

Responding to the global human resources crisis

The global community is in the midst of a growing response to health crises in developing countries, which is focused on mobilising financial resources and increasing access to essential medicines. However, the response has yet to tackle the most important aspect of health-care systems--the people that make them work. Human resources for health--the personnel that deliver public-health, clinical, and environmental services--are in disarray and decline in much of the developing world, particularly in sub-Saharan Africa. The reasons behind this disorder are complex. For decades, efforts have focused on building training institutions. What is becoming increasingly clear, however, is that issues of supply, demand, and mobility (transnational, regional, and local) are central to the human-resource problem. Without substantial improvements in workforces, newly mobilised funds and commodities will not deliver on their promise. The global community needs to engage in four core strategies: raise the profile of the issue of human resources; improve the conceptual base and statistical evidence available to decision makers; collect, share, and learn from country experiences; and begin to formulate and enact policies at the country level that affect all aspects of the crisis.

From Crisis to Opportunity: Human Resource Challenges for the Public Sector in the Twenty‐First Century

AbstractA great deal of attention has been focused on the human capital crisis in the public sector since the mid‐1990s. Experts and practitioners give many reasons why the current crisis emerged. This article examines the important factors that led to the crisis, what is being done about them through presidential agendas, legislators, oversight agencies, professional societies, and public policy think tanks. Concerns are many in terms of a large number of upcoming retirements, early retirements, unplanned downsizing, difficulty in attracting new generations to public service, and the changing nature of public service. However, the human resource crisis also presents an opportunity to fundamentally change those features of public sector human resource management practices that have become outdated for contemporary organizations and position government agencies for the twenty‐first century by meaningfully reforming the civil service. This transformation would require public sector organizations to take a more strategic view of human resource management and to give greater policy attention to human capital issues.

RURAL SCHOLARSHIP SCHEMES A solution to the human resource crisis in rural district hospitals?

ABSTRACTRecruiting sufficient health personnel for rural hospitals is an ongoing problem. The Friends of Mosvold Scholarship Scheme in northern KwaZulu-Natal is a locally based scholarship scheme that offers the local community a chance to develop its own human resources for health care. Students are required to work in the local hospital during their vacations and sign a contract to work back their scholarship year for year. Already 44 people from Ingwavuma are being supported to study for a variety of health professions. This concept is being extended to the Limpopo and North-West provinces through the Wits Initiative for Rural Health Education. The scheme provides a model for human resource development at a district level that could be usefully adopted by any tier of government.

Impact of International Business Education on Ethnocentricity

As evidenced by recent surveys of American managers, there is a serious shortage of qualified candidates on the US job market. This shortage is most evident in two specialization areas: high-technology knowledge workers and internationally competent managers. Indeed, American companies rate lack of qualified high-technology personnel as their number one reason for slower than desired business expansion. The other less glamorized, yet serious shortcoming of the American educational system is its inadequate training of cross-culturally competent workers for this truly global post-industrial era. In response to this human resources crisis, realizing that “the future economic welfare of the US will depend substantially on increasing international skills in the business community,” the United States Department of Education began an active campaign of promoting international education and research in several major American universities in the late 1980s. Since 1988, nearly 40 universities have been awarded tens of millions of dollars to engage in such activities as developing formal international business curricula, offering foreign language courses, promoting internationally-oriented research, provoking international education and research dialogues among the faculty, exchange programs between American and foreign universities for students and the faculty and similar activities. This research is a first attempt in evaluating the impact of one such program on the internationalization level of American students. It will be shown that the international education program at one major American university has successfully produced a cadre of more global and less ethnocentric workforce for American corporations.

Hepatitis C (HCV)—still an epidemic hidden from the public eye?

Comprehensive emergency obstetric care including major surgery such as caesarean section is a major health system problem in rural areas of poor countries, where there are no doctors. Innovative trainings of mid-level workforce have now demonstrated viable, scientifically valid solutions. Delegation of major surgery to duly trained ‘non-physician clinicians’ – ‘task shifting’ – should be seriously considered to address the human resources crisis in poor countries to cope with current challenges to enhance maternal and neonatal survival.Nationwide, non-physician clinicians in Mozambique perform approximately 90% of caesarean sections at the district hospital level. A comparison between the outcomes of caesarean sections provided by this category and medical doctors, respectively, demonstrates no clinically significant differences. These mid-level providers have a remarkably high retention rate in rural areas (close to 90%). They are cost-effective, as their training and deployment is three times more cost-effective than that of medical doctors.

The Human Resource Crisis in Social Work Education

The Human Resource Crisis in Social Work Education

Public Administration and the Theater Metaphor: The Public Administrator as Villain, Hero, and Innocent Victim

Since the founding of this nation, the theater metaphor has had an influence on political discourse. Politicians often invoke the metaphor when they enact political dramas to construct themselves in the image of leader. An argument is presented that former President Ronald Reagan and his political strategists made extensive use of this strategy and were effective in portraying public administrators as evil villains. It is also argued that supporters of the administrative state relied on the theater metaphor as well. In an effort to counter Reagan's negative image of villain, supporters responded by portraying public administrators as heroes and innocent victims. This article suggests that the theater metaphor is problematic when viewed from the perspective of public administration theory and practice. The images of villain, hero and innocent victims emanating from the theater metaphor are troublesome and deserve scrutiny. The political climate of the 1980s gave the public administration community much about which to write. With the Reagan revolution at its zenith, academic journals and the popular press burst at the seams with articles assessing this historic period in American politics. The so-called Reaganites came to the nation's capital with a mission. Proclaiming to have had a mandate from the American people, they aggressively sought to carry out a conservative and probusiness agenda. This agenda championed the transfer of broad decision-making authority and power from the federal government to the states. It also advocated regulatory relief for private industry. To sustain political momentum and showcase Reagan's leadership abilities, the Reaganites relied upon his oratory skills and reputation as the Great Communicator. This strategy was guided by the skillful use of antigovernment rhetoric. Reagan consistently criticized and blamed the federal bureaucracy and career civil servants for what he perceived as America's problems. The Reagan administration's jihad against career civil servants caused a great deal of soul searching within the public administration community. There was a sense of urgency. Many writers argued that the administrative state was in the midst of a crisis. The perception was that decisive action was needed to counteract the immediate and long-term damage of Reagan's seemingly endless assault on the bureaucracy. Although students of public administration may remember the Reagan era as a time of crisis, this period did have a positive influence on the field. Academicians, practitioners, and others joined hands to produce a vast and impressive body of literature. This literature publicized the human resources crisis in the public sector (Lane and Wolf, 1990), documented the long-term consequences of caustic attacks on the administrative state (Adams, 1984; Farazmand, 1989; Rosen, 1983a, 1983b, 1986), challenged prevailing conceptions of public bureaucracies (Goodsell, 1985), and established an alternative basis upon which to legitimate the role of public administrators in the American political system (Cook, 1992; Kass and Catron, 1990; Rohr, 1986; Wamsley et al., 1990). Now that the Reagan era has ended, we should critically examine this literature.(1) This examination may prove beneficial, especially if it contributes to an understanding of public administration theory and practice. I argue that the theater metaphor provided the subtext for much of the literature that addressed Reagan-era attacks on the administrative state. Since the founding of this country, the theater metaphor has shaped and influenced political discourse (Fearnow, 1992; Richards, 1991; Silverman, 1976), especially in times of crisis (Turner, 1982). The highly publicized legitimacy crisis of the administrative state was no exception (Freedman, 1978; Rohr, 1986; Stever, 1988). In an effort to defend the administrative state, many writers helped prepare the script of political dramas primarily enacted by the Reaganites and their supporters (social conservatives, radical economic libertarians, and classical liberals). …