1.  Title: IAPAC recommendations to the Obama administration for the US response to the global HIV pandemic [editorial] Source: Journal of the International Association of Physicians in AIDS Care. 2009 Jan-Feb;8(1):13-20. Abstract: Includes the text from a January 5, 2009 letter from the International Association of Physicians in AIDS Care (IAPAC) to the Obama-Biden Presidential Transition Team outlining top-line recommendations for the administration's response to the global HIV pandemic. Recommendations are made for HIV care and treatment, HIV prevention, HIV testing, Human resources, Access to treatment, and PEPFAR. Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | PHYSICIANS | RECOMMENDATIONS | HIV PREVENTION | TITLE 19 MEDICAL ASSISTANCE | AIDS | TREATMENT | CARE AND SUPPORT | HIV TESTING | HUMAN RESOURCES | Developed Countries | North America | Americas | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Public Assistance | Grants | Financial Activities | Economic Factors | Medical Procedures | Medicine | Health Services | Laboratory Examinations and Diagnoses | Examinations and Diagnoses Document Number: 331305 |
| 2. Title: Human resources for health in the low-resource world: collaborative practice and task shifting in maternal and neonatal care. Author: FIGO Safe Motherhood and Newborn Health Committee Source: International Journal of Gynaecology and Obstetrics. 2009 Apr;105(1):74-6. Abstract: An important barrier to the attainment of Millennium Development Goals (MDGs) 4 and 5 in many countries is the lack of trained and skilled clinical staff who can provide timely and high-quality care to mothers with pregnancy complications. This article presents guidelines and recommendations on how to better make use of existing health human resources in order to improve maternal and neonatal care. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | HEALTH PERSONNEL | MATERNAL-CHILD HEALTH SERVICES | HUMAN RESOURCES | GYNECOLOGY | OBSTETRICS | OBSTETRICAL SURGERY | TRAINING PROGRAMS | Delivery of Health Care | Health | Primary Health Care | Health Services | Economic Factors | Medicine | Surgery | Treatment | Medical Procedures | Education Document Number: 341381 |
| 3. Peer Reviewed Title: Quality of obstetric care in public-sector facilities and constraints to implementing emergency obstetric care services: evidence from high- and low-performing districts of Bangladesh. Author: Anwar I; Kalim N; Koblinsky M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):139-55. Abstract: This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in rural areas of Khulna and Sylhet divisions, relatively high- and low-performing areas of Bangladesh respectively. Quality was explored by physically inspecting all public-sector EOC facilities and the constraints through in-depth interviews with public-sector programme managers and service providers. Distribution of the functional EOC facilities satisfied the United Nation's minimum criteria of at least one comprehensive EOC and four basic EOC facilities for every 500,000 people in Khulna but not in Sylhet region. Human-resource constraints were the major barrier for maternal health. Sanctioned posts for nurses were inadequate in rural areas of both the divisions; however, deployment and retention of trained human resources were more problematic in rural areas of Sylhet. Other problems also plagued care, including unavailability of blood in rural settings and lack of use of evidence-based techniques. The overall quality of care was better in the EOC facilities of Khulna division than in Sylhet. 'Context' of care was also different in these two areas: the population in Sylhet is less literate, more conservative, and faces more geographical and sociocultural barriers in accessing services. As a consequence of both care delivered and the context, more normal vaginal and caesarian-section deliveries were carried out in the public-sector EOC facilities in the Khulna region, with the exception of the medical college hospitals. To improve maternal healthcare, there is a need for a human-resource plan that increases the number of posts in rural areas and ensures availability. All categories of maternal healthcare providers also need training on evidence-based techniques. While the centralized push system of management has its strengths, special strategies for improving the response in the low-performing areas is urgently warranted. Language: English Keywords: BANGLADESH | RURAL AREAS | RESEARCH REPORT | OBSTETRICS | EMERGENCY SERVICES | IMPLEMENTATION | MATERNAL HEALTH SERVICES | QUALITY OF HEALTH CARE | OBSTACLES | HEALTH FACILITIES | PUBLIC SECTOR | HUMAN RESOURCES | BLOOD SUPPLY | SAFE MOTHERHOOD | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Maternal-Child Health Services | Primary Health Care | Health Services Evaluation | Program Evaluation | Macroeconomic Factors | Economic Factors | Equipment and Supplies | Medical Procedures | Maternal Health Document Number: 341937 |
| 4. Peer Reviewed Title: "Conditional scholarships" for HIV/AIDS health workers: educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa. Author: Barnighausen T; Bloom DE Source: Social Science and Medicine. 2009 Feb;68(3):544-51. Abstract: Without large increases in the number of health workers to treat HIV/AIDS (HAHW) many countries in sub-Saharan Africa will be unable to achieve universal coverage with antiretroviral treatment (ART), leading to large numbers of avoidable deaths among people living with HIV/AIDS. We conduct a cost-benefit analysis of a health care education scholarship that is conditional on the recipient committing to work for several years after graduation delivering ART in sub-Saharan Africa. Such a scholarship could address two of the main reasons for the low numbers of health workers in sub-Saharan Africa: low education rates and high emigration rates. We use Markov Monte Carlo microsimulation to estimate the expected net present value (eNPV) of "conditional scholarships" in sub-Saharan Africa. The scholarships are highly eNPV-positive under a wide range of assumptions. Conditional scholarships for a HAHW team sufficient to provide ART for 500 patients have an eNPV of 1.24 million year-2000 US dollars, assuming that the scholarship recipients are in addition to the health workers who would have been educated without scholarships and that the scholarships reduce annual HAHW emigration probabilities from 15% to 5% for five years. The eNPV of the education effect of the scholarships is larger than eNPV of the migration effect. Policy makers should consider implementing "conditional scholarships" for HAHW, especially in countries where health worker education capacity is currently underutilized or can be rapidly expanded. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | MARKOV CHAIN | LABOR FORCE | HEALTH PERSONNEL | HUMAN RESOURCES | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | AIDS | COST BENEFIT ANALYSIS | MANAGEMENT | Africa | Developing Countries | Probability | Statistical Studies | Studies | Research Methodology | Economic Factors | Delivery of Health Care | Health | HIV | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation | Organization and Administration Document Number: 330870 |
| 5. Title: Task-shifting: exposing the cracks in public health systems [editorial] Author: Berer M Source: Reproductive Health Matters. 2009 May;17(33):4-8. Abstract: This editorial piece discusses the innovative efforts to increase access to skilled reproductive health care especially in resource-poor settings where physicians are in short supply or physicians are not necessary due to trained mid-level providers performing procedures. It also examines the lack of capacity or failure of developing countries to build and strengthen their health systems and develop a strong, well-trained public health workforce. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | HEALTH PERSONNEL | PUBLIC HEALTH | PRIMARY HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | HUMAN RESOURCES | TRAINING ACTIVITIES | HEALTH POLICY | DELIVERY OF HEALTH CARE | ANTIRETROVIRAL THERAPY | FINANCIAL ACTIVITIES | QUALITY OF HEALTH CARE | Health | Health Services | Economic Factors | Training Programs | Education | Policy | Political Factors | Sociocultural Factors | HIV | HIV Infections | Viral Diseases | Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 342010 |
| 6. Title: Laboratory challenges in the scaling up of HIV, TB, and malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery. Author: Birx D; de Souza M; Nkengasong JN Source: American Journal of Clinical Pathology. 2009 Jun;131(6):849-51. Abstract: Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | HIV INFECTIONS | TUBERCULOSIS | MALARIA | LABORATORY | NEEDS | INTEGRATED PROGRAMS | HUMAN RESOURCES | LOGISTICS | TRAINING ACTIVITIES | STANDARDS | QUALITY CONTROL | Viral Diseases | Diseases | Infections | Parasitic Diseases | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Economic Factors | Programs | Organization and Administration | Management | Training Programs | Education | Research Methodology Document Number: 341768 |
| 7. Peer Reviewed Title: Surgical task shifting in Sub-Saharan Africa. Author: Chu K; Rosseel P; Gielis P; Ford N Source: PLoS Medicine. 2009 May 19;6(5):e1000078. Abstract: Surgically treatable problems account for a significant proportion of disease burden in resourcelimited settings, but are neglected due to lack of skilled professionals, adequate infrastructure and equipment, and the perception that surgical services are complex and expensive. In the absence of trained surgeons, surgical tasks are often performed by non-specialist physicians and non-physician clinicians. While evaluations have proven the effectiveness of such task shifting, this is often done de facto, with little supervisory or training framework in place. As efforts increase to scale up surgical care in the developing world, a number of important lessons from task shifting in the field of HIV/AIDS care could serve to support task shifting in surgery. These include clearly defining the limits of task shifting, ensuring adequate training and supervision, providing adequate recognition and remuneration, developing simplified tools and guidelines, ensuring engagement with regulatory bodies, and mobilizing community health workers. Language: English Keywords: AFRICA, SUB SAHARAN | CRITIQUE | HEALTH PERSONNEL | SURGERY | ANESTHESIA | HUMAN RESOURCES | TRAINING PROGRAMS | AIDS | HIV INFECTIONS | REFERRAL AND CONSULTATION | SUPERVISION | ETHICS | Africa | Developing Countries | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Health Services | Economic Factors | Education | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Management | Sociocultural Factors Document Number: 341772 |
| 8. Peer Reviewed Title: The health and health system of South Africa: historical roots of current public health challenges. Author: Coovadia H; Jewkes R; Barron P; Sanders D; McIntyre D Source: Lancet. 2009 Sep 5;374(9692):817-34. Abstract: The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa. Language: English Keywords: SOUTH AFRICA | HISTORICAL REVIEW | PUBLIC HEALTH | COLONIALISM | POLITICAL FACTORS | ECONOMIC FACTORS | SOCIAL DISCRIMINATION | SEX DISCRIMINATION | INEQUALITIES | FAMILY LIFE | VIOLENCE | HEALTH SERVICES | HUMAN RESOURCES | POLICY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Health | Political Systems | Sociocultural Factors | Social Problems | Socioeconomic Factors | Family and Household | Behavior | Delivery of Health Care Document Number: 342803 |
| 9. Peer Reviewed Title: The effect of changes in health sector resources on infant mortality in the short-run and the long-run: a longitudinal econometric analysis. Author: Farahani M; Subramanian SV; Canning D Source: Social Science and Medicine. 2009;68:1918-1925. Abstract: While countries with higher levels of human resources for health typically have better population health, the evidence that increases in the level of human resources for health leads to improvements in population health is limited. We use a dynamic regression model to obtain estimates of both the short-run and long-term effects of changes in physicians per capita, our measure of health system resources, on infant mortality. Using a dataset of 99 countries at 5-year intervals from 1960-2000, we estimate that increasing the number of physicians by one per 1000 population (roughly a doubling of current levels of provision) decreases the infant mortality rate by 15% within 5 years and by 45% in the long-run with half the long-run gain being achieved in 15 years. We conclude that the long-run effects of heath system resources are substantially larger than previously estimated. Our results suggest, however, that countries that have delayed action on the Millennium Development Goal of reducing infant andchild mortality rate by two-thirds by 2015 (relative to 1990) may have difficulty meeting this goal even if they rapidly increase resources now. Language: English Keywords: GLOBAL | RESEARCH REPORT | LONGITUDINAL STUDIES | PHYSICIANS | HUMAN RESOURCES | INFANT MORTALITY | HEALTH SERVICES | CHANGES | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Social Change | Sociocultural Factors Document Number: 340203 |
| 10. Peer Reviewed Title: Maternal health: a case study of Rajasthan. Author: Iyengar SD; Iyengar K; Gupta V Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):271-92. Abstract: This case study has used the results of a review of literature to understand the persistence of poor maternal health in Rajasthan, a large state of north India, and to make some conclusions on reasons for the same. The rate of reduction in Rajasthan's maternal mortality ratio (MMR) has been slow, and it has remained at 445 per 1000 livebirths in 2003. The government system provides the bulk of maternal health services. Although the service infrastructure has improved in stages, the availability of maternal health services in rural areas remains poor because of low availability of human resources, especially midwives and clinical specialists, and their non-residence in rural areas. Various national programmes, such as the Family Planning, Child Survival and Safe Motherhood and Reproductive and Child Health (phase 1 and 2), have attempted to improve maternal health; however, they have not made the desired impact either because of an earlier emphasis on ineffective strategies, slow implementation as reflected in the poor use of available resources, or lack of effective ground-level governance, as exemplified by the widespread practice of informally charging users for free services. Thirty-two percent of women delivered in institutions in 2005-2006. A 2006 government scheme to give financial incentives for delivering in government institutions has led to substantial increase in the proportion of institutional deliveries. The availability of safe abortion services is limited, resulting in a large number of informal abortion service providers and unsafe abortions, especially in rural areas. The recent scheme of Janani Suraksha Yojana provides an opportunity to improve maternal and neonatal health, provided the quality issues can be adequately addressed. Language: English Keywords: INDIA | LITERATURE REVIEW | MATERNAL HEALTH | REPRODUCTIVE HEALTH | WOMEN'S STATUS | MATERNAL MORTALITY | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | QUALITY OF HEALTH CARE | SAFE MOTHERHOOD | PERFORMANCE IMPROVEMENT | HUMAN RESOURCES | CONTRACEPTION | ABORTION | Asia, Southern | Asia | Developing Countries | Health | Socioeconomic Factors | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Management | Family Planning | Fertility Control, Postconception Document Number: 341929 Notification |
| 11. Peer Reviewed Title: The health worker shortage in Africa: are enough physicians and nurses being trained? Author: Kinfu Y; Poz MR; Mercer H; Evans DB Source: Bulletin of the World Health Organization. 2009 Feb 10;87:225-230. Abstract: Objective: To estimate systematically the inflow and outflow of health workers in Africa and examine whether current levels of pre-service training in the region suffice to address this serious problem, taking into account population increases and attrition of health workers due to premature death, retirement, resignation and dismissal. Methods: Data on the current numbers and types of health workers and outputs from training programmes are from the 2005 WHO health workforce and training institutions' surveys. Supplementary information on population estimates and mortality is from the United Nations Population Division and WHO databases, respectively, and information on worker attrition was obtained from the published literature. Because of shortages of data in some settings, the study was restricted to 12 countries in sub-Saharan Africa. Findings: Our results suggest that the health workforce shortage in Africa is even more critical than previously estimated. In 10 of the 12 countries studied, current pre-service training is insufficient to maintain the existing density of health workers once all causes of attrition are taken into account. Even if attrition were limited to involuntary factors such as premature mortality, with current workforce training patterns it would take 36 years for physicians and 29 years for nurses and midwives to reach WHO's recent target of 2.28 professionals per 1000 population for the countries taken as a whole -and some countries would never reach it. Conclusion: Pre-service training needs to be expanded as well as combined with other measures to increase health worker inflow and reduce the rate of outflow. Language: English Keywords: AFRICA | RESEARCH REPORT | PHYSICIANS | NURSES AND NURSING | HEALTH PERSONNEL | BRAIN DRAIN | RETIREMENT | DEATH | UNEMPLOYMENT | EMPLOYMENT | HUMAN RESOURCES | Developing Countries | Delivery of Health Care | Health | International Migration | Migration | Population Dynamics | Demographic Factors | Population | Employment Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Mortality | Macroeconomic Factors Document Number: 340208 |
| 12. Peer Reviewed Title: The Pediatric AIDS Corps: responding to the African HIV/AIDS health professional resource crisis. Author: Kline MW; Ferris MG; Jones DC; Calles NR; Mizwa MB; Schwarzwald HL Source: Pediatrics. 2009 Jan;123(1):134-6. Abstract: Health professional capacity for delivery of HIV/AIDS care and treatment is severely constrained across sub-Saharan Africa. African health professional expertise in pediatrics is in particularly short supply. Here we describe a Pediatric AIDS Corps program that was designed to place pediatricians and other physicians in Africa on a long-term basis to expand existing health professional capacity for pediatric and family HIV/AIDS care and treatment. In the first 2 years of this program, 76 physicians were placed in 5 African countries that have been hit hard by HIV/AIDS. Enrollment of HIV-infected children in care more than quadrupled over a 24-month period, to 26 590. We believe that this pilot program can serve as a model for larger-scale efforts to immediately expand access for African children and families to life-saving HIV/AIDS care and treatment. Language: English Keywords: AFRICA, SUB SAHARAN | EVALUATION REPORT | RECOMMENDATIONS | PILOT PROJECTS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | PHYSICIANS | HUMAN RESOURCES | CAPACITY BUILDING | HIV INFECTIONS | TREATMENT | PROGRAM DESIGN | TRAINING PROGRAMS | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | Africa | Developing Countries | Evaluation | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Health Personnel | Health | Economic Factors | Program Sustainability | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Education | Program Evaluation Document Number: 328038 |
| 13. Peer Reviewed Title: Maternal health in Gujarat, India: a case study. Author: Mavalankar DV; Vora KS; Ramani KV; Raman P; Sharma B; Upadhyaya M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):235-48. Abstract: Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness. Language: English Keywords: INDIA | RESEARCH REPORT | CASE STUDIES | MATERNAL HEALTH | MATERNAL HEALTH SERVICES | HEALTH SERVICES ADMINISTRATION | OBSTETRICS | EMERGENCY SERVICES | TRANSPORTATION | MATERNAL MORTALITY | BLOOD SUPPLY | HUMAN RESOURCES | TRAINING PROGRAMS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Health | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Management | Organization and Administration | Medicine | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Equipment and Supplies | Medical Procedures | Education Document Number: 341932 |
| 14. Peer Reviewed Title: Improving maternal survival in South Asia--what can we learn from case studies? Author: McPake B; Koblinsky M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):93-107. Abstract: Technical interventions for maternal healthcare are implemented through a dynamic social process. Peoples' behaviours--whether they be planners, managers, providers, or potential users--influence the outcomes. Given the complexity and unpredictability inherent in such dynamic processes, the proposed cause-and-effect relationships in any one context cannot be directly transferred to another. While this is true of all health services, its importance is magnified in maternal healthcare because of the need to involve multiple levels of the health system, multiple types of care providers from the highly skilled specialist to community-level volunteers, and multiple technical interventions, without the ability to measure significant change in the outcome, the maternal mortality ratio. Patterns can be followed however, in terms of outcomes in response to interventions. From these case studies of implementation of maternal health programmes across five states of India, Pakistan, and Bangladesh, some patterns stand out and seem to apply virtually everywhere (e.g., failure of systems to post staff in difficult areas) while others require more data to understand the observed patterns (e.g., response to financial incentives for improving maternal health systems; instituting available accessible safe blood). The patterns formed can provide guidance to programme managers as to what aspects of the process to track and micro-manage, to policy-makers as to what features of a context may particularly influence impacts of alternative maternal health strategies, and to governments more broadly as to the factors shaping dynamic responses that might themselves warrant intervention. Language: English Keywords: ASIA, SOUTHERN | CRITIQUE | CASE STUDIES | MATERNAL MORTALITY | MATERNAL HEALTH SERVICES | CHILDBIRTH | BLOOD SUPPLY | HUMAN RESOURCES | FINANCIAL ACTIVITIES | INCENTIVES | HEALTH SERVICES ADMINISTRATION | HEALTH POLICY | Asia | Developing Countries | Studies | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Equipment and Supplies | Medical Procedures | Medicine | Economic Factors | Policy | Political Factors | Sociocultural Factors | Management | Organization and Administration Document Number: 341940 |
| 15. Peer Reviewed Title: Public-sector maternal health programmes and services for rural Bangladesh. Author: Mridha MK; Anwar I; Koblinsky M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):124-38. Abstract: Achieving Millennium Development Goal 5 in Bangladesh calls for an appreciation of the evolution of maternal healthcare within the national health system to date plus a projection of future needs. This paper assesses the development of maternal health services and policies by reviewing policy and strategy documents since the independence in 1971, with primary focus on rural areas where three-fourths of the total population of Bangladesh reside. Projections of need for facilities and human resources are based on the recommended standards of the World Health Organization (WHO) in 1996 and 2005. Although maternal healthcare services are delivered from for-profit and not-for-profit (NGO) subsectors, this paper is focused on maternal healthcare delivery by public subsector. Maternal healthcare services in the public sector of Bangladesh have been guided by global policies (e.g., Health for All by the Year 2000), national policies (e.g., population and health policy), and plans (e.g., five- or three-yearly). The Ministry of Health and Family Welfare (MoHFW), through its two wings-Health Services and Family Planning-sets policies, develops implementation plans, and provides rural public-health services. Since 1971, the health infrastructure has developed though not in a uniform pattern and despite policy shifts over time. Under the Family Planning wing of the MoHFW, the number of Maternal and Child Welfare Centres has not increased but new services, such as caesarean-section surgery, have been integrated. The Health Services wing of the MoHFW has ensured that all district-level public-health facilities, e.g., district hospitals and medical colleges, can provide comprehensive essential obstetric care (EOC) and have targeted to upgrade 132 of 407 rural Upazila Health Complexes to also provide such services. In 2001, they initiated a programme to train the Government's community workers (Family Welfare Assistants and Female Health Assistants) to provide skilled birthing care in the home. However, these plans have been too meagre, and their implementation is too weak to fulfill expectations in terms of the MDG 5 indicator-increased use of skilled birth attendants, especially for poor rural women. The use of skilled birth attendants, institutional deliveries, and use of caesarean section remain low and are increasing only slowly. All these indicators are substantially lower for those in the lower three socioeconomic quintiles. A wide variation exists in the availability of comprehensive EOC facilities in the public sector among the six divisions of the country. Rajshahi division has more facilities than the WHO 1996 standard (1 comprehensive EOC for 500,000 people) whereas Chittagong and Sylhet divisions have only 64% of their need for comprehensive EOC facilities. The WHO 2005 recommendation (1 comprehensive EOC for 3500 births) suggests that there is a need for nearly five times the existing national number of comprehensive EOC facilities. Based on the WHO standard 2005, it is estimated that 9% of existing doctors and 40% of nurses/midwives were needed just for maternal healthcare in both comprehensive EOC and basic EOC facilities in 2007. While the inability to train and retain skilled professionals in rural areas is the major problem in implementation, the bifurcation of the MoHFW (Health Services and Family Planning wings) has led to duplication in management and staff for service-delivery, inefficiencies as a result of these duplications, and difficulties of coordination at all levels. The Government of Bangladesh needs to functionally integrate the Health Services and Family Planning wings, move towards a facility-based approach to delivery, ensure access to key maternal health services for women in the lower socioeconomic quintiles, consider infrastructure development based on the estimation of facilities using the WHO 1996 recommendation, and undertake a human resource-development plan based on the WHO 2005 recommendation. Language: English Keywords: BANGLADESH | RURAL AREAS | HISTORICAL REVIEW | MATERNAL HEALTH SERVICES | PUBLIC SECTOR | HEALTH POLICY | OBSTETRICS | EMERGENCY SERVICES | NEEDS | COORDINATION | HUMAN RESOURCES | TRAINING PROGRAMS | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Macroeconomic Factors | Economic Factors | Policy | Political Factors | Sociocultural Factors | Medicine | Organization and Administration | Education Document Number: 341938 |
| 16. Peer Reviewed Title: Innovations and challenges in reducing maternal mortality in Tamil Nadu, India. Author: Padmanaban P; Raman PS; Mavalankar DV Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):202-19. Abstract: Although India has made slow progress in reducing maternal mortality, progress in Tamil Nadu has been rapid. This case study documents how Tamil Nadu has taken initiatives to improve maternal health services leading to reduction in maternal morality from 380 in 1993 to 90 in 2007. Various initiatives include establishment of maternal death registration and audit, establishment and certification of comprehensive emergency obstetric and newborn-care centres, 24-hour x 7-day delivery services through posting of three staff nurses at the primary health centre level, and attracting medical officers to rural areas through incentives in terms of reserved seats in postgraduate studies and others. This is supported by the better management capacity at the state and district levels through dedicated public-health officers. Despite substantial progress, there is some scope for further improvement of quality of infrastructure and services. The paper draws out lessons for other states and countries in the region. Language: English Keywords: INDIA | RESEARCH REPORT | CASE STUDIES | MATERNAL MORTALITY | WOMEN'S STATUS | MATERNAL HEALTH SERVICES | NATIONAL HEALTH SERVICES | QUALITY OF HEALTH CARE | OBSTETRICS | EMERGENCY SERVICES | HUMAN RESOURCES | FAMILY PLANNING PROGRAMS | ABORTION | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Socioeconomic Factors | Economic Factors | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Medicine | Family Planning | Fertility Control, Postconception Document Number: 341934 Notification |
| 17. Peer Reviewed Title: Assessing missed opportunities for the prevention of mother-to-child HIV transmission in an Eastern Cape local service area. Author: Rispel LC; Peltzer K; Phaswana-Mafuya N; Metcalf CA; Treger L Source: South African Medical Journal. 2009 Mar;99(3):174-9. Abstract: BACKGROUND: Prevention of new HIV infections is a critical imperative for South Africa; the prevention of mother-to-child transmission (PMTCT) is one of the most efficacious HIV prevention interventions. OBJECTIVE: Assessment of a PMTCT programme to determine missed opportunities. SETTING: The Kouga local service area (LSA), bordering Nelson Mandela Bay Municipality (Port Elizabeth) in the Eastern Cape. METHODS: An assessment was conducted in 2007 before implementing technical support for strengthening the PMTCT programme, including: interviews with 20 PMTCT managers, 4 maternity staff and 27 other health workers on service provision, management, infrastructure, human resources and the health information system; 296 antenatal clinic users on their service perceptions; 70 HIV-positive women on HIV knowledge, infant feeding, coping, support and service perceptions; 8 representatives from community organisations and 101 traditional health practitioners (THPs). Observations were conducted during site visits to health facilities, and the District Health Information System (DHIS) data were reviewed. RESULTS: Staff had high levels of awareness of HIV policies and most had received some relevant training. Nevirapine uptake varied by clinic, with an average of 56%. There were many missed opportunities for PMTCT, with 67% of pregnant women tested for HIV and only 43% of antenatal care attendees tested during a previous pregnancy. Only 6% of HIV-positive women reported support group participation. CONCLUSIONS: Reducing missed opportunities for PMTCT requires strengthening of the formal health sector, intersectoral liaison, and greater community support. Priority areas that require strengthening in the formal health sector include HIV counselling and testing; family planning and nutrition counselling; infant follow-up; human resources; and monitoring and evaluation. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | HEALTH PERSONNEL | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS | BREASTFEEDING | INFANT NUTRITION | CARE AND SUPPORT | PERCEPTION | HEALTH SERVICES | AWARENESS | ANTENATAL CARE | PREGNANCY | COUNSELING | FAMILY PLANNING | HUMAN RESOURCES | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Delivery of Health Care | Health | Disease Transmission Control | Prevention and Control | Diseases | Viral Diseases | Nutrition | Psychological Factors | Behavior | Knowledge | Sociocultural Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Reproduction | Clinic Activities | Program Activities | Programs | Organization and Administration | Economic Factors Document Number: 342687 |
| 18. Title: The global fight against HIV/AIDS, tuberculosis, and malaria: current status and future perspectives. Author: Vitoria M; Granich R; Gilks CF; Gunneberg C; Hosseini M; Were W; Raviglione M; De Cock KM Source: American Journal of Clinical Pathology. 2009 Jun;131(6):844-8. Abstract: HIV/AIDS, tuberculosis, and malaria are 3 major global public health threats and cause substantial morbidity, mortality, negative socioeconomic impact, and human suffering. Despite the significant increase in financial support and recent progress in addressing these 3 diseases, important obstacles and unmet priorities remain. Disease-specific interventions have had a considerable impact on improving health systems. However, despite considerable investment, weak health systems, inadequate human resources, and poor laboratory infrastructure continue to be major obstacles to expanding health services. Health system strengthening should be addressed in an integrated approach that includes HIV-, tuberculosis-, and malaria-specific interventions. Investment in strategic information and public health laboratory network capacity strengthening are key actions to expand services to successfully address those diseases in heavily impacted countries. Language: English Keywords: GLOBAL | CRITIQUE | AIDS | HIV INFECTIONS | TUBERCULOSIS | MALARIA | INTERNATIONAL COOPERATION | FOREIGN AID | INTERVENTIONS | GOALS | OBSTACLES | HUMAN RESOURCES | Viral Diseases | Diseases | Infections | Parasitic Diseases | Political Factors | Sociocultural Factors | Financial Activities | Economic Factors | Programs | Organization and Administration | Planning Document Number: 341769 |
| 19. Title: Involving new actors to achieve ART scaling-up: difficulties in an HIV/AIDS counselling and testing centre in Cameroon. Author: Yakam JC; Gruenais ME Source: International Nursing Review. 2009 Mar;56(1):50-7. Abstract: BACKGROUND: The high HIV/AIDS-related mortality among young adults is devastating countries in sub-Saharan Africa. The implementing capacity of the health systems is the main limiting factor of antiretroviral treatment (ART) scaling-up;(1) this capacity depends mainly on the health workforce. Tackling the issue of human resources for health is thus of paramount importance to achieve universal access to ART and for the survival of health systems in time of AIDS. To support such a process, the World Health Organization stresses the importance of task shifting(2) from medical doctors to nurses and from nurses to community health workers. Such task shifting is not easy to achieve but undoubtedly needed. STUDY OBJECTIVE: This paper raises issues about the involvement of new actors(3) without precise redefinitions of roles and task-shifting procedures. We take the example of a 'Centre de Prevention et de Depistage Volontaire du VIH/sida'(4) in one major town of the Far-North province of Cameroon (Central Africa). METHODOLOGY: The study was qualitative. Observations were carried out in the service and in-depth interviews conducted with health workers and actors of Cameroon's National AIDS Control Committee. These interviews were recorded and transcribed. The material was analysed using keywords. KEY RESULT: The involvement of new actors in a context of human resources for health shortage and health system crisis creates confusion and role conflicts, which lead to frustration. It favours the appearance of chinks within which these new actors slip and 'find their way' in the system; it finally raises problems related to their legitimacy and position within the existing hierarchy. KEY POLICY MESSAGE: It is necessary, when involving new staff members (particularly when they do not belong to internationally recognized health professionals such as nurses, doctors and pharmacists), to redefine roles and build precise task-shifting procedures so that everyone may still have a place in the whole system and feel useful. Language: English Keywords: CAMEROON | RESEARCH REPORT | KAP SURVEYS | HEALTH PERSONNEL | ANTIRETROVIRAL THERAPY | CAPACITY BUILDING | VOLUNTARY COUNSELING AND TESTING | HIV TESTING | HUMAN RESOURCES | PROGRAM ACCESSIBILITY | PARTICIPATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Delivery of Health Care | Health | HIV | HIV Infections | Viral Diseases | Diseases | Program Sustainability | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Economic Factors | Program Evaluation | Social Behavior | Behavior Document Number: 330984 |
20.  Title: Worker retention in human resources for health: catalyzing and tracking change. Author: Yumkella F Source: Chapel Hill, North Carolina, IntraHealth International, Capacity Project, 2009 Mar. [4] p. (Capacity Project Knowledge Sharing Technical Brief No. 15) Abstract: There is increasingly widespread commitment to initiatives to attract and retain skilled workers, especially in rural areas. Retention continues to be a serious challenge in the human resources for health (HRH) crisis. This brief from the Capacity Project updates and documents a previously published resource paper and technical brief which focus on the area of worker retention. The author highlights key findings from three country assessments in Uganda, Tanzania and Liberia. The brief shows how a number of developing countries are employing various strategies to energise the workforce and stem flows. Many practices show promise for wider application across countries, but evidence of successful programmes is seldom documented or shared. Various schemes to improve worker retention are described in countries including Kenya and Zambia. Language: English Keywords: AFRICA, SUB SAHARAN | RECOMMENDATIONS | CRITIQUE | CASE STUDIES | HEALTH PERSONNEL | RURAL POPULATION | CAPACITY BUILDING | BRAIN DRAIN | RURAL-URBAN MIGRATION | HUMAN RESOURCES | SATISFACTION | EMPLOYMENT | HEALTH SERVICES ADMINISTRATION | HEALTH SERVICES EVALUATION | OCCUPATIONAL HEALTH | Africa | Developing Countries | Studies | Research Methodology | Delivery of Health Care | Health | Population Characteristics | Demographic Factors | Population | Program Sustainability | Programs | Organization and Administration | International Migration | Migration | Population Dynamics | Economic Factors | Psychological Factors | Behavior | Macroeconomic Factors | Management | Program Evaluation Document Number: 331350 |
| 21. Peer Reviewed Title: Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Author: Zachariah R; Ford N; Philips M; Lynch S; Massaquoi M; Janssens V; Harries AD Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):549-58. Abstract: Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious diseases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Medecins Sans Frontieres' experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international 'brain drain'. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes. Language: English Keywords: MALAWI | SOUTH AFRICA | LESOTHO | RESEARCH REPORT | HUMAN RESOURCES | HEALTH PERSONNEL | HIV | AIDS | ANTIRETROVIRAL THERAPY | BRAIN DRAIN | TRAINING ACTIVITIES | RECRUITMENT ACTIVITIES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Economic Factors | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | International Migration | Migration | Population Dynamics | Demographic Factors | Population | Training Programs | Education | Program Activities | Programs | Organization and Administration Document Number: 342754 |
| 22. Title: Human relations: building leadership in southern Sudan's health sector. Author: IntraHealth International. Capacity Project Source: Voices. 2008 Oct;(24):2 p. Abstract: This article presents the personal story of a manager in the Ministry of Health who benefited from the Project's leadership development training and went in to train key managers in the health sector. Language: English Keywords: SUDAN | PROGRESS REPORT | EVALUATION | GOVERNMENT AGENCIES | GOVERNMENT OFFICIALS | HEALTH PERSONNEL | TRAINERS | LEADERSHIP | HEALTH SERVICES | CAPACITY BUILDING | MANAGEMENT | HUMAN RESOURCES | TRAINING OF TRAINERS | Africa, North | Africa | Developing Countries | Organizations | Political Factors | Sociocultural Factors | Administrative Personnel | Organization and Administration | Delivery of Health Care | Health | Training Programs | Education | Program Sustainability | Programs | Economic Factors Document Number: 328334 |
| 23. Title: Wellness programme and health policy development at a large faith-based organisation in Khayelitsha, South Africa. Author: Arend ED Source: African Journal of AIDS Research. 2008 Nov;7(3):259-270. Abstract: This paper presents a case study of wellness programme and health policy development based on an HIV/AIDS organisation's Khayelitsha site in the Western Cape Province, South Africa. The study examines the different challenges that the organisation faces in relation to its predominantly low-income staff, donor-driven structure, its limited resources and organisational capacity, and the highly stressful and demanding nature of HIV-related treatment and care. This case study also examines the significant and contentious challenges lying in the organisation's faith-based identity. Research began with a review of civil society organisations' responses to HIV in sub-Saharan Africa, as well as related topics, such as South Africa's public health system, and health-seeking attitudes, beliefs and behaviours in high-risk South African communities. The organisation's health policy was analysed and 'workshopped' with multiple employees. Focus groups were conducted with mid-management and fieldwork staff in the Khayelitsha office, while a comprehensive, anonymous, wellness questionnaire was distributed in order to collect quantitative data. Data acquired from the questionnaire responses and the focus group discussions indicated that wellness programme and health policy development faces its greatest challenges on two fronts, namely due to a critical lack of organisational development and capacity, and a host of practical, social and cultural challenges among the most vulnerable people whom the NGO intends to serve. The study's primary recommendations include: taking its employees' cultural and social norms into consideration; addressing issues related to capacity and organisational development with the major donors; broadening the scope of its health policy to extend beyond issues related to HIV; and examining and clarifying expectations of employee behaviour in light of its identity as a faith-based organisation. The study also issues a secondary list of recommendations for other resource-constrained NGOs that also wish to develop and implement wellness programmes and health policies in their workplace. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CASE STUDIES | FAITH-BASED ORGANIZATION | HIV PREVENTION | POLICY DEVELOPMENT | EMPLOYMENT-BASED SERVICES | ORGANIZATION AND ADMINISTRATION | CAPACITY BUILDING | HUMAN RESOURCES | SOCIOCULTURAL FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Organizations | Political Factors | HIV Infections | Viral Diseases | Diseases | Planning | Programs | Program Sustainability | Economic Factors Document Number: 341270 |
| 24. Title: Private provider networks in Ethiopia. Author: Barnes J; Cuellar C; Melkamu Y Source: Bethesda, Maryland, Abt Associates, Private Sector Partnerships-One [PSP-One], 2008 Jul. 45 p. (Technical Report No. 9USAID Contract No. GPO-I-00-04-00007-00) Abstract: In response to the United States Agency for International Development's (USAID) Ethiopia mission's request, the Private Sector Partnerships-One (PSP-One) project fielded an assessment team from February 11-24, 2007, to document the state of operations for the Biruh Tesfa network, identify strategies to improve network sustainability, and determine local organizations that could have a role in network management and support. In addition the team was asked to explore opportunities to integrate HIV services into the Biruh Tesfa network.The principle findings of the assessment were the following: The Biruh Tesfa network operates effectively to support the provision of family planning in the private sector, albeit less intensively than at the outset of the project; Training and brand promotion are limited, but supervision and data collection continue and product supply is increasing; The structures and processes that support the Biruh Tesfa network are not strong enough to consider increasing their sustainability; The environment for pursuing private provider networks is favorable and the lessons learned from the Biruh Tesfa network experience can be useful in pursuing new network strategies; A number of interventions supporting private networks can be implemented quickly and easily. These actions include research, financing, and policy interventions that will inform and facilitate future work with private providers; There is no single organization that stands out as the best option to ensure franchisor functions and network support; There is no single network strategy that stands out as the best way to achieve the public health goals of USAID and the government of Ethiopia. The assessment team recommends combining a less-intensive network that will achieve scale more rapidly with another network option that will build local ownership and more sustainable structures for the long term. (Excerpt) Language: English Keywords: ETHIOPIA | SUMMARY REPORT | NEEDS | CONTRACEPTIVE PREVALENCE | TRAINING ACTIVITIES | REPRODUCTIVE HEALTH | HEALTH FACILITIES | VOLUNTARY COUNSELING AND TESTING | MANAGEMENT | HUMAN RESOURCES | HIV/FP INTEGRATION | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Economic Factors | Contraceptive Usage | Contraception | Family Planning | Training Programs | Education | Health | Delivery of Health Care | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Organization and Administration | Programs Document Number: 331580 |
| 25. Peer Reviewed Title: Effects of policy options for human resources for health: An analysis of systematic reviews. Author: Chopra M; Munro S; Lavis JN; Vist G; Bennett S Source: Lancet. 2008 Feb 23;371(9613):668-674. Abstract: Policy makers face challenges to ensure an appropriate supply and distribution of trained health workers and to manage their performance in delivery of services, especially in countries with low and middle incomes. We aimed to identify all available policy options to address human resources for health in such countries, and to assess the effectiveness of these policy options. We searched Medline and Embase from 1979 to September, 2006, the Cochrane Library, and the Human Resources for Health Global Resource Center database. We also searched up to 10 years of archives from five relevant journals, and consulted experts. We included systematic reviews in English which assessed the effects of policy options that could affect the training, distribution, regulation, financing, management, organisation, or performance of health workers. Two reviewers independently assessed each review for eligibility and quality, and systematically extracted data about main effects. We also assessed whether the policy options were equitable in their effects; suitable for scaling up; and applicable to countries with low and middle incomes. 28 of the 759 systematic reviews of effects that we identified were eligible according to our criteria. Of these, only a few included studies from countries with low and middle incomes, and some reviews were of low quality. Most evidence focused on organisational mechanisms for human resources, such as substitution or shifting tasks between different types of health workers, or extension of their roles; performance-enhancing strategies such as quality improvement or continuing education strategies; promotion of teamwork; and changes to workflow. Of all policy options, the use of lay health workers had the greatest proportion of reviews in countries with a range of incomes, from high to low. We have identified a need for more systematic reviews on the effects of policy options to improve human resources for health in countries with low and middle incomes, for assessments of any interventionsthat policy makers introduce to plan and manage human resources for health, and for other research to aid policy makers in these countries. (author's) Language: English Keywords: DEVELOPED COUNTRIES | DEVELOPING COUNTRIES | RESEARCH REPORT | LITERATURE REVIEW | HEALTH | HEALTH POLICY | HUMAN RESOURCES | SUPERVISION | MANAGEMENT | PERFORMANCE IMPROVEMENT | HEALTH SERVICES | DELIVERY OF HEALTH CARE | EVALUATION | Policy | Political Factors | Sociocultural Factors | Economic Factors | Organization and Administration Document Number: 324869 |
| 26. Peer Reviewed Title: How much is not enough? Human resources requirements for primary health care: A case study from South Africa. Author: Daviaud E; Chopra M Source: Bulletin of the World Health Organization. 2008 Jan;86(1):46-51. Abstract: The objective was to quantify staff requirements in primary health care facilities in South Africa through an adaptation of the WHO workload indicator of staff needs tool. We use a model to estimate staffing requirements at primary health care facilities. The model integrates several empirically-based assumptions including time and type of health worker required for each type of consultation, amount of management time required, amount of clinical support required and minimum staff requirements per type of facility. We also calculate the number of HIV-related consultations per district. The model incorporates type of facility, monthly travelling time for mobile clinics, opening hours per week, yearly activity and current staffing and calculates the expected staffing per category of staff per facility and compares it to the actual staffing. Across all the districts there is either an absence of doctors visiting clinics or too few doctors to cover the opening times of community health centres. Overall the number of doctors is only 7% of the required amount. There is 94% of the required number of professional nurses but with wide variations between districts, with a few districts having excesses while most have shortages. The number of enrolled nurses is 60% of what it should be. There are 17% too few enrolled nurse assistants. Across all districts there is wide variation in staffing levels between facilities leading to inefficient use of professional staff. The application of an adapted WHO workload tool identified important human resource planning issues. (author's) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CASE STUDIES | HEALTH PERSONNEL | CLIENTS | HUMAN RESOURCES | MANPOWER NEEDS | PRIMARY HEALTH CARE | DELIVERY OF HEALTH CARE | HEALTH SERVICES | HEALTH FACILITIES | SATISFACTION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Health | Program Activities | Programs | Organization and Administration | Economic Factors | Psychological Factors | Behavior Document Number: 323382 |
| 27. Title: HIV in Papua New Guinea: the need for practical action, and a focus on human resources and health systems for women and children [editorial] Author: Duke T Source: Journal of Paediatrics and Child Health. 2008 Nov;44(11):611-2. Abstract: PNG has been the recipient of a large amount of funding through the Global Fund for HIV, tuberculosis and malaria. Therefore, HIV is both a challenge and an opportunity. This funding must be harnessed to establish effective PPTCT and ART treatment and holistic maternal and child health programmes to help all mothers and children. The Global Fund has provided an administrative position -an HIV coordinator -in each of the four regions. However, there is a pressing need for more midwives and paediatric nurses to be trained and employed to deal with the ever-increasing complexity of delivering maternal and child health services, which now includes HIV. For health education and clinical care, these front-line workers will contribute substantially. This will require investment in schools of nursing, undergraduate and postgraduate midwifery and child health courses, and work towards ensuring the sustainability of such positions within the Health Department structure. Addressing HIV care and prevention in an equitable way will require a focus on health systems and human resources, not just on antiretroviral drugs and HIV education. The lack of support for additional health workers to introduce new programmes is often a major deficiency in globally funded programmes. Global funding must be utilised to improve the prevention and treatment specific for children with HIV, but also to find mechanisms for supplying the practical general interventions that are common to health-care delivery for both HIV positive and negative women and children. PNG is going through a phase of economic improvement. The challenge is to ensure that health, and the health of mothers and children in particular, receives an increased share of the nation's resources. An approach to HIV education based on practical interventions, utilising global funds to improve health systems and increase essential human resources, and increasing the proportion of government funding for women's and children's health will be the path to progress in addressing HIV and improving equity. (excerpt) Language: English Keywords: PAPUA NEW GUINEA | CRITIQUE | RECOMMENDATIONS | EVALUATION | WOMEN IN DEVELOPMENT | CHILDREN | HUMAN RESOURCES | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL THERAPY | PROGRAM SUSTAINABILITY | AIDS PREVENTION | SEX EDUCATION | HEALTH EDUCATION | Developing Countries | Oceania | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | HIV | Programs | Organization and Administration | AIDS | Education Document Number: 330391 |
| 28. Peer Reviewed Title: Raising interest in contraception and sexual health: Special study modules for medical students. Author: Fey C; Evans C Source: Journal of Family Planning and Reproductive Health Care. 2008;34(1):64-65. Abstract: Getting the balance correct in medical workforce planning, particularly in Obstetrics and Gynaecology (O&G), has been a problem for a number of years. Over the last 10 years, training numbers have varied and the balance between trainees qualified and number of consultant posts available has wavered. Bearing in mind the Government's aims for a consultant-delivered service, and the need for future increase in senior posts (another discussion entirely around consultants vs non-consultant senior grade!), we are now seeing the possibility of failure to provide enough trainees to fill anticipated posts. In particular, there are notably fewer trainees attracted to O&G, and we see parallel problems in recruiting to Contraception and Sexual Health (C&SH). Even now we have unfilled consultant and trainee posts throughout the country (see Workforce Planning Committee reports) and attracting trainees to our speciality remains a challenge. (excerpt) Language: English Keywords: UNITED KINGDOM | CRITIQUE | STUDIES | LABOR FORCE | MEDICAL STUDENTS | SEX EDUCATION | HEALTH | REPRODUCTIVE HEALTH | CONTRACEPTION | OCCUPATIONS | GYNECOLOGY | HUMAN RESOURCES | EMPLOYMENT | Developed Countries | Europe, Western | Europe | Research Methodology | Economic Factors | Students | Education | Family Planning | Medicine | Health Services | Delivery of Health Care | Macroeconomic Factors Document Number: 323396 |
| 29. Title: Human Resources for Health (HRH) action workshop assessment. Author: Fogarty L Source: Chapel Hill, North Carolina, IntraHealth International, Capacity Project, 2008 Jul. 21 p. Abstract: The Joint Learning Initiative (JLI) meetings in Abuja (December 2004) and Oslo (February 2005) and other meetings in South Africa (May 2005) and Brazzaville (July 2005) focused global attention on critical human resources for health (HRH) issues, providing much needed high-level support and calls for action to address the HRH crisis. The Capacity Project's HRH Action Workshop series was intended to extend this work by focusing on specific HRH actions and experiences-what is being done in countries, what is working and what is not. The Capacity Project assessed the influence of the workshop on subsequent country-level HRH activities, and found that a combination of the workshop methodology and a meeting of the right participants led to notable HRH action in several countries. Language: English Keywords: AFRICA, SUB SAHARAN | PROGRESS REPORT | KAP SURVEYS | HEALTH PERSONNEL | HUMAN RESOURCES | WORKSHOPS | USAID | CAPACITY BUILDING | HEALTH SERVICES | NEEDS ASSESSMENT | MANPOWER NEEDS | HEALTH AND WELFARE PLANNING | INFORMATION RETRIEVAL SYSTEMS | TRAINING PROGRAMS | PERFORMANCE IMPROVEMENT | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Delivery of Health Care | Health | Economic Factors | Education | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Program Sustainability | Programs | Organization and Administration | Evaluation | Social Planning | Data Storage and Retrieval | Information Processing | Information | Management Document Number: 308935 |
| 30. Peer Reviewed Title: Nurses, community health workers, and home carers: Gendered human resources compensating for skewed health systems. Author: George A Source: Global Public Health. 2008;3 Suppl 1:75-89. Abstract: This review examines the experiences of nurses, community health workers, and home carers in health systems from a gender analysis. With respect to nursing, current discussions around delegation take place over layers of historical struggle that mark the evolution of nursing as a profession. Female community health workers also struggle to be recognized as skilled workers, in addition to defending at a personal level the legitimacy of their work, as it transgresses traditional norms proscribing morality and the place of women in society, at times with violent consequences. The review concludes by exploring the characteristics of, and challenges faced by, home carers, who fail to be recognized as workers at all. A key finding is that these mainly female frontline health workers compensate for the shortcomings of health systems through individual adjustments, at times to the detriment of their own health and livelihoods. So long as these shortcomings remain as private, individual concerns of women, rather than the collective responsibility of gender, requiring public acknowledgement and resolution, health systems will continue to function in a skewed manner, serving to replicate inequalities in the health labour force and in society more broadly. (author's) Language: English Keywords: GLOBAL | LITERATURE REVIEW | WOMEN | NURSES AND NURSING | COMMUNITY WORKERS | HEALTH PERSONNEL | HOME CARE | GENDER ISSUES | HUMAN RESOURCES | HEALTH SERVICES EVALUATION | Demographic Factors | Population | Delivery of Health Care | Health | Care and Support | Health Services | Sociocultural Factors | Economic Factors | Program Evaluation | Programs | Organization and Administration Document Number: 326808 |
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