Health Systems Strengthening

Who’s Doing What in the HRH World?

Kate TulenkoI still find out most of my important health workforce information via word of mouth. Yes, I regularly read the latest journal articles and subscribe to half a dozen human resources for health (HRH) and health systems listservs, follow over 250 people on Twitter, and receive RSS updates from several HRH websites, but I never seem to get the information I really need. Who is working to strengthen health managers? What country is interested in designing a retention package for its health workers? What funder might be interested in funding a survey of how health workers currently use their mobile phones and how they would like to use them to do their jobs better? In this digital world there has to be a better way for us to share information. Read more »

Update on the MDGs: Where Are the Health Workers?

Sarah DwyerThe UN’s Millennium Development Goals Report 2011 provides a fascinating snapshot of how far we’ve come in improving health outcomes—and how much further we need to go. Unfortunately, the report ignores the health workforce crisis in many of the countries struggling to meet their 2015 health goals. The MDGs cannot be achieved when large numbers of people lack access to a health worker, yet the persistent, severe shortage of health workers is paid scant attention in the recently released UN report.

A fundamental barrier to improving health is the health worker crisis. The report’s section on Goal 5 (Improve Maternal Health), for example, points out that far too many women are without access to a skilled birth attendant during delivery. While many regions have made progress, “coverage remains low in sub-Saharan Africa and Southern Asia, where the majority of maternal deaths occur.” Read more »

Health Workers’ Role in Health Service Integration

Mesrak BelatchewIn the past decade, the global health field has seen a number of interventions that tried to integrate health services for various purposes. Integrating family planning and HIV services have helped countries make use of the resources available for the latter to expand the scope and coverage of services. TB and HIV service integration is another example of synergy to strengthen both programs. The advantage of integration for consumers is clear: patients get comprehensive services, whether in the community or at health facilities.

Focusing on health workers
Through the years, we have learned that it’s vital to strengthen the existing health system as a whole. In integrating health services, these initiatives bring a welcome focus on the key role of health workers who provide services across the system. Read more »

Addressing the Global Burden of NCDs: Health Workers Needed

Mesrak BelatchewIn the past few decades, the incidence and prevalence of noncommunicable diseases (NCDs) has continued to grow. The more we learn about the magnitude of NCDs, especially in developing countries, the more it’s clear that we need to focus on health workers as the center of our efforts to manage NCDs effectively.

The first Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control, held in April 2011 in Moscow, drew much-needed attention to the global burden of NCDs. The conference report showed that cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases are the leading causes of morbidity, disability, and mortality in the world. NCDs cause over 60% of global deaths, 80% of which occur in developing countries. In addition NCDs are projected to contribute to 75% of global deaths by 2030, significantly impacting all levels of health services, health care costs, and the health workforce, as well as national productivity. The June 2011 Global Health Council annual conference provided further exposure for global and country-based research findings, program interventions, lessons learned, and the way forward in addressing NCDs. Read more »

Microfinance Institutions for Better Health: How Can They Benefit Health Workers?

Mesrak BelatchewIn my work with CapacityPlus to strengthen the global health workforce, I explore ways to improve the support system for health workers in developing countries. The Global Health Council conference session on “Wealth and health: Leveraging microfinance for better health outcomes,” which was organized by SHOPS (Strengthening Health Outcomes through the Private Sector), made me reflect on how microfinance might be used to support health workers.

The session highlighted different ways of engaging microfinance institutions for addressing community health needs. For instance, in Nigeria, the community health insurance is enrolling increasing number of participants in the benefit scheme. Such interventions have demonstrated improvement in accessibility of health services with affordable premiums. These and other initiatives could play a key role in modifying the purpose of microfinance institutions, which are traditionally designed to provide loan options and support the poor segments of the population to access small businesses and sustain life. Read more »

Discrimination in Law: Putting Female Health Workers at Risk

Max SeunikThe temperature is stifling, red-tinged dust seems to coat every surface, and the whir of many fans fills the air with a rhythmic pulsing. I am seated on a bench in a small community center in Kati, Mali, observing a training meeting for all of the relais (health care volunteers) from the surrounding villages, sponsored by CapacityPlus.

The room is packed with women wearing bright and colourful boubous. Some are cradling babies, others are scribbling down notes—but they are all intensely attentive.

Relais are the backbone of Mali’s health care system. They are most important in remote underserved villages that lack health infrastructure, where they provide advice on prenatal and postnatal care. The training session focused on a picture book developed by the Malian government and a host of NGO partners.

The innovative guide has everything from images of a woman dragging her daughter to be excised under the word “NON” in a bold red to an illustration of a couple and their baby sleeping under a mosquito net. Read more »

Open Access: The Only Viable Option for Change

Rebecca RhodesWhy do we publish health research? If the editors of PLoS Medicine are correct that “medical journals have many roles, but, above all, dissemination of medical information is key,” then journals need to be accessible to the most important data consumers—frontline health workers.

While research for its own sake is necessary to advance scientific understanding, this is not enough. At its core health development research should save the lives of people who—without access to basic health care—die from diseases easily cured or preventable childbirth complications.

Impact
If the individuals who could most contribute to and benefit from information on health in the developing world find the resources cost-prohibitive to access, then how much impact can we really expect from research? Read more »

Retaining Community Health Workers in Ethiopia

Mesrak BelatchewIn a recent New York Times opinion, Tina Rosenberg asked “What makes community health care work?” Her commentary highlights the important elements for sustaining community health work in developing countries—careful financing, using teaching as part of the sustainability structure, supervision and training, working with the government, and scaling up according to the program and country context—and refers to the rich experiences of BRAC in Bangladesh.

Ethiopia’s health extension worker (HEW) initiative, established in 2004, is another example of a successful program in sub-Saharan Africa. Developed and implemented by the Federal Ministry of Health in collaboration with the Ministry of Education, the HEW program has evolved both in scope and scale to accommodate new health initiatives. Read more »

Health Workers for a New Century

Hopital El Hadj Ibrahma Niaso Kaolack“Health is about people—those with needs and those who are entrusted to respond to those needs,” said Dr. Julio Frenk, Harvard School of Public Health dean and cochair of Education of Health Professionals for the 21st century: A Global Independent Commission.

Dr. Frenk presented the Commission’s new report, "Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world," at the World Bank recently, noting that this report represents a change in basic thinking about health education. Read more »

Less Buck for the Bang? The Flattening of Global Health Funding

Shaun NoronhaThe availability of funding for global health may well decide to what extent the health workforce will be able to meet countries' health care needs. With current financial uncertainties, the questions on our minds are: Will a decrease in global aid force cuts in spending for human resources? Is the era of big funding for global health already over?
 
“No,” says Dr. Cristian Baeza, World Bank director for health, nutrition, and population. While this era may not be over yet, in a recent lecture, Dr. Baeza discussed changes that will exert pressure on the availability of global health financing. Read more »

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