Health Workers

What’s Really Holding Us Back? Resolving the Health Workforce Crisis

Maurice MiddlebergLately I’ve been thinking about the big picture in the global health workforce crisis. What’s keeping us from getting where we need to be?

On the one hand, we’ve come a long way in just a few years. Since the release of the 2006 World Health Report and the First Global Forum on Human Resources for Health in 2008, we’ve made notable progress:

  • Awareness of the health workforce crisis is now pervasive; this is reflected in high-level declarations of both developing and developed nations.
  • We’ve amassed a large body of knowledge and practical experience.
  • There is emerging consensus on the actions needed on a range of issues, from retention to community health workers to task-shifting.
  • Many countries have developed health workforce strategies.
  • A few countries (Ethiopia’s a great example) have made remarkable progress in expanding access to qualified health workers.

On the other hand, let’s face it: progress has been slow.

Access to health workers with the right skills is still denied to millions of people. We’re not yet where we need to be. What are the root causes of this unsatisfactory progress?

At the core is a failure of implementation. Read more »

mHealth Africa Summit—the Personal Emerging

This post is excerpted from an original post on the IntraHealth International blog.

Dykki SettleLike the mHealth Summit in Washington, DC in November, the mHealth Africa Summit in Accra, Ghana was well-organized and filled with energy. It was also much smaller. This meant that the conversations were intimate and impassioned, and as expected, much more personal.

As my colleague Piers Bocock at Management Sciences for Health pointed out in his blog, this conference offered great examples of country ownership. Like Piers, I, too, learned far more at this inaugural and important conference than I felt able to teach. It also offered me a great opportunity to hear more about the ways mobile phones were already being used by health workers, which I think is key to mHealth’s success, traction, and scalability. Read more »

Crowdsourcing: The New Buzz in Productivity and Quality

Laura WurtsCapacityPlus is developing a crowdsourcing application and exploring pilot sites in several countries. This initiative will allow the general public with any mobile telephone—with simple SMS texting capability—to report on the presence or absence of health workers, patient waiting times, or other selected quality or productivity indicators at any given clinic at any point in time.

Unless health workers report to their assigned facilities at the agreed upon hours and efficiently manage their time, increasing the production of qualified health workers is meaningless.

However, a relatively easy method for improving health worker productivity is through crowdsourcing. Read more »

Global Health Workforce: A Household Name

Adam BuzzaccoIt’s impossible to forget a woman caring for five kids, in a cockroach-infested plywood house, in 90-degree weather. She has no access to clean water or adequate health care.

I was fortunate as a teenager to have experienced the health and quality of life conditions in the developing world firsthand. On a 10-day school trip to Matamoros, Mexico, this image was ingrained in my mind and in the minds of 12 other high school students. (In case you’re unaware of Matamoros’s location, it’s barely five miles from the US border.)

Public opinions
Diseases and issues such as HIV and AIDS, malaria, malnutrition, and access to clean water are often cited as the biggest public health concerns for developing nations. While these issues are rightfully at the center of the public and government discourse, I wanted to see how the global health workforce stacked up against these other widely recognized problems. Read more »

Not Training: Educating Health Workers in the 21st Century

Shaun Noronha“We don’t train health workers. We train dogs. We educate health workers,” said David Gordon, visiting professor at the World Federation for Medical Education, to participants at the World Health Organization (WHO)/ PEPFAR consultation meeting on the transformative scale-up of medical, nursing, and midwifery education.

Held in Geneva in December, this high-level consultation brought together global, country, and institutional leaders from both the health worker education and health sectors in order to develop an opinion base and engage stakeholders for cooperative success.

Transformative scale-up
While the guidelines on transformative scale-up are still being written, this new concept recognizes two paradigms. Read more »

Tracking and Counting 140,000 New Health Workers

Dana SingletonThe PEPFAR Monitoring and Evaluation and Human Resources for Health Technical Working Groups asked CapacityPlus to develop tools and guidance to support country team efforts in tracking and counting the new health workers being trained with PEPFAR support.

As part of its reauthorization, PEPFAR now includes an indicator that mandates its contribution to addressing the health workforce crisis. The legislation states that PEPFAR will “…help partner countries to train and support retention of health care professionals and paraprofessionals, with the target of training and retaining at least 140,000 new health [workers].”

Conducting interviews
Dykki Settle and I began this work by conducting telephone interviews with 13 PEPFAR country teams to determine what activities were underway to increase health worker production, and what activities were being counted toward the 140,000. We then visited Tanzania to further explore these trends. After analyzing all of these data, one main ground truth emerged—it takes a systems approach to produce health workers. Read more »

mHealth: The Possibilities of the Personal

This post was originally published on the IntraHealth International blog.

Dykki SettleThere are more than 5 billion cell phones in use worldwide, which means globally nearly 70% of people—including children—would own a cell phone if everyone had just one cell. Yet in places like Germany, where the cell phone market penetration has reached more than 130%, many people own more than one mobile.

Mobile phones are so popular in part because they are uniquely personal communication tools. Their portability makes it possible to talk to colleagues, friends, and family from nearly anywhere and anytime.

With mobile phones, we’ve managed to extend our social circles from the immediate to the global. Read more »

Social Justice and the Global Health Workforce

Amanda PuckettThis year's American Public Health Association (APHA) annual meeting, themed around social justice, represented a strong commitment to addressing domestic and global health challenges, milestones, and successes. As Dr. Howard Koh, the United States assistant secretary for health, said, “If you don’t stand for something, you’ll fall for anything.”

Energized participants and presenters expressed the importance of social justice, human rights, and the intersections in public health. It has been over 100 years since the APHA annual meeting was last held in Denver, and the Mile High City did not disappoint as this year’s host. Read more »

Faith-Based Organizations: Serving and Uniting the Health Sector

Friends Kaimosi HospitalRecently on the HIFA2015 listserv there has been discussion on the role of mission and faith-based health care facilities in the developing world. Statistics vary from country to country, and even region to region within a country, but the most common statistic for countries in sub-Saharan Africa is that mission and faith-based health facilities provide approximately 40-70% of health care.

Rural and isolated areas

As has been noted, these mission and faith-based health facilities have a long history of providing services in the most rural and isolated parts of the countries—places where government health care personnel often aren’t. Read more »

Money Matters! A New Costing Tool for Health Worker Retention

Subrata RouthI work on health systems strengthening, mostly for low-income countries. One major challenge is attracting and retaining health workers in rural and remote areas where health services are mostly scanty. Let me quote the recent WHO global policy recommendations for retention:

Approximately one half of the global population lives in rural areas, but these areas are served by only 38% of the total nursing workforce and by less than a quarter of the total physician workforce.

Which retention strategies should be pursued, and how much will they cost? Faced with multiple priorities and limited means, policy-makers want to know up-front what a recommendation will cost, to gauge the affordability of its implementation. Uganda, for instance, developed its Motivation and Retention Strategy back in 2008, but could not implement it because it didn’t know what the incremental costs would be.

In collaboration with WHO, CapacityPlus is designing a simple and user-friendly costing tool. Instead of depending on external technical assistance, HR managers or other health officials will be able to cost a retention strategy at the district, regional, or national level.

Historically, this kind of costing has been undertaken by health economists, which can be expensive. In contrast, our new tool is designed with the layperson in mind. You don’t need to be an economist to use it and understand the results. Read more »

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