Health Workers

Three Myths about Health Worker Retention

Maurice MiddlebergHow can we encourage health workers to take up and remain in rural postings? This is a key challenge for increasing access to health care. But as we address health worker retention in hard-to-reach areas, there are numerous myths afloat. Here are just a few.

Myth 1. Health workers leave rural posts because they want more money
To be sure, salaries are important. But it’s more complicated than that.

As my colleague Kate Tulenko has pointed out, health workers are consistently among the top wage earners in developing countries. And in terms of international migration, an OECD policy brief notes that while “wage differentials across countries play an important role,” that’s not the only reason health workers leave. Other factors are also at play.

In a South African study cited in Fatu Yumkella’s brief on retention, for example, doctors noted that improving their salary was one of the most important factors for rural retention—yet they also stated that salary alone would not retain them. Money is only one part of the picture.

Myth 2. International migration is the greatest threat
We often think that developing-country health workers’ migration to the US, UK, and elsewhere is the most pressing challenge we face in addressing the workforce shortage. But it’s less of a concern for rural health care than we might expect. Read more »

Addressing Human Resources Constraints in Public Health Supply Chains

Amanda PuckettAt the recent Critical Issues Series: Strengthening Human Resources for Supply Chain Management of Health Commodities event, IntraHealth International staff Uche Ekenna presented CapacityPlus’s new Life Cycle Approach to professionalizing under-recognized cadres.

Ekenna delivered key messages on workforce development, workforce effectiveness, and policy and planning to specific supply chain functions. His panel focused on the professionalization of under-recognized cadres—i.e., supply chain management professionals—and how the Life Cycle Approach can systematically address all crucial steps in the cadre professionalization process.

Hosted by the USAID DELIVER Project, this event featured presentations by human resources for health (HRH) and health commodities panelists, and offered experts a forum to discuss and identify future areas for building strong collaborations, sharing lessons learned, and identifying strategies to address human resources constraints affecting the distribution of health commodities to clients. Read more »

Innovation and Exchange at the Global Health Mini-University

Jennifer SolomonLast week, public health professionals, students, and government workers from across the country and abroad filled the George Washington University’s Marvin Center’s third floor to attend USAID’s 10th Annual Global Health Mini-University. The day-long program offered over 80 sessions and poster presentations on topics spanning technology, workforce issues, funding, and diseases.

Innovation
In an afternoon session, Maurice Middleberg proposed a strategy for the Obama Administration’s Global Health Initiative (GHI) to consider for addressing the current worldwide health worker shortage. “The US should create HRH [human resources for health] strategies that are responsive to national HRH strategies, with country ownership,” said Middleberg. Furthermore, the strategy must also address health workers’ needs. In addition to training and deploying new health workers, the GHI strategy must include retention. “Nobody stops to ask the health worker why she or he is leaving. It turns out that health workers are real human beings with complex needs,” he said. Read more »

Deploying an Integrated Human Resources for Health Approach to Achieving the Millennium Development Goals

Sara Pacque-MargolisThe global health workforce crisis demands a strategic investment in a long-term solution. Given the limited human resources for health (HRH) available in many countries, an integrated, systems-based approach is necessary if countries are to achieve all the health-related Millennium Development Goals.

The Center for Global Development’s (CGD’s) recent report argues that donors must evolve from the emergency approach required to scale up vertical HIV/AIDS programs to a more sustainable approach that plans for, develops, deploys, and retains a health workforce responsive to the population as a whole.

A call to donors
Based on research conducted in Mozambique, Uganda, and Zambia, the CGD report examined how AIDS programs leveraged health workers, their financial and programmatic inputs into health worker training and deployment, and the effects of these actions on health services. Read more »

Saving Mothers’ Lives

Amanda PuckettMuch literature has celebrated the recent World Health Organization report that maternal mortality declined by a third in the past decade. Though this downward trend is remarkable, the global public health community is concerned that the declaration will shift attention away from sustaining and increasing efforts to address maternal deaths throughout the world. Also important is decreasing maternal morbidity, which creates huge costs in terms of human suffering, health care expenditures, and lost productivity.

Health systems strengthening reduces maternal mortality
The headline The Top Three Things We’re Not Doing to Save Mother’s Lives recently caught our attention. CapacityPlus’s result areas—global leadership, policy and planning, education and training, workforce effectiveness, and evaluation and knowledge-sharing—are key pieces of the health systems strengthening puzzle needed to improve health outcomes for men, women, and children. Addressing the global health worker shortage, which is most critical in countries with higher maternal mortality rates, will strengthen health systems and improve more than just maternal outcomes. Read more »

Linking the Millennium Development Goals with Human Resources for Health

Wilma GormleyAfter being escorted past more security guards than I’ve encountered in my entire life, I arrived in a conference room in the United Nations building overlooking the East River in New York City eager to hear luminaries discuss the critical link between human resources for health (HRH) and the attainment of the Millennium Development Goals (MDGs).

I took the train from Washington, DC to NYC early this morning and watched the birth of a sunny, early fall day. I “immigrated” to NYC from Kansas after graduate school, and I still love its positive energy.

Progress in human resources for health
No Health Workforce. No Health MDGs. Is that acceptable? was a side event held at the MDG Summit this week, sponsored by the Global Health Workforce Alliance (GHWA) along with the governments of Norway, Brazil, and Cameroon, and the Health Workforce Advocacy Initiative. President of Malawi Dr. Bingu wa Mutharika delivered the keynote address, and Dr. Mubashar Sheikh from GHWA delivered the opening and closing remarks. The panelists included ministers of health from Cameroon, Malawi, Norway, and Brazil; a DFID representative; and a Japan International Cooperation Agency (JICA) vice president. Read more »

Global Leaders Speak Out for Health Workforce Partnerships

Uganda health studentsHealth education in the global context
At the Accordia Foundation’s Health Workforce Partnership Symposium, held September 14 in Washington, DC, US Ambassador Dr. Eric Goosby noted three key points about health education.

1) The US Government (PEPFAR) is committed to building health capacity in developing countries; 2) Over the long term, country ownership and sustainable national capacity is critical to this effort; and 3) PEPFAR will be working with the Global Fund to merge planning processes, initially in 10 countries, and by implication this includes health workforce education. Read more »

From Rural Virginia to Remote Areas of Laos: Keeping Health Workers in the Communities That Need Them

Maurice MiddlebergOn a recent Monday I spotted an article in the Washington Post about a young doctor who accepted a position in rural Virginia. She and many other health workers are struggling to balance their professional commitment—“I really wanted to help people who wouldn’t otherwise get help,” Dr. Sarah Carricaburu told the reporter—with the drawbacks of living far from an urban center. She’s not sure if she’ll stay.

I was struck by the similar context of this article and the stories I hear every week from developing countries around the world. The factors driving doctors and nurses away from rural posts in the US are largely the same as those in developing countries—social and professional isolation, access to the Internet, housing, cultural options, schooling for children, lack of opportunity for continuing education.

We often assume the problem is one of salary. But it’s more complicated than that. Read more »

No More Business as Usual: Strengthening Health Sector Human Resources Management

Paul MarsdenOn August 18, I saw these words in front of me:

“The ‘competency of HR workers’ is one of seven ‘major obstacles to building a first-class federal workforce’. […] It's not that the human relations professionals are incompetent. They don't have the training or the technology needed to keep up with a quickly changing workplace.”

I didn’t write these, but I could have. In the recent Washington Post article “Key personnel officials identify obstacles to federal hiring reforms”, I was struck by the similarities between the human resources (HR) situation described and the situation I often find in the health sector in many developing countries, including those where CapacityPlus is active.

Obstacles in the US and globally
The article, describing recent reforms in federal government hiring, highlights the challenges to realizing these—such as limitations in the competencies, skills level, and technology limitations of existing HR officials. Additionally, it flags the need to overhaul various human resources management (HRM) functions and competencies. Read more »

Live from Uganda: Field Testing a Rapid Assessment Tool to Improve Health Worker Retention

CapacityPlus Program Officer Laura Wurts is traveling in Uganda for three weeks and shared some of her experiences in the field thus far.

Mbarara UniversityPlease tell us about the purpose of this trip to Uganda, and where will you be working.
CapacityPlus is field testing a rapid assessment tool for determining priority retention interventions for costing to inform Ministry of Health policy-making to improve attraction and retention of health workers in rural and remote areas. While in Uganda, we expect to survey 500-600 people. The sample will include both final-year students and practicing health workers in four cadres: medical officers, nursing officers, pharmacists, and lab techs.

We will collect data in Kampala, Jinja, 10 districts around Mbarara town, and 10 districts around Gulu town. Specific universities include Makere University, Mbarara University for Science and Technology, Gulu University, and Jinja School of Nursing and Midwifery. Read more »

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