Leading the Way Back Home: Nigerian Minister of State for Health, Dr. Muhammad Ali Pate

Dr. Kate TulenkoAll eyes were on newly appointed Minister of State for Health Dr. Muhammad Ali Pate as he presented his vision of health for Nigeria: 1,000,000 lives saved and quality of care measurably improved. He expertly laid out four pillars to achieve this goal: expanding basic services; disease prevention (particularly through scaling-up Hib and pneumococcal vaccination); increasing quality of care via improved clinical governance; and unlocking the health sector’s market potential via increased public and private investment.

One of the special reasons for the excitement in the room at the “Innovative Approaches to Expanding Health Care Services in Nigeria” meeting on September 21 at Africare in Washington, DC, was the fact that many of the attendees, myself included, knew and had worked with Dr. Pate personally.
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International Nurses Day 2011: Increasing Access and Equity

Shaun NoronhaMay 12 is celebrated the world over as International Nurses Day, with this year’s theme calling particular attention to issues of access and equity in health care.

Nurses make up the bulk of the health workforce, especially in sub-Saharan Africa, which has 5.5 nurses and midwives for every physician. While nurses’ contributions to the health system are well-established in the literature, to date, scant attention has been directed toward many of the critical issues nurses face in their careers.

The status of nursing education in developing countries is poorly understood. Read more »

Creative Approaches to the Global Health Workforce Crisis

Maurice I. MiddlebergFive years ago the World Health Organization told us that 57 countries had a critical shortage of health workers—fewer than 2.3 service providers for every thousand people. Today, all 57 countries are still below this threshold. What’s holding us back from faster progress?

First, the good news: many of these countries have national health workforce plans in place. Forty-four of the 57 crisis countries have a plan, according to the Global Health Workforce Alliance’s recent progress report.

Now, the bad news: not all of these countries are implementing their plans. Among the 57 crisis countries, only 24 have evidence-based and costed plans and are in the process of implementing them. Countries may be daunted by perceived barriers to implementation.

That’s why it makes me hopeful to see how many countries are trying creative approaches and moving from planning to action. Read more »

Mind over Matter

Shaun NoronhaCan we condition health workers to believe that they should work in underserved areas? Among the nonmonetary incentives used for retaining workers in rural areas, intrinsic motivation—or inherent willingness—can be a significant influence. The problem with intrinsic motivation is that by definition, it’s intrinsic, and cannot be cultivated or systematically introduced into a cohort of health workers. Or can it?

Cognitive dissonance
A classic study by psychologists Leon Festinger and James Carlsmith (1959) on cognitive dissonance—the phenomenon by which a person states an opinion different from what he or she believes to be true—may hold the answer. Read more »

Retaining Health Workers in Rural Kenya: What We Can Learn from Other Countries

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

Achim ChiajiIn the northern arid lands and other remote parts of Kenya, the Capacity Kenya project has been working with the Ministry of Health to design simple packages to attract health workers and encourage them to stay. Starting with a selected list of diverse pilot sites, the project set out to design intervention packages, implement them, and systematically evaluate their impact on health worker retention over time.

A couple of weeks ago I attended the Second Global Forum on Human Resources for Health in Bangkok, which gave me a unique opportunity to learn about the struggles, successes, and constraints of other countries. As I listened to the experiences of others and what they see as best practices, I kept thinking about what new interventions might work best in the Kenyan context. Read more »

To Bali and Back: Photo Blogging from the AAAH Conference

A few weeks ago, I traveled to Bali for CapacityPlus associate partner Asia-Pacific Action Alliance on Human Resources for Health’s (AAAH) fifth annual conference, “HRH Challenges for Achieving Millennium Development Goals.” Scroll through the photos and check out the descriptions below.

Photo 1
Traditional dancers at the opening ceremony.

Photo 2
The conference kicked off with side meetings on October 3rd—CapacityPlus coorganized both “Taking action on the WHO’s recommendations for rural retention” and “Implementing the HRH Action Framework (HAF) within the Country Coordination and Facilitation (CCF) process.”

Photo 3
In the side session “Taking action on the WHO’s recommendations for rural retention”, CapacityPlus's Wanda Jaskiewicz showcased the project’s cutting-edge work in developing a discrete choice experiment-based toolkit for rapid retention assessments. 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 »

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 »

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.

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 »

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 »

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