Who are health managers ? Case studies from three African countries

A rapid descriptive assessment was undertaken in three African countries, namely Ethiopia, Ghana, the United Republic of Tanzania (mainland and Zanzibar) to gain an initial understanding of the management workforce for service delivery in these countries and to test selected criteria for assessing managers as part of the health workforce. The study was approached using the WHO framework on leadership and management of health services that identifies four essential conditions for effective management in health systems. The framework proposes that effective management requires an adequate number of managers with appropriate competencies, working with effective support systems in an enabling organizational environment. The study focused on the first two conditions and was intended to help provide better knowledge and data on who the managers of health services are, what their main characteristics are and how they are deployed and utilized to achieve service delivery goals. This initial study focused on persons leading health units such as districts, hospitals, provinces/regions and national directorates. Other managerial staff such as accountants, logisticians and general administrators were not included.

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Handbook on monitoring and evaluation of human resources for health
With special applications for low- and middle-income countries

This Handbook offers health managers, researchers and policy makers a comprehensive and standard reference for monitoring and evaluating human resources for health. It brings together an analytical framework with strategy options for improving the health workforce information and evidence base, as well as country experiences to highlight approaches that have worked.

The present publication is the result of a collaborative effort between the United States Agency   for International Development, the World Bank and the World Health Organization. The volume was written by an international group of authors and edited by Mario R Dal Poz, Neeru Gupta, Estelle Quain and Agnes LB Soucat.  

The Handbook can be downloaded [pdf 3.4 Mb] from htttp://www.who.int/hrh/documents/en/..

The Shortage of Medical Workers in Sub-Saharan Africa and Substitution Policy

 Arnaud Bourgain, Patrice Pieretti and Benteng Zou

abstract:

Substitution policies are strategies sometimes chosen in Sub-Saharan Africa for curtailing the shortage of health professionals especially caused by the outflow of medical personnel. The aim of our contribution is to propose a way to assess the merits and drawbacks of substitution policies by developing a simple growth model of healthcare productivity with medical brain drain. Within this framework, we use a medical care production function of the CES type which aggregates low and high specialized health workers. We then run simulations which compare scenarios with and without substitution strategies by using data from the Ghana’s medical sector. To download the PDF file, please click on this link : http://www.imw.uni-bielefeld.de/research/wp407.php

WHO RURAL HEALTH WORKER RETENTION PROGRAMME

 Download the flyer from : http://www.who.int/entity/hrh/migration/flyer_retention_130pix.jpg

Wrong schools or wrong students? The potential role of medical education in regional imbalances of the health workforce in the United Republic of Tanzania

Beatus K Leon  and Julie Riise Kolstad

Published 26 February 2010 

The lack of a primary interest in medicine among medical school entrants, biases in recruitment, the absence of rural related clinical curricula in medical schools, and a preference for specialisation not available in rural areas are among the main obstacles for building a motivated health workforce which can help correct the inequitable distribution of doctors in the United Republic of Tanzania.

The complete article is available at   http://www.human-resources-health.com/content/8/1/3/abstract

Midwifery tutors' capacity and willingness to teach contraception, post-abortion care, and legal pregnancy termination in Ghana

Voetagbe G, Yellu N, Mills J, Mitchell E, Adu-Amankwah A, Jehu-Appiah K, Nyante F Human Resources for Health 2010, 8:2 (23 February 2010)

Abstract

In total, 74 midwifery tutors were interviewed. Of these, 66 (89.2%) were females. The tutors had mainly been trained as midwives (51.4%) and graduate nurses (33.8%). Respondents were predominantly Christians (97.3%). The study discovered that only 18.9% of the tutors knew all the legal indications under which safe abortion care could be provided. The content of pre-service training of tutors did not include uterine evacuation with manual vacuum aspirator (MVA). The study also highlighted some factors that influence midwifery tutors' willingness to teach comprehensive abortion care. It was also revealed that personal and religious beliefs greatly influence teaching of Comprehensive Abortion Care.

The complete article is available at   http://www.human-resources-health.com/content/8/1/2/abstract. 

Consultation on the concept of Health Mid-Level cadres in the African Region

To bridge the gap created by HRH shortage, many african countries have at various times created cadres of health workers that respond to specific country contexts. This is normally outside the more internationally recognized conventional professional categories such as nurses, doctors and pharmacists. Such cadres include physician assistants, clinical officers, medical assistants, nurse clinicians, health officers and pharmacy technicians, which often mean different things in different countries. The literature also contains reference to substitute cadres, frontline line workers, community health workers, assistants, associates and mid-level health workers which rather imprecisely attempt to group the disparate cadres into one category. For instance, the term “mid-level” is sometimes used to categorize nursing cadres that take on clinician tasks, and yet nursing is an internationally recognized profession.

As a region, WHO-AFRO has not developed a document to guide countries on what terminology to use in categorizing a mix of the health workforce in addition to the conventional professional cadres arising from innovative approaches. This is despite the fact that many countries in the region are increasingly using such cadres. Given the high health worker needs in the region, and the need for efficient utilization of available health workers, the WHO-AFRO needs to build consensus on the mid-level health workers concept and its related aspects. The outcome of this process will provide a basis for guiding countries in their attempt to scale up numbers of health workers to alleviate the shortages.

The WHO-AFRO is planning to organize an expert consultation to be held from 28-30 May 2012 in Addis Ababa, Ethiopia on this topic. The consultation will bring together various multi-stakeholder experts consisting of employers from Ministries of health, regulators who accredit their training and certification to practice, the trainers and other professional bodies.

The overall aim of the expert meeting will be to provide inputs to the  regional document on policy direction on effective use of midlevel cadres within the broader framework of HRH development.

Consultation on Regional staffing norms and standards

There are various methods for estimating the HRH supply and  requirements. One of the methods used quite frequently is the health worker-to-population ratio. For example physicians per 1000 population or health professionals per 1000 population. This ratio can be compared against an identified threshold density that is assumed to correspond with a health system’s ability to deliver essential health services.

However, given its limitations to be applied to all countries, WHO defined in 2006 a global threshold in workforce density (2.3 doctors, nurses and midwives per 1,000 populations) below which high coverage of essential interventions is very unlikely. Based on these estimates, out of 57 countries globally identified with critical shortages, 36 are in African Region. This global threshold do not take account of the wide regional and country variations which can be found within every region and country health systems, such as the different levels and patterns of morbidity, national staffing norms, the access to the health care and the economic and cultural backgrounds.

Based on this situation, attention shifted to address these limitations. WHO developed a workload indicator for staffing needs of individual health facilities (WISN). This can be considered as an important step toward developing national staffing norms and standards.

Some Member States have requested WHO to provide guidance on regional staffing norms and standards that countries should follow or use. In order to do this, WHO AFRO is organizing an expert consultation in Addis Ababa, from 31 May – 2^nd June 2012. The objectives are to review the success and limitations of current methodologies, tools and guides used to develop staffing norms and standards; to share country experiences on staffing norms and standards and to make technical recommendations and next steps for developing regional staffing norms.

OFFICIAL LAUNCH OF THE BURUNDI HEALTH WORKFORCE OBSERVATORY

Bujumbura, 26 January 2012

The official launching ceremonyof of the Burundi Health Workforce Observatory (ONRHS) was held January 26, 2012 in the Conference Room of the National Institute of Public Health (INSP), chaired by the Permanent Secretary of the Ministry of Public Health and the Fight against AIDS, Dr. Norbert BIRINTANYA Representative His Excellency Madam Minister Dr. Sabine Ntakarutimana in presence of the WHO Representative in Burundi, Dr. Joseph W. CABORE, the Lead Partners of the Health Sector in Burundi, Mr Guy BOREUX and the WHO Regional Adviser in Charge of the African Health Workforce Observatory, Dr Ahmat Adam. There was also the presence of Parliamentarians, General Managers, Technical and Financial Partners, Representatives of Health Professional Associations, Trade Union of Health workers and other senior executives from other sectors such as Education, Public Administration and Finance.

Speaking on the occasion, the WHO Representative, Dr. Joseph W. Cabore, stressed the importance of human resources for health that are an essential component of the health system before saying that "The National Observatory of Human Resources for Health can be considered as a mechanism to generate, share and promote the use of relevant information on health workforce in order to support the development and implementation of policies, strategies and plans for human resources for health development in the country. "

He also added that the multi-sectoral dimensions of human resources for health implies a consensus between stakeholders and the Burundi Health Workforce Observatory can be the venue for all stakeholders to exchange and discuss options based on evidence. The WHO Representative concluded his speech by saying: "WHO in close collaboration with other partners will provide the required support to the Burundi Health Workforce Observatory to produce the expected results and that, as part of reforms underway in the health sector.”

In his speech of launching, the representative of Madam Minister of Public Health and the Fight against AIDS, Dr. Norbert BIRINTANYA said the Objectives 4, 5 and 6 of the Millennium Development Goals cannot be achieved without the availability in quantity and quality of skilled and motivated health personnel in right place. He emphasized that Burundi faces a number of recurring challenges and constraints in human resources for health such as the issue of unemployment of a number of trained professionals who are not absorbed by the labor market, the brain drain of the specialists, the issue of retention of health workers in the remote areas, the workload in some health facilities and the imbalance of certain categories of health workers.

Given this situation, the Representative of the Minister highlighted the reforms undertaken since 2011 in the areas of nursing education, decentralization of the human resource management and the improvement of the capacity of the HR Department by strengthening the HR information system and the strategic management of HRH.

Prior to officially launch the activities of the Burundi Health Workforce Observatory, Dr. Norbert BIRINTANYA concluded with a call for partners in these terms: "This day of official launch of the Burundi Health Workforce Observatory is also an opportunity for us to ask all our partners involved in one way or another in the HRH management and human resources development to incorporate in their plans of activities, the firm commitment of invest in human resources for health ". Then he thanked them for their constant support in the country's health development.

 

Participants then followed three presentations respectively on the African Health Workforce Observatory presented by Dr. Adam Ahmat, from WHO Regional Office for Africa in Brazzaville, the Burundi Health Workforce Observatory and the country profile by the HR Director of the Ministry of Public Health and the Fight against AIDS (MSPLS), Mr. Barnabé Mahenehene.

In his presentation, Dr. Adam Ahmat briefly highlighted the situation of human resources for health in Africa, which is characterized by a significant number of countries with deficit in health professionals. However, from 2010 to 2011, some countries including Burundi have made significant efforts in the direction of dealing with this deficit, but progress remains limited in most countries in order to overcome the crisis.

Dr Ahmat Adam added that the Burundi Health Workforce Observatory is part of the Africa Health Workforce Observatory Network. Its main objective is to contribute in the strengthening of the health systems by providing a framework for dialogue and exchange in HRH between Member States and partners by providing evidence and platform to help to find appropriate solutions to address the HRH crisis in Africa.

 

 

 As for the Director of Human Resources, Mr. Barnabé Mahenehene, he made the genesis of the process of setting up the Burundi Health Workforce Observatory (ONRHS) and presented its objectives and functions. The Burundi Health Workforce Observatory aims to produce, share and promote the use of information on the health workers to support the development and the implementation of policies and plans for HRH in Burundi. It is a national network of stakeholders and partners to generate evidence and knowledge necessary for decision making in human resources for health. Also, the ONRHS intend to facilitate the concertation of stakeholders on HRH issues, information sharing and promoting best practices on human resources for health.  

 

The opportunity was also given to participants to react to these presentations with comments, questions and congratulations. It was found that the value of having this observatory as a forum for dialogue and exchanges on HRH is well welcomed by all.

During this ceremony, the first products of the observatory were distributed to participants, namely: the HRH Country Profile document, 2010 edition and a booklet on the Burundi Health Workforce Observatory  including T-shirts and caps bearing the image of the Observatory. Also, a web page was created under the MSPLS website, it can be found at the following link: http://www.yi-ci.com/observatoire.

 

 

 

 

 

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Official launch of the Mauritania Health Workforce Observatory

Nouakchott, 14 December 2010

 

Acting for the Minister of Health who is on mission, the Minister of Water and Sanitation, Mr. Mohamed Ould Lemine Aboye conducted the official launch of the Mauritania Health Workforce Observatory at Atlantic Hotel, Nouakchott, 14 December 2010. The ceremony was attended by other two Ministers : that of Civil Service and that of Employment and Training in presence of the WHO Representative in Mauritania, Dr. Jean Pierre Baptiste.

During this event, which brought together about 80 participants, the Acting Minister of the Ministry of Health also conducted the inauguration of the new website of the Mauritania Health Workforce Observatory. The ceremony ended with the presentation of the HRH country profile followed by a long discussion on major HRH issues that undermine the development of health workforce in the country.

 

 

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Official launch of the process for estblishing Burundi Health Workforce Observatory 

 

The process of establishment of the National Health Workforce Observatory of Burundi has been officially launched the 20 October 2010 by the Minister of Public Health and the Fight against AIDS, Hon. Dr. Sabine Ntakarutimana in the presence of the WHO Representative in Burundi, Dr. Joseph W. CABORE and the UNICEF Representative in Burundi, Mr K. Aboudou Adjibade. Other technical and financial partners, senior officials of ministries of Education and Public Service and Heads of Health Training Institutions including representatives of civil society (unions, professional bodies and professional associations) have attend the meeting.

 

 

Atelier technique sur la planification des ressources humaines pour la santé

17 – 20 Août 2010, Ouagadougou, Burkina Faso

 

Organisé par l'Équipe Inter pays d'Appui de l’OMS Afro en Afrique de l'Ouest avec le soutien financier de la Commission Européenne, l’atelier technique sur la planification des ressources humaines pour la santé s’est tenue du 17 au 20 Août 2010 dans la salle de conférence de l’hôtel Palm Beach de Ouagadougou, Burkina Faso. Cet atelier a regroupé les  points focaux en RHS des Ministère de la Santé et des Bureaux pays de l'OMS avec la participation de l’Organisation Ouest Africaine pour la Santé (OOAS). Quinze (15) pays ont pris part à cet atelier, à savoir: Bénin, Burkina Faso, Cap Vert, Côte D'ivoire, Ghana, Guinée, Guinée Bissau, Liberia, Mali, Mauritanie, Niger, Nigeria, Sénégal, Sierra Léone et Togo

 

La cérémonie d’ouverture a été présidée par Dr Touré Bokar, Coordonnateur de l’équipe inter pays  d’appui de l’Afrique de l’Ouest. Dr Touré Bokar a souligné l’importance des ressources humaines dans le développement des systèmes de santé en général et particulièrement pour les pays de la sous région qui pour la plupart sont en crise. Il a par ailleurs indiqué le caractère multisectoriel des problèmes de ressources humaines avant de réaffirmer la disponibilité de l’OMS à soutenir les pays dans le processus du développement des ressources humaines de santé. Il a appelé les participants à percevoir cet atelier en fonction des possibilités qu'elle offre aux participants et organisateurs de ne pas seulement discuter des questions épineuses relatives à la planification des RHS, mais aussi de partager les meilleures pratiques dans le domaine.

 

Le thème principal du Forum Mondial sur les RHS est - Bilan des progrès accomplis, renouvellement des engagements aux personnels de santé vers l’atteinte des OMD et au-delà.

L’objectif général de l’atelier est de partager les expériences sur la formulation, la mise en œuvre, le suivi et l’évaluation des politiques et plans des ressources humaines pour la santé dans le contexte des politiques et plans stratégiques nationaux de santé (PNS et PSNS).

 

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OFFICIAL LAUNCH OF THE NATIONAL HUMAN RESOURCES FOR HEALTH OBSERVATORY OF CENTRAL AFRICAN REP (ONRHS).

 

 

The conference room of the Hotel JM of Bangui hosted in 16 July, 2010, the official launch ceremony of the National Observatory of Human Resources for Health under the Ministry of Public Health, Population and Fight against AIDS, Mr André NALKE DOROGO attended by representatives of WHO and UNFPA and several partners and managers of different ministries and HRH stakeholders.

 
In his speech, the Minister noted the multisectoral development of human resources for health and the need to establish an Observatory of Human Resources for Health to generate information and knowledge for decision making and to foster a synergy of all stakeholders in order to contribute to the development of human resources for health in the country.

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The speech of the Minister was followed by the presentation of the HRH situation in the country which is marked by shortages in health personnel in quantity and quality and geographic maldistribution. Next was the presentation of the National Observatory and its website.

 

 

 

 

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New Website for the Africa Health Workforce Observatory

 

 April 2010

 

 

The Secretariat of the Africa Health Workforce Observatory (AHWO) is pleased to announce the launch of the new website with new logo. We have not only improved the design, but have added some features and products to the AHWO site. We trust that you will find the improvements beneficial in your efforts to find the information you desire in the language you choose . 

We believe that this new website offers cleaner presentation and easier navigation and therefore represents a significant improvement on the old one. In creating the new website, the objective is to facilitate not only the access depending of the language of the user (English, French and Portuguese) but also useful information likely to be of interest to a large audience.

We stress that the new site is not yet in its final form. It is still under development in its French and Portuguese version and we anticipate that many enhancements will be made to it in the coming months. By making it available now, we are inviting you to contribute to its further development.

We appreciate your feedback on the website contents. If you should have any questions and/or suggestions for us, please click on Contact Us

Thank you in advance for your continued interest in AHWO for working together for health.

 

You can follow AHWO on Twitter at http://twitter.com/ahwobservatory

 

 

Orientation & Capacity Building meeting on use of tools & Guidelines to scale up service delivery, Nairobi, Kenya 20-24th April 2009

 
WHO and Global Health Workforce Alliance (GHWA) were  organised an Orientation & Capacity Building meeting on use of tools & Guidelines to scale up service delivery in the context of PHC renewal in Nairobi, Kenya from 20-24 April 2009. The overall aim of the meeting is to contribute to the capacity building of nurses and midwives as frontline health workers in accelerating action at country level in addressing HRH issues and challenges within existing national health and HRH policies and strategic orientations using the available tools/guidelines. Twenty one countries are expected to attend this meeting.

 

 

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Human Resources for Health Results (HR)2 Africa Health Labor Markets and Pre-service Training Conference Addis Ababa, May 11-14, 2009

 
The World Bank Africa Health Workforce Program in collaboration with the World Health Organization and the Global Health Workforce Alliance were hosted a “Human Resources for Health Results (HR2) Research Symposium” 11-14 May 2009 in Addis Ababa, Ethiopia. The HR2 Research Symposium  presented the latest findings from the World Bank and other development partners in the fields of health labor markets and scaling up health worker education.

 

 

 

 

57th Session of the International Statistical Institute (ISI) : our past, present and future” with special topic meeting on Measuring health workforce inequalities: methods and applications 16-22 August 2009 Durban, South Africa

 
On 16-22 August 2009, Durban played host to the 57th Session of the International Statistical Institute, the first in Sub-Saharan Africa. An ISI Session, held biennially, provides a platform for the gathering of over 5000 of the world’s statisticians from public, private, research and educational institutions to share experience in a diverse range of statistical issues. The theme of this Session is aptly titled “Statistics: our past, present and future”, with Special Topic Meeting on measuring health workforce inequalities and the implications for policy and planning.

 

 

         

Launch of WHO programme on Increasing access to health workers in remote
and rural areas through improved retention

2 February 2009, World Health Organization, Geneva

 

                    On February, WHO launched a new programme to increase access to health workers in remote and rural areas through improved retention. The programme is an integral part of the organisation's renewed efforts to strengthen health systems through a primary healthcare approach. More than 30 international experts on health workforce rural retention met in Geneva to map out a plan of action to develop evidence-based recommendations, for publication in Spring 2010. Read more go to http://www.who.int/hrh/migration/expert_meeting/en/indexT-shirts and caps bearing the image of the Observatory. Also, a web page was created under the MSPLS website, it can be found at the following link: http://www.yi-ci.com/observatoire.