http://www.human-resources-health.com The latest research articles published by Human Resources for Health 2010-03-18T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ Background: Management training is fundamental to developing human resources for health. Particularly as Liberia revives its health delivery system, facility and county health team managers are central to progress. Nevertheless, such management skills are rarely prioritized in health training, and sustained capacity building in this area is limited. We describe a health management delivery program in which north and south institutions collaborated to integrate classroom and field-based training in health management and to transfer the capacity for sustaining management development in Liberia. Methods: We developed and implemented a 6-month training program in health management skills (i.e. strategic problem solving, financial management, human resource management and leadership) delivered by Yale University and Mother Patern College from Liberia, and with support from the Clinton HIV/AIDS Initiative. Over three 6-month cycles, we transferred the course from being primarily taught by the north institution to being primarily provided by the south institution. We conducted a self-administered survey of all participants completing the course to measure changes in self-rated management skills, the degree to which the course was helpful and met its stated objectives, and faculty members' responsiveness to participant needs as the transfer process occurred. Results: Respondents (n= 93, response rate 95.9%) reported substantial improvement in self-reported management skills and rated the helpfulness of the course, and the degree to which the course met its objectives, highly. Levels of improvement and course ratings were similar over the three cohorts as the course was transferred to the south institution. We suggest a framework of five elements for implementing successful management training programs that can be transferred and sustained in resource-limited settings, including: 1) use a short-course format focusing on four key skill areas with practical tools; 2) include didactic training, on-site projects, and on-site mentoring; 3) collaborate with an in-country academic institution, willing and able to scale-up and maintain the training; 4) provide training for the in-country academic faculty; and 5) secure Ministry-level support to ensure participation. Conclusion: Our findings demonstrate key elements for scaling up and replicating educational initiatives that address management skills essential for long-term health systems strengthening in resource-poor settings. http://www.human-resources-health.com/content/8/1/5 Laura Rowe Sister Barbara Brillant Emily Cleveland Bernice Dahn Shoba Ramanadhan Mae Podesta Elizabeth Bradley Human Resources for Health 2010, 8:5 2010-03-18T00:00:00Z doi:10.1186/1478-4491-8-5 Human Resources for Health 1478-4491 8 5 2010-03-18T00:00:00Z PDF Background: Public health, as a field of knowledge, depends on its professionals. Their education and training, therefore, is considered to be an important factor for the quality of health services. In Brazil, the Course of Specialization in Public Health of the National School of Public Health is one of the oldest in the country. The course has existed for over 80 years, during which it has had an eventful history, with modifications in its organization, interruptions in its delivery, threats to its survival and changes in the institutions hosting it, reflecting the wider transformation in Brazilian society and public life over that period. Methods: In this article we analyse this course via its history, disciplines, organization and characteristics of the student body, Results: Insights were gained into the advancement of public health in Brazil and the progress of education for professionals in this field was highlighted. The course has formed nearly 2000 specialists in public health. Conclusions: An analysis of the course's history provides valuable lessons for other schools of public health trying to train professionals in developing countries. Monireh Obbadi Human Resources for Health 2010, 8:4 2010-03-05T00:00:00Z ${item.identifier} Human Resources for Health 1478-4491 8 4 2010-03-05T00:00:00Z PDF Background: The United Republic of Tanzania, like many other countries in sub-Saharan Africa, faces a human resources crisis in its health sector, with a small and inequitably distributed health workforce. Rural areas and other poor regions are characterised by a high burden of disease compared to other regions of the country. At the same time, these areas are poorly supplied with human resources compared to urban areas, a reflection of the situation in the whole of Sub-Saharan Africa, where 1.3% of the world's health workforce shoulders 25% of the world's burden of disease. Medical schools select candidates for training and form these candidates' professional morale. It is therefore likely that medical schools can play an important role in the problem of geographical imbalance of doctors in the United Republic of Tanzania. Methods: This paper reviews available research evidence that links medical students' characteristics with human resource imbalances and the contribution of medical schools in perpetuating an inequitable distribution of the health workforce.Existing literature on the determinants of the geographical imbalance of clinicians, with a special focus on the role of medical schools, is reviewed. In addition, structured questionnaires collecting data on demographics, rural experience, working preferences and motivational aspects were administered to 130 fifth-year medical students at the medical faculties of MUCHS (University of Dar es Salaam), HKMU (Dar es Salaam) and KCMC (Tumaini University, Moshi campus) in the United Republic of Tanzania. The 130 students represented 95.6% of the Tanzanian finalists in 2005. Finally, we apply probit regressions in STATA to analyse the cross-sectional data coming from the aforementioned survey. Results: 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. Conclusion: This study suggests that there is a need to re-examine medical school admission policies and practices. http://www.human-resources-health.com/content/8/1/3 Beatus Leon Julie Riise Kolstad Human Resources for Health 2010, 8:3 2010-02-26T00:00:00Z doi:10.1186/1478-4491-8-3 Human Resources for Health 1478-4491 8 3 2010-02-26T00:00:00Z XML Background: Ghana has a high maternal mortality rate of 540 per 100 000. Although abortion complications usually are treatable, the risks of morbidity and death increase when treatment is delayed. Delay in care may occur when women have difficulty accessing treatment because health care providers are not trained, equipped, or willing to treat the complications of abortion. Gaps in the midwifery tutors' knowledge on comprehensive abortion care (CAC) have resulted in most midwives in Ghana not knowing the legal indications under which safe abortion care can be provided, and lacking the skills and competencies for CAC services. The aim of this study is to assess the capacity and willingness of midwifery tutors to teach contraception, post abortion care and legal termination in Ghana. Methods: This study focused on all 14 midwifery schools in the country. A total of 74 midwifery tutors were interviewed for this study. Structured self-administered questionnaires were used for data collection. The data were entered and checked for consistencies using Epiinfo 6.04 and analyzed using Stata 8. Descriptive analysis was used and frequencies reported with percentages. Results: 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. Conclusion: The findings of this survey suggest that the majority of tutors did not know the abortion law in Ghana as well as the Ghana Health Service Reproductive Health Standards and Protocol. Thus, there is a need to enhance their capacities to teach the present pre-service students the necessary skills to offer CAC after school and to understand related issues such as related legal matters. http://www.human-resources-health.com/content/8/1/2 Gertrude Voetagbe Nathaniel Yellu Joseph Mills Ellen Mitchell Amanda Adu-Amankwah Koma Jehu-Appiah Felix Nyante Human Resources for Health 2010, 8:2 2010-02-23T00:00:00Z doi:10.1186/1478-4491-8-2 Human Resources for Health 1478-4491 8 2 2010-02-23T00:00:00Z XML IntroductionIn 2002, the Egypt Ministry of Health and Population faced the challenge of improving access to and quality of services in rural Upper Egypt in the face of low morale among health workers and managers.From 1992 to 2000, the Ministry, with donor support, had succeeded in reducing the nationwide maternal mortality rate by 52%. Nevertheless, a gap remained between urban and rural areas.Case descriptionIn 2002, the Ministry, with funding from the United States Agency for International Development and assistance from Management Sciences for Health, introduced a Leadership Development Programme (LDP) in Aswan Governorate. The programme aimed to improve health services in three districts by increasing managers' ability to create high performing teams and lead them to achieve results.The programme introduced leadership and management practices and a methodology for identifying and addressing service delivery challenges. Ten teams of health workers participated.Discussion and evaluationIn 2003, after participation in the LDP, the districts of Aswan, Daraw and Kom Ombo increased the number of new family planning visits by 36%, 68% and 20%, respectively. The number of prenatal and postpartum visits also rose.After the United States funding ended, local doctors and nurses scaled up the programme to 184 health care facilities (training more than 1000 health workers). From 2005 to 2007, the Leadership Development Programme participants in Aswan Governorate focused on reducing the maternal mortality rate as their annual goal. They reduced it from 85.0 per 100,000 live births to 35.5 per 100,000. The reduction in maternal mortality rate was much greater than in similar governorates in Egypt. Managers and teams across Aswan demonstrated their ability to scale up effective public health interventions though their increased commitment and ownership of service challenges. Conclusions: When teams learn and apply empowering leadership and management practices, they can transform the way they work together and develop their own solutions to complex public health challenges. Committed health teams can use local resources to scale up effective public health interventions. http://www.human-resources-health.com/content/8/1/1 Morsi Mansour Joan Mansour Abdo El Swesy Human Resources for Health 2010, 8:1 2010-01-19T00:00:00Z doi:10.1186/1478-4491-8-1 Human Resources for Health 1478-4491 8 1 2010-01-19T00:00:00Z XML Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions. http://www.human-resources-health.com/content/7/1/87 Carl-Ardy Dubois Debbie Singh Human Resources for Health 2009, 7:87 2009-12-19T00:00:00Z doi:10.1186/1478-4491-7-87 Human Resources for Health 1478-4491 7 87 2009-12-19T00:00:00Z XML Background: The physician assistant (PA) profession is a nationally recognized medical profession in the United States of America (USA). However, relatively little is known regarding national trends of the PA workforce. Methods: We examined the 1980-2007 USA Census data to determine the demographic distribution of the PA workforce and PA-to-population relationships. Maps were developed to provide graphical display of the data. All analyses were adjusted for the complex census design and analytical weights provided by the Census Bureau. Results: In 1980 there were about 29 120 PAs, 64% of which were males. By contrast, in 2007 there were approximately 97 721 PAs with more than 66% of females. In 1980, Nevada had the highest estimated rate of 40 PAs per 100 000 persons, and North Dakota had the lowest rate (three). The corresponding rates in 2007 were about 85 in New Hampshire and ten in Mississippi. The levels of PA education have increased from less than 21% of PAs with four or more years of college in 1980, to more than 65% in 2007. While less than 17% of PAs were of minority groups in 1980, this figure rose to 23% in 2007. Although nearly 70% of PAs were younger than 35 years old in 1980, this percentage fell to 38% in 2007. Conclusion: The trends of sustained increase and geographic variation in the PA workforce were identified. Educational level, percentage of minority, and age of the PA workforce have increased over time. Major causes of the changes in the PA workforce include educational factors and federal legislation or state regulation. http://www.human-resources-health.com/content/7/1/86 Xiaoxing He Ellen Cyran Mark Salling Human Resources for Health 2009, 7:86 2009-11-26T00:00:00Z doi:10.1186/1478-4491-7-86 Human Resources for Health 1478-4491 7 86 2009-11-26T00:00:00Z XML Background: In 2000, an external review mission of the National Tuberculosis Control Programme of Indonesia identified suboptimal results of TB control activities. This led to a prioritization on human resource capacity building representing a major shift in the approach following the recommendations of the external review team.Case descriptionThe National Tuberculosis Control Programme (NTP) used a systematic process to develop and implement two strategic action plans focussing on competence development based on specific job descriptions. The approach was a change from only focussing on training, to a broader, long term approach to human resource development for comprehensive TB control.A structured plan for capacity building, including standardized competency based training modules and curricula, was developed in the first phase. This was supported by an organisational system comprised of a training focal point, master trainers, and regional training centres in which nationwide training of supervisors was implemented. Training was expanded to the health service delivery level in the second phase, as well as broadened in the scope of activities beyond training to also include other aspects of human resource development.Discussion and evaluationThe result was improved technical and managerial capacity of health workers for TB control at all levels. The impact on case detection and treatment outcome was spectacular, with major improvements in quality of all aspects of service delivery. Conclusion: The strategic decision by the NTP in 2000 to put the highest priority on capacity building has resulted in impressive progress towards TB control targets, a progress that despite many challenges has been sustained. http://www.human-resources-health.com/content/7/1/85 Carmelia Basri Karin Bergstrom Wanda Walton Jan Voskens Asik Surya Firdosi Metha Human Resources for Health 2009, 7:85 2009-11-16T00:00:00Z doi:10.1186/1478-4491-7-85 Human Resources for Health 1478-4491 7 85 2009-11-16T00:00:00Z XML Background: Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. Methods: A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. Results: A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. Conclusion: To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations. The upcoming accreditation survey of Lebanese hospitals (2010-2011) presents an opportunity to strengthen HR management and enhance competencies of existing HR managers. Recognizing HR challenges and the importance of effective HR strategies should become a priority to policy makers and top managers alike. Study findings may extend to other countries in the Eastern Mediterranean region. http://www.human-resources-health.com/content/7/1/84 Fadi El-Jardali Victoria Tchaghchagian Diana Jamal Human Resources for Health 2009, 7:84 2009-11-12T00:00:00Z doi:10.1186/1478-4491-7-84 Human Resources for Health 1478-4491 7 84 2009-11-12T00:00:00Z XML This commentary paper highlights changing patterns of outward migration of Zambian nurses. The aim is to discuss these pattern changes in the light of policy developments in Zambia and in receiving countries.Prior to 2000, South Africa was the most important destination for Zambian registered nurses. In 2000, new destination countries, such as the United Kingdom, became available, resulting in a substantial increase in migration from Zambia. This is attributable to the policy of active recruitment by the United Kingdom's National Health Service and Zambia's policy of offering Voluntary Separation Packages: early retirement lump-sum payments promoted by the government, which nurses used towards migration costs.The dramatic decline in migration to the United Kingdom since 2004 is likely to be due to increased difficulties in obtaining United Kingdom registration and work permits. Despite smaller numbers, enrolled nurses are also leaving Zambia for other destination countries, a significant new development.This paper stresses the need for nurse managers and policy-makers to pay more attention to these wider nurse migration trends in Zambia, and argues that the focus of any migration strategy should be on how to retain a motivated workforce through improving working conditions and policy initiatives to encourage nurses to stay within the public sector. http://www.human-resources-health.com/content/7/1/83 Naomi Hamada Jill Maben Barbara McPake Kara Hanson Human Resources for Health 2009, 7:83 2009-11-11T00:00:00Z doi:10.1186/1478-4491-7-83 Human Resources for Health 1478-4491 7 83 2009-11-11T00:00:00Z XML