Capacity building and health worker training

Central to the issue of human resources is capacity building and health worker training. Factors such as the shortage of health workers and the need to scale up ARV treatment critically impact upon African countries' capacity to produce enough, properly trained health care workers to deliver adequate health services.

A major joint initiative by the WHO (World Health Organization) and the World Bank - Building strategic partnerships in education and health in Africa - brought together African stakeholders in the development and management of human resources for health from a wide range of interested countries. The collaborative approach between health professionals, government and other stakeholders mirrors the successful PAHO (Pan American Health Organization) initiative of human resource observatories in Latin America.

Participants at this consultation identified a lack of information available for health care providers and a lack of reviews of educational institutions and programmes as key issues in the human resource crisis. Agreed priority areas of action included ensuring relevant education and training for health professionals and forging partnerships between health and education sectors.

The report Investing in Tanzanian human resources for health argues that the only effective means of really addressing the HRH challenge in Tanzania is to immediately scale up training capacity. The authors outline how this approach is relatively inexpensive when the long-term benefits are considered.

However, Human resources for obstetric care in northern Tanzania argues that there are adequate numbers of suitably trained health care workers in Tanzania to meet the national standards for health care delivery. But most are concentrated in a few centralised locations and the remainder are inefficiently and inequitably distributed in rural areas. The authors conclude that availability of trained staff does not translate into availability of obstetric care due to these distributional problems, and argue that more attention should be paid to quality of care, rather than just coverage.

What is the access to continued professional education among health workers in Blantyre, Malawi? finds that most health care workers had little access to professional journals and internet facilities and few were satisfied with their own knowledge of health matters. The authors recommend improving access to relevant publications and regulating mandatory continuing professional development credits for re-certification.

A model for analysis, systemic planning and strategic synthesis for health science teaching in the Democratic Republic of the Congo: a vision for action looks at which educational, environmental and organisational factors are needed to improve the skills and ability of trained health workers. The authors argue that a global and integrated approach to training, which addresses the complex determinants of health behaviour, is needed. Moreover, this multi-disciplinary approach needs to be integrated within the existing organisational structure of the Ministry of Health.

The capacity of health workers is not only affected by levels of education and training. Organisational changes such as health sector reform need to address the capacity of staff to implement reforms successfully.

Human resources and the success of health sector reform examines the impact of health sector reform on staff in Zambia. The authors found that there was little strategic planning and capacity to implement new personnel management systems at decentralised levels. Moreover, newly created management systems were inadequately staffed to meet the challenges of the new system and became further distanced from high level decisions.

The authors argue that key diagnostic questions need to be asked to help policy makers and planners identify key issues relating to human resources (HR) when developing and implementing health sector reform.

• Is HR an integral element of the reforms agenda, from pre-planning through to implementation and evaluation?
• Is there sufficient capacity to implement the necessary changes in HR, and to deal with the challenges that will arise?
• Does the health care workforce understand the need for the reforms? To what extent does it support the reform plan?
  

Online training resources:

• Treating HIV & AIDS: a training toolkit This project by aidsmap is intended to support the scaling-up of antiretroviral therapy in resource-limited settings. It was developed with the support of doctors providing training on ARVs in Botswana, Kenya and South Africa.
• Increasing healthcare professionals' knowledge of HIV/AIDS and reproductive health through an email course JHPIEGO offered two e-mail courses under its Training and Reproductive Health Project, Meeting the Family Planning and Reproductive Health Needs of Clients with HIV/AIDS in Low-Resource Settings.