Intersectionality of gender in recruitment and retention of the health workforce in Africa: a rapid review

Background: Despite the importance of gender and intersectionality in policy-making for human resources for health, these issues have not been given adequate consideration in health workforce recruitment and retention in Africa. Aims: The objective of this review was to show how gender intersects with other sociocultural determinants of health to create different experiences of marginalization and/or privilege in the recruitment and retention of human resources for health in Africa. Methods: This was rapid review of studies that investigated the intersectionality of gender in relation to recruitment and retention of health workers in Africa. A PubMed search was undertaken in April 2020 to identify eligible studies. Search terms used included: gender, employment, health workers, health workforce, recruitment and retention. Criteria for inclusion of studies were: primary research; related to the role of gender and intersectionality in recruitment and retention of the health workforce; conducted in Africa; quantitative or qualitative study design; and published in English. Results: Of 193 publications found, nine fulfilled the study inclusion criteria and were selected. Feminization of the nursing and midwifery profession results in difficulties in recruiting and deploying female health workers. Male domination of management positions was reported. Gender power relationship in the recruitment and retention of the health workforce is shaped by marriage and cultural norms. Occupational segregation, sexual harassment and discrimination against female health workers were reported. Conclusion: This review highlights the importance of considering gender analysis in the development of policies and programmes for human resources for health in Africa.

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Intersectionality of gender in recruitment and retention of the health workforce in Africa: a rapid review

Eastern Mediterranean Health Journal ◽

10.26719/2021.27.7.698 ◽

2021 ◽

Vol 27 (07) ◽

pp. 698-706

Author(s):

Chigozie Uneke ◽

Bilikis Uneke

Keyword(s):

Human Resources ◽

Health Workforce ◽

Health Workers ◽

Human Resources For Health ◽

Rapid Review ◽

Cultural Norms ◽

Power Relationship ◽

Recruitment And Retention ◽

Management Positions ◽

Pubmed Search

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Community health workers at the dawn of a new era: 2. Planning, coordination, and partnerships

Health Research Policy and Systems ◽

10.1186/s12961-021-00753-7 ◽

2021 ◽

Vol 19 (S3) ◽

Cited By ~ 6

Author(s):

Muhammad Mahmood Afzal ◽

George W. Pariyo ◽

Zohra S. Lassi ◽

Henry B. Perry

Keyword(s):

Global Health ◽

Human Resources ◽

Community Health ◽

Community Health Workers ◽

Health Systems ◽

Health Workforce ◽

Health Workers ◽

Human Resources For Health ◽

Critical Role ◽

New Era

Abstract Background Community health workers (CHWs) play a critical role in grassroots healthcare and are essential for achieving the health-related Sustainable Development Goals. While there is a critical shortage of essential health workers in low- and middle-income countries, WHO and international partners have reached a consensus on the need to expand and strengthen CHW programmes as a key element in achieving Universal Health Coverage (UHC). The COVID-19 pandemic has further revealed that emerging health challenges require quick local responses such as those utilizing CHWs. This is the second paper of our 11-paper supplement, “Community health workers at the dawn of a new era”. Our objective here is to highlight questions, challenges, and strategies for stakeholders to consider while planning the introduction, expansion, or strengthening of a large-scale CHW programme and the complex array of coordination and partnerships that need to be considered. Methods The authors draw on the outcomes of discussions during key consultations with various government leaders and experts from across policy, implementation, research, and development organizations in which the authors have engaged in the past decade. These include global consultations on CHWs and global forums on human resources for health (HRH) conferences between 2010 and 2014 (Montreux, Bangkok, Recife, Washington DC). They also build on the authors’ direct involvement with the Global Health Workforce Alliance. Results Weak health systems, poor planning, lack of coordination, and failed partnerships have produced lacklustre CHW programmes in countries. This paper highlights the three issues that are generally agreed as being critical to the long-term effectiveness of national CHW programmes—planning, coordination, and partnerships. Mechanisms are available in many countries such as the UHC2030 (formerly International Health Partnership), country coordinating mechanisms (CCMs), and those focusing on the health workforce such as the national Human Resources for Health Observatory and the Country Coordination and Facilitation (CCF) initiatives introduced by the Global Health Workforce Alliance. Conclusion It is imperative to integrate CHW initiatives into formal health systems. Multidimensional interventions and multisectoral partnerships are required to holistically address the challenges at national and local levels, thereby ensuring synergy among the actions of partners and stakeholders. In order to establish robust and institutionalized processes, coordination is required to provide a workable platform and conducive environment, engaging all partners and stakeholders to yield tangible results.

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Developing a Competitive Advantage: Considerations from Australia for the Recruitment and Retention of Rural and Remote Primary Health Workers

Australian Journal of Primary Health ◽

10.1071/py08014 ◽

2008 ◽

Vol 14 (1) ◽

pp. 106 ◽

Cited By ~ 7

Author(s):

Julaine Allan ◽

Patrick Ball

Keyword(s):

Human Resources ◽

Health Workforce ◽

Health Workers ◽

Health Service Delivery ◽

Research Literature ◽

The Body ◽

Rural And Remote ◽

Retention Strategies ◽

Recruitment And Retention ◽

Workforce Issues

Globally, health workforce shortages in rural and remote areas significantly affect the capability of health systems, both public and private, to deliver their services. Regional and national governments and academic and professional bodies have been active in attempting to address the situation. This paper overviews the extensive human resources literature on recruitment and retention. Findings are contrasted with recent Australian and international research literature investigating health workforce issues. The context of rural health service delivery, workforce issues and recruitment and retention strategies implemented are discussed. Recruitment and retention issues for the rural and remote health workforce would be well understood if human resources knowledge was applied to the problem. However, few retention strategies were identified other than for general practitioners and no analyses of their effectiveness could be found. Health employers need to use the body of knowledge developed in the business sector to implement recruitment and retention strategies consistently, evaluate them and report the findings. "Silos" created by a sector or discipline-specific approach can be broken down by seeking knowledge from a number of disciplines. Health research can then focus on developing models of health care that address professional and community needs.

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Need for Increased Investment in Human Resource for Health in India: Estimating the Required Investment for Increased Production of Health Professionals for Achieving Universal Health Coverage and Sustainable Development Goals by 2030.

10.21203/rs.3.rs-1043860/v1 ◽

2021 ◽

Author(s):

Anup Karan ◽

Himanshu Negandhi ◽

Mehnaz Kabeer ◽

Tomas Zapata ◽

Dilip Mairembam ◽

...

Keyword(s):

Human Resources ◽

Health Worker ◽

Health Workforce ◽

Health Workers ◽

Human Resources For Health ◽

Labour Force ◽

Labour Productivity ◽

Health Sector ◽

National Income ◽

Health Coverage

Abstract BACKGROUND: COVID-19 has reinforced the importance of having sufficient, well-distributed and competent health workforce. In addition to improving health outcomes, increased investment has the potential to generate employment, increase labour productivity along with fostering economic growth. With COVID-19 highlighting the gaps in human resources for health in India, there is a need to better and empirically understand the level of required investment for increasing the production of health workforce in India for achieving the UHC/SDGs.METHODS: The study used data from a range of sources including National Health Workforce Account 2018, Periodic Labour Force Survey 2018-19, population projection of Census of India, and review of government documents and reports. The study estimated shortages in the health workforce and required investments to achieve recommended health worker: population ratio thresholds by the terminal year of the SDGs 2030.RESULTS: Our results suggest that to meet the threshold of 34.5 skilled health worker per 10,000 population, there will be a shortfall of 0.16 million doctors and 0.65 nurses/midwives in the total stock of human resources for health by the year 2030. The shortages at the same threshold will be much higher (0.57 million doctors and 1.98 million nurses/midwives) in active health workforce by 2030. The shortages are even higher when compared with a higher threshold of 44.5 health workers per 10,000 population. The estimated investment for the required increase in the production of health workforce ranges from INR 523 billion to 2,580 billion for doctors. For nurses/midwives, the required investment is INR 1,096 billion. Such investment during 2021-25 has the potential of an additional employment generation within the health sector to the tune of 5.4 million and contribute to national income to the extent of INR 3,429 billion annually.Conclusion: India needs to significantly increase the production of doctors and nurses(/midwives) through investing in opening up of new medical colleges. Nursing sector should be prioritized to encourage talents to join nursing profession and provide quality education. India needs to set-up a benchmark of skill-mix ratio and provide attractive employment opportunities in health sector to increase the demand and absorb the new supply of graduates.

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Applying WHO COVID-19 Workforce Estimate Tools Remotely in an African Context: A Case Report From Mali and Kenya

10.21203/rs.3.rs-838020/v1 ◽

2021 ◽

Author(s):

Pamela A. McQuide ◽

Amy Finnegan ◽

Katherine M Terry ◽

Andrew Nelson Brown ◽

Cheick Oumar Toure ◽

...

Keyword(s):

Human Resources ◽

Health Systems ◽

Health Workforce ◽

Health Workers ◽

Human Resources For Health ◽

Human Resources Management ◽

World Health ◽

Local Context ◽

African Countries ◽

African Context

Abstract BackgroundThe COVID-19 pandemic has increased the burden on health systems, particularly in low- and middle-income countries where health systems already struggle. To meet health workforce planning needs during the pandemic, IntraHealth International used two tools created by the World Health Organization (WHO) Regional Office for Europe. The Health Workforce Estimator (HWFE) allows the estimation of the quantity of health workers needed to treat patients during a surge, and the Adaptt Surge Planning Support Tool helps to predict the timing of a surge in cases and the number of health workers and beds needed for predicted caseload. These tools were adapted to fit the African context in a rapid implementation over five weeks in one region in Mali and one region in Kenya with the objective to test the feasibility of adapting these tools, which use a Workload Indicators of Staffing Need (WISN)-inspired human resources management methodology, to obtain daily and surge projections of COVID-19 human resources for health needs.Case presentationUsing a remote team in the US and in-country teams in Mali and Kenya, IntraHealth enacted a phased plan to gather stakeholder support, collect data related to health systems and COVID-19 cases, populate data into the tools, verify modeled results with results on the ground, enact policy measures to meet projected needs, and conduct national training workshops for the ministries of health.ConclusionsThis phased implementation in Mali and Kenya demonstrated that the WISN approach applied to the Health Workforce Estimator and Adaptt tools can be readily adapted to the local context for African countries to rapidly estimate the number of health workers and beds needed to respond to the predicted COVID-19 pandemic caseload. The results may also be used to give a proxy estimate for needed health supplies—e.g., oxygen, medications, and ventilators. Challenges included accurate and timely data collection and updating data. The success of the pilot can be attributed to the adapted WHO tools, the team composition in both countries, access to human resources data, and early support of the ministries of health, with the expectation that this methodology can be applied to other country contexts.

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Human resources for health in Botswana: The results of in-country database and reports analysis

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v6i1.716 ◽

2014 ◽

Vol 6 (1) ◽

Cited By ~ 12

Author(s):

Oathokwa Nkomazana ◽

Wim Peersman ◽

Merlin Willcox ◽

Robert Mash ◽

Nthabiseng Phaladze

Keyword(s):

Human Resources ◽

Health Workforce ◽

Urban Areas ◽

Health Workers ◽

Human Resources For Health ◽

Monitoring And Evaluation ◽

Health Professions ◽

World Health ◽

African Countries ◽

Middle Income

Background: Botswana is a large middle-income country in Southern Africa with a population of just over two million. Shortage of human resources for health is blamed for the inability to provide high quality accessible health services. There is however a lack of integrated, comprehensive and readily-accessible data on the health workforce.Aim: The aim of this study was to analyse the existing databases on health workforce in Botswana in order to quantify the human resources for health.Method: The Department of Policy, Planning, Monitoring and Evaluation at the Ministry of Health, Ministry of Education and Skills Development, the Botswana Health Professions Council, the Nursing and Midwifery Council of Botswana and the in-country World Health Organization offie provided raw data on human resources for health in Botswana.Results: The densities of doctors and nurses per 10 000 population were four and 42,respectively; three and 26 for rural districts; and nine and 77 for urban districts. The average vacancy rate in 2007 and 2008 was 5% and 13% in primary and hospital care, respectively, but this is projected to increase to 53% and 43%, respectively, in 2016. Only 21% of the doctors registered with the Botswana Health Professions Council were from Botswana, the rest being mainly from other African countries. Botswana trained 77% of its health workforce locally.Conclusion: Although the density of health workers is relatively high compared to the region, they are concentrated in urban areas, insuffiient to meet the projected requirements and reliant on migrant professionals.

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Data Collection on Donor-Supported Health Workers: Lessons Learned From Improving Health Workforce Data Supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)

10.21203/rs.3.rs-1032412/v1 ◽

2021 ◽

Author(s):

Sarah Ackerman ◽

Jerilyn Hoover ◽

Lauren Heinrich ◽

Erin Dunlap ◽

Ohvia Muraleetharan ◽

...

Keyword(s):

Data Collection ◽

Human Resources ◽

Health Workforce ◽

Health Workers ◽

Human Resources For Health ◽

Program Planning ◽

The United States ◽

Valuable Insight ◽

Emergency Plan ◽

The U.S

Abstract The Global Strategy on Human Resources for Health: Workforce 2030 has called for the improvement of health workforce data and implementation of health workforce registries. It is critical to capture the health workforce supported by donors in order to have a complete understanding of the health workforce across countries. The United States Agency for International Development (USAID) developed an innovative pilot human resources for health (HRH) data collection system (including a data entry template and structured dataset) to collect HRH data for the health workforce supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The pilot system filled HRH data gaps in nine key countries, providing valuable insight for program planning. The implementation details of this exercise can be used as a case study on collecting and applying data on health workers, including those supported by donor funding.

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Impact of the COVID-19 pandemic on the human resources for health in India and key policy areas to build a resilient health workforce

Gates Open Research ◽

10.12688/gatesopenres.13196.1 ◽

2020 ◽

Vol 4 ◽

pp. 159

Author(s):

Ankita Mukherjee ◽

Rakesh Parashar

Keyword(s):

Human Resources ◽

Health Workforce ◽

Emergency Preparedness ◽

Health Workers ◽

Human Resources For Health ◽

System Level ◽

Individual Level ◽

Media Reports ◽

Critical Components ◽

The Individual

The COVID-19 pandemic has disrupted the already low resourced, fragmented and largely unregulated health systems in countries like India. It has only further exacerbated the stress on human resources for health (HRH) in many unanticipated ways. We explored the effect of COVID-19 pandemic on the health workforce in India, and analytically extrapolated the learnings to draw critical components to be addressed in the HRH policies, which can further be used to develop a detailed ‘health workforce resilience’ policy. We examined the existing literature and media reports published during the pandemic period, covering the gaps and challenges that impeded the performance of the health workers. Recommendations were designed by studying the learnings from various measures taken within India and in some other countries. We identified seven key areas that could be leveraged and improved for strengthening resilience among the health workforce. The system-level factors (at macro level) include developing a health workforce resilience policy, planning and funding for emergency preparedness, stakeholder engagement and incentivization mechanisms; the organization-level factors (meso level) include identifying HRH bench strength, mobilizing the health workforce, psycho-social support, protection from disease; and the individual-level factors (micro level) include measures around self-care by health workers. In keeping with the interdisciplinary nature of the associated factors, we emphasize on developing a future-ready health workforce using a multi-sectoral approach for building its strength and resilience.

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Size, composition and distribution of health workforce in India: why, and where to invest?

Human Resources for Health ◽

10.1186/s12960-021-00575-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Anup Karan ◽

Himanshu Negandhi ◽

Suhaib Hussain ◽

Tomas Zapata ◽

Dilip Mairembam ◽

...

Keyword(s):

Labor Markets ◽

Health Workforce ◽

Health Professionals ◽

Health Workers ◽

Human Resources For Health ◽

Labour Force ◽

Medical Practitioner ◽

Skewed Distribution ◽

Sample Survey ◽

Skill Mix

Abstract Background Investment in human resources for health not only strengthens the health system, but also generates employment and contributes to economic growth. India can gain from enhanced investment in health workforce in multiple ways. This study in addition to presenting updated estimates on size and composition of health workforce, identifies areas of investment in health workforce in India. Methods We analyzed two sources of data: (i) National Health Workforce Account (NHWA) 2018 and (ii) Periodic Labour Force Survey 2017–2018 of the National Sample Survey Office (NSSO). Using the two sources, we collated comparable estimates of different categories of health workers in India, density of health workforce and skill-mix at the all India and state levels. Results The study estimated (from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses/midwives (2.34 million), pharmacist (1.20 million), dentists (0.27 million), and traditional medical practitioner (AYUSH 0.79 million). However, the active health workforce size estimated (NSSO 2017–2018) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million, respectively. Stock density of doctor and nurses/midwives are 8.8 and 17.7, respectively, per 10,000 persons as per NHWA. However, active health workers’ density (estimated from NSSO) of doctor and nurses/midwives are estimated to be 6.1 and 10.6, respectively. The numbers further drop to 5.0 and 6.0, respectively, after accounting for the adequate qualifications. All these estimates are well below the WHO threshold of 44.5 doctor, nurses and midwives per 10,000 population. The results reflected highly skewed distribution of health workforce across states, rural–urban and public–private sectors. A substantial proportion of active health worker were found not adequately qualified on the one hand and on the other more than 20% of qualified health professionals are not active in labor markets. Conclusion India needs to invest in HRH for increasing the number of active health workers and also improve the skill-mix which requires investment in professional colleges and technical education. India also needs encouraging qualified health professionals to join the labor markets and additional trainings and skill building for already working but inadequately qualified health workers.

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Retention and Task Shifting in Human Resources for Health through Data Mining

International Business Research ◽

10.5539/ibr.v10n5p29 ◽

2017 ◽

Vol 10 (5) ◽

pp. 29

Author(s):

Cheng-Kun Wang

Keyword(s):

Data Mining ◽

Literature Review ◽

Human Resources ◽

Rural Areas ◽

Health Workers ◽

Human Resources For Health ◽

Task Shifting ◽

Good Tool ◽

Medical Manpower ◽

And Task

Human resources for health (HRH) are the backbone of the healthcare system, but a shortage of medical manpower and the misdistribution of human resources are critical problems in the rural areas of many countries till 2017. The shortage of medical manpower is a big issue between 2004 and 2013. Data mining of bibliometrics is a good tool to find the solutions for shortage of medical manpower. By analyzing 118,092 citations in 2,000 articles published in the SSCI and SCI databases addressing HRH from 2004 to 2013, we plotted the networks among authors in the field. We combine quantitative bibliometrics and a qualitative literature review to determine the important articles and to realize the relationships between important topics in this field. We find that retention and task shifting are the hot topics in HRH field between 2004 and 2013, and find out the solutions for these issues through literature review in later papers. The solution to the HRH shortage is to determine the motivations of health workers and to provide incentives to maintain their retention. Task shifting is another solution to the HRH crisis.

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