Human resources for primary health care in sub-Saharan Africa: progress or stagnation?

BACKGROUND: The World Health Organization defines a "critical shortage" of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years. METHODS: This study is a review of published and unpublished "grey" literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa. RESULTS: Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers. CONCLUSION: There is an "inverse primary health care law" in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources more cost-effectively by involving skilled staff to supervise and support lower level health care workers who currently provide the front line of primary health care in most of Africa

Reaching the millennium development goal for child mortality : improving equity and efficiency in Ecuador's health budget

health care; infant mortality; health policy;

Primary health care nurses caring for people with diabetes: An integrative review of the literature

The aim of this integrative literature review was to analyse and synthesize findings from primary empirical studies concerning how nurses in primary care, care for people with diabetes (PWD). Diabetes is a recognized health priority in United Kingdom (UK) and New Zealand (NZ). Health policies are directing a shift in diabetes services from secondary to primary care. New Zealand primary health care (PHC) nurses are playing an increasing role in caring for a growing number of people with diabetes (PWD) and as such, need to be positioned effectively to contribute to preventing or minimizing associated long term diabetes complications. This research project has identified contrasted and highlighted similarities or differences in breadth and context in NZ nursing practice with UK practice and established important concepts and subsequent implications for this emerging role in NZ. The findings of this integrated review indicate that PHC nurses have developed extended and in some instances advanced specialised practice in caring for PWD across the breadth of the wellness disease continuum. Contextual factors have had a significant influence on how the role has emerged in both countries. The role is more evident in the UK and findings from the UK literature have implications for this emerging specialised PHC nursing role in NZ, particularly in relation to nurses increased role in medicine management of PWD. Recommendations are that new diabetes policies or programmes of care have structures that promote and support effective relationships and collaboration between all providers of the diabetes team. Education for this role should be provided at a nationally agreed standard where nurses’ competencies are measured. Furthermore appropriately qualified diabetes PHC nurses should have an increased role in medicine management and/or prescribing in NZ primary care similar to UK nurses. Finally, contribution of the emerging role of the diabetes PHC nurse should seriously be considered within the context of ‘Better, Sooner, More Convenient Primary Care’ structures that are designed to address chronic disease management and health inequities within the NZ population