Migration of South African health workers: the extent to which financial considerations influence internal flows and external movements

Background: The loss of human resource capacity has had a severe impact on the health system in South Africa. This study investigates the causes of migration focussing on the role of salaries and benefits. Health professionals from public, private and non-governmental (NGO) health facilities located in selected peri-urban and urban areas in KwaZulu-Natal, South Africa were surveyed about their current positions and attitudes toward migration. Methods: The study uses cross-sectional data collected in 2009. A total of 694 health professionals (430 in the public sector, 133 in the NGO sector and 131 in the private sector) were surveyed. An additional 11 health professionals were purposively selected for in-depth interviews. Odds ratios with 95% confidence intervals were calculated to determine whether salaries influenced HWs decisions to migrate. Results: HWs decision to move was not positively associated with lower salaries. It was found, instead, that the consideration to move was determined by other factors including age, levels of stress experienced and the extent to which they were satisfied at their current place of work. Conclusions: The OSD appears to have lowered the risk of HWs migrating due to low salaries. However, the results also indicate that the South African Department of Health needs to improve working conditions for HWs within the public health sector to assist in retention

Understanding the factors influencing health-worker employment decisions in South Africa

Background: The provision of health care in South Africa has been compromised by the loss of trained health workers (HWs) over the past 20 years. The public-sector workforce is overburdened. There is a large disparity in service levels and workloads between the private and public sectors. There is little knowledge about the nonfinancial factors that influence HWs choice of employer (public, private or nongovernmental organization) or their choice of work location(urban, rural or overseas). This area is under-researched and this paper aims to fill these gaps in the literature. Method: The study utilized cross-sectional survey data gathered in 2009 in KwaZulu-Natal province. The HWs sample came from three public hospitals (n=430), two private hospitals (n=131) and one nongovernmental organization hospital (n=133) in urban areas, and consisted of professional nurses, staff nurses and nursing assistants. Results: HWs in the public sector reported the poorest working conditions, as indicated by participants' self-reports on stress, workloads, levels of remuneration, standard of work premises, level of human resources and frequency of in-service training. Interesting, however, HWs in the nongovernmental organization sector expressed a greater desire than those in the public and private sectors to leave their current employer. Conclusions: To minimize attrition from the overburdened public-sector workforce and the negative effects of the overall shortage of HWs, innovative efforts are required to address the causes of HWs dissatisfaction and to further identify the nonfinancial factors that influence work choices of HWs. The results highlight the importance of considering a broad range of nonfinancial incentives that encourage HWs to remain in the already overburdened public sector

Global Assessment Programme on Drug Abuse

Drug Abuse (GAP). The main objective of GAP is to assist countries in collecting reliable and internationally comparable drug abuse data, in building capacity at the local level to collect data that can guide demand reduction activities, and in improving cross-national, regional and global reporting on drug trends. To support that process, the GAP Toolkit Module 1 has been produced to assist States Members of the United Nations in developing culturally appropriate systems, relevant to the countries concerned, for collecting drug information, to support existing drug information systems by promoting their conformity with internationally recognized standards of good practice, and to focus on harmonization of drug abuse indicators. Module 1 of the GAP toolkit forms one component of a compendium of methodological guides that have been developed to support data collection activities. Other modules currently under development provide support in the following areas: school surveys; indirect prevalence estimation techniques; data interpretation and management for policy formation; and basic data manipulation using a statistical software package for the social sciences (SPSS)

Hand-waving and interpretive dance: an introductory course on tensor networks

The curse of dimensionality associated with the Hilbert space of spin systems provides a significant obstruction to the study of condensed matter systems. Tensor networks have proven an important tool in attempting to overcome this difficulty in both the numerical and analytic regimes. These notes form the basis for a seven lecture course, introducing the basics of a range of common tensor networks and algorithms. In particular, we cover: introductory tensor network notation, applications to quantum information, basic properties of matrix product states, a classification of quantum phases using tensor networks, algorithms for finding matrix product states, basic properties of projected entangled pair states, and multiscale entanglement renormalisation ansatz states. The lectures are intended to be generally accessible, although the relevance of many of the examples may be lost on students without a background in many-body physics/quantum information. For each lecture, several problems are given, with worked solutions in an ancillary file.Comment: Published version. Introductory lecture notes, worked solutions to problems in ancillary file. Comments welcom

To serve or to leave: a question faced by public sector healthcare providers in Pakistan

BACKGROUND: The availability of properly trained and motivated providers is a prerequisite for provision of easily accessible healthcare. Pakistan has been listed by the World Health Organization in its World Health Report 2006 as one of 57 countries with a critical health workforce deficiency. This study examines the factors associated with the willingness of public sector healthcare providers to leave government service and recommends measures that can be adopted to attract and retain staff in the country’s public healthcare system. METHODS: A stratified, random sampling methodology was adopted to recruit a nationally representative sample of 1,296 public sector healthcare providers, including paramedics, medical doctors, and specialists. A semi-structured questionnaire was used to interview these providers. Logistic regressions measured the association with determinants of their willingness to leave the public health sector for better prospects elsewhere. RESULTS: A third of all healthcare providers who were interviewed were of the view that, provided the opportunity, they would leave government service. The odds of willingness to leave service were highest among providers from the region of Azad Jammu and Kashmir (adjusted odds ratio [AOR] = 4.33; 95% CI, 2.49–7.54) followed by the province of Balochistan (AOR = 4.21; 95% CI, 2.41–7.33), and the region of Gilgit Baltistan (AOR = 3.34; 95% CI, 1.67–6.67). Providers who expressed dissatisfaction in the manner their performance was evaluated and those who were dissatisfied with the current salary, each had higher odds of considering leaving government service (AOR = 1.67; 95% CI, 1.18–2.40 and AOR = 2.03; 95% CI, 1.47–2.81, respectively). Providers who reported experiencing interference in their work by influential politicians of the area were more inclined to leave (AOR = 1.44; 95% CI, 1.05–1.98). CONCLUSION: This study clearly highlights the need to implement more focused strategies in the public healthcare system in Pakistan in order to build sufficient staff motivation and prevent providers from leaving government service. In order to improve coverage of healthcare services in Pakistan, the government will have to introduce more focused interventions to attract and retain healthcare providers, especially in remote and rural areas of the country