Editorial: Of Institutaions and Persons

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International Aid to HRH development in Ethiopia: Assessment of Irish Aid investment in the development of human resources for health in Southern Nations, Nationalities and Peoples Region (SNNPR)

Background: Human resources for health (HRH) are considered the linchpin in health development but, until recently, donors were reluctant to support HRH development considered as higher education and not a priority for support. There have been changes in this attitude in the last few years. The evolution in Ethiopia is explored using the experience of Irish Aid (IA) as a case study.Methods: The evolution of HRH in SNNP is explored through study of IA and Regional documents and interviews of key informants, focus group discussions and field visits in the region.Results: Major national initiatives with short and long term impact on HRH are briefly documented including the ‘flooding strategy’, the Accelerated Health Officers Training and the rapid deployment of health extension workers (HEW). Major constraints/uncertainties in improved IA support are noted including absence of specific HRH policy and an outdated health policy; delays in the development of an HRH strategy; impacts of over-drawn BPR process… IA impacts on HRH in the region, including middle level HRH training; training of HEW, in-service training in general…, are commendable. The assessment also documents current weaknesses/gaps in IA support including lack of training needs assessment, weak supportive supervision, lack/delay in upgrading training - for HEW in particular, lag in training to clear the backlog of junior categories and inadequate increase of HRH for Emergency Obstetric Care. Adequate measures have not been taken to improve quality of pre-service training; improve motivation, efficiency and retention of the health workforce (HWF) and strengthen HRH management.Conclusions and Recommendations: Overall, IA had discernable impact on HRH development in the region. Areas for future policy level dialogue and improved impact are recommended

Lessons from the evolution of human resources for health in Ethiopia: 1941-2010

Human resources for health (HRH) policy and planning is highly challenging in any setting but the more so in underdeveloped countries. Ethiopia has relatively vast and distinctive experience in accelerated training, use of substitute categories/task-shifting… from which important lessons could be drawn.Based on thorough analysis of documents (official, unofficial, government and others) and 1st hand experience of the authors, the paper explores the major issues in HRH development between 1941 – end of the Italian Occupation - and 2010 – end of the Health Sector Development Program (HSDP) III.The socio-cultural and economic context; development in education, higher education in particular and the general human resources development policy, strategy and plans in the successive periods are assessed briefly.Major developments of• Reconstruction and Basic Health Services Period (1941-1974): the successive five-year plans; the training of orderlies/dressers, the 1st nursing schools, training abroad…; the Gondar Public Health College and the Gondar Team; the beginnings of medical education …• Primary Health Care Period (1974-1991) the Ten Years Perspective Health Plan; the training of Community Health Workers - Community Health Agents and Trained Traditional Birth Attendants -, nurse practitioners, health assistants; discontinuation of the health officers (HO) training, the initiation of Jimma College of Health Sciences and of post-graduate training in medicine at the Faculty of Medicine Addis Ababa University…• Sector-Wide Approach Period (1991-2010) the Health Sector Development Programs I-III, the reintroduction of Health Officers training, the accelerated training/‘Flooding Strategy’, Health Extension Workers, retention/‘Brain-Drain’ of health workers…are explored in some depth and lessons drawn for future HRH development in the country.The conclusions underscore the laudable efforts in all periods but difficulties of learning from the past; the continued very low workforce density and the highly skewed distribution; the recurring challenges of sustained human resources development – quality, motivation, retention… - of the task-shifting and accelerated training attempts and the need to develop specific HRH policy and strategy

Background and objectives of launching The Ethiopian Journal of Health Development, 1984

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Assessment of the Training of the First Intake of Health Extension Workers

Introduction: Ethiopia's poor health status is due primarily to communicable diseases, poor nutrition, and lack of access to health services in general and for most of the rural, nomadic pastoralist and fringe areas in particular. In response, the government has launched a Health Extension Program (HEP) for which training of Health Extension Workers (HEW) has been started. This study assesses the first year's HEW training program in terms of its inputs, processes and output. Methods: The Method of the study included a questionnaire survey and an in-depth study of all the training centers except one. Results: All the Technical and Vocational Education and Training Institutes (TVETIs) studied were found to lack adequate facilities to receive the HEW trainees including classrooms, libraries ICT, water and latrines. The selection of HEW was flawed, most being from woreda towns and not the rural villages they will be working in. Most trainees had very low grade point average. Trainees did not have adequate orientation on their future job at recruitment. Trainees in some regions did not receive stipends while they did in others. However, trainees expressed a high level of commitment to work in rural areas. The number of trainers was low and very few were female or with degree. Top-up of salaries were given in some regions but not others and trainers saw their employment status as ambiguous. Teaching and learning conditions were constrained with very little practical training. Conclusion: Major issues are discussed and recommendations made on improving future training, improving the knowledge and skill of graduates through continuing education and on future training to replace attrition.Ethiopian Journal of Health Development Vol. 21 (3) 2007: pp. 232-23

Human Resource Development for Health in Ethiopia: Challenges of Achieving the Millennium development Goals

Review of different documents on human resource for health was undertaken. Particular attention was given to documents from Ethiopia. Generally there is shortage in number of different groups of professionals, mal distribution of professionals between regions, urban and rural setting, and governmental and non governmental/private organizations. There is no policy specific to human resource development (HRD) for health and no proper mechanism to manage the existing health workforce. A number of measures are being taken to alleviate these problems. The enrollment of students has been increased in different categories and new trainings started in professions like dentistry. The process to develop policy and strategy for managing human resource for health has been started. The implications of these for HRD by 2015 are explored briefly.Ethiopian Journal of Health Development Vol. 21 (3) 2007: pp. 216-23

Study of the Working Conditions of Health Extension Workers in Ethiopia

Background: Ethiopia is well placed as a potential candidate for the Millennium Development Goals (MDGs) fasttracking but the current 0.2/1000 human resource for health (HRH) clearly indicates the challenges ahead. However, there are also opportunities as the country has now launched an “Accelerated Expansion of Primary Health Care Coverage: 2005-2009” of which “The Health Extension Program (HEP)” is a major component”. Objective: The study focuses on the first batch of Health Extension Workers (HEWs) with the overall objective of assessing the working conditions of HEWs and their job satisfaction. Methods: An in-depth field study was carried out on 60 HEW in 50 health posts (HP) from six regions, 23 zones and 27 woredas. Results: There are challenges in harmonizing the staffing pattern at the HP level, guiding time-use, work schedule and relationship with the community. There are no clear guidelines on relationship with other health workers at the community level, on career structure, transfer, and leave of absences. Reporting and health management information system in general is weak. Conclusion: Placing HEW at community level is a commendable undertaking but fulfilling favorable working conditions is an important challenge which is compounded by long distances and poor transportation and communication facilities. These issues are elaborated and possible responses discussed.Ethiopian Journal of Health Development Vol. 21 (3) 2007: pp. 246-25

New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries.

As more new and improved vaccines become available, decisions on which to adopt into routine programmes become more frequent and complex. This qualitative study aimed to explore processes of national decision-making around new vaccine adoption and to understand the factors affecting these decisions. Ninety-five key informant interviews were conducted in seven low- and middle-income countries: Bangladesh, Cameroon, Ethiopia, Guatemala, Kenya, Mali and South Africa. Framework analysis was used to explore issues both within and between countries. The underlying driver for adoption decisions in GAVI-eligible countries was the desire to seize GAVI windows of opportunity for funding. By contrast, in South Africa and Guatemala, non-GAVI-eligible countries, the decision-making process was more rooted in internal and political dynamics. Decisions to adopt new vaccines are, by nature, political. The main drivers influencing decisions were the availability of funding, political prioritization of vaccination or the vaccine-preventable disease and the burden of disease. Other factors, such as financial sustainability and feasibility of introduction, were not as influential. Although GAVI procedures have established more formality in decision-making, they did not always result in consideration of all relevant factors. As familiarity with GAVI procedures increased, questioning by decision-makers about whether a country should apply for funding appeared to have diminished. This is one of the first studies to empirically investigate national processes of new vaccine adoption decision-making using rigorous methods. Our findings show that previous decision-making frameworks (developed to guide or study national decision-making) bore little resemblance to real-life decisions, which were dominated by domestic politics. Understanding the realities of vaccine policy decision-making is critical for developing strategies to encourage improved evidence-informed decision-making about new vaccine adoptions. The potential for international initiatives to encourage evidence-informed decision-making should be realised, not assumed