Using a human resource management approach to support community health workers: experiences from five African countries

Background Like any other health worker, community health workers (CHWs) need to be supported to ensure that they are able to contribute effectively to health programmes. Management challenges, similar to those of managing any other health worker, relate to improving attraction, retention and performance. Methods Exploratory case studies of CHW programmes in the Democratic Republic of Congo, Ghana, Senegal, Uganda and Zimbabwe were conducted to provide an understanding of the practices for supporting and managing CHWs from a multi-actor perspective. Document reviews (n = 43), in-depth interviews with programme managers, supervisors and community members involved in managing CHWs (n = 31) and focus group discussions with CHWs (n = 13) were conducted across the five countries. Data were transcribed, translated and analysed using the framework approach. Results CHWs had many expectations of their role in healthcare, including serving the community, enhancing skills, receiving financial benefits and their role as a CHW fitting in with their other responsibilities. Many human resource management (HRM) practices are employed, but how well they are implemented, the degree to which they meet the expectations of the CHWs and their effects on human resource (HR) outcomes vary across contexts. Front-line supervisors, such as health centre nurses and senior CHWs, play a major role in the management of CHWs and are central to the implementation of HRM practices. On the other hand, community members and programme managers have little involvement with managing the CHWs. Conclusions This study highlighted that CHW expectations are not always met through HRM practices. This paper calls for a coordinated HRM approach to support CHWs, whereby HRM practices are designed to not only address expectations but also ensure that the CHW programme meets its goals. There is a need to work with all three groups of management actors (front-line supervisors, programme managers and community members) to ensure the use of an effective HRM approach. A larger multi-country study is needed to test an HRM approach that integrates context-appropriate strategies and coordinates relevant management actors. Ensuring that CHWs are adequately supported is vital if CHWs are to fulfil the critical role that they can play in improving the health of their communities

Ex-ante benefit-cost analysis of the elimination of a Glossina palpalis gambiensis population in the Niayes of Senegal

Background: In 2005, the Government of Senegal embarked on a campaign to eliminate a Glossina palpalis gambiensis population from the Niayes area (,1000 km2) under the umbrella of the Pan African Tsetse and Trypanosomosis Eradication Campaign (PATTEC). The project was considered an ecologically sound approach to intensify cattle production. The elimination strategy includes a suppression phase using insecticide impregnated targets and cattle, and an elimination phase using the sterile insect technique, necessary to eliminate tsetse in this area. Methodology/Principal Findings: Three main cattle farming systems were identified: a traditional system using trypanotolerant cattle and two ''improved'' systems using more productive cattle breeds focusing on milk and meat production. In improved farming systems herd size was 45% lower and annual cattle sales were J250 (s.d. 513) per head as compared to J74 (s.d. 38) per head in traditional farming systems (p,1023). Tsetse distribution significantly impacted the occurrence of these farming systems (p = 0.001), with 34% (s.d. 4%) and 6% (s.d. 4%) of improved systems in the tsetse-free and tsetse-infested areas, respectively. We calculated the potential increases of cattle sales as a result of tsetse elimination considering two scenarios, i.e. a conservative scenario with a 2% annual replacement rate from traditional to improved systems after elimination, and a more realistic scenario with an increased replacement rate of 10% five years after elimination. The final annual increase of cattle sales was estimated at ,J2800/km2 for a total cost of the elimination campaign reaching ,J6400/km2. Conclusion/Significance: Despite its high cost, the benefit-cost analysis indicated that the project was highly cost-effective, with Internal Rates of Return (IRR) of 9.8% and 19.1% and payback periods of 18 and 13 years for the two scenarios, respectively. In addition to an increase in farmers' income, the benefits of tsetse elimination include a reduction of grazing pressure on the ecosystems. (Résumé d'auteur

The Climate-Smart Village approach: putting communities at the heart of restoration

Land degradation affects 24% of the world’s land surface and 1.5 billion of its people. It is the result of human activities, exacerbated by natural processes, and is closely linked to climate change and loss of biodiversity. In Africa two-thirds of arable land is degraded. In Senegal, 2.5 million hectares are degraded (CSE 2011); the central “groundnut basin” is particularly affected. Increasing the capacity of smallholders to address land degradation and adapt to climate variation is paramount, which is why the Senegalese Institute for Agricultural Research (ISRA) and its partners adopted the holistic and participatory “climate-smart village” approach. Based on innovative local governance, this approach includes seven components: (1) climate forecasts and information; (2) resilient crop varieties and good agricultural practices; (3) agroforestry with fruit and fodder species; (4) farmer managed natural regeneration; (5) inter-village silvopastoral areas; (6) planting of native fruit trees; and (7) small forestry and farm businesses

Rift Valley Fever in Small Ruminants, Senegal, 2003

Serologic incidence was estimated at 2.9%