New Indochina Studies Program

New Indochina Studies Program

Task sharing in Zambia: HIV service scale-up compounds the human resource crisis

BACKGROUND: Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. METHODS: Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. RESULTS: Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. CONCLUSIONS: This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. The findings are based on an analysis of routine data that are available to district and national managers. Mixed methods research is needed, combining quantitative analyses of routine health information with follow-up qualitative interviews, to explore and explain workload changes, and to identify and measure where problems are most acute, so that decision makers can respond appropriately. This study provides quantitative evidence of a human resource crisis in health facilities in Zambia, which may be more acute in rural areas

Utilising a cultural–historical analysis to map the historicity of Social Studies, Natural Science and Technology education in the early years

Background: South Africa needs citizens who are morally sound, adaptive to change, technologically innovative and literate in socio-scientific issues. The young child is apparently being prepared for active citizenry through basic “Social Science, Natural Sciences and Technology” education as encapsulated in the South African curriculum. Aim: We foreground a theoretical and analytical framework to map the cultural–historical trajectory of South Africa’s Beginning Knowledge curriculum. Setting: Cultivating citizenship requires that these science subject domains be incorporated in a coherent, well-conceptualised and relevant early childhood curriculum as suggested by international literature. Educators need to be specialists in socio-scientific issues in both the content and pedagogy of these sciences in order to expound the curriculum. Methods: Our newly coined hybridised theoretical framework - the ‘Hybrid CHAT’ - together with an aligned analytical framework enabled us to illuminate the historical subject-didactical genetic development of Beginning Knowledge. An extensive sample of typographical textbooks, artefacts and cultural tools were analysed and interpreted. Results: Beginning Knowledge is afforded limited teaching time. The knowledge, skills and values associated with these science subjects serve to support and strengthen the acquisition of language and mathematics competencies. Currently, Beginning Knowledge does not sufficiently prepare child citizens for the global demands of the 21st century. Conclusion: Hybrid CHAT could invite further studies to place Beginning Knowledge on par with international curricula. This would also align the curriculum with the aspirations for an ideal South African citizenry as well as prepare child citizens to pursue Science and Technology for social development