African leaders’ views on critical human resource issues for the implementation of family medicine in Africa

Moosa, Shabir; Downing, Raymond; Essuman, Akye; Pentz, Stephen; Reid, Steve; Mash, Robert

doi:10.1186/1478-4491-12-2

Cited by 14 publications

(17 citation statements)

References 10 publications

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“…However, in the absence of any official review of professional scopes of practice, and without adequate training and supervision, task shifting is inappropriate and raises concerns about quality of care [ 9 , 32 ] and “task piling” or “dumping of tasks to others” [ 33 ]. The evidence generated by the WISN application in Uganda could be useful in supporting a more integrated model of care that enables task sharing, fosters teamwork and promotes an appropriate and diversified skill mix [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Making the transition to workload-based staffing: using the Workload Indicators of Staffing Need method in Uganda

Namaganda

Oketcho²,

Maniple

et al. 2015

Hum Resour Health

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BackgroundUganda’s health workforce is characterized by shortages and inequitable distribution of qualified health workers. To ascertain staffing levels, Uganda uses fixed government-approved norms determined by facility type. This approach cannot distinguish between facilities of the same type that have different staffing needs. The Workload Indicators of Staffing Need (WISN) method uses workload to determine number and type of staff required in a given facility. The national WISN assessment sought to demonstrate the limitations of the existing norms and generate evidence to influence health unit staffing and staff deployment for efficient utilization of available scarce human resources.MethodsA national WISN assessment (September 2012) used purposive sampling to select 136 public health facilities in 33/112 districts. The study examined staffing requirements for five cadres (nursing assistants, nurses, midwives, clinical officers, doctors) at health centres II (n = 59), III (n = 53) and IV (n = 13) and hospitals (n = 11). Using health management information system workload data (1 July 2010–30 June 2011), the study compared current and required staff, assessed workload pressure and evaluated the adequacy of the existing staffing norms.ResultsBy the WISN method, all three types of health centres had fewer nurses (42–70%) and midwives (53–67%) than required and consequently exhibited high workload pressure (30–58%) for those cadres. Health centres IV and hospitals lacked doctors (39–42%) but were adequately staffed with clinical officers. All facilities displayed overstaffing of nursing assistants. For all cadres at health centres III and IV other than nursing assistants, the fixed norms or existing staffing or both fell short of the WISN staffing requirements, with, for example, only half as many nurses and midwives as required.ConclusionsThe WISN results demonstrate the inadequacies of existing staffing norms, particularly for health centres III and IV. The results provide an evidence base to reshape policy, adopt workload-based norms, review scopes of practice and target human resource investments. In the near term, the government could redistribute existing health workers to improve staffing equity in line with the WISN results. Longer term revision of staffing norms and investments to effectively reflect actual workloads and ensure provision of quality services at all levels is needed.

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Section: Discussionmentioning

confidence: 99%

Making the transition to workload-based staffing: using the Workload Indicators of Staffing Need method in Uganda

Namaganda

Oketcho²,

Maniple

et al. 2015

Hum Resour Health

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“…The contract service in rural areas can be seen as a counterpart to family medicine which has become a pervasive measure to deliver public health services in countries all over the world [24][25][26][27][28]. After signing the contract with families, the village doctors act as family doctors and need to provide health protection and medical care to the family members individually, although most of them are not qualified general practitioners due to they received their education below college level [21].…”

Section: Introductionmentioning

confidence: 99%

Evaluation and mechanism for outcomes exploration of providing public health care in contract service in Rural China: a multiple-case study with complex adaptive systems design

Zhou

Zhang

et al. 2015

BMC Public Health

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BackgroundThe Chinese government has increased the funding for public health in 2009 and experimentally applied a contract service policy (could be seen as a counterpart to family medicine) in 15 counties to promote public health services in the rural areas in 2013. The contract service aimed to convert village doctors, who had privately practiced for decades, into general practitioners under the government management, and better control the rampant chronic diseases. This study made a rare attempt to assess the effectiveness of public health services delivered under the contract service policy, explore the influencing mechanism and draw the implications for the policy extension in the future.MethodsThree pilot counties and a non-pilot one with heterogeneity in economic and health development from east to west of China were selected by a purposive sampling method. The case study methods by document collection, non-participant observation and interviews (including key informant interview and focus group interview) with 84 health providers and 20 demanders in multiple level were applied in this study. A thematic approach was used to compare diverse outcomes and analyze mechanism in the complex adaptive systems framework.ResultsWithout sufficient incentives, the public health services were not conducted effectively, regardless of the implementation of the contract policy. To appropriately increase the funding for public health by local finance and properly allocate subsidy to village doctors was one of the most effective approaches to stimulate health providers and demanders’ positivity and promote the policy implementation. County health bureaus acted as the most crucial agents among the complex public health systems. Their mental models influenced by the compound and various environments around them led to the diverse outcomes. If they could provide extra incentives and make the contexts of the systems ripe enough for change, the health providers and demanders would be receptive to the transition of the policy.ConclusionsThe innovative fund raising measures could be taken by relatively developed counties of China to conduct public health services. Policymakers could take systems thinking as a useful tool to design plans and predict the unintended outcomes during the process of public health reforms.

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“… 8 , 28 The emerging role of family medicine in SA and Africa can help guide this project. 3 , 4 , 8 , 28 , 36 , 37 …”

Section: Discussionmentioning

confidence: 99%

Insights of private general practitioners in group practice on the introduction of National Health Insurance in South Africa

Moosa¹,

Luiz

Carmichael

et al. 2016

Afr. j. prim. health care fam. med.

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BackgroundThe South African government intends to contract with ‘accredited provider groups’ for capitated primary care under National Health Insurance (NHI). South African solo general practitioners (GPs) are unhappy with group practice. There is no clarity on the views of GPs in group practice on contracting to the NHI.ObjectivesTo describe the demographic and practice profile of GPs in group practice in South Africa, and evaluate their views on NHI, compared to solo GPs.MethodsThis was a descriptive survey. The population of 8721 private GPs in South Africa with emails available were emailed an online questionnaire. Descriptive statistical analyses and thematic content analysis were conducted.ResultsIn all, 819 GPs responded (568 solo GPs and 251 GPs in groups). The results are focused on group GPs. GPs in groups have a different demographic practice profile compared to solo GPs. GPs in groups expected R4.86 million ($0.41 million) for a hypothetical NHI proposal of comprehensive primary healthcare (excluding medicines and investigations) to a practice population of 10 000 people. GPs planned a clinical team of 8 to 12 (including nurses) and 4 to 6 administrative staff. GPs in group practices saw three major risks: patient, organisational and government, with three related risk management strategies.ConclusionsGPs can competitively contract with NHI, although there are concerns. NHI contracting should not be limited to groups. All GPs embraced strong teamwork, including using nurses more effectively. This aligns well with the emergence of family medicine in Africa.

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African leaders’ views on critical human resource issues for the implementation of family medicine in Africa

Cited by 14 publications

References 10 publications

Making the transition to workload-based staffing: using the Workload Indicators of Staffing Need method in Uganda

Making the transition to workload-based staffing: using the Workload Indicators of Staffing Need method in Uganda

Evaluation and mechanism for outcomes exploration of providing public health care in contract service in Rural China: a multiple-case study with complex adaptive systems design

Insights of private general practitioners in group practice on the introduction of National Health Insurance in South Africa

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