Strengthening the oral health system in Nigeria: A health systems building block approach

Aim: The present study aimed to describe the building blocks of the oral health system, including the role that the community plays in strengthening the oral health system in Nigeria. Methodology: This research was a scoping review of the existing literature retrieved from search engines and databases. Thus, we utilised grey literature, peer-reviewed literature, policy documents and websites. The oral health system was analysed using the World Health Organisation's Health systems framework, and we adapted this framework by introducing a seventh block, community participation. We also inserted the links between the oral health service delivery and oral health workforce blocks of the framework to improve the oral health outcomes. Results: More dental clinics are required to improve the availability and accessibility of oral health services. Dental workforce expansion is imperative. This can be approached by training of junior cadre dental professionals and incorporating community health practitioners to deliver basic oral care. There is an unregulated access to medication to treat dental conditions; hence, oral disease treatments need to be included in the country's treatment guidelines to improve standard of care. The government needs to improve on overall health spending and invariably increase oral health care allocation urgently. Furthermore, the country's stewardship of oral health care is hinged on well disseminated and implemented national policies on oral health. The oral health system can achieve its overall goals with community participation, engagement and ownership. Conclusion: Strengthening the oral health system in Nigeria requires urgent attention on each building block and cross-cutting interventions across the system's building blocks. The role of the community will need to be recognised because it is vital in sustaining any organisational change.

Strengthening healthcare workforce capacity during and post Ebola outbreaks in Liberia : an innovative and effective approach to epidemic preparedness and response

Introduction: the 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017.Methods: data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained.Results: the ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events.Conclusion: no infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings

Contribution of the Nelson R. Mandela School of Medicine to a socially accoun table health workforce

Background: A socially accountable health professional education curriculum aims to produce fit-for-purpose graduates to work in areas of need. 'Fit-for-purpose' can be assessed by monitoring graduate practice attributes. Aim: The aim of this article was to identify whether graduates of 'fit-for-purpose' programmes are socially accountable. Setting: The setting for this project was all 37 district hospitals in the KwaZulu-Natal province in Durban, South Africa. Methods: We surveyed healthcare professionals working at district hospitals in the KwaZulu-Natal province. We compared four social accountability indicators identified by the Training for Health Network Framework, comparing medical doctors educated at the Nelson R. Mandela School of Medicine (NRMSM) with medical doctors educated at other South African and non-South African medical schools. In addition, we explored medical doctors' characteristics and reasons for leaving or staying at district hospitals. Results: The pursuit of specialisation or skills development were identified as reasons for leaving in the next 5 years. Although one-third of all medical doctors reported an intention to stay, graduates from non-South African schools remained working at a district hospital longer than graduates of NRMSM or other South African schools and they held a majority of leadership positions. Across all schools, graduates who worked at the district hospital longer than 5 years cited remaining close to family and enjoyment of the work and lifestyle as motivating factors.Conclusion: Using a social accountability approach, this research assists in identifying areas of improvement in workforce development. Tracking what medical doctors do and where they work after graduation is important to ensure that medical schools are meeting their social accountability mandate to meet community needs

Is the health workforce distribution in Beijing, China perfectly equitable?

Background: The quantity and distribution of the health workforce is one of the most important aspects of a health care system. Inequality in the distribution of the health workforce is common in China and in many developing countries. This paper aimed to evaluate and discuss inequality in the distribution of the health workforce in Beijing, China, and explain the sources of the inequality. Methods: The study described and measured inequality in the distribution of the health workforce in Beijing using data from the Beijing Regional Statistical Yearbook 2017. The 16 districts of Beijing are divided into four divisions and the paper used methods from the economics literature, including the Lorenz curve, Gini coefficient and Theil L index, to measure inequality in the distribution of the health workforce at sub-provincial level in Beijing for three categories of health workers: doctors, nurses and all health workers. Results: There are inequalities in the densities of health workers at the district and division levels. In terms of the densities of all health workers, doctors and nurses, the Capital Core Functional Division is 3.95 times, 3.82 times and 4.13 times, respectively, higher than the Urban Development New Division. All the Gini coefficients are between than 0.2 to 0.3, which means that the health worker distribution is rather equitable. The Theil L index shows that the inequalities mainly come from the differences between the four divisions, and that nurses are more unequally distributed between divisions (0.28 for Gini coefficient and 0.380 for the Theil L index). Conclusions and recommendations: According to the study findings, the inequalities in health workforce distribution in Beijing could be addressed by increasing investment in the numbers and quality of nurses, as well as by establishing additional policies to attract more health workers to work in remote areas. Chinese governments need to think more carefully about the current distribution of health workers at the sub-provincial level

Nursing Shortage Paradigm: The Bayelsa State Situation

This paper attempted to educate the reader about the shortage of nursing staff and how it affects Bayelsa State's health sector. Bayelsa State like any other state in Nigeria has enormous health challenges associated with manpower shortage. Bayelsa's situation is unique because of its terrain. Some factors such as cost of river transport; insecurity of lives and properties due to incessant attacks from sea pirates; poor housing; lack of portable water; deplorable state of hospitals and health centres; erratic or lack of power supply; inadequate nursing personnel; and uneven distribution of the few nurses available; were identified to be peculiar with Bayelsa terrain. This consequently resulted in increased nurse- patient load; risk for error; infection spread; high mortality rate; quackery and chances of nurses being over stressed. Recommendation such as increase in the rural posting allowance for nurses; provision of social amenities in rural areas; employment of more nurses from various states of the federation among others were made

Evidence of Strategic Human Resource Management Practice in a Public Sector Organisation: a Content Analysis of the HRM Policy and Strategy of the Ministry of Health of Ghana; 2007- 2011

Competitive forces coupled with new and continuing demands require public sector organisations to be increasingly careful in thinking about their strategies. This is complicated especially for the health sector because it must do so in a multi-sectoral environment where system complicate decision making. This paper examines the evidence of Human Resource Management Strategies and practices in a public sector organization; the Ministry of Health of Ghana. The paper examines strategies of the Human Resources of the Ministry of Health of Ghana to achieve the objectives of reforms which are largely to make quality health care accessible and affordable to the people of Ghana with the right staff doing the right job at the right place. It is an established fact that the success of every organization depends greatly on its human resource. However having the right quantity and quality of employees at the right place is the problem. HRM strategy is about providing the right numbers and calibre of staff; as well as retaining and motivating staff to enhance productivity. There are difficulties in developing appropriate HRM strategies to enable especially public sector organisations achieve their objectives. There is no perfect solution as to how to evolve an effective HRM strategy. Nonetheless there are some general principles of best practice that policy makers should keep in mind. Where these principles are not considered and a balance is not achieved; a policy may be impotent at birth and not facilitate organisational success

Knowledge and Perception of e-Health and Telemedicine among Health Professionals in LAUTECH Teaching Hospital; Osogbo; Nigeria

Depression is a complex but treatable disorder if diagnosed appropriately. However; despite the advances in the understanding of the molecular basis of this disorder and the vast range of medication; psychotherapy and electroconvulsive therapy; very safe and effective drug to treat this disease is still being sought. Several studies suggest that St.John's wort (Hypericum perforatum L.) has phloroglucinol derivative; hyperforin; exhibiting antidepressant activity. This bioactive component can be exploited to create a major shift in the safer treatment of depression

Wellness Programme and Health Policy Development at a Large Faith-Based Organisation in Khayelitsha; South Africa

This paper presents a case study of wellness programme and health policy development based on an HIV/AIDS organisation's Khayelitsha site in the Western Cape Province; South Africa. The study examines the different challenges that the organisation faces in relation to its predominantly low-income staff; donor-driven structure; its limited resources and organisational capacity; and the highly stressful and demanding nature of HIV-related treatment and care. This case study also examines the significant and contentious challenges lying in the organisation's faith-based identity. Research began with a review of civil society organisations' responses to HIV in sub-Saharan Africa; as well as related topics; such as South Africa's public health system; and health-seeking attitudes; beliefs and behaviours in high-risk South African communities. The organisation's health policy was analysed and 'workshopped' with multiple employees. Focus groups were conducted with mid-management and fieldwork staff in the Khayelitsha office; while a comprehensive; anonymous; wellness questionnaire was distributed in order to collect quantitative data. Data acquired from the questionnaire responses and the focus group discussions indicated that wellness programme and health policy development faces its greatest challenges on two fronts; namely due to a critical lack of organisational development and capacity; and a host of practical; social and cultural challenges among the most vulnerable people whom the NGO intends to serve. The study's primary recommendations include: taking its employees' cultural and social norms into consideration; addressing issues related to capacity and organisational development with the major donors; broadening the scope of its health policy to extend beyond issues related to HIV; and examining and clarifying expectations of employee behaviour in light of its identity as a faith-based organisation. The study also issues a secondary list of recommendations for other resource-constrained NGOs that also wish to develop and implement wellness programmes and health policies in their workplace

Challenges of Retaining Health Workers in the PNFP Sector:The Case of Uganda Catholic Health

Shortage of human resource for health poses a major challenge to achieving the millennium development goals. Uganda is among the 57 countries with human resource shortage reaching critical level and the situation is worst at lower levels of the health system. The private-not-for-profit (PNFP) health sub-sector in Uganda complements government efforts to achieve the MDG; the second health sector strategic plan (HSSP II) and the health-related objectives of the poverty eradication plan (PEAP).The Uganda Catholic Medical Bureau coordinates the Roman Catholic health facilities network; one of the three PNFP networks in Uganda. This paper; presented at a conference organized by the Faculty of Health Sciences of Uganda Martyrs University in March 2007; looks at the HRH crisis as experienced by the UCMB network giving the trend; examining the reasons; the destinations of attritional cases and what the network is trying to do to improve human resource stability.The information is based on quarterly reports received by the bureau from its affiliated health facilities

Implementation of the Mental Health Care Act (2002) at District Hospitals in South Africa : Translating Principles into Practice

Legislation prior to 2002 tended to reinforce the alienation; stigmatisation and disempowerment of mentally ill patients in South Africa. In line with international develop- ments in mental health legislation; the Mental Health Care Act (2002) was promulgated in South Africa. Its core principles - human rights for users; decentralisation and integration of mental health care at primary; secondary and tertiary levels of care; and a focus on care; treatment and rehabilitation - are progressive and laudable. However; the task of implementing the requirements of the Act at community and district hospital levels is fraught with problems. Lack of infrastructure; inadequate skills and poor support and training undermine its successful implementation.Health workers already burdened with enormous workloads and inadequate resources struggle to manage mentally ill patients at district hospitals. The 72- hour observation is a particular area of difficulty throughout the country. This paper outlines the rationale and sense behind this legislation; discusses the problems encountered at the 'rock face'; and offers solutions to the problem of translating principles into practice

Addressing the human resources crisis: a case study of the Namibian health service

Background: This paper addresses an important practical challenge to staff management. In 2000 the United Nations committed themselves to the ambitious targets embodied in the Millennium Development Goals (MDGs). Only five years later; it was clear that poor countries were not on track to achieve them. It was also clear that achieving the three out of the eight MDGs that concern health would only be possible if the appropriate human resources (HR) were in place. Method: We use a case study based on semi-structured interview data to explore the steps that Namibia; a country facing severe health problems that include an alarmingly high AIDS infection rate; has taken to manage its health workers. Results: In the fifteen years since independence; Namibia has patiently built up a relatively good strategic framework for health policy in the context of government policy as a whole; including strong training arrangements at every level of health staffing; and it has brought HIV/AIDS under the strategic umbrella through its National Strategic Plan for HIV/AIDS. Its major weakness is that it has not kept pace with the rise in HIV/AIDS and TB infection: the community counselling service; still at the pilot stage at the time of this study; was the only specific response. That has created a tension between building long-term capacity in a strategic context and responding to the short-term demands of the AIDS and TB crisis; which in turn affects the ability of HR to contribute to improving health outcomes. Conclusions: It is suggested that countries like Namibia need a new paradigm for staffing their health services. Building on the existing strategic framework; it should target the training of mid-level cadres. Higher-level cadres should take on the role of supporting and monitoring the mid-level cadres. To do that; they will need management training and a performance management framework for staff support and monitoring

Lost investment returns from the migration of medical doctors from Malawi

Migration of medical doctors from African countries to developed nations compromises the delivery of health care on the continent. The full cost of producing a medical doctor was estimated in Malawi by adding the costs of education from primary school through undergraduate medical education. The cost in fees for one medical doctor produced was US$ 56;946.79. The amount of lost investment returns for a doctor who migrated out and served for 30 years in the receiving country ranged from about US$ 433;493 to US$46 million at interest rates 7and 25; respectively. Quantitative assessments of the estimated loss in investment allows for informed policy discussions and decisions

The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger

Background: For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own.Methods: Information was triangulated from three sources in two rural districts in Niger: first; 46 semi-structured interviews with health centre nurses; second; 42 focus group discussions with an average of 12 participants - patients; relatives of patients and others; third; 231 semi-structured interviews with referred patients.Results: Passive patients without 'voice' reinforce authoritarian attitudes of health centre staff. The latter appear reluctant to refer because they see little added value in referral and fear loss of power and prestige. As a result staff communicates poorly and show little eagerness to convince reluctant patients and families to accept referral proposals.Conclusions: Diminishing referral costs and distance barriers is not enough to correct failing referral systems. There is also a need for investment in district hospitals to make referrals visibly worthwhile and for professional upgrading of the human resources at the first contact level; so as to allow for more effective referral patterns

A model for analysis; systemic planning and strategic synthesis for health science teaching in the Democratic Republic of the Congo: a vision for action

Background: The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care. Methods: Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC); a systemic approach; based on the PRECEDE PROCEED model of analysis; led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals. This article must be read on two complementary levels: one reading; focused on the methodological process; should allow our findings to be transferred to other problems (adaptation of a health promotion model to the educational sphere). The other reading; revolving around the specific theme and results; should provide a frame of reference and specific avenues for action to improve human resources in the health field (using the results of its application in health science teaching in the DRC). Results: The results show that it is important to start this training with a global and integrated approach shared by all the actors. The strategies of action entail the need for an approach taking into account all the aspects; i.e. sociological; educational; medical and public health. Conclusions: The analysis of the results shows that one cannot bring any change without integrated strategies of action and a multidisciplinary approach that includes all the complex determinants of health behaviour; and to do it within the organization of local structures and institutions in the ministry of health in the DRC

The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain

Background: The objective of this paper is to describe the numbers; characteristics; and trends in the migration to the United States of physicians trained in sub-Saharan Africa. Methods: We used the American Medical Association 2002 Masterfile to identify and describe physicians who received their medical training in sub-Saharan Africa and are currently practicing in the USA. Results :More than 23of America's 771 491 physicians received their medical training outside the USA; the majority (64) in low-income or lower middle-income countries. A total of 5334 physicians from sub-Saharan Africa are in that group; a number that represents more than 6of the physicians practicing in sub-Saharan Africa now. Nearly 86of these Africans practicing in the USA originate from only three countries: Nigeria; South Africa and Ghana. Furthermore; 79were trained at only 10 medical schools. Conclusions: Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain

The role of wages in the migration of health care professionals from developing countries

Several countries are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals. This trend has led to concerns that in many of the source countries - especially within Africa - the outflow of health care professionals is adversely affecting the health care system. This paper examines the role of wages in the migration decision and discusses the likely effect of wage increases in source countries in slowing migration flows. This paper uses data on wage differentials in the health care sector between source country and receiving country (adjusted for purchasing power parity) to test the hypothesis that larger wage differentials lead to a larger supply of health care migrants. Differences in other important factors affecting migration are discussed and; where available; data are presented. There is little correlation between the supply of health care migrants and the size of the wage differential between source and destination country. In cases where data are available on other factors affecting migration; controlling for these factors does not affect the result. At current levels; wage differentials between source and destination country are so large that small increases in health care wages in source countries are unlikely to affect significantly the supply of health care migrants. The results suggest that non-wage instruments might be more effective in altering migration flows

Human resources for emergency obstetric care in northern Tanzania: distribution of quantity or quality?

Background: Health care agencies report that the major limiting factor for implementing effective health policies and reforms worldwide is a lack of qualified human resources. Although many agencies have adopted policy development and clinical practice guidelines; the human resources necessary to carry out these policies towards actual reform are not yet in place. Objectives: The goal of this article is to evaluate the current status of human resources quality; availability and distribution in Northern Tanzania in order to provide emergency obstetric care services to specific districts in this area. The article also discusses the usefulness of distribution indicators for describing equity in the decision-making process.Methods: We conducted a quantitative facility survey in six districts of Northern Tanzania. We collected data from all 129 facilities that provide delivery services in the study area. The data includes information on the emergency obstetric care indicators; as described by the WHO/UNICEF/UFPA guidelines for monitoring the provision of obstetric care. The inventory also includes information on the numbers of qualified health personnel at the basic and comprehensive emergency obstetric care level. We analysed the distribution and workload of the available human resources in a wider policy context with a particular focus on equity; use and quality; by means of descriptive statistics and the Spearman's correlation test. Results: We determined that there are adequate human resources allocated for health care provision in Tanzania; according to national standards. Compared to similar countries however; Tanzania has a very low availability of health care staff. Most qualified staff are concentrated in a few centralized locations; while those remaining are inequitably and inefficiently distributed in rural areas and lower-level services. Rural districts have restricted access to government-run health care; because these facilities are understaffed. In fact; voluntary agency facilities in these districts have more staff than the government facilities. There is a statistical correlation between availability of qualified human resources and use of services; but the availability of qualified human resources does not automatically translate into higher availability of qualified emergency obstetric care services. Conclusion: National guidelines for human resources for health care in Tanzania require focused revisions in order to reflect the quality indicators more adequately when monitoring and setting criteria for HR distribution. Availability of qualified personnel as well as institutional management and capacity determine the quality of emergency obstetric care services and personnel. The current wide distribution of staff of inadequate quality should be reconsidered. The use of distribution indicators alone is not useful to properly monitor equity. This article suggests increasing access to high-quality health care instead of distributing low-quality services widely

Wastage in the health workforce: some perspectives from African countries

"Background: Sub-Saharan Africa faces a human resources crisis in the health sector. Over the past two decades its population has increased substantially; with a significant rise in the disease burden due to HIV/AIDS and recurrent communicable diseases and an increased incidence of noncommunicable diseases. This increased demand for health services is met with a rather low supply of health workers; but this notwithstanding; sub-Saharan African countries also experience significant wastage of their human resources stock. Methods: This paper is a desk review to illustrate suggestions that the way human resources for health (HRH) are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers. The paper suggests data types for use in measuring various forms of ""wastage"". Results: ""Direct"" wastage - or avoidable increases in loss of staff through factors such as emigration and death - is on the rise; perhaps as a result of the HIV/AIDS epidemic. ""Indirect"" wastage - which is the result of losses in output and productivity from health professionals' misapplied skills; absenteeism; poor support and lack of supervision - is also common. HIV/AIDS represents a special cause of wastage in Africa. Deaths of health workers; fear of infection; burnout; absenteeism; heavy workloads and stress affect productivity. Conclusion: The paper reviews strategies that have been proposed and/or implemented. It suggests areas needing further attention; including: developing and using indicators for monitoring and managing wastage; enhancing motivation and morale of health workers; protecting and valuing the health worker with enhanced occupational safety and welfare systems; and establishing the moral leadership to effectively tackle HIV/AIDS and the brain drain."