CHP has launched a series of mini-symposia on topical health policy and systems research issues to promote networking and engagement between researchers and policy makers.
The first mini-symposium focused on Human Resources for Health, and was held in October 2011. It featured the Department of Health’s new strategy on Human Resources for Health 2012/13 – 2016/17 and was attended by about 35 researchers and policy-makers.
Health workers are critical to health system functioning and development, and make up a large proportion of health expenditure. There is a global crisis around human resources for health, with insufficient numbers of health workers, inequity around distribution of human resources, an imbalance of skills, poor performance from demotivated staff in poor working conditions, and inadequate information systems for human resource planning and management.
CHP Research on HRH
Outlining CHP’s work in this area, Duane Blaauw and Prudence Ditlopo explained that CHP’s HRH research on health systems are focused on understanding health worker behaviour, motivation and job choices; the ambit of nursing and community health workers; and maternal health. In terms of health policy, CHP is examining health workers as street level bureaucrats and human resources policy interventions. [See below for a list of CHP’s most recent research on HRH.]
One study outlined at the symposium examined the relative importance of different factors on health worker motivation and retention, and the impact of human resources interventions on motivation and retention.
Using in-depth interviews, a health worker survey and discrete choice experiments, the research found financial incentives to be a key motivational determinant, followed by career development and facility management. Hospital infrastructure was cited the least number of times as a motivational determinant. In a survey between South African, Malawian and Tanzanian health workers, only 52% of South African health workers stated they were generally satisfied with their jobs, compared to 71% of Malawians and 82% of Tanzanians. Over 40% of South African health workers declared that they were actively seeking other employment, in contrast to 26% of Malawians and 19% of Tanzanians.
Future research plans include investigating the motivation and performance of nursing managers in hospitals and clinics; exploring factors influencing nurses’ job choices over time; the contribution of the private sector to nurse training; understanding the impact of different payment mechanisms on health worker behaviour and patient attitudes; and assessing whether health systems strengthening, including HRH, can improve maternal health.
“CHP is a small research group. Although we can’t tackle all HRH issues, we want to ensure that our HRH research agenda is relevant to both national and international priorities,” said Dr Blaauw. Consequently, he posed two questions to the delegates for further deliberation: “What are the most important HRH research questions for South Africa at present? Which HRH research questions should CHP focus on given its orientation, skills and capacity?”
Human Resources for Health Strategy
Presenting a bird's eye view of the HRH strategy was consultant, Dr Brigid Strachan, who assisted the National Department of Health in compiling the document, which she described as a guide for action. She welcomed CHP's speedy response to the strategy and the opportunity for engagement.
"Leadership and participation with groups like this are critical for the way forward," she commented.
This view was echoed by her colleagues, Tebogo Gumede and Maggie Ravhengani in the NDOH, who said the strategy was a working document with acknowledged gaps, including the issue of demand: there is no evidence for the health workers and their skill levels, and where the gaps are. They mentioned that the Director-General was open to meetings with academics and researchers to help with implementation based on evidence.
"We'd like your research briefs to see the opportunities for synergy between research and policy. This forum is useful to see what's happening and is a way of communicating to ensure the information reaches those who should get it," said Ms Ravhengani.
The delegates agreed there was often a gap between technical expertise and implementation process, and that the current strategy would require strong project management to ensure an effective process of reform, of institution building as outlined in the strategy. Other gaps included the issue of clinical associates and the role of provinces and municipalities, where human resources needed to be strengthened as part of a management issue.
CHP’s recent research on Human Resources for Health includes:
Motivation study: - The relative importance of different factors on health worker motivation and retention- The impact of different HR interventions on motivation and retention
Consortium for Research on Equitable Health Systems (CREHS):- Attitudes and values of final year nursing students towards working in rural areas- Relative effectiveness of different policy interventions to increase nurses in rural areas- Factors influencing nurses’ job choices
Research on the State of Nursing (RESON):- Patterns and health system consequences of nursing casualisation (moonlighting/agency nursing)- Analysis of nursing policy development and implementation with particular reference to the Nursing Strategy, the Occupational Specific Dispensation (OSD) for nurses, the nursing scope of practice, and reform of nursing qualifications
Community Health Worker (CHW) study:- To determine whether services provided by CHWs contribute to comprehensive primary health care
Researching Access to Health Care (REACH):- Exploring equity of access to antiretroviral, TB and comprehensive emergency obstetric care services- Health worker attitudes and practices as barriers to access