Scaling training facilities for patent and proprietary medicine vendors in Nigeria: insights and lessons learned for policy implication and future partnerships.

Patent and proprietary medicine vendors in Nigeria play a very integral role in providing primary health care services and are an important source of care for the poor. They are located close to communities and are often the first source of care for hygiene and family planning (FP) products and treatment of child illnesses. Since 2017, Pharmacy Council of Nigeria (PCN) has partnered with Society for Family Health through the IntegratE project to address the poor quality of services by patent and proprietary medicine vendors (PPMVs) and reposition them for better service delivery through piloting the three-tier accreditation system. The partnership has engendered innovation for human resource for health, and considering the peculiarity of their situation, new emerging methods and arrangements to deliver the training to PPMVs in diverse geographical locations within their catchment areas are developed. In this study, we aimed to discuss the role of patent and proprietary medicine vendors in the provision of quality health delivery and provide key lessons and recommendations which have been learned from the pilot scaling of training facilities for PPMVs in Nigeria through the IntegratE project. From the lessons learnt, we propose that, for a successful scale-up of implementation of the three-tier accreditation of PPMVs, PCN will have to establish a budget line for accreditation. In addition, the government should also consider supporting this training through the Basic Healthcare Provision Fund as a way of strengthening human resources at the primary healthcare level. Other alternative sources of funding include licensing and registration fees and other dues generated internally by PCN.

Mapping the Locations of Medical Specialists in the Ministry of Health's Hospitals in Malaysia by Specialty, Subspecialty and Area of Interest.

Mapping the distribution of medical specialists in the Ministry of Health (MOH) Malaysia facilities is expected to be more complex as the demand for specialty and subspecialty services increases in the future. A more robust and definitive gap analysis is needed to facilitate planning and resource allocation. The Medical Development Division developed a master list of framework of specialties, subspecialties and areas of interest, and Specialist Database Module in the Medical Programme Information System (MPIS) as tools to facilitate mapping of services. Relational database of specialists' location, facilities, workload, population profile and other relevant parameters were developed to provide data visualisation in specific dashboard. Needs versus supply ratio is proposed as one of parameters to visualise specialised medical services distribution by geographical localities.

A multi-phase approach for developing a conceptual model for human resources for health observatory (HRHO) toward integrating data and evidence: a case study of Iran.

BACKGROUND: Evidence-informed policymaking on human resources for health (HRH) has been directly linked with health system productivity, accessibility, equity, quality, and efficiency. The lack of reliable HRH data has made the task of planning the HRH more difficult in all settings. AIM: This study aimed to develop a conceptual model to integrate HRH data and evidence. METHODS: The current study is a mixed-method study conducted in three phases: a rapid literature review, a qualitative phase, and an expert panel. Firstly, the electronic databases were searched up to 2018. Then, in the qualitative phase, semi-structured interviews with 50 experts were conducted. Data analysis was performed using the content analysis approach. After several expert panels, the draft of the model was validated with 15 key informants via two Delphi rounds. RESULTS: Our proposed model embraces all dominant elements on the demand and supply side of the HRH in Iran. The conceptual model consists of several components, including input (regulatory system, structure, functions), educational system (pre-service and in-service education), health labor market structure, process (technical infrastructure), and output (productions, policymaking process). We considered networking toward sustainable interaction among stakeholders, and also the existence of capacity to integrate HRH information and produce evidence for actions. CONCLUSION: The proposed model can be considered a platform for developing a harmonized system based on the HRH data flow to evidence-informed decision-making via networking. We proposed a step-by-step approach for the sustainability of establishing a national human resources for health observatory (HRHO). The proposed HRHO model can be replicable and flexible enough to be used in different context domains.

PUSK AND PULL FACTORS OF EMIGRATION AMONG PHYSICIAN IN NIGERIA.

Background: Physician emigration is increasing exponentially in developing countries. In Nigeria, with the last decade's unprecedented brain drain, it has gained the popular moniker 'japa syndrome'. Aim: This study aimed to determine push and pull factors affecting physician migration in Nigeria, to provide evidence-backed recommendations for physician retention policies. Materials/Methods: A cross-sectional study was conducted among attendees at the 2022 Abuja Cardiovascular Symposium hosted by Limi Multispecialty Hospital and the Nigerian Cardiac Society. Convenience and snowball sampling were used, and 295/400 responded to comprehensive self-administered questionnaires (73.7% response rate). Data was analysed using SPSS v.26. Results: Most participants (79.4%) were aged 20-39 years (Mean 35 years SD ±10.17); female (58.6%); married (58.4%) and had family size below six (73.6%). About 85.8% were employed, and 55.9% worked in private establishments. Solely basic medical degrees were possessed by 64.4%, and 63.7% earned N300,000-N399,999 (USD 396.82-USD 527.78) monthly. Top destinations were UK (50.5%), Canada (43.3%), and USA (37.9%), with low remuneration (71.2%), insecurity (62.7%), and difficult working environments (55.9%) most frequent push factors. Postgraduate-training frustrations (38.6%), and limited educational opportunities for oneself (37.6%), children (26.4%), or spouse (19.7%) were the least. High earning potential (76.6%), career growth opportunities (70.8%), and high-level equipment/technology (54.9%) were frequent pull factors. Conclusion: Physician emigration threatens Nigeria's health system and should be addressed multi-sectorally to boost physician remuneration and improve work environments and societal security. Additionally, innovative education and digital technology would encourage health workforce retention.

How Many Doctors Do We Need in the Public Sector?: A Guide to Human Resource Planning and Specialist Training.

Estimating number of doctors including medical specialists needed in the public sector is fundamental to guide human resource planning and implementation of specialist training in Malaysia. Crude population-based and individual basic specialities population-based ratios were used to estimate number of doctors including specialists needed in the public sector by 2025 and 2030. These estimates were then compared with existing number of specialists, current production rates and other parameters to determine level of deficit of the various medical specialities in the future. Medical specialist production versus deficit index was introduced as a tool to present the expected outcome of the existing specialist training. The index can be used as a guide to strategise policies and implementation plans related to training and human resource.

Applying the workload indicators of staffing needs method in nursing health workforce planning: evidences from four hospitals in Vietnam.

BACKGROUND: Vietnam has encountered difficulties in ensuring an adequate and equitable distribution of health workforce. The traditional staffing norms stated in the Circular 08/TT-BYT issued in 2007 based solely on population or institutional size and do not adequately take into consideration the variations of need such as population density, mortality and morbidity patterns. To address this problem, more rigorous approaches are needed to determine the number of personnel in health facilities. One such approach is Workload Indicators of Staffing Need (WISN) developed by the World Health Organization (WHO), a facility-based workforce planning method that assists managers in defining the responsibilities of different workforce categories and improving the appropriateness and efficiency of a staff mix. METHODS: This study applied the WISN approach and was employed in 22 clinical departments at four hospitals in Vietnam between 2015 and 2018. 22 targeted group discussions involving nurses were conducted. Hospital personnel records have been retrieved. The data were analyzed according to WISN instructions. RESULTS: Of the 22 departments, there was a shortage of 1 to 2 nurses in 10 departments, with WISN ratios ranging between 0.88 and 0.95. Only 01 clinical colleges at Can Tho Hospital lacked 05 nurses, facing a high workload with a WISN ratio of 0.78. Administrative time represented 20-40% of the total work time of a nurse. In comparison, nurses at Can Tho Hospital spent time on administration from 24 onwards. 5-41.7% of their working time while nurses at Thanh Hoa Hospital spent 21-33%. CONCLUSIONS: The application of the WISN enabled health managers to analyze the workload of nurses, calculate staffing needs, and thus effectively contribute to the workforce planning process. It is expected that the results of this research will encourage the use of the WISN tool in other hospitals and health facilities across the health system. At provincial and national levels, this study provides important evidence to help policy makers develop guidelines for personnel norms for health facilities in the context of limited resources, while the existing regulation is no longer appropriate.

Establishing an Observatory on Human Resources for Health (HRH) in Iran: A Qualitative Case Study.

Background: Many countries face critical challenges due to shortage and maldistribution of human resources for health (HRH). An HRH observatory can be used as a mechanism to monitor HRH issues and facilitate evidence-based decision-making. This study aims to identify the essential elements of an HRH observatory for Iran. Methods: This qualitative study was conducted through semi-structured interviews with 30 key informants over two months since May 2019. Purposeful and snowball sampling methods were used. Each interview lasted a minimum of 60 min. Data analysis was performed using the content analysis approach. Results: The essential elements for integrating HRH information were categorized into the following themes: organizational structure, partnership, prerequisites for implementing HRH observatory, data management, and evidence-informed policymaking. Our results propose a national HRH observatory for Iran consisting of steering, technical and research boards, and also stakeholders' and research networks under the governance of the ministry of health and medical education (MOHME). It is required to make a comprehensive plan in several steps and arrangements based on the country's situation. The stakeholder's network was identified based on their role in HRH development and production of information and evidence. The main aim of the HRH observatory considers monitoring trends in patterns of the HRH for evidence-based decision-making and policy development. Our results propose an evidence development network consisting of a national HRH Research Center (HRHRC) and a cooperative network formed by several medical universities. Conclusion: We provide a comprehensive approach to establishing a national HRH observatory. We consider the HRH observatory as a cooperative initiative among key stakeholders to produce knowledge in order to improve human resource policymaking. The proposed HRH observatory model emphasizes networking and stakeholder involvement.

Size, composition and distribution of health workforce in India: why, and where to invest?

BACKGROUND: Investment in human resources for health not only strengthens the health system, but also generates employment and contributes to economic growth. India can gain from enhanced investment in health workforce in multiple ways. This study in addition to presenting updated estimates on size and composition of health workforce, identifies areas of investment in health workforce in India. METHODS: We analyzed two sources of data: (i) National Health Workforce Account (NHWA) 2018 and (ii) Periodic Labour Force Survey 2017-2018 of the National Sample Survey Office (NSSO). Using the two sources, we collated comparable estimates of different categories of health workers in India, density of health workforce and skill-mix at the all India and state levels. RESULTS: The study estimated (from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses/midwives (2.34 million), pharmacist (1.20 million), dentists (0.27 million), and traditional medical practitioner (AYUSH 0.79 million). However, the active health workforce size estimated (NSSO 2017-2018) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million, respectively. Stock density of doctor and nurses/midwives are 8.8 and 17.7, respectively, per 10,000 persons as per NHWA. However, active health workers' density (estimated from NSSO) of doctor and nurses/midwives are estimated to be 6.1 and 10.6, respectively. The numbers further drop to 5.0 and 6.0, respectively, after accounting for the adequate qualifications. All these estimates are well below the WHO threshold of 44.5 doctor, nurses and midwives per 10,000 population. The results reflected highly skewed distribution of health workforce across states, rural-urban and public-private sectors. A substantial proportion of active health worker were found not adequately qualified on the one hand and on the other more than 20% of qualified health professionals are not active in labor markets. CONCLUSION: India needs to invest in HRH for increasing the number of active health workers and also improve the skill-mix which requires investment in professional colleges and technical education. India also needs encouraging qualified health professionals to join the labor markets and additional trainings and skill building for already working but inadequately qualified health workers.

System dynamics modelling of health workforce planning to address future challenges of Thailand's Universal Health Coverage.

BACKGROUND: System dynamics (SD) modelling can inform policy decisions under Thailand's Universal Health Coverage. We report on this thinking approach to Thailand's strategic health workforce planning for the next 20 years (2018-2037). METHODS: A series of group model building (GMB) sessions involving 110 participants from multi-sectors of Thailand's health systems was conducted in 2017 and 2018. We facilitated policymakers, administrators, practitioners and other stakeholders to co-create a causal loop diagram (CLD) representing a shared understanding of why the health workforce's demands and supplies in Thailand were mismatched. A stock and flow diagram (SFD) was also co-created for testing the consequences of policy options by simulation modelling. RESULTS: The simulation modelling found hospital utilisation created a vicious cycle of constantly increasing demands for hospital care and a constant shortage of healthcare providers. Moreover, hospital care was not designed for effectively dealing with the future demands of ageing populations and prevalent chronic illness. Hence, shifting emphasis to professions that can provide primary care, intermediate care, long-term care, palliative care, and end-of-life care can be more effective. CONCLUSIONS: Our SD modelling confirmed that shifting the care models to address the changing health demands can be a high-leverage policy of health workforce planning, although very difficult to implement in the short term. of health workforce planning, although very difficult to implement in the short term.

Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements.

BACKGROUND: The shortage of a skilled health workforce is a global crisis. International efforts to combat the crisis have shown few benefits; therefore, more country-specific efforts are required. Tanzania adopted health sector reforms in the 1990s to ensure, among other things, availability of an adequate skilled health workforce. Little is documented on how the post-reform training and deployment of medical doctors (MDs) have contributed to resolving Tanzania's shortage of doctors. The study aims to assess achievements in training and deployment of MDs in Tanzania about 20 years since the 1990s health sector reforms. METHODS: We developed a human resource for health (HRH) conceptual model to study achievements in the training and deployment of MDs by using the concepts of supply and demand. We analysed secondary data to document the number of MDs trained in Tanzania and abroad, and the number of MDs recommended for the health sector from 1992 to 2011. A cross-sectional survey conducted in all regions of the country established the number of MDs available by 2011. RESULTS: By 1992, Tanzania had 1265 MDs working in the country. From 1992 to 2010, 2622 MDs graduated both locally and abroad. This translates into 3887 MDs by 2011. Tanzania needs between 3326 and 5535 MDs. Our survey captured 1299 MDs working throughout the country. This number is less than 40% of all MDs trained in and needed for Tanzania by 2011. Maldistribution favouring big cities was evident; the eastern zone with less than 30% of the population hosts more than 50% of all MDs. No information was available on the more than 60% of MDs uncaptured by our survey. CONCLUSIONS: Two decades after the reforms, the number of MDs trained in Tanzania has increased sevenfold per year. Yet, the number and geographical distribution of MDs practicing in the country has remained the same as before the reforms. HRH planning should consider the three stages of health workforce development conceptualized under the demand and supply model. Auditing and improvement of the HRH database is highly recommended in dealing with Tanzania's MD crisis.

Auxiliary midwives in hard to reach rural areas of Myanmar: filling MCH gaps.

BACKGROUND: Auxiliary Midwives (AMWs) are community health volunteers supporting the work of midwives, especially maternal and child health services in hard to-reach areas in Myanmar. This paper assessed the contributions of AMW to maternal and child health services, factors influencing their productivity and their willingness to serve the community. METHOD: The study applied quantitative cross-sectional survey using census method. Total of 1,185 AMWs belonging to three batches: trained prior to 2000, between 2000 and 2011, and in 2012, from 21 townships of 17 states and regions in Myanmar participated in the study. Multiple logit regression was used to examine the impact of age, marital status, education, domicile, recruitment pattern and 'batch of training', on AMW's confidence level in providing care, and their intention to serve the community more than 5 years. RESULTS: All AMWs were able to provide essential maternal and child health services including antenatal care, normal delivery and post-natal care. They could identify and refer high-risk pregnancies to larger health facilities for proper management. On average, 9 deliveries, 11 antenatal and 9 postnatal cases were performed by an AMW during the six months prior to this study. AMWs had a comparative advantage for longer service in hard-to-reach villages where they lived, spoke the same dialect as the locals, understood the socio-cultural dimensions, and were well accepted by the community. Despite these contributions, 90 % of the respondents expressed receiving no adequate supervision, refresher training, replenishment of the AMW kits and transportation cost. AMWs in the elder age group are significantly more confident in taking care of the patients than those in the younger groups. Over 90 % of the respondents intended to stay more than five years in the community. The confidence in catering services appeared to have significant association with a longer period of stay in AMW jobs as evidenced by the odds ratio of 3.5, compared to those reporting unconfident. CONCLUSIONS: Comprehensive support system and national policy are needed to sustain and strengthen the contributions of AMWs, in sharing the workload of midwives, particularly in hard-to-reach areas of Myanmar.

"I am the one taking care of her and donating blood": lived experiences of role-routines of hospital-based informal caregiving in Nigeria.

PURPOSE: Informal caregivers (ICs) in Africa perform a long list of tasks to support hospitalization care. However, available studies are weak in accounting for the experiences of everyday role-routines of hospital-based informal caregiving (HIC) in under-resourced settings. This article explored the experiences of role-routines among informal caregivers in a Nigerian tertiary health facility. METHODS: The ethnographic exploratory study relied on primary data collected from 75 participants, including 21 ICs, 15 inpatients, 36 hospital staff, and 3 ad-hoc/paid carers in a tertiary health facility in Southwestern Nigeria. RESULTS: ICs perform several essential roles for hospitalized relatives, with each role characterized by a range of tasks. An integrative narrative of everyday routines of HIC as experienced by ICs showed critical complexities and complications involved in seemingly simple tasks of assisting hospitalized relatives with hygiene maintenance, medical investigations, blood donation, resource mobilization, errand-running, patient- and self-care and others. The role-routines are burdensome and ICs' experiences of them revealed the undercurrents of how health systems dysfunctions condition family members to support hospitalization care in Nigeria. CONCLUSION: The intensity and repetitive nature of role-routines is suggestive of "routinization of suffering". We recommend the closing of gaps driving hospital-based informal caregiving in Africa's under-resourced settings.

Attrition of dental therapists in South Africa-A 42-year review.

INTRODUCTION: Dental therapists are mid-level oral healthcare providers introduced in 1977 to the South African health system to improve access to oral health services. There has, however, been anecdotal evidence of their unusually high rate of attrition that is cause for concern. AIM AND OBJECTIVES: This study aimed to determine the demographic profile and attrition rate among members of the South African Dental Therapy profession. METHODS: A retrospective time series review of records of all dental therapists who were previously registered and who are still registered with the Health Professions Council of South Africa (HPCSA) between 1977 and 2019 was conducted. RESULTS: A total of 1232 dental therapists were registered from 1977 to 2019. The majority (64%) were Africans. Most practicing dental therapists were based in KwaZulu-Natal (44%) and Gauteng (27%), which are the provinces where dental therapists are trained. The overall attrition rate between 1977 and 2019 was 40%, with a figure of 9% for the last 10 years of the study (2010 to 2019). CONCLUSION: This study has provided the first evidence of the high attrition rate of dental therapists in South Africa. The high attrition warrants further investigation to address the loss of valuable human resources from an already overburdened and under-resourced public oral health sector.

"What Are You Really Doing in This Country?": Emigration Intentions of Nigerian Doctors and Their Policy Implications for Human Resource for Health Management.

The emigration of doctors from Nigeria has been on the increase in recent years, with no obvious efforts to manage or mitigate the negative impacts of this growing trend on the already weak health system. This study assessed the emigration intentions of doctors undergoing residency training at the premier tertiary healthcare center in Nigeria and the factors that influence these intentions. This mixed-method study was cross-sectional in design. A semi-structured questionnaire was used to identify the factors that influence the emigration intentions of resident doctors at the University College Hospital, Ibadan, Southwest Nigeria. In-depth interviews (IDIs) were also conducted to further explore the push and pull factors identified from the survey and their migration preferences. A total of 244 resident doctors completed the questionnaires and 10 participated in the IDIs. Overall, 57.4% of the respondents had emigration intentions and 34.8% had made various attempts at emigrating. Major factors that encouraged resident doctors to emigrate to developed countries included better working and living conditions, good salary and the opportunity for career advancement in destination countries. Family ties was the single most important factor that deterred resident doctors from emigrating. The UK was found to be the top preferred destination. Strategic approaches and multisectoral collaborations will be required to address doctors' emigration from Nigeria. These efforts should be targeted at not just the health sector but should also include the social and economic aspects of the lives of resident doctors, to improve their living conditions.

Assessment of Resources for Primary Health Care: Implications for the Revitalization of Primary Health Care in Akwa Ibom, Nigeria.

CONTEXT: Primary health care (PHC) is the cornerstone of the Nigerian National Health Policy. The national policy on PHC under one roof is undergoing implementation nationwide as a means of strengthening the PHC system. Akwa Ibom State (AKS) is set to commence full implementation of the policy. AIMS: The aim of the study was to assess the existing human resource and infrastructure in PHC facilities in AKS. SETTINGS AND DESIGN: A descriptive cross-sectional study was carried out in 18 facilities selected from the three senatorial zones of AKS, Nigeria. SUBJECTS AND METHODS: A rapid assessment of selected PHC facilities based on a checklist adapted from the minimum standards for PHC as provided by the National PHC Development Agency. The results were analyzed using Excel and presented in tables. RESULTS: A total of 18 health facilities were included in the study. Human resources available were 276 full time core health workers, of which 48 (17.4%) were volunteer workers. There was inequitable distribution in district and facility type as 122(44.2%) work in Ikot Ekpene Senatorial district and 242 (87.7%) of them work in the Operational Base. Basic lifesaving equipment such as resuscitation sets was unavailable in more than 50% of the health facilities. CONCLUSIONS: There are absolute deficit and inequitable distribution of available human resources in AKS PHCs. Basic-lifesaving equipment is grossly inadequate. There is an urgent need for more health workers to be employed and provision of basic equipment for the PHCs.

Impact of the COVID-19 pandemic on the human resources for health in India and key policy areas to build a resilient health workforce.

The COVID-19 pandemic has disrupted the already low resourced, fragmented and largely unregulated health systems in countries like India. It has only further exacerbated the stress on human resources for health (HRH) in many unanticipated ways. We explored the effect of COVID-19 pandemic on the health workforce in India, and analytically extrapolated the learnings to draw critical components to be addressed in the HRH policies, which can further be used to develop a detailed 'health workforce resilience' policy. We examined the existing literature and media reports published during the pandemic period, covering the gaps and challenges that impeded the performance of the health workers. Recommendations were designed by studying the learnings from various measures taken within India and in some other countries. We identified seven key areas that could be leveraged and improved for strengthening resilience among the health workforce. The system-level factors (at macro level) include developing a health workforce resilience policy, planning and funding for emergency preparedness, stakeholder engagement and incentivization mechanisms; the organization-level factors (meso level) include identifying HRH bench strength, mobilizing the health workforce, psycho-social support, protection from disease; and the individual-level factors (micro level) include measures around self-care by health workers. In keeping with the interdisciplinary nature of the associated factors, we emphasize on developing a future-ready health workforce using a multi-sectoral approach for building its strength and resilience.

Assessing the governance of human resources for health in Iran: A qualitative study.

BACKGROUND: The main issue for advancing any health system is human resources for health (HRH); although efforts to address HRH shortage and performance have accelerated over recent years, HRH is still a problem for delivering quality services. Addressing key governance issues is essential for developing capable health workforce, and good governance should be an integral part of planning and implementation of HRH. MATERIALS AND METHODS: This is a qualitative study, undertaken in 2017. Data processing included 14 in-depth interviews with the experts of human resource management in medical universities and the Ministry of Health and Medical Education. The sampling was carried out using purposeful sampling method and continued until reaching data saturation. Data analysis was performed using subject analysis method. RESULTS: This study assessment of the human resource governance in ten principles includes strategic vision, participation and consensus orientation, rule of law, transparency, responsiveness, equity and inclusiveness, effectiveness and efficiency, accountability, intelligence and information, and ethics. The result showed that although MOHME tries to reduce insufficient and unbalance's human resources and expand the capacity building in human resource planning, there are not enough practical knowledge and skills among policy-makers. CONCLUSIONS: Strengthening human resource governance should have been among the priorities identified in the health national strategy and government should have a long-term perspective, and all key factors in government, civil society, academia, and other stakeholders should participate in human resource policy-making and their participations should be accepted as a culture.

To establish a talent pool for global health in China: from political will to action.

Recently, China has played a more and more important role in global health, mainly by improving health outcomes of its own population nationwide and participating international health activities. In addition, China has participated in a dozen of international organizations, which all contained health domains, particularly the Belt and Road Initiative with an ambitious goal to improve health of the people in the countries alongside closely partnered with the World Health Organization. All these highlight the need of human resource for global health at the national level. The National Health and Family Planning Commission translated this political will into action - that a talent pool candidate for global health will be established in China. The establishment of the talent pool would be of great significance for China's engagement in global health activities. However, much work, such as training, collaboration, and innovation, etc., remains to be done in the future. Based on the successful practice, China can share lessons learned to other countries.

Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda.

BACKGROUND: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. METHODS: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. RESULTS: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. CONCLUSION: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.

The effect of mutual task sharing on the number of needed health workers at the Iranian Health Posts; Does task sharing increase efficiency?

BACKGROUND: Nowadays task sharing is a way to optimize utilization of human resources for health. This study was designed to assess the effect of task sharing, mutually between midwives and Family Health Workforces (FHWs), on the number of needed staff across the Iranian Health Posts. METHODS: The workload and required number of midwives and FHWs in a Health Post were calculated and compared in two different scenarios of task division using a combined approach for estimating the number of required staff. In the first scenario, the midwives and FHWs provide their specialized services and in the second one, using mutual task sharing, a midwife provides all services traditionally delivered by FHWs and each FHW provides prenatal care in addition to the special tasks. Sensitivity analysis was performed to estimate the effects of different hypotheses. RESULTS: By applying mutual task sharing, the required number of staff for Health Posts was one midwife and two FHWs for a standard population of 12,500; one FHW less than that when no task sharing was applied. Sensitivity analysis illustrated that the number of needed staff is the same in both scenarios when different demographic, epidemiologic, cultural and organizational conditions were applied. CONCLUSION: Task sharing can reduce the required number of health workers which increases efficiency and productivity at health facilities. However, apart from a need to consider quality, acceptability, and feasibility of care, increasing efficiency must be judged against the contextual circumstances.