Human resources in health systems

RESYST research has explored a number of issues related to nursing labour markets in low and middle income countries. A cohort of South African nursing graduates was followed for a number of years to investigate their job choices, with a focus on retention in rural areas. Other work in Thailand, India and Kenya investigated the expanding role played by private nurse training institutions, identifying a range of challenges relates to integration of graduates from these programmes into the public health system.

Lucy Gilson works in South Africa with wider teams of researchers, educators and health managers on a Health system leadership and change programme. Working in this embedded way, while linking research and educational activities, involves direct, regular and continuing engagement with policy-makers and health care managers, offering opportunities for policy influence. It allows the development of shared ideas, as well as opportunities to support changes in policy and practice for health system development.

Community health volunteers as mediators of accessible and responsive community health systems: lessons from the Health Development Army in Ethiopia – Funded by MRC/DFID/ESRC/ Wellcome Trust Joint Health Systems Research Initiative, Dina Balabanova, Martin McKee, Susannah Mayhew and Mirkuzie Woldie Kerie and team in Jimma University are studying whether community volunteers can improve appropriateness and acceptability of health services, and improve access and the uptake of essential interventions. The project explores the role of community volunteers in Oromia region known as the Health Development Army, serving as mobilisers, service providers and intermediaries between the population and the health system, as well as agents for good governance. Focus group discussions, semi- structured and key informant interviews and policy analysis in locations characterised with different health system performance, are combined with self-directed video diaries to enable volunteers to provide authentic narratives and allow co-production of research findings. The project synthesises the evidence on the role of the community volunteers worldwide.

Other HPSR work includes understanding the health systems conditions promoting effective task shifting of HIV/AIDS treatment roles to nurses in Uganda based on mixed quantitative and qualitative methods, and philanthropic foundations’ strategic priority setting and grant making decisions based on qualitative key informant interviews supervised by Neil Spicer.

Natasha Howard and Elizabeth Speakman have been working with colleagues from the Royal Tropical Institute Amsterdam, Médecins Sans Frontières, and Jhpiego to assess initiatives to train and embed skilled midwives within remote under- resourced communities as a means of strengthening health services provision and improving maternal and neonatal survival in fragile and conflict-affected settings.


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