tailieunhanh - báo cáo sinh học:" Health workforce responses to global health initiatives funding: a comparison of Malawi and Zambia"

Tuyển tập các báo cáo nghiên cứu về sinh học được đăng trên tạp chí sinh học quốc tế đề tài : Health workforce responses to global health initiatives funding: a comparison of Malawi and Zambia | Brugha et al. Human Resources for Health 2010 8 19 http content 8 1 19 HUMAN RESOURCES FOR HEALTH RESEARCH Open Access Health workforce responses to global health initiatives funding a comparison of Malawi and Zambia 2 3 1 4 1 Ruairí Brugha 1 John Kadzandira Joseph Simbaya Patrick Dicker Victor Mwapasa Aisling Walsh Abstract Background Shortages of health workers are obstacles to utilising global health initiative GHI funds effectively in Africa. This paper reports and analyses two countries health workforce responses during a period of large increases in GHI funds. Methods Health facility record reviews were conducted in 52 facilities in Malawi and 39 facilities in Zambia in 2006 07 and 2008 quarterly totals from the last quarter of 2005 to the first quarter of 2008 inclusive in Malawi and annual totals for 2004 to 2007 inclusive in Zambia. Topic-guided interviews were conducted with facility and district managers in both countries and with health workers in Malawi. Results Facility data confirm significant scale-up in HIV AIDS service delivery in both countries. In Malawi this was supported by a large increase in lower trained cadres and only a modest increase in clinical staff numbers. Routine outpatient workload fell in urban facilities in rural health centres and in facilities not providing antiretroviral treatment ART while it increased at district hospitals and in facilities providing ART. In Zambia total staff and clinical staff numbers stagnated between 2004 and 2007. In rural areas outpatient workload which was higher than at urban facilities increased further. Key informants described the effects of increased workloads in both countries and attributed staff migration from public health facilities to non-government facilities in Zambia to PEPFAR. Conclusions Malawi which received large levels of GHI funding from only the Global Fund managed to increase facility staff across all levels of the health system urban district