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Challenges Associated with Human Resources for Health

In this video, Assefa Seme Deresse shares some lessons learned from human resources challenges in the polio eradication campaigns. (Step 4.5)
ASSEFA SEME DERESSE: Our next topic is about the challenges associated with human resources for health. The challenges that are associated with human resources for health include, generally, shortage, means not having enough skilled workers, maldistribution– a situation where the skilled workers are concentrated in one area when there are deficits in other areas, concentration is mostly happening in urban areas– skill mix imbalance– the skills workers have may not be the ones that are needed. And the other is motivation. Some of the health worker’s workforces are demotivated to work in some areas. And then the other general human resource challenge is migration, where workers may leave for higher paying jobs in other countries, or within a country itself.
So think about how polio eradication officials overcome some of these challenges in your setting. Some of the measures that are taken is, like, task modifications for unskilled or semi-skilled workers, or pulling on a wide range of workers, including those outside the health sector. And some technical assistance from other countries could be one of the strategies that the officials usually take into account to overcome those challenges. The other challenge that’s usually associated with human resources for health is high turnover. Because of their overworked and poorly paid status in some of the facilities and some of the countries, inconducive working environment in some areas because of the poor infrastructure, lack of appropriate provisions, or poor accountability.
Usually, health workers, there is a high turnover of health workers. Shortage of well-trained staff across activities, especially in high dense population, is some of the challenges that some countries have already faced. With regard to turnover, here is one of their knowledge on what the policymakers has to say. The turnover of health workers is too fast. After they are trained, sometimes, after six months or one year, they have moved to other departments. Certain regions have a lesser number. Sometimes they have double or triple job. This is an issue that goes beyond polio eradication, but it has impact on polio eradication activities. Is this an issue in your area? Why would this be the case?
The second example is an example taken from India. A respondent says the following. Motivation factor and money factor, the frontline workers getting small money and still, we have three campaigns slotted for 2019. So the demotivation factor will come again and then we have to compromise on the quality. And this is a big challenge. Is this an issue in your area? Why would this be the case? Recruitment is another challenge associated with polio human resources for health. Political appointment of staff, especially in leadership roles, resulting in unqualified persons running the program when there is an appropriate qualified person to be placed in the post. Deployment is another important challenge.
Unequal distribution of health workers in terms of geographical areas, health establishment, gender, category of workers, is one of the challenges that usually faced the country. Health workers from other programs pulled in to support polio program activities, and this results in disturbing the other programs. This is a situation some countries have already faced. Here are some more challenges that have been faced in different context of the global polio eradication initiative. These are some more challenges that have been faced in different contexts of the global polio eradication initiatives. How are these challenges played out in your context? Another example from an Indonesian policymaker. Concerning challenges facing human resources for health, here is what he has to say.
In conducting national immunization days, many challenges came from infrastructure and geographical barriers. For example, in 1995, health staff had to leave for the area they weren’t working two days before the national immunizing days due to difficult transportation. If the boat could not operate, they had to walk to that village carrying all the equipment, such as fridge and generator to keep the vaccine. Is this an issue in your area? Why would this be the case? Could this be solved by hiring local health workers? What might be some of the challenges there? Here are some more challenges that have been faced in different contexts, funding.
Irregular payment due to lack of coordination and transparency between actors, and a target-based funding is a problem that is associated with human resources for health for polio eradication. Security is another challenge, where killing and harassing of health workers in areas of conflict and instability, that paves the lives of many health workers. The motivation, that is associated with poor supervision and support from the higher authorities, low morale due to prolonged activities, and some health workers stay in the same place all of their time and they’re distrustful of the system are some of the challenges that has been associated with human resources for health. How do you think these challenges play out in your text?
And what solutions might exist for such problems? Here is a statement that an Ethiopian health worker mentioned while being interviewed about the challenges associated with human resources for health. The work makes you tired. Working home-to-home makes you tired. Working like this for so many years makes you tired. When you go, you don’t find them. When you go the next day, you don’t get them again because they are out for work. Such things have an impact on the effort of the campaign.

Assefa Seme Deresse, MD, MPH School of Public Health, Addis Ababa University, Ethiopia

Consider the lecture and reading “Polio eradication: Mobilizing and managing the human resources”.

Can you think of unique features of the polio eradication initiative, that have resulted in some of the challenges described here?

Post your answers in the discussion section. Then, collaborate with other learners. Respond to one post with your thoughts on: What steps could have been taken to stop this challenge from occurring?

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Planning and Managing Global Health Programmes: Promoting Quality, Accountability and Equity

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