PS018 - Human Resources: Policies and Retention Strategies

Job Satisfaction among Staff in a Rural Hospital in Burundi

Médecins Sans Frontières (MSF) is working in a very poor rural area of Burundi with the aim of improving access and quality of care and supporting the existing health infrastructure. Problems of low morale and thus performance and quality of care among both Ministry of Health (MoH) employees and staff employed through local health structure management (HSM) prompted the MSF to carry out a survey to identify both reasons for staff dissatisfaction and key solutions.

Motivation is affected by a range of factors which can vary depending on the terms of employment (MoH or HSM), levels of training or education, job status and geographical origin. Non-local members of staff with higher levels of training were found to be more likely to be dissatisfied or to leave their jobs. The survey highlighted the following as key issues affecting staff morale:

• The absence of clearly defined job descriptions leading to lack of job satisfaction;
• Poor living conditions and long distances to travel to work;
• Low levels of remuneration and insufficient financial incentives to cover basic needs;
• Working conditions, for example low staffing levels, poor treatment of staff and HR management, lack of safety or protection at work and poor working environment.

Some issues, such as housing, must be dealt with at national level. MSF have implemented the following actions:

• Precise job descriptions for all staff;
• Provision of protective equipment;
• Staff (refresher) training;
• Free health care for staff and direct family.

Due to a particular shortage, incentives to recruit and retain medical doctors include 'specialist' status for all and a significant increase in salary. Nursing staff benefit from increased performance-linked incentives.

Donor Alignment and Harmonisation in Relation to Health Research - Implications for Human Resources for Health Research (HR - HR) Retention

The objectives of this study being carried out by the Council on Health Research for Development (COHRED) are to assess the implementation of the Paris Declaration in the area of Human Resources for Health Research (HR - HR) as well as to gain a better understanding of national health research systems (NHRS) and donor funding strategies in specific donor and African countries.

This Donor Alignment and Harmonisation (AHA) study highlights that NHRS in the five African countries in question are not fully operational. HR - HR at country level is currently characterised by fragmentation, the absence of a defined agenda or operational research policies, limited government funding and a high dependence on external funding. Needs assessments have not been carried out and there is inequity in career development. Donor alignment and harmonisation in support for health research capacity has not yet been achieved. Implications of this include the fragmentation of HR-HR into donor areas of interest, lack of programme continuity, possible brain drain and increased costs. This will lead to problems for governments and institutions in building long-term HR-HR and retention strategies.

To move forward, countries now need to focus on developing the following: a needs assessment of research capacity, dialogue with donors for long-term partnerships, greater links between education and research and also between HR - HR and broader human resources for health initiatives.

Building a Framework for Strengthening Nursing Leadership and Nursing at Muhimbili Hospital

A partnership model between the UK health service and Tanzania is being developed to address the human resources crisis in health care and promote leadership in the nursing profession.

Nurses at Muhimbili Hospital face a range of challenges including staff and equipment shortages, high demand for hospital beds, lack of admission and care protocols and poor employment benefits. More generally, a chronic crisis in recruitment of health care professionals is leading to a serious shortage of nurses. A low professional profile and low levels of motivation, particularly in the public sector, are attracting nurses away to the private sector or abroad and few graduates are joining the profession.

In essence, moving forward depends on "bringing back the vibrancy and motivation" in nursing. Partnership working is essential for the implementation of an effective framework for recruiting and retaining health care staff. A training and professional development programme for nurses is a key priority and must focus on providing high quality pre-service and in-service training for all nursing staff and enabling nurses to share best practice. Skills gaps must be addressed and the right staff matched to the right jobs.