Jeff Gow

Salaries and incomes of health workers in sub-Saharan Africa

Public-sector health workers are vital to the functioning of health systems. We aimed to investigate pay structures for health workers in the public sector in sub-Saharan Africa; the adequacy of incomes for health workers; the management of public-sector pay; and the fiscal and macroeconomic factors that impinge on pay policy for the public sector. Because salary differentials affect staff migration and retention, we also discuss pay in the private sector. We surveyed historical trends in the pay of civil servants in Africa over the past 40 years. We used some empirical data, but found that accurate and complete data were scarce. The available data suggested that pay structures vary across countries, and are often structured in complex ways. Health workers also commonly use other sources of income to supplement their formal pay. The pay and income of health workers varies widely, whether between countries, by comparison with cost of living, or between the public and private sectors. To optimise the distribution and mix of health workers, policy interventions to address their pay and incomes are needed. Fiscal constraints to increased salaries might need to be overcome in many countries, and non-financial incentives improved.

Migration of South African health workers: the extent to which financial considerations influence internal flows and external movements.

BackgroundThe loss of human resource capacity has had a severe impact on the health system in South Africa. This study investigates the causes of migration focussing on the role of salaries and benefits. Health professionals from public, private and non-governmental (NGO) health facilities located in selected peri–urban and urban areas in KwaZulu-Natal, South Africa were surveyed about their current positions and attitudes toward migration.MethodsThe study uses cross-sectional data collected in 2009. A total of 694 health professionals (430 in the public sector, 133 in the NGO sector and 131 in the private sector) were surveyed. An additional 11 health professionals were purposively selected for in-depth interviews. Odds ratios with 95% confidence intervals were calculated to determine whether salaries influenced HWs decisions to migrate.ResultsHWs decision to move was not positively associated with lower salaries. It was found, instead, that the consideration to move was determined by other factors including age, levels of stress experienced and the extent to which they were satisfied at their current place of work.ConclusionsThe OSD appears to have lowered the risk of HWs migrating due to low salaries. However, the results also indicate that the South African Department of Health needs to improve working conditions for HWs within the public health sector to assist in retention.

The effects of Internet usage, financial development and trade openness on economic growth in South Africa

Investigate the relationship among Internet use, economic growth and financial development.Internet use has grown rapidly in the last few years in South Africa.The ARDL bounds testing is applied.Internet use and financial development stimulate economic growth.Further investment in Internet infrastructure is recommended. This study estimates the effects of Internet usage, financial development and trade openness on economic growth using annual time series data for South Africa for the period 1991-2013. Structural unit root test and Johansen and ARDL cointegration tests are performed to examine the long run relationship amongst Internet usage, financial development, trade openness and economic growth. Findings from ARDL cointegration tests indicate a long-run relationship between the variables. Results from the ARDL estimates indicate a positive and significant long run relationship between Internet usage and economic growth in South Africa. Also, there is significant positive relationship between financial development and economic growth. However, the short run relationship among the variables was found to be insignificant. The robustness of the long-run relationship between the variables was checked by the application of dynamic ordinary least squares (DOLS) estimation. The Granger causality test reveals that both Internet usage and financial development Granger-cause economic growth in South Africa. This causal link is found to be robust from the application of impulse response and variance decomposition analysis. Based on these findings, this study recommends that the South African government continue with policies that aim to invest more resources into its Internet infrastructure to further expand its network and usage.

Evaluating traditional healers knowledge and practices related to HIV testing and treatment in South Africa

BackgroundIn a context of inadequate human resources for health, this study investigated whether traditional healers have the knowledge and skill base which could be utilised to assist in the scaling up of HIV prevention and treatment services in South Africa.MethodsUsing a cross-sectional research design a total of 186 traditional healers from the Northern Cape province were interviewed. Responses on the following topics were obtained: socio-demographic characteristics; HIV training, experience and practices; and knowledge of HIV transmission, prevention and symptoms. Descriptive statistics and chi square tests were used to analyse the responses.ResultsTraditional healers’ knowledge of HIV and AIDS was not as high as expected. Less than 50% of both trained and untrained traditional healers would treat a person they suspected of being HIV positive. However, a total of 167 (89%) respondents agreed using a condom can prevent HIV and a majority of respondents also agreed that having one sexual partner (127, 68.8%) and abstaining from sex can prevent HIV (145, 78.8%). Knowledge of treatment practices was better with statistically significant results being obtained.ConclusionThe results indicate that traditional healers could be used for prevention as well as referring HIV positive individuals for treatment. Traditional healers were enthusiastic about the possibility of collaborating with bio-medical practitioners in the prevention and care of HIV and AIDS patients. This is significant considering they already service the health needs of a large percentage of the South African population. However, further development of training programmes and materials for them on HIV and AIDS related issues would seem necessary.

Local democracy and local government efficiency: the case of elected executives in Australian local government

In the international context it has been argued that institutional reform to leadership in local government can improve the sector in terms of both its democratic legitimacy and its operational efficiency. In Australia, despite two decades of far-reaching reform processes across state government jurisdictions, focused heavily on structural change, local government still faces daunting problems, yet the potential of reform to political leadership as a method of alleviating these problems has not been fully explored. This paper thus examines the applicability of alternative leadership models to Australian local government, in particular the elected executive model which characterises some American and European local government systems. We argue that the introduction of elected executives could prove problematic in terms of accountability and representation in Australian local government.

Understanding the factors influencing health-worker employment decisions in South Africa

BackgroundThe provision of health care in South Africa has been compromised by the loss of trained health workers (HWs) over the past 20 years. The public-sector workforce is overburdened. There is a large disparity in service levels and workloads between the private and public sectors. There is little knowledge about the nonfinancial factors that influence HWs choice of employer (public, private or nongovernmental organization) or their choice of work location (urban, rural or overseas). This area is under-researched and this paper aims to fill these gaps in the literature.MethodThe study utilized cross-sectional survey data gathered in 2009 in the province of KwaZulu-Natal. The HWs sample came from three public hospitals (n = 430), two private hospitals (n = 131) and one nongovernmental organization (NGO) hospital (n = 133) in urban areas, and consisted of professional nurses, staff nurses and nursing assistants.ResultsHWs in the public sector reported the poorest working conditions, as indicated by participants’ self-reports on stress, workloads, levels of remuneration, standard of work premises, level of human resources and frequency of in-service training. Interesting, however, HWs in the NGO sector expressed a greater desire than those in the public and private sectors to leave their current employer.ConclusionsTo minimize attrition from the overburdened public-sector workforce and the negative effects of the overall shortage of HWs, innovative efforts are required to address the causes of HWs dissatisfaction and to further identify the nonfinancial factors that influence work choices of HWs. The results highlight the importance of considering a broad range of nonfinancial incentives that encourage HWs to remain in the already overburdened public sector.

A review of the integration of traditional, complementary and alternative medicine into the curriculum of South African medical schools

BackgroundTraditional, complementary and alternative (TCAM) medicine is consumed by a large majority of the South African population. In the context of increasing overall demand for healthcare this paper investigates the extent to which South African medical schools have incorporated TCAM into their curriculum because of the increased legislative and policy interest in formally incorporating TCAM into the health care system since democracy in 1994.MethodsHeads of School from seven South African medical schools were surveyed telephonically.ResultsOne school was teaching both Traditional African Medicine (TM) and CAM, five were teaching either TM or CAM and another was not teaching any aspect of TCAM.ConclusionsIn conclusion, there is a paucity of curricula which incorporate TCAM. Medical schools have not responded to government policies or the contextual realities by incorporating TCAM into the curriculum for their students. South African medical schools need to review their curricula to increase their students’ knowledge of TCAM given the demands of the population and the legislative realities.

Attitudes towards current and alternative management of the Sundarbans Mangrove Forest, Bangladesh to achieve sustainability

This paper examines the challenges of achieving sustainable management of the worlds largest mangrove forest, the Sundarbans (SMF) in Bangladesh. During the past two decades, conflicts between mangrove maintenance and the pressure to provide economic livelihoods to forest-dependent communities (FDCs) have emerged and persisted. The SMF is currently managed by the Bangladesh Forest Department (BFD) under a state property rights regime. This study explores an alternative property rights regime which includes participatory approaches and co-management with FDCs to achieve sustainability, both economically and environmentally. Focus group discussions and a survey were the methods used to assess the prospects. The study finds that the absence of a management partnership between the BFD and FDCs is mainly responsible for the policy failures to achieve sustainable management of the SMF. However, evidence is presented that a ‘co-management’ property rights regime cannot be established until FDC capacity is enhanced through the formation of community level institutions.

Costs of screening for colorectal cancer: an Australian programme.

The total costs (direct and indirect) associated with the operation of an Australian community based screening programme for colorectal cancer (CRC) were estimated. One-year costs of the programme were estimated to be AUS

The adequacy of policy responses to the treatment needs of South Africans living with HIV (1999-2008): a case study

1 347 948 to screen 24 000 participants. This corresponded to AUS