Browsing Faculty of Community & Health Sciences by Author "Lehmann, Uta"
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Schneider, Helen; Lehmann, Uta (Routledge, 2010)[more][less]
Abstract: One of the consequences of massive investment in antiretroviral access and other AIDS programmes has been the rapid emergence of large numbers of lay workers in the health systems of developing countries. In South Africa, government estimates are 65,000, mostly HIV/TB care-related lay workers contribute their labour in the public health sector, outnumbering the main front-line primary health care providers and professional nurses. The phenomenon has grown organically and incrementally, playing a wide variety of care-giving, support and advocacy roles. Using South Africa as a case, this paper discusses the different forms, traditions and contradictory orientations taken by lay health work and the system-wide effects of a large lay worker presence. As pressures to regularise and formalise the status of lay health workers grow, important questions are raised as to their place in health systems, and more broadly what they represent as a new intermediary layer between state and citizen. It argues for a research agenda that seeks to better characterise types of lay involvement in the health system, particularly in an era of antiretroviral therapy, and which takes a wider perspective on the meanings of this recent re-emergence of an old concept in health systems heavily affected by HIV/AIDS. URI: http://hdl.handle.net/10566/458 Files in this item: 1
SchneiderHealthSystems2010.pdf (278.2Kb) -
Lehmann, Uta (Health Systems Trust, 2008)[more][less]
Abstract: This chapter reviews the progress made in recent years to strengthen human resources to deliver health care within a Primary Health Care approach. It focuses specifically on the availability and preparedness of old and new cadres of health workers, their distribution within the South African health system, as well as their training and development. Findings suggest that overall the health workforce is substantially weaker today than it was in the mid-1990s. There are fewer doctors and nurses available for the vast majority of public sector dependent population, as production has not kept up with population growth, increasing care needs and attrition. Disparities between provinces remain, and disparities between the private and public sectors have grown. The nursing sector faces a serious crisis brought on by an aging professional population. Progress with the development of mid-level cadres has been slow, with pharmacy being the exception. Furthermore, the implementation of community health worker programmes remains fragmented and uneven. Importantly, while there has been curriculum reform in many medical schools, there has been no fundamental shift in the orientation and resourcing of health professions. Health workers entering primary or community care services, thus, often remain illprepared and find themselves poorly supported and resourced. It is suggested that the following areas must be a priority in the human resource agenda in coming years: an accelerated production of professionals and mid-level cadres; comprehensive curriculum audits; the regulation and integration of community health workers; and an integrated and comprehensive reconfiguration of Primary Health Care teams. URI: http://hdl.handle.net/10566/437 Files in this item: 1
LehmannPrimaryHealthCare2009.pdf (692.3Kb) -
Lehmann, Uta; Van Damme, Wim; Barten, Francoise; Sanders, David (BioMed Central, 2009)[more][less]
Abstract: Ever since the 2006 World Health Report advocated increased community participation and the systematic delegation of tasks to less-specialized cadres, there has been a great deal of debate about the expediency, efficacy and modalities of task shifting. The delegation of tasks from one cadre to another, previously often called substitution, is not a new concept. It has been used in many countries and for many decades, either as a response to emergency needs or as a method to provide adequate care at primary and secondary levels, especially in understaffed rural facilities, to enhance quality and reduce costs. However, rapidly increasing care needs generated by the HIV/AIDS epidemic and accelerating human resource crises in many African countries have given the concept and practice of task shifting new prominence and urgency. Furthermore, the question arises as to whether task shifting and increased community participation can be more than a short-term solution to address the HIV/AIDS crisis and can contribute to a revival of the primary health care approach as an answer to health systems crises. In this commentary we argue that, while task shifting holds great promise, any long-term success of task shifting hinges on serious political and financial commitments. We reason that it requires a comprehensive and integrated reconfiguration of health teams, changed scopes of practice and regulatory frameworks and enhanced training infrastructure, as well as availability of reliable medium- to long-term funding, with time frames of 20 to 30 years instead of three to five years. The concept and practice of community participation needs to be revisited. Most importantly, task shifting strategies require leadership from national governments to ensure an enabling regulatory framework; drive the implementation of relevant policies; guide and support training institutions and ensure adequate resources; and harness the support of the multiple stakeholders. With such leadership and a willingness to learn from those with relevant experience (for example, Brazil, Ethiopia, Malawi, Mozambique and Zambia), task shifting can indeed make a vital contribution to building sustainable, cost-effective and equitable health care systems. Without it, task shifting runs the risk of being yet another unsuccessful health sector reform initiative. URI: http://hdl.handle.net/10566/316 Files in this item: 1
LehmannTaskShifting2009.pdf (219.6Kb)
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