<p>Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-)&nbsp / the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive&nbsp / study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the&nbsp / privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government&nbsp / sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females) / in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female.&nbsp / Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the&nbsp / post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition&nbsp / rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period.&nbsp / Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate&nbsp / a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students&nbsp / was low which is encouraging but the finding that males were more likely to drop out than females deserves attention.</p>

<p>In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the&nbsp / human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR&nbsp / odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and&nbsp / proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas) / researchers / academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government&rsquo / s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category&nbsp / has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical&nbsp / health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system.</p>

<p>Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-)&nbsp / the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive&nbsp / study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the&nbsp / privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government&nbsp / sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females) / in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female.&nbsp / Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the&nbsp / post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition&nbsp / rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period.&nbsp / Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate&nbsp / a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students&nbsp / was low which is encouraging but the finding that males were more likely to drop out than females deserves attention.</p>

<p>In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the&nbsp / human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR&nbsp / odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and&nbsp / proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas) / researchers / academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government&rsquo / s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category&nbsp / has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical&nbsp / health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system.</p>

Made available in DSpace on 2014-12-17T14:46:38Z (GMT). No. of bitstreams: 1 JoseJAJ.pdf: 4288006 bytes, checksum: 88e1eb3aa202fb2b352400054f55b1ab (MD5) Previous issue date: 2008-10-31 / This study addresses the interdisciplinary training in perspective for the Brazilian Health System (SUS) in view of graduation students in the areas of health of Federal University of Rio Grande do Norte s (UFRN) former students of the course Health and Citizenship (SACI). Emphasizes also the importance of commitment to social policies, particularly with those focused on the area of health. This is a case study with a qualitative approach. There was the lifting of data through documental research, from 14 portfolios of learning, which are weekly records of students from the respective discipline, corresponding to 2005.2 to 2007.2 semesters. From the analysis undertaken, inferred that the methodology problematizing, used by the discipline, enables students to understand that learning is not restricted to the confined university walls. It shows the health from a complex and concrete social reality, allowing students to an interdisciplinary dialogue in search of the transformation of this reality. It means an opportunity to interact with the dynamics of society in their area of activities, developing a relationship of solidarity in the formation of the citizen. Moreover, it was clear the direction of experienced interdisciplinary and recognized by students of various professions that make up the discipline. Thus, the SACI in preparation for construction of SUS, helps to form a new professional, more committed to the promotion and with a collective work in health / O presente estudo aborda a interdisciplinaridade na perspectiva da forma??o para o Sistema ?nico de Sa?de (SUS) na ?tica de estudantes da ?rea da sa?de da Universidade Federal do Rio Grande do Norte (UFRN) egressos da disciplina Sa?de e Cidadania (SACI). Ressalta, igualmente, a import?ncia do compromisso com as pol?ticas sociais e, em particular, com aquelas voltadas para a ?rea da sa?de. Trata-se de um estudo de caso com abordagem qualitativa. Realizou-se o levantamento dos dados atrav?s de pesquisa documental, a partir de 14 portf?lios de aprendizagem, que s?o registros semanais dos estudantes da respectiva disciplina, correspondendo aos semestres 2005.2 a 2007.2. Da an?lise empreendida, inferiu-se que a metodologia problematizadora, utilizada pela referida disciplina, possibilita aos estudantes compreender que a aprendizagem n?o se limita aos restritos muros universit?rios. Ela situa a sa?de partindo de uma realidade social concreta e complexa possibilitando aos estudantes um di?logo interdisciplinar na busca da transforma??o desta realidade. Significa uma oportunidade de interagir com a din?mica da sociedade no seu espa?o de a??es, desenvolvendo uma rela??o de solidariedade na forma??o do cidad?o. Por outro lado, ficou evidente o sentido da interdisciplinaridade vivenciada e reconhecida pelos estudantes de diversas profiss?es que integram a disciplina. Desse modo, a SACI na perspectiva de constru??o do SUS, ajuda a formar um novo profissional, mais comprometido com a promo??o e com um trabalho coletivo em sa?de

p. 1-100 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-11T19:40:09Z No. of bitstreams: 1 Diss Claudia Santiago.pdf: 1498564 bytes, checksum: 31a0c4b3718e695a3e7a3a4b37a3a014 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:20:48Z (GMT) No. of bitstreams: 1 Diss Claudia Santiago.pdf: 1498564 bytes, checksum: 31a0c4b3718e695a3e7a3a4b37a3a014 (MD5) / Made available in DSpace on 2013-05-04T17:20:48Z (GMT). No. of bitstreams: 1 Diss Claudia Santiago.pdf: 1498564 bytes, checksum: 31a0c4b3718e695a3e7a3a4b37a3a014 (MD5) Previous issue date: 2009 / Esse trabalho descreve a construção da política de recursos humanos em vigilância sanitária (PRH-Visa) para estados e municípios desencadeada pela Anvisa, visando a responder as seguintes indagações: como aconteceu o processo de formulação dessa política? Existe uma política planificada de recursos humanos em Visa para estados e municípios? A análise desse processo foi feita à luz de referências teóricas sobre política, política de saúde, planificação e política de recursos humanos em saúde. Utilizou como categorias de análise certas dimensões correspondentes a etapas da formulação de política de saúde: Imagem-Objetivo, formulação de proposições, análise de proposições, desenho estratégico e formalização da política. A análise documental e de entrevistas com informanteschave permitiu concluir que não existe uma política planificada e formalizada de recursos humanos em vigilância sanitária para estados e municípios. Entretanto, houve iniciativas nessa perspectiva que possibilitaram reflexões e implementação de ações que possivelmente influíram sobre o SNVS. Apesar de não ter sido aplicado método formal de planificação pode-se afirmar indícios da existência de um pensamento e uma postura estratégicos na programação das ações. Foram observadas evidências que apontam para as motivações que demandaram esse movimento e alguns efeitos nos dias atuais. Por fim, apresentam-se algumas considerações para a continuidade desse processo, superando problemas do passado e avançando para a formalização de uma política de RH em Visa, consoante com as políticas de saúde do SUS. / Salvador

Submitted by Rosangela Silva (rosangela.silva3@unioeste.br) on 2018-05-15T12:47:09Z No. of bitstreams: 2 Manuela Aparecida Soares.pdf: 917821 bytes, checksum: a5d4e0a3d8d5e84adefeb66920a1e555 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-05-15T12:47:09Z (GMT). No. of bitstreams: 2 Manuela Aparecida Soares.pdf: 917821 bytes, checksum: a5d4e0a3d8d5e84adefeb66920a1e555 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2012-12-04 / The Reorientation Program for Vocational Training in Health (Pro-Health) was established by the Ministry of Health, through the Secretary of Labor Management and Health Education (SGTES), in partnership with the Department of Higher Education (SESU), with the National Institute for Educational Studies and Research Teixeira (INEP), Ministry of Education and with support from the Pan American Health Organization (PAHO). It was created to stimulate the process of reorientation training of undergraduate health care, aiming to provide skilled professionals to meet the needs of the population and the operationalization of the SUS. In this work we use as the research object the Pro-Health, aiming at analyzing the theoretical and methodological assumptions that support the two axes Program - Theoretical and Pedagogical Guidance. This is an exploratory and descriptive that had as a primary source, documents prepared and published by official bodies linked to the Ministry of Health and Ministry of Education. For the construction of theoretical mark was production used theoretics critique of two fields of knowledge: education and health. In health, we seek a benchmark for understanding the disease process health, an of the constituent elements of Orientation Theoric Axis. Already the field of education contributed with referential for understanding and analyzing Pedagogical Orientation axis, which focuses on the methodological aspects of the learning process. The benchmark was based health studies Asa Cristina Laurell and Jaime Breilh. These show the health illness as social determinants. Regarding the education sector were adopted theoretical constructions of Dermeval Saviani (Historical Critical Pedagogy) and Newton Duarte (critical constructivism) to perform the analyzes for the teaching-learning process. Also in this field Edilson Moreira de Oliveira, José Luís Vieira de Andrade and Maria Eliza Brefere Arnoni contributed theoretical contributions to the analysis of the theme of questioning in teaching-learning process. The results of the study are presented in three chapters. The first chapter takes place on a track the training of workers in the health field. In the second, there are explicit the historical background and the conformation of the National Reorientation of Vocational Training in Health (Pro-Health) and in the third chapter, we present the analyzes about the theoretical and methodological foundations of the two axes of the Pro- Health objects of this research. Among the findings highlight the adoption of the Social Determinants of Health, World Health Organization (WHO) as a reference for explaining the disease process, and constructivism as current theory and method of teaching and learning that supports the pedagogical axis Program. / O Programa de Reorientação da Formação Profissional em Saúde (Pró-Saúde) foi instituído pelo Ministério da Saúde, por meio da Secretaria de Gestão do Trabalho e da Educação na Saúde (SGTES), em parceria com a Secretaria de Educação Superior (SESU), com o Instituo Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira (INEP), do Ministério da Educação e com o apoio da Organização Panamericana de Saúde (OPAS). Foi criado para estimular a reorientação do processo de formação dos cursos de graduação da área da saúde, com vistas a oferecer profissionais habilitados para responder às necessidades da população brasileira e à operacionalização do SUS. Neste trabalho tomou-se como objeto de investigação o Pró-Saúde, tendo como objetivo geral analisar os pressupostos teóricos e metodológicos que dão sustentação a dois eixos do Programa - Orientação Teórica e Orientação Pedagógica. Trata-se de um estudo exploratório e descritivo, que teve como fonte primária documentos elaborados e publicados por órgãos oficiais vinculados ao Ministério da Saúde e Ministério da Educação. Para a construção do marco teórico serviu-se de produção teórica crítica de dois campos do conhecimento: a educação e a saúde. No campo da saúde, buscou-se um referencial para o entendimento do processo saúde-doença, um dos elementos constitutivos do Eixo Orientação Teórica. Já o campo da educação contribuiu com referencial para a compreensão e análise do eixo Orientação Pedagógica, que foca os aspectos metodológicos do processo ensino-aprendizagem. Para a construção do referencial do campo da saúde utilizou-se dos estudos de Asa Cristina Laurell e Jaime Breilh, que tratam do processo saúde-doença como determinação social. Em relação à área educacional adotaram-se as construções teóricas de Dermeval Saviani (Pedagogia Histórico Crítica) e Newton Duarte (crítica ao construtivismo) para realizar as análises referentes ao processo ensino-aprendizagem. Ainda neste campo Edilson Moreira de Oliveira, José Luís Vieira de Andrade e Maria Eliza Brefere Arnoni contribuíram com aportes teóricos para a análise da temática da problematização no processo ensino-aprendizagem. Os resultados do estudo são apresentados em três capítulos. No primeiro capítulo realiza-se um histórico sobre a formação dos trabalhadores da área da saúde. No segundo, explicitam-se os antecedentes históricos e a conformação do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde) e, no terceiro capítulo, apresentam-se as análises realizadas acerca dos fundamentos teóricos e metodológicos dos dois eixos do Pró-Saúde objetos da presente pesquisa. Entre os achados destaca-se a adoção dos Determinantes Sociais da Saúde, da Organização Mundial da Saúde (OMS), como referencial de explicação para o processo saúde-doença, e o construtivismo como corrente teórica e método de ensino-aprendizagem que fundamenta o eixo pedagógico do Programa.

O Sistema Único de Saúde (SUS) avançou muito desde o seu surgimento, entretanto, ainda existem muitos desafios que precisam ser superados. Entre eles, encontram-se a qualificação e a formação dos profissionais de saúde. Os cursos de graduação em saúde têm privilegiado uma formação tecnicista e fragmentada, incapaz de formar a força de trabalho necessária à resolução dos problemas de saúde da população brasileira. Neste sentido, há necessidade de desenvolver instrumentos direcionados ao incentivo de mudanças curriculares no ensino superior em saúde, tendo como um dos eixos a interação com os serviços de saúde. Cita-se, nesse contexto, o Programa de Educação pelo Trabalho para a Saúde (PET-Saúde). A presente investigação se propôs a avaliar o PET-Saúde instituído na Universidade de São Paulo (USP), campus Capital. Os sujeitos do estudo foram tutores, preceptores e alunos de odontologia que integraram o Programa em algum momento da sua existência. Foi utilizada uma abordagem qualitativa, sendo a coleta de dados realizada com o auxílio das técnicas Delphi e de Grupo Focal. O tratamento do material coletado foi orientado pela análise de conteúdo. Os dados levantados evidenciaram que, apesar das mudanças já implementadas, o modelo formador em odontologia apresenta fragilidades no sentido de atender completamente as Diretrizes Curriculares Nacionais (DCN), visto que é persistente a tendência tecnicista, biologicista e fragmentada. Os sujeitos reforçaram que a aproximação dos estudantes com os cenários de prática é capaz de auxiliar no processo formativo de alunos e na qualificação de profissionais inseridos nos serviços e professores dos cursos de graduação em saúde. Além disso, o PET-Saúde proporciona a ampliação do olhar do estudante em direção ao processo saúde/doença e o despertar para atuação futura no âmbito do SUS. A imersão no Programa foi responsabilizada pela quebra de pré-conceitos e pela consequente compreensão da organização da Atenção Primária e do trabalho desenvolvido no setor. Uma das vantagens apontadas pelos moldes de interação ensino-serviço do PET-Saúde consiste no estabelecimento da interdisciplinaridade no processo formador o que, dentre outras características, o conforma como um modelo de interação ensino-serviço mais próximo do ideal almejado. Como principais limites foram apontados a incompatibilidade de horários entre os protagonistas do programa, a distância dos cenários de prática em relação às unidades de ensino, além da ausência de diretrizes operacionais claras e da heterogeneidade de organização das atividades pelas unidades de saúde. Os resultados do estudo traduzem o PET-Saúde como um poderoso instrumento de indução de mudanças na concepção dos profissionais de saúde, contribuindo para uma formação condizente com as necessidades do SUS. / The Unified Health System of Brazil has advanced greatly since itsestablishment, but there are many challenges that need be overcome. Among them are the qualification and the education of health workers. Health courses have privileged a technicist and fragmented education, that is unable to create the workforce needed to solve the health problems of the Brazilian population. So there is a need to create instruments directed to the encouragement of curriculum changes in the higher health education , based on the interaction with health services. In this context, the Education Program of Work for Health is pointed out. The research evaluated the Education Program of Work for Health established at the University of São Paulo, Brazil. The study subjects were dental students, preceptors and tutors in the program. A qualitative approach was used and data collected using the Delphi technique and focus group. The material obtained was treated by Bardin analysis of content . Data collected evidenced that despite changes already implemented, dentistry education model presents fragilities onfully meeting the National Curriculum Guidelines since much students keep the technicist, fragmented and biologicist tendency. The subjects reinforcedthat students approximation with practice scenarios is able to assist in the formation process of students and qualification of professionals inserted in services and of health courses professors. Moreover, the Education Program of Work for Health provides a wider view from students toward the health/disease process and also an awakening for later operating in the Unified Health System. The immersion in the program was responsible for breaking preconceptions and for the consequent understanding of the organization of Primary Care and of work in the sector. One of the advantages pointed by the model of interaction between teaching and service by the Education Program of Work for Health is the establishment of interdisciplinarity in the formation process that, among others characteristics, conforms it as a model of interaction between teaching and service closest to the desired ideal. The incompatibility of schedules between the protagonists of the program, the distance of the practice scenarios in relation to teaching units besides the absence of clear operational guidelines and diverse organization of activities by health units were pointed as the main limitations. The study results reflect the Education Program of Work for Health as a powerful tool to induce changes in the conception of health professionals, contributing to an education consistent with the needs of the Unified Health System.

Magister Public Health - MPH / In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas); researchers; academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government’s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system. / South Africa

Magister Public Health - MPH / Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-) the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females); in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female. Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period. Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students was low which is encouraging but the finding that males were more likely to drop out than females deserves attention. / South Africa