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Chapter 5: Managing and Motivating > SCALING UP: NOT JUST NUMBERS - Pg. 86

Managing and Motivating SCALING UP: NOT JUST NUMBERS A critical issue for many low-income country health systems is that high-income countries are attracting their most experienced health workers. Yet the focus of research and reporting on the human resources crisis has been largely on the numbers of health workers needed (Hagopian et al., 2004; Padarath et al. 2003; Wyss, Moto, Yemadji & Kurowski, 2002). Equally the country-level response has been focused purely on increasing numbers of doctors and nurses with little regard to where the gaps are occurring in their health systems and what specific types of expertise might be needed to meet demand. Most countries have addressed the shortfall by increasing output from their training colleges. The impact of this strategy is only now being felt in their health systems as they become overpopulated with new, young graduates with little experience. Figure 1, which one ends up not doing justice to the people that they are supposed to supervise; they end up doing things because they have to do them and they have to address issues without honestly being guided and supervised. Regarding leadership, you forget as a leader that you play many roles to the people that you are leading; you don't just command them to do 1, 2, 3, but you are supposed to guide and monitor them as well as take care of their person- nel issues. When you forget them; that means you are going to lose them because you don't handle them in such a way that they feel that you are part of them; they feel you actually don't appreciate them, and that too de-motivates them. Another person felt that supervision is some- thing that only happens when you make a mistake. I think people who are supposed to supervise us do not really have interest in that; you will only