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Health labour market policies in support of universal health coverage: a comprehensive analysis in four African countries
© Sousa et al.; licensee BioMed Central Ltd. 2014
- Received: 21 November 2013
- Accepted: 7 August 2014
- Published: 26 September 2014
Progress toward universal health coverage in many low- and middle-income countries is hindered by the lack of an adequate health workforce that can deliver quality services accessible to the entire population.
We used a health labour market framework to investigate the key indicators of the dynamics of the health labour market in Cameroon, Kenya, Sudan, and Zambia, and identified the main policies implemented in these countries in the past ten years to address shortages and maldistribution of health workers.
Despite increased availability of health workers in the four countries, major shortages and maldistribution persist. Several factors aggravate these problems, including migration, an aging workforce, and imbalances in skill mix composition.
In this paper, we provide new evidence to inform decision-making for health workforce planning and analysis in low- and middle-income countries. Partial health workforce policies are not sufficient to address these issues. It is crucial to perform a comprehensive analysis in order to understand the dynamics of the health labour market and develop effective polices to address health workforce shortages and maldistribution as part of efforts to attain universal health coverage.
- Africa
- Cameroon
- Health labour market
- Health workforce
- Health workforce policies
- Human resources for health
- Kenya
- Sudan
- Universal health coverage
- Zambia
Universal health coverage is defined as access of all people to comprehensive health services (including prevention, promotion, treatment, and rehabilitation) at affordable cost and without financial hardship, through protection against catastrophic health expenditures [1]. However, even when financial protection is ensured, access to health services will not be guaranteed without an adequate health workforce. Health workers are a fundamental and instrumental component of service delivery. Unless countries have the appropriate health workforce to deliver quality services, universal health coverage will not be attained. This is a particular challenge for many low- and middle-income countries, which often suffer from severe shortages and maldistribution of health workers [2–4].
These problems, however, are not exclusive to low- and middle-income countries; many developed countries are likely to face severe shortages and maldistribution of health workers as a consequence of the latest global economic downturn of 2008/2009. Many wealthy countries are cutting their budgets for social services, including health, which will affect the number of health workers trained and deployeda. In addition, the socioeconomic consequences of the financial crisis – increased unemployment rates, poverty, and social deprivation – coupled with emerging issues, such as aging populations and a higher prevalence of chronic conditions, will increase the demand for public health services in both developed and developing countries [5]. Moreover, the new dynamics of migration – for example, moving from one developing country to another – pose a major challenge for global health labour markets [6]. To cope with these challenges and attain universal health coverage, countries will have to do in-depth analyses of their health labour markets in order to understand the driving forces that affect supply and demand both within the country and at a global level [5].
In this paper, we use a health labour market framework to investigate the key indicators of the dynamics of the health labour market in Cameroon, Kenya, Sudanb, and Zambia, and identify the main policies implemented in the past decade to address shortages and maldistribution of health workers in order to highlight the challenges to attaining universal health coverage. These four African countries were chosen because they had reliable and good quality data and the necessary institutional capacity to conduct the analysis, and the Ministry of Health was in each case willing to undertake the analysisc.
Sociodemographic indicators for the four countries a in 2011
20,386,799 [8]
30,894,000 [9]
13,046,508 [10]
GDP per capita in PPP terms[11]
Expenditure on health (% of GDP)[7]
Under-five mortality rate (per 1000 live births)[7]
HIV prevalence (%)[7]
Main causes of death
Malaria, HIV/AIDS
HIV/AIDS, malaria, and tuberculosis
Heart diseases, septicemia, respiratory infections, malaria, diarrheal diseases, gastroenteritis [12]
HIV/AIDS, tuberculosis, and malaria [13]
Sociodemographic indicators available in the four countries a in 2002
The health labour market framework
In many low- and middle- income countries, health workforce policies are frequently formulated on the basis of the number of health workers required to meet the needs of the population (needs-based assessment), and are aimed at training more health workers. However, unless appropriate employment conditions are in place to absorb the newly trained health workers into the labour market, there is a risk of increasing unemployment and brain drain, and wasting resource [17].
The level of employment in a country's health sector is in large part determined by health labour market dynamics, not the population health needs or the worker education capacity alone. The health labour market encompasses a number of dimensions. The combination of needs, demand, supply, training, and governance of health workers determines the wages and allowances, the number of health workers employed, the number of hours they work, their geographic location, their employment setting, their productivity, and their performance [18].
The education and training of health workers is a key determinant of the supply of health labour in a country. The availability of new graduates depends on a number of factors, such as the number of slots available in training programs and the admissions criteria, the location and social orientation of the medical training, and the debt burden. It also depends on individual decisions by potential health workers whether to pursue a health profession and obtain the required education. Those decisions will be based, at least in part, on the attractiveness of the salaries and potential returns for the years of study and financial investment needed (e.g., for tuition fees, books, etc.). The pool of qualified health workers is the number of individuals who have been trained, but the supply is only the number of qualified health workers willing to work at the prevailing wage rate.
The demand for health care workers is determined by the private and public institutions that hire and pay health workers in clinics, hospitals, and other settings. These institutions will compete for workers based on their wage rates, budgets, provider payment practices, benefits packages, working conditions, and other labour regulations and rules. The competitiveness of institutions across all of these factors will influence how attractive they are to health professionals (including new graduates) in comparison with other labour markets or other countries [19]. Opportunities for self-employment also affect the demand for health workers.
In general, the higher the wage, the larger the number of available health workers willing to work in the health sector. However, the wage is not the only determining factor. Good working conditions, safety, availability of supplies and technical support, and career opportunities also play important roles. Taken together, these factors influence whether health professionals decide to work in the country (or migrate), in the health sector (or in another sector), in a public institution (or a private one), on a full-time basis (or part-time), and in an urban area (or a rural one).
In many countries, health worker shortages occur because of labour market mismatches rather than because of an overall lack of workers to fill the jobs in question.
Methods and data
Selected health labour market indicators in the four countries a in 2011
Stock and density indicators 2011
Density of health workers (per 1,000 population)
(total no. 38,207)
(total no. 31,060)
(total no. 77,280)
(total no. 18,397)
Density of physicians (per 1,000 population) b
(total no. 1,842)
(total no. 4,660)
(total no. 19,778)
(total 2,419)
Density of nurses and midwives (per 1,000 population) c
(total no. 18,954)
(total no. 18,749)
(total no. 33,193)
(total no. 11,193)
Distribution of health workers by category
4.8% physicians, 49.6% nurses, 45.6% others
15% physicians, 60.4% nurses and midwives, 24.6% others
25.6% physicians, 43% nurses and midwives, 31.4% others
13.2% physicians, 60.8% nurses and midwives, 26% others
Percentage over 40 years old
43 (nurses) 46 (physicians)
70 (nurses)
49 (all health workers)
56 (midwives)d
Percentage female (all health workers
Percentage of health workers employed in public sector e
Categories of health workers in informal economy
0.5% nurses, support staff and paramedical stafff
traditional medicine practitioners, traditional birth attendants
community health workers, village midwives
traditional birth attendants, traditional attendants
Data not available
51% physicians, 8.3% nurses [20]
60% physicians, 25% pharmacists
0.5% of nurses
Main destination countries
Data not available
USA, Australia, Namibia
Saudi Arabia, United Kingdom, Ireland
United Kingdom, Swaziland, Botswana
Geographical distribution (per 1,000 population)
Highest density 3.2 (Yaoundé) lowest density 0.7 (North province)
Highest density 1.81 (Central province) lowest density 0.84 (North Eastern province)
Highest density 3.2 (Northern state) lowest density 0.7 (South Darfur)
Highest density 1.66 (Lusaka (urban) and Copperbelt) lowest density 0.68 (Northern province (rural))
Shortage indicators
Needs-based shortage of health workers
55% overall; 65% physicians, 42% nurses
70% overall; 59% physicians, 57% nurses and midwives
57% physicians, 61% nurses and midwives
54% overall; 63% physicians, 50% nurses and midwives
Economic shortage of health workers (vacancy rate)
Data not available
39% physicians, 33% nurses and midwives
25% overall; 36% physicians, 21% nursesg
62% physicians, 53% nurses and midwives
Wage shortage h
Physicians' wage 6.8 times average income per capita; nurses' wage 3.8 times average income per capita
Physicians' wage 44 times average income per capita; nurses' wage 15 times average income per capita
Physicians' wage 55% more than average income per capita; nurses' wage same as average income per capita
Physicians' wage 15 times average income per capita; nurses' wage 7.5 times average income per capita
- (1)
The economic shortage, defined by the vacancy rate (the ratio of unfilled vacancies to funded health care posts), to identify the gap between demand and supply;
- (2)
The wage shortage (the ratio of the average health worker wage to the country's per capita GDP) to identify the gap between the wages in the health sector and the country as a whole; and
- (3)
The needs-based shortage (the gap between the available health workforce and the workforce required to meet the health needs of the population), to identify health sector deficiencies in meeting population needs.
The main sources of data were official statistics from the Ministry of Health, the Ministry of Finance, health professional councils, population censuses, and labour force surveys [20–23]. We additionally used the framework and policy levers proposed by Sousa et al. [5] to identify the major policies that have been implemented in the past ten years in these four countries to address different dimensions of the health labour market.
Health labour market indicators
The available supply of health workers varies from country to country (Table 3). The wealthiest of the four countries, Sudan, has the highest density of total health workers and physicians per 1,000 population, while Kenya and Cameroon, the poorest countries, have the lowest density. In the past ten years, there have been notable increases in the availability of health workers in these four countries, with an average annual growth rate of around 5%.
Selected health labour market indicators in the four countries a in 2004 and difference in indicators from 2004 to 2011
Stock and density indicators 2004
Density of health workers (per 1,000 population)
2.34 (total no. 37,752)
1.2 (total no. 38,922)
2.55 (total no. 99,538)
3.8 (total no. 41,429)
Density of physicians (per 1,000 population) b
0.192 (total no. 3,124)
0.037 (total no. 1,203)
0.22 (total no. 7,552)
0.137 (total no. 1,499)
Density of nurses and midwives (per 1,000 population) c
1.598 (total no. 26,042)
0.498 (total no. 16,146)
0.917 (total no. 31,496)
2.015 (total no. 22,010)
Distribution of health workers by category
8.2% physicians, 69% nurses and midwives, 22.8% others
3.1% physicians (significantly less than 2002 or 2008), 41.5% nurses and midwives, 55.4% others
7.6% physicians, 31.6% nurses and midwives, 60.8% others
3.6% physicians, 53.1% nurses and midwives, 43.3% others
Difference in indicators from 2004 to 2011
Density of health workers
Density of physician
Density of nurses and midwives
Summary of the main health labour market policies in four countries, 2000–2011 f
Type of policy
Policies to increase the production of health workers
1. Investment in health training institutions since 2000.
Positive effect: this policy together with policy to grant subsidies to private sector increased the number of trained medico-sanitary workers from 2,285 in 2000 to 3,307 in 2011 (69%).
1. National health training policy in 2009.
Negative effect: lack of coordination among training agencies resulted in inefficiencies, duplication of effort and wastage of resources. Lack of investments in training despite increase in demand; thus, the number of graduates in various cadres, e.g., nurses, has steadily decreased.
1. Revolution of Higher Education (1996).
Positive effect: About 10 new universities were opened and intake increased. The number of medical schools increased 8 times between 1996 and 2012. The number of doctors graduating each year increased from 400 to 1,400. Number of health workers in the public sector increased. Negative effect: increase in unemployment among new graduates, e.g., junior doctors.
1. Reopening of closed public training institutions, increased number of scholarships for in-service training programs, provision of financial retention incentives for teaching staff (within past five years).
Positive: number of graduates increased from 1,101 in 2007 to 2,311 in 2010 (increase of 110%).
2. Reform of the Faculty of Medicine and Biomedical Sciences (FMBS) with the opening of new training branches; creation of 3 new faculties of medicine (2007).
Positive effect: increased number of students in the faculty. Education of a medical officer requires at least 7 years, thus the benefit in terms of more health workers will be effective from 2014.
2. Facilitate rational development of the health workforce through alignment of curricula and training needs, create pre-service scholarships, establish cadre-based colleges, and establish medical training colleges in every county by 2017.
Positive effect: increased enrolment of students in the areas of need. Negative effect: the transition phase as devolution takes effect will bring some confusion in the health system.
2. Sudan Declaration for Allied Health Professionals (2004) to scale up the education of nurses, midwives, and allied health professions.
Positive effect: increased intake in different universities; a bridging programme was adopted to raise educational level of vocationally-trained cadres. Negative effect: universities could not expand the intake of nurses, midwives, and allied health professions to meet the needs, which resulted in the initiation of the Academy of Health Sciences.
2. Training community health workers to improve access of rural population to health services, 2010.
Positive effect: 307 community health workers graduated in 2011 and all have been placed in health posts in rural areas; 290 were enrolled for training in 2012.
3. Institutionalization of competence- based training programs, e.g., e-learning programme for nurses.
Positive effect: increased number of nurses trained in rural areas.
3. Decentralized Health Professional Education (HPE) through Academies of Health Science (in 2005) to ensure that programs are established according to the needs of the state and increase the training capacity of the allied health academy.
Positive effect: increased production of nurses, midwives, and allied health professions and improved skill mix composition of health workers; 6,000 new graduates from nursing, midwifery, and allied health professions recruited within their states.
Policies to address inflows and outflows
1. Performance-based financing approach in Eastern region since 2006. Now extended to other regions (North West, South West, and Littoral).
Positive effect: improvement in quality and quantity of care delivered, more resources collected by involved health centres, and better remuneration of staff.
1. Introduction of hardship and commuter allowances; improve data collection on health worker mobility and retention to curb out migration of health workers within and without the country since 2011. Improve working conditions (since 2009).
Positive effect: decreased migration of nurses. Negative effect: has not been enough to stop exits of medical doctors (50% between 2005 and 2009) and enrolled community nurses (81%).
No national policy to address inflows and outflows.
No national policy to address inflows and outflows.
1. Policies to attract foreign health workers with same conditions as nationals, except that foreign nationals are employed on renewable fixed-term three-year contracts.
Positive effect: The percentage of doctors increased by 30%.
2. Structural adjustment programme (before 2007) resulted in employment freeze of civil servants (with the exception of doctors). Freeze reversed in 2009 with expansion and opening of new facilities and upgrading of existing ones.
Positive effect: a significant reduction in vacancy rates; an increase in staff of 2,793, representing 8.4% growth between 2009 and 2010. Negative effect: the employment freeze resulted in a long-term decline in the number of civil servants including health workers; as a consequence, some cadres, such as nurses, medical laboratory, and dental technologists, have a high proportion of over 45-year-olds.
2. Improve employment conditions for health workers, and introduce in-service training and opportunities for progression within the public sector. More intense implementation since 2003.
Positive effect: decreased migration of nurses, from 99 in 2007 to 44 in 2011.
3. The retirement age of civil servants raised from 55 to 60 years in 2009.
Effect: changed the age profile of public sector health workers, which may result in high rates of unemployment and brain drain among new graduates, who will have difficulty finding a job in the health sector.
3. Public sector incentives to improve wages. Deliberate policy since 2005 to improve salaries for health workers.
Positive effect: decreased migration of nurses from 99 in 2007 to 44 in 2011. Negative effect: vacancy rates not necessarily decreased because staffing requirements keep changing with growing demand for services.
Policies to address maldistribution and inefficiencies
1. Emergency plan for upgrading quantity and quality of workforce (2006–2008).
Positive effect: helped recruit nearly 2,500 health workers in remote areas with severe needs for health workers. Negative effect: donor funding of programme came to an end; health workers have the right to move.
1. Review workforce norms and standards, measure performance of health workforce, establish frameworks to manage and monitor health workers, improve performance standards, strengthen supervision and accountability by 2030.
Positive effect: decreased inequality in the distribution of health workers and improved quality of services. Negative effects: main challenge is lack of functional infrastructure for service delivery, which undermines the performance of health workers.
1. Policy on deployment of medical specialists adopted in 2002. A contract with the Ministry of Health offers specialist training in exchange doctors agreeing to work in states according to health needs.
Negative effect: doctors may not abide by the contract and recipient states may not provide competent training services.
1. Compensation scheme for medical doctors serving in rural areas introduced in 2003 and expanded to other health workers in 2007.
Positive effect: this programme helped increase the number of health workers in rural areas between 2005 and 2010. Limited effect: no reduction in shortages of health workers in remote areas, because of effect of other factors, such as living conditions, safety, infrastructure, and job opportunities.
2. Programme to encourage employment in difficult areas (supported by C2D funding) launched in 2012.
Too early to measure effects.
2. Emergency hiring programme (2006) to provide a 3-year contract for health workers who work in underserved areas, recruit local health workers and provide hardship allowances, housing grants and paid leave.
Positive effect: increased number of health workers in rural areas. Negative effect: disharmonized remuneration.
2. Policy on deployment of medical specialists adopted in 2002: every medical or health graduate is obliged to work one year as national service; handled by the Ministry of Defence, which distributes them throughout the country to address geographical maldistribution.
Negative effect: the new graduates are young and inexperienced.
2. The UN Population Fund introduced a bonding system, in which nursing students in Northern Western Province received a bursary for payment of tuition fees from 2003.
Positive effect: improved staffing and retention of nurses in the province, as students are bonded for a period of 2 years after graduation.
3. Enhance staff motivation with payment of "productivity allowance" (10% of financial resources generated by the facility activities) since 1994.
Positive effect: improved quality of care delivered; Negative effect: no proof of reduced out-migration.
3. Develop a national electronic database for nurses to better match nurses to underserved areas in 2005.
Positive effect: reduced unfilled rural posts and faster recruitment.
3. Grant specialization scholarships for doctors practising in hardship areas. Provide incentive packages to retain doctors.
Positive effect: increased rotation of health workers in underserved areas. Negative effect: sporadic efforts not sustained.
Policies to regulate public and private sectors
1. Subsidies granted to private sector since 2000.
Positive effect: (together with investment in health training institutions) number of trained medico-sanitary workers increased from 2,285 in 2000 to 3,307 in 2011 (69%).
1. Launch distance e-learning through public-private partnership, establish interagency coordinating committee for human resources for health (HRH), form 26-member multi-stakeholder group for HRH
Positive effect: improved harmony in addressing HRH issues. Negative effects: difficult to convince some stakeholders to prioritize the issues raised in the health sector.
1. Directorate of Planning of the Federal Ministry of Health in 2010 adopted a policy towards private sector.
Negative effect: The Ministry of Health has weak regulatory and monitoring tools.
1. Encourage private sector participation in pre-service training.
Positive effect: (together with other policies) number of graduates increased from 1,101 in 2007 to 2,311 in 2010 (increase of 110%).
In the four countries, the majority of health workers are women: for example, in Sudan 67% of medical students are women, and in Kenya and Zambia 60% of all health workers are women. This implies that further policies should be oriented to making the working environment friendly for women.
In Cameroon, Sudan, and Zambia, the main employer of health workers is the public sector; however, a large proportion of health workers work in both the public and the private sector. In Sudan, for example, 90% of health workers have a dual practice. However, since there are no policies to regulate it, there are concerns about the availability of health workers in practice and about the quality of services. This suggests that further actions should be oriented to properly regulating and understanding the implications of dual practice employment and its impact on the quality of health services. There is also the need to incorporate informal health workers into the formal economy as in all four countries there is a proportion of the population covered by unregulated health providers such as traditional birth attendants.
In Kenya and Sudan, migration – particularly of physicians – is a major problem. This suggests that there are a number of qualified physicians who would rather work abroad for better working conditions and higher wages than in their home country with the current working conditions and wages.
Despite efforts to decrease health workforce inequalities between poor and non-poor areas (see Table 5 for a summary of the main policies) major inequalities remain in all four countries. In Kenya and Zambia, the best-served areas have approximately twice as many health workers as the areas with the lowest density; in Cameroon, the capital city (Yaoundé) has 4.5 times more health workers per 1,000 population than the poorest province (North), which also has the lowest coverage of skilled birth attendants. These data imply that poorer areas have difficulty attracting and retaining health workers, and therefore the population has less access to health services and worse health outcomes than the population in better-off areas. This lack of health workforce capacity to provide health services to the entire population is a major challenge for ensuring equitable access to health services and universal health coverage. Thus, policies should be directed to retaining health workers in underserved and poor areas.
Despite the efforts made to decrease the shortages of health workers (see Table 5 for a summary of the main policies), such shortages remain a critical constraint for service delivery. The needs-based shortage measure suggests that, in each country, the health sector has less than half of the health workers required to meet the needs of the population.
A higher probability of labour shortage is typically associated with a higher vacancy rate. In Zambia, the particularly high rate of unfilled vacancies (62% of physician posts unfilled and 53% of nurse and midwife posts unfilled) suggests that the number of health workers that employers are willing to hire exceeds the number who is willing to work with the proposed working conditions and wages.
Wages are a key component of labour markets. Some governments need to pay higher wages than at present to keep physicians and nurses they are currently training in the health sector and in the country. Between 1990 and 2004, Zambia experienced an exodus of physicians. To discourage more physicians from leaving the country, the government increased the wages of physicians by 16% between 2007 and 2011, to a level 15 times higher than the average income per capita and higher than that of other professions with a similar level of education, such as lawyers. However, despite this increase, the average annual wage of physicians is still only US $21,780.
These findings suggest that there are problems on the demand and the supply side. Unless policies to address health worker shortages and maldistribution are designed with a health labour market perspective, they are unlikely to be effective.
Health labour market policies
We used the framework and policy levers proposed by Sousa et al. [5] to identify the major policies that have been implemented in the past ten years in the four countries and their impact on: 1) the production of new graduates; 2) inflows and outflows of health workers; 3) maldistribution of health workers and inefficiencies; and 4) regulation of the private sector (Table 5).
Production of new graduates
In the past ten years, major efforts have been undertaken by all four countries to decrease the shortages of health workers. On the production side, the most significant efforts include opening new training institutions, awarding scholarships, providing financial incentives for teaching staff, and training new cadres of health workers. These policies have been highly effective in increasing the number of new graduates in Cameroon and Zambia. However, in Kenya and Sudan, the policies have had limited or negative effects, as they did not take into account the labour market dynamics. In Sudan, for example, there was an increase in unemployment among new graduates, as vacancies and funding were not adjusted to absorb the new graduates into the labour market. The result was a waste of resources and increased brain drain.
Inflows and outflows of health workers
Inflows and outflows refer to the movement of health workers into and out of the country as well as into and out of the overall health workforce. Efforts to address inflows and outflows of health workers have included policies to increase wages and provide extra allowances, improve working conditions, and provide training opportunities. In Zambia, for example, policies targeted at increasing wages and allowancesd were effective in reducing migration of nurses but not effective in decreasing the vacancy rate – although more nurses remained employed, there was still a large pool of unmet needs that increased over time. In Kenya, the introduction of allowances reduced the migration of nurses, but was not sufficient to reduce exitse of medical doctors and community nurses. Kenya also implemented specific policies to increase the retirement age of civil servants, from 55 to 60 years, to tackle the problem of aging nurses and other cadres of health workers. These efforts have changed the age profile of the health workforce; however, they may result in high rates of unemployment and brain drain among new graduates, who will have difficulty finding a job in the health sector, compromising the availability of health workers in the medium and long term and, therefore, the attainment of universal health coverage.
Maldistribution of health workers and inefficiencies
Several policies have been implemented to address maldistribution and inefficiencies of health workers such as training local health workers, providing allowances, and awarding scholarships to increase the supply of health workers in underserved and rural areas. Kenya launched an e-learning programme to train health workers in rural areas, while Zambia trained community health workers to work in underserved areas. These policies have been effective in increasing the number of health workers in rural and underserved areas. However, they have not been sufficient to reduce health worker shortages and increase access to quality services for the entire population. In Zambia, the provision of compensation schemes for health workers serving in rural areas was effective in increasing the number of health workers in the targeted areas. However, it did not lead to a decrease in the overall shortage of health workers. In Sudan, several efforts have been made to increase access in underserved areas, although the efforts were poorly implemented and had very limited effect in decreasing health worker shortages. For example, in 2002, a specific policy was introduced to provide in-service training to physicians working in underserved areas; however, some of the recipient states were not able to provide competent training services and physicians did not abide by the contracts.
To ensure equitable access to quality services for the entire population, there is a need to eliminate health workforce inefficiencies and waste of resources, by improving the productivity and performance of health workers [1, 5]. However, Cameroon is the only one of the four countries that has implemented effective strategies to improve the productivity and performance of health workers; for example, a productivity allowance was introduced, comprising 10% of the financial resources generated by the health facility, to motivate staff. As a result, the quality of the health services increased.
Regulation of the private sector
Policies to regulate both the public and private sectors have mainly focused on boosting private sector participation in training health workers. These policies have contributed to the growth in the number of graduates in the four countries over the past decade. However, the lack of government regulation may compromise the quality of training and service delivery. The growth of the private health labour market means that there is a need to develop specific policies to regulate the private sector, to improve the quality of training and service delivery, and to manage dual practice in order to ensure equitable access to quality health services for the entire population.
An understanding of the interactions between the factors that determine demand and supply of the health workforce – the health labour market dynamics – is critical if countries are to develop effective polices to address health workforce shortages and maldistribution and attain universal health coverage. Partial health workforce policies, such as those that focus just on training more health workers, are not sufficient to reduce health worker shortages.
We found that over the past decade, there have been great improvements in the availability of health workers in Cameroon, Kenya, Sudan, and Zambia. However, despite these improvements, there are persistent health workforce shortages and maldistribution. Several factors contribute to and aggravate the shortage of health workers in the four countries, including migration, an aging workforce, and imbalances in the skill mix composition. The lack of health workforce capacity to provide health services to the entire population is a major challenge for ensuring equitable access to health services and for attaining universal health coverage.
In Kenya and Sudan, increasing the production of health workers, particularly physicians, may not be the most appropriate strategy in the short term to reduce health worker shortages, as these countries experience high vacancy and physician migration rates. In Cameroon and Zambia, however, training of new graduates, coupled with recruitment strategies, such as improving working conditions, safety, and wages to attract health workers back to the health sector, could decrease the geographical inequalities and economic shortage of health workers.
For further policies to be effective in reducing health workforce shortages, the countries will need to take into consideration the dynamics of the health labour market. In general, policies should be directed to recruiting and retaining health workers in underserved areas, and should include strategies to improve the retention, productivity, and quality of the current health workforce. In addition, appropriate regulation of the private sector should be implemented, including monitoring of dual practice. Eliminating health workforce inefficiencies by improving productivity and performance will be critical in increasing the supply of services, and, therefore, to some extent mitigating the shortage of health workers [1]. Measures to improve productivity, such as having the optimal workforce mix and providing the appropriate technology and capital, can be important overall strategies. Finally, changes should be made to the skill mix of health workers, by growing and appropriately training and supervising non-professional cadres of health workers, such as community health workers and other health care providers, to perform a variety of health care tasks [24–26].
aFor example, the 2010 UK Coalition Government engaged in retrenchment and restructuring of the public sector [8].
bSudan in this paper refers to former Sudan, before South Sudan gained independence in 2011.
cThe country analyses were based on a protocol written by R Scheffler in consultation with WHO, aimed at understanding the health labour dynamics and productivity in low- and middle-income countries [18].
dIn Zambia, health workers receive a recruitment and retention allowance of 25% of their basic monthly salary; those in rural areas also receive a 20–25% rural and remote hardship allowance. In addition, health workers serving in rural areas are entitled to top-up allowances under the health worker retention scheme of 30–70% of their basic monthly salary [21].
eExits are due to attrition, resignation, or internal or external migration.
fThe analysis of "positive" and "negative" effect is a broad categorization that applies only to the countries in this sample. It is not generalizable to other situations or other countries.
The research for this paper was partially funded by the European Commission and the United States Agency for International Development. The authors would like to thank Jere Mwila, Mutinta Musonda, Marlyse Paule Peyou Ndi, Achille Christian Bela, Caroline Kiio, and Nour for acquisition and interpretation of data. The country analyses were based on a protocol written by R Scheffler in consultation with WHO, aimed at understanding the health labour dynamics and productivity in low- and middle-income countries.
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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.


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2011 Taxes due Monday 10/15
or Where did 2012 go?
Tax Time Work-A-Long, aka Action w/o Blame
April was a blink ago, it seems. Have you totaled up all your mileage and filed your taxes? More importantly, have you accomplished all that you planned?
Me neither (website redesign is creeping along, not to mention the SquareOne home-study version). Here's what to do:
- List out what is the situation. "just the facts" separate out your judgements and your stories
- Acknowledge that you would prefer things were different.
- Accept how things are as your current starting point. Be sure you include all your resources.
- List out steps forward towards your goals.
- Take Action, and more action (celebrating as you go).
If you haven't completed your 2011 income tax return, you aren't alone.
Join one of the small groups tackling this on Friday. Have it done! Have a good time doing it, too.

subset: commoncrawl


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Breast uplift & enlargement
The breasts are uplifted (mastopexy) and enlarged (augmented) using a silicone implant at the same time. This is done by lifting the nipple, tightening the breast issue and then removing the excess skin from the breast. This leaves you with a scar around the nipple, one running vertically down from the nipple to breast crease and possibly one in the breast crease depending on how much skin excess there is. You can have a Breast uplift and enlargement in Bristol, London and Newport clinics.
Frequently asked questions
What's involved in a breast uplift and enlargement operation?
The operation is performed under general anaesthesia and you will be in hospital overnight. Usually you will have a surgical drain (tube) coming out of each breast, which is removed before you go home. Following the surgery you will have to wear a non underwired supportive bra for 6 weeks.
The aim of an augmentation mastopexy is improve the shape of the breasts, particularly the fullness in the upper part of the breast. The uplift (or mastopexy) will correct the shape and the implant (augmentation) will restore volume or size to the breast.
How long does the operation take?
Implants are available in differing shapes and sizes and level of fill. The most common types of implants that you will hear of are round or anatomical (also known as tear drop) shaped implants. The round type prosthesis looks almost like a semicircle in profile (hence round), whereas the anatomic shape tries to recreate the natural shape of the breast, which is tear drop in profile. The approximates to the number of millilitres (mls) inside the implant, and the level of fill equates to the projection that the implant will have from the chest wall.
What happens after the surgery?
The surgery takes 2-3 hours and involves an overnight stay. If you have drains these will be removed the following morning. You will need to wear a supportive non-underwired bra for the next 6 weeks to help support the tissue whilst they are healing.
Following an uplift and implant you will need to avoid exercise and heavy lifting for the first 2 weeks, following which you can gradually increase your activity levels. By 6 weeks you should be able to resume normal activities but be guided by what your body is telling you – everyone is different!.
Is there anything else I should know?
No one has 2 breasts that are the exactly the same on both sides! Although you will not be symmetrical following the procedure augmentation mastopexy surgery has a symmetrising effect. Any pre-existing asymmetries between your breasts will influence the final outcome of the procedure.
The shape of your breasts following an augmentation mastopexy will change over the first 6 to 9 months following your operation. Initially you will by be very pert (think of the Jean-Paul Gautier bra worn by Madonna) but as the swelling settles the breast will gradually assume a more natural tear drop shape.


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What is a Fugue?
By Edwin Hall Pierce
A fugue is a piece of music formed by the recurrence of the same theme in several different voices, according to certain strict laws of imitation. These laws have not been invented by composers or theorists any more than the laws of waveforms have been invented by mathematicians. They have simply been discovered. Theorists record them, not to place a limit on the possibility of music creation, but as a guide and help to young composers. In listening to a fugue, it is not at all necessary to pleasure that one should understand these laws. One is simply conscious of the surging motion of music and underlying unity.
The reason many people do not enjoy fugues, is that they are accustomed to listen for a single predominant melody as in a song for a solo voice, the harmony being to them only for enrichment, like the gravy on meat. Not that a fugue has no melody – the trouble is, in fact, that it is all melody – soprano, alto, tenor and bass alike – and the inexperienced ear cannot take in so much at once.
When a pianist hears the word "fugue" he instinctively recalls Bach's Well-Tempered Clavier; but the first fugues were vocal, not instrumental. Even in speaking of instrumental fugues we still use the term "voices" to describe the different parts which enter one by one at different pitch. In Handel's Messiah, Haydn's Creation and other of the older oratorios, nearly all the choruses are vocal fugues with orchestral accompaniment. As we approach our own day, fugue writing becomes less frequent. Mendelssohn and Gounod, for instance, use it only occasionally. Much of the ancient church music, for instance the Masses of Palestrina or of Byrd, is in the form of unaccompanied vocal fugues. The organ is a particularly grateful medium for the presentation of fugues.
We now come to the technical structure of the fugue.
The "Subject"
Fugues are written for a certain definite number of "voices," from two to give, but the favorite number is four – soprano, alto, tenor and bass. Any voice may begin, according to the composer's fancy, and the first thing it sings is the subject. For a vocal fugue, the first requirement is that it be singable in character and not too great in compass. This, to begin with; but there are several other considerations which an experienced composer learns to take into account. For instance, its fitness for an "answer" and its opportunities for a possible "stretto" – two things which we will explain later.
(This last example illustrates the somewhat rare case of a double subject, starting what is called a Double Fugue.)
In an instrumental fugue, as it is more difficult to preserve the individuality of the voices, the composer takes great pains usually to device a subject which has a strongly marked character, so that it may be easily recognized no matter how concealed among the "voices." This "character" may consist in unusual melodic intervals, peculiar rhythm, or anything else which serves the desired purpose. We give a few examples:
This exhibits a striking character in the intervals of the melody.
This exhibits rhythm easily attracting the attention.
This has a peculiar opening and shutting effect, reminding one of a pair of scissors.
Generally a fugue subject is quite brief. If it is longer, it is usually in rapid time and contains "sequences" (repetitions of the same motive a degree higher or lower.)
It is very seldom that a theme drawn from a song, dance, modern hymn tune or other music of a modern type would be suitable for a fugue subject; because such a theme contains within itself the laws of periodic construction. It has a regular recurrence of cadences, whereas the very essence of a good fugue is its great flow and its almost entire avoidance of cadences and marked divisions of any kind. To realize this you only have to try to take half a fugue for a lesson, and see if you can find any good place at which to stop.
The "Answer"
At the close of the "subject" (sometimes slightly before the close) a second voice starts in with the "answer." The answer is essentially nothing but the subject transposed into the key a fifth higher, or, which is the same thing, a fourth lower. But there are certain licenses allowed and indeed required, in order to keep the answer from leading on to a more distant and undesired key, as the entry of the third voice, which has presently to take place, must be in the original key.
The exact determination of these licenses is of a highly technical nature and to enter fully into a discussion of them would lead us too far afield. Suffice it to say that the tonic (first note of the scale), and, conversely, the dominant by the tonic, notwithstanding the fact that in the first case the interval is a fifth and in the other case only a fourth. One may compare it to "foreshortening" in drawing. A round wheel, seen from the front, is a circle; seen from a little at one side it is an ellipse. Occasionally one finds a subject which can be answered without the least change. The fugue is then called a "real fugue;" but the term is unfortunately chosen, as the greater number of good fugues are of the other kind, called "tonal fugues," and are just as genuine fugues.
Of these to examples, the first shows a "tonal" answer, the second a "real" answer, so-called.
Besides the change of interval that takes place in the tonal fugues, there is another license occasionally found in "answers": the first note may be shortened.
Why Imitate at the Fifth?
Sometimes pupils of an inquiring mind ask the question, "Why pick on the fifth as an interval of imitation?" "Why not use some other interval for variety?" As a good illustration that Fugue rests on natural laws, and not on the arbitrary say-so of theorists, it seems interesting to answer this question. Imitation of one voice by another is possible at any interval, and examples may be found at the Unison, Second, Third, Fourth, Fifth, Sixth, Seventh or Octaves.
Of these, we may dismiss the Unison as being lacking in variety. The Octave is in fact in use, but is more convenient for the third voice than the second. The fourth actually is more or less in use in certain parts of "tonal" answers. That reduces us to the second, third, sixth and seventh. We give a subject and a choice of two different answers: The first keeps the proper relative intervals, but takes us into so remote a key that it will be very clumsy trying to get back again for the entry of the next voice. The second keeps in the same key; but the character of the theme is lost by the change in position of the semitones.
A similar problem would be met with, even if less extreme, in case of the Second, Third and Sixth.
Another good reason for the choice of the intervals of imitation is common use is the fact that in vocal fugue they are peculiarly convenient for the requirements of the human voice. The compass of basses and tenors differs by about the interval of a fifth, and so does the compass of sopranos and altos. The compass of basses and altos differs by about an octave, and so does the compass of tenors and sopranos. Hence nothing could be more convenient.
The "Counter-subject"
When the second voice begins the answer, the first voice continues as a sort of accompaniment to it. If what it sings is a real new theme and is used again repeatedly by other voices for a similar purpose, it is called a Counter-subject, but if it is of no great significance and is changed freely later on, or other material substituted, it is better to call it simply "counter point to the subject." In the former case, the fugue is called "strict;" in the latter, "free."
The "Exposition" and What Follows
When all the voices have had their chance at the subject or answer, the "Exposition" is said to be complete. There follows a shorter or longer bit of free writing, and then the subject and answer begin to appear again, one at a time, in the various voices. The structure of this part of the fugue is very free. There is usually more modulation, and the entries may be in any order; only in good fugues, whenever a voice has a rest, it usually enters again with the subject or answer. Bits of free writing intervene here and there, called "Episodes." In short fugues, these are scarcely distinguishable in style from the rest of the fugue, except for the fact that they are neither the subject or the answer. In long instrumental fugues, for instance Bach's E minor organ Fugue (Peters book II), the episodes are brilliant little bits of free writing not in any way related to the subject, but giving an entire contrast.
The "Stretto"
Toward the latter part of most fugues it is the custom to have the answer follow the subject at a shorter interval of time; overlapping it. Sometimes there are several successive strettos, in which case, the closer ones come last. Some subjects afford no chance of a stretto. If a composer wishes one, he generally plans for it when he is inventing the subject. Sometimes he even writes the stretto first.
The Pedal
Near the end of a fugue there is often a low note in the bass, held for several measures, on the dominant. This is called a Dominant Pedal. At the very end there may be a similar long held note on the tonic. These may come after the stretto, but more often it is combined with one or both of them. Neither a stretto nor a pedal is absolutely necessary to a fugue, but they add greatly to its effectiveness if well placed, forming a climax.
Another device to form a climax to a fugue, and often used by Handel – never so far as we know, by Bach – is to suddenly cease from contrapuntal writing and present the subject simply harmonized with dignified and majestic chords.
Unusual Examples in the Art of Fugue
Sometimes exceptional forms of imitation are found, either in the Exposition or Stretto; for instance, imitation is contrary motion.
In Bach's Organ Fugue in C major (Peters Book II), the subject is
and the pedal keyboard of the organ is not used until near the end of the fugue, when the subject is heard in the deep pedal notes for the first time, but played twice as slow
while the hands keep up the usual lively movement. This is called "augmentation," and must not be confused with what we have described as the "Pedal" of a fugue, which is a long sustained note in the bass.
Examples are said to exist of "diminution" – the "answer" coming on the scene at double speed, but I do not recall any instance worth quoting.
Bach was the greatest of fugue writers; since his day there has been a reaction and the art is less and less cultivated, yet it has never been allowed to die.


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Dissection of Regulatory Networks Mediating Resistance and Susceptibility of Arabidopsis thaliana to the Downy Mildew Pathogen Hyaloperonospora parasitica
MetadataShow full item record
Plants and pathogenic microorganisms are in constant conflict with each other. Understanding the molecular networks that trigger resistance, along with the molecular networks that pathogens might co-opt to infect susceptible plants, is important for developing the integrated, holistic perspective that is necessary for innovative development of engineered resistance to current and emerging pathogens.
The first objective of the dissertation was to increase the understanding of mechanisms by which plants recognize pathogen attack and mount an appropriate defense response. These experiments focused on resistance triggered by the Arabidopsis thaliana R gene, RPP7, which encodes a coiled-coil nucleotide binding-leucine-rich repeat (CC-NB-LRR) protein that activates race-specific resistance to the downy mildew pathogen, Hyaloperonospora parasitica (Hpa). Previously-published genetic epistasis tests have established that RPP7 activates defense responses through a signaling mechanism that does not require accumulation of salicylic acid (SA), or components of the ethylene and jasmonate response pathways. Furthermore, RPP7 is not strongly compromised by mutations in genes associated with defense signal transduction (PAD4, NDR1, NPR1, RAR1). Double mutant combinations of these signal transduction components were analyzed to detect additive or functionally-redundant contributions to RPP7-dependent resistance. Most of the double mutants support an enhanced level of asexual sporulation compared to the single mutant parental lines. Time-course experiments with histochemical stains revealed that these double mutants delay, but do not suppress, the oxidative burst and the hypersensitive response. These results suggest that RPP7 activates multiple signaling pathways, each of which makes incremental contributions to the timing of defense activation.
The second objective of the dissertation was to investigate the role that auxin plays in enabling virulent H. parasitica to colonize Arabidopsis. Transcript profiling revealed induction of auxin-associated genes in response to infection of Arabidopsis thaliana by virulent strains of the oömycete pathogen, H. parasitica. Experiments with the DR5::GUS reporter gene demonstrated that auxin responses are activated at interaction sites following hyphal penetration. A strong reduction-of-susceptibility phenotype was observed in the cyp79B2/cyp79B3 double mutant that lacks cytochrome p450 monoxygenases that catalyze for a key step in biosynthesis of indole acetic acid. Cytological and molecular experiments demonstrated that uninfected cyp79B2/cyp79B3 double mutants do not exhibit constitutive defense activation. However, penetration by an otherwise virulent H. parasitica isolate induces cell death at infection sites and transcription of defense-marker genes, suggesting that reduction of susceptibility in cyp79B2/cyp79B3 is due to derepression of defenses. Similar phenotypes were observed in the twisted dwarf (TWD1) auxin transport mutant, twd1-1, and in response to application of auxin export inhibitors. Together, these data indicate that auxin is a susceptibility factor for successful infection by H. parasitica, most likely because it retards defense responses at early stages in the interaction. Manipulation of auxin biosynthesis and transport may therefore play an important role in colonization of susceptible hosts by H. parasitica.References: Dangl, J. L. and J. D. Jones (2001). "Plant pathogens and integrated defence responses to infection." Nature 411(6839): 826-33. McDowell, J. M., A. Cuzick, et al. (2000). "Downy mildew (Peronospora parasitica) resistance genes in Arabidopsis vary in functional requirements for NDR1, EDS1, NPR1 and salicylic acid accumulation." Plant J 22(6): 523-9. Robert-Seilaniantz, A., L. Navarro, et al. (2007). "Pathological hormone imbalances." Curr Opin Plant Biol 10(4): 372-379. Slusarenko, A. and N. Schlaich (2003). "Downy Mildew of Arabidopsis thaliana caused by Hyaloperonospora parasitica (formerly Peronospora parasitica)." Molecular Plant Pathology 4: 159-170.
- Doctoral Dissertations [13849]


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|Article number:
Palm of the glove in B-TACK grip for a soft touch and reliable catch. Back of the hand in CLARINO® and Spandex Lycra nylon for a good protection during the movement. Palm: 50% polyurethane, 50% nylon. Back of the hand: 70% polyester, 25% cotton 5% elasthanne. Great touch of the ball, very resistant, adjustment with straps


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Chicken Elisofon
"Wilson Hicks, the picture editor of LIFE, gave a dinner for returning war correspondents (World War II) at the Waldorf Astoria which included Robert Capa and Eliot Elisofon. It was suggested that I do the menu, and after a meeting with Oscar I suggested a chicken dish I liked to make which has Hungarian antecedents. I gave Oscar the recipe, he tried it, liked it, and named it Chicken Elisofon on the menu."
Two broilers, about 3 lbs. each, cut in quarters with fat trimmed off.
2 cups canned Italian plum tomatoes with basilico and juice.
1 cup diced onions
1/4 cup diced parsley with stems
1/4 lb. fresh mushrooms
1/2 cup diced sweet pimento
1/2 pint sour cream
1 cup flour
1/4 lb. butter
1 tbsp. diced garlic (not too small)
1 level tbsp. paprika
10 drops Tabasco
Salt and pepper
Lightly dredge chicken with flour and some of the salt and pepper in a bag. Sauté with garlic and butter in skillet until golden. Separately, sauté sliced or quartered mushrooms, also with some garlic. Place all other ingredients and chicken and mushrooms in a casserole or iron pot, mixing Tabasco, paprika, additional black pepper and salt into the sour cream. Gently work throughout contents by stirring. Bake uncovered in a 350 degree oven for one hour and fifteen minutes. Serve over broad egg noodles or steamed rice with a salad and a Beaujolais wine.
--Eliot Elisofon


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Surely this review is 3 and a half months too early
The Thule Pack 'n Pedal Bike Wallet is part of Thule's new Pack 'n Pedal bicycle luggage range. It clips on a handlebar mount that has space for both the wallet and a handlebar bag we are also reviewing and writing up separately. Thule also make an iPad sleeve for the same bar mount.
The bar mount is cleverly designed to be installed around the handlebar and stem, and is made from a combination of aluminium and plastic. It looks, and is, very sturdy and comes with a selection of shims to fit your choice of handlebar diameter. It holds the wallet securely and positions it over the intersection of stem and handlebars. This is a good position from a seeing-the-phone point of view, but I found the wallet getting in the way of my knees when climbing out of the saddle.
The wallet itself has a zipped, landscape-oriented mobile compartment that allows you to use your phone through its transparent window. It swallows an iPhone 4 fine, but is a bit tight around bigger phones like the Nexus 4. If your phone is more like a mini-tablet (phablet?), make sure it fits before you buy.
The wallet also has a zipped main compartment with enough room to fit your wallet, keys and maybe one or two other small items, though the vast majority of the space is taken up by the recess for the phone compartment and the bracket moulding.
The wallet comes with a waterproof cover held in a little mesh pocket inside the wallet. You'll need this in anything other than very mild rain - those zips are not waterproof. Not so clever is the fact that you won't be able to see your phone through the cover. When it starts raining, you better not need to see the screen anymore. Although I haven't tried, I wouldn't trust my phone to it in a prolonged downpour.
All in all, both the wallet and bar mount are very well made (as you'd expect from Thule). However, at over £70 for the combo, it's a heavy and pricy way to use your phone on the move, even when offset against the bar mount allowing you to carry a handlebar bag at the same time.
Secure, but heavy and bulky system to attach and use your phone from your handlebars. It'll store your wallet and keys too.
If you're thinking of buying this product using a cashback deal why not use the road.cc Top Cashback page and get some top cashback while helping to support your favourite independent cycling website
road.cc test report
Make and model: Thule Pack 'n Pedal Handlebar Wallet
Size tested: xx
Tell us what the product is for, and who it's aimed at. What do the manufacturers say about it? How does that compare to your own feelings about it?
Thule say it's an organiser for smartphones, keys or other small items:
o Easy access and great for use with GPS apps through transparent cover.
o Easy click in/out from Thule Pack 'n Pedal™ Handlebar Attachment.
o Includes rain cover.
Tell us some more about the technical aspects of the product?
Volume: 1.25 l
Weight: 290 g
Dimensions HxWxD: 18x14x5 cm
Materials: Non-PVC
Warranty: 5 years
The construction is as good as you'd expect if you've used any of their other products.
It does what it says on the tin.
My initial concerns that the stem cap would wear through the wallet have remained unfounded so far. Other than that, it looks like the wallet should last a long time.
It feels quite heavy, especially taking the weight of the bracket into account too. You would only use this on a bike or journey where weight was of no consideration.
The zips have nice rubberised toggles. The phone screen can easily be seen while riding, and I can operate my iPhone through the transparent cover.
The wallet costs £40 (RRP) and doesn't come with the handlebar mount, which costs an additional £35. That's really quite expensive compared to other decent phone holders. That should be offset against the fact that you can carry a handlebar bag at the same time.
Tell us how the product performed overall when used for its designed purpose
It holds a phone, wallet and keys securely in place on the handlebars. The phone screen is visible and it's easy to see the screen while riding.
Tell us what you particularly liked about the product
Having my phone at my fingertips while riding. The quick release bracket works well.
Tell us what you particularly disliked about the product
The position the wallet is mounted in on my bike means I knock my knees on it when climbing out of the saddle.
Did you enjoy using the product? Yes, for leisurely rides without significant climbs, where I didn't know the way.
Would you consider buying the product? No, too expensive.
Would you recommend the product to a friend? Probably not, unless they were rich.
Anything further to say about the product in conclusion?
A well constructed, but heavy and pricey solution to being able to use your phone while cycling.
About the tester
Age: 36 Height: 1.78m Weight: 76kg
I usually ride: All of them! My best bike is: Cannondale CAAD10
I've been riding for: Over 20 years I ride: Every day I would class myself as: Expert
I regularly do the following types of riding: cyclo cross, commuting, touring, mtb,


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"Play to your Strengths"
Happy Sunday everyone!
Have you ever had one of those moments where you learn something new and your first thought is: "I need to blog about this"? On Friday, I was in a training at my workplace, and I had one of those exact moments. As part of our training we watched a video by a man named Marcus Buckingham, and I was instantly hooked on his philosophy. Buckingham speaks all around the world about the importance of discovering and capitalizing on your personal strengths. After watching his video at the training, we discussed our own strengths and how we can best apply our own strengths in our current work positions.
Here are some of Marcus Buckingham's main points/ideas:
- When people are asked, "Do you have the chance to use your strengths in your workplace?" only 2 out of 10 people answer "yes." That means that 8 out of 10 people are unhappy in their current positions and do not feel that their employers allow them to play to their strengths.
- A "strength" is not just something your are good at in your life. Your strengths are those activities that "make you feel strong, that interest you, that you are passionate about, that you look forward to." You are the best judge of your own strengths. Just because someone says you are good at something does not mean it's a strength for you (in fact many of us may be good at things that we absolutely hate doing).
- There are some myths about our strengths:
- Myth #1: As you grow, your personality changes.
- Truth: As you grow, you will become more of who you already are.
- Myth #2: You will grow most in your areas of weakness.
- Truth: You will grow most in your areas of greatest strength.
- Myth #3: A great team member does whatever it takes to help the team.
- Truth: A great team member deliberately volunteers his or her strengths to the team.
If you want to find out more about Marcus Buckingham's work (like I have already been doing), visit: www.simplystrengths.com, www.strengthscampus.com, or www.thestrengthsfoundation.org. Please note: all of the above information was gathered from those websites and from information I learned at my training.
Quotable Sunday
Feeling "gutsy."
I am not usually one to enjoy receiving compliments, but yesterday I received a compliment that really meant a lot to me…
In the middle of another busy work day my one co-worker turned to me and said: "Amanda, you have the guts of a 6-foot tall man."
This came after I made the choice to speak up about a situation that I didn't agree with in our workplace. It was a normal everyday occurrence for me, but it still took some self-confidence. I was suprised at the compliment, though, because I do not consider myself to be the most self-confident person. Honestly, I would not describe myself as gutsy in any way, shape, or form. I wouldn't even say that I always speak my mind or stand up for what I believe.
My co-worker seemed to think differently than me, though, and this really got me thinking. I wonder—how many times we fail to see the good in ourselves?
How often do we rely on the comments and feedback from others to make us feel good about ourselves?
How often do we only see the positive once someone else points it out to us?
How often do we fail to praise and compliment ourselves?
How often do we do these things? It didn't take me very long to draw some conclusions and find an answer. We do it all of the time. I, myself, do it regularly. I forgot to believe in myself. I forget to see my strengths. I forget to praise myself when I'm doing a good job. I fail to see all of the positive things until someone else points them out to me (I have no problem seeing the negatives and pointing out my own mistakes).
We all fall into these holes from time to time, and it makes us human. The most important thing we can do is be self-aware. Recognize when you are falling into these traps. Counteract the negatives with the positives. Praise yourself. Compliment yourself.
See your strengths, and never rely on the opinions of others to determine your self-worth.
Quotable Sunday
You can't help what you think or feel.
It's been an entire week since I last blogged, and even longer since I've sat down to compose a truly honest post.
I've spent the last week devoting some time here and there thinking as to why it's been so long since I've blogged and thinking about the place I've been in recently. I could lie and simply state that I've been too busy to blog (which isn't always very far from the truth), but this week it's been something different. I've been a little scared to blog because I'm not sure what would come out if I really sat down to write a post.
I don't want (or in any way expect) pity or sympathy from anyone when I say that I had a rough week last two weeks for a variety of reasons. I had a lot going on internally and was overly emotional for reasons I'm not quite sure of entirely. I was doubting where I am in my life right now. I have a birthday where I will turn 24 in a couple of weeks (yes I do realize that this is still young), and I started to think about where I expected to be right now at this point in my life. I expected to be living on my own and possibly in a long-term relationship. Although I know these are things that I don't need to happen right now in my life, I still couldn't help thinking about it.
I think we all create expectations for ourselves in our minds sometimes that aren't realistic or necessarily even important. We do it because we see where other people are in their lives or simply because we are feeling idealistic. Creating these expectations isn't always a problem. The problem comes when you fail to meet these expectations and you spend too much time feeling disappointed or upset because of it. That's the state that I was in up until recently. I wasn't thinking of all of my accomplishments. I didn't credit myself for being two years into my graduate school program while having a full-time job that I love. I didn't credit myself for having goals for my future and friends/family who care about me. Instead I thought about the should of's and could of's. I smiled on the outside, but meanwhile I felt pretty crappy on the inside.
As I already said, I'm writing this post (and hitting "publish" in a couple of minutes) not to be negative or because I want people to feel sorry for me. If you know me or read my blog you should know that for the most part I am positive, optimistic, and easygoing. At the same time, however, I want everyone to realize that we all have "those days" or even "those weeks" where we simply feel miserable. It makes us human. It makes us real. It makes us appreciate the times when we are feeling happy and optimistic.
It's moving on from those times and learning to let those times go that makes us stronger.
Thanks for listening if you made it to the end of this post! I promise to write some upbeat and not-so-serious posts in the upcoming week, but this post is what I needed to write today. Happy Sunday everyone, and have a great week!
Quotable Sunday


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Resumes & Interviews >> Browse Articles >> Interview Tips & Advice
Ten Job-Seeking Tips for Introverts
Dr. Katharine Brooks
June 28, 2010
In my previous post, I discussed the challenges for shy (or introverted) people in the job market. I offered some general advice, but in this post I'd like to highlight ten things you can do (or think about) that might give you the edge in the very situations you prefer to avoid.
1. First, stop apologizing for what being who you are. Work with it— find your strengths and get to know them so well that they are all you think of when you are in the interview. You may never be comfortable in certain settings— but you can learn to function well in them, and then you can go home where you are comfortable. A small amount of discomfort and pain and "faking it" can go a long way. You are who you are— which means you are talented in a lot of areas and you can learn to extravert yourself when needed.
2. Don't defeat yourself or argue for your limitations. Introverts can be particularly hard on themselves, analyzing every moment, being too sensitive to "mistakes" they might have made, etc., all due to being self-conscious when on public display. And unfortunately, unless you're at home you probably feel like you're on some form of "public display." In his excellent book "Feeling Good" (which I highly recommend) Dr. David Burns warns about being a "mind-reader" or a "fortune-teller"— guessing what people are thinking and/or presuming we know how something will turn out. Remember, when you live inside your head, your head is the only information you're getting— and it can be wrong. As Dr. Burns says, just because you feel something, doesn't make it true. Or as Anais Nin said, "We don't see things as THEY are; we see things as WE are."
So after an interview, networking event, or any other extroverted activity don't be too hard on yourself. Don't over-analyze your situation and hyper-focus on those moments that make you cringe.
Next Page: Focus on your successes →
Featured Author: Dr. Katharine Brooks
Dr. Katharine S. Brooks is the Director of Career Services for the College of Liberal Arts at The University of Texas in Austin, where she also teaches courses focusing on the connection between a liberal arts education and the workplace. She is a licensed and certified counselor, and is the creator of the National Association of Colleges and Employers' Career Coaching Intensives, highly successful sold-out training sessions for college career counselors. She has been in the career services field for over twenty years, is the author of You Majored in What? Mapping Your Path from Chaos to Career and writes a blog, "Career Transitions", for Psychology Today. Brooks has a doctorate in educational psychology and a master's degree in rehabilitation counseling from West Virginia University. Her bachelor's degree is in sociology and anthropology from Gettysburg College.


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This story appears in the February 10, 2014 issue of Forbes. Subscribe
You wouldn't know it from its modest adobe-and-brick-tile headquarters on National Avenue, but like a lot of its larger neighbors in Mountain View, Calif.,
Making the world a better place can be a pretty good business. AnchorFree has been buoyed by dissident movements in the Middle East, Thailand and Turkey. But it's also gained fans in the U.S., with heightened concerns about intrusions by relentless data gatherers, from the NSA to
It took a while for Gorodyansky and cofounder Eugene Malobrodsky, also 31, to find their focus. Both the children of computer engineers who immigrated to Silicon Valley as the Soviet Union crumbled, the two met at their Palo Alto synagogue 18 years ago and have remained inseparable. Gorodyansky, an intense, fast-talking Muscovite, and Malobrodsky, a laid-back techie born in Lithuania, founded their first venture in 2002: Intelligent Buying, a network-equipment sales platform that reached $1 million in revenue.
The duo aimed higher. While keeping the business and their college courses going, they met in coffee shops--and groused. "This paid Wi-Fi stuff has to die," Gorodyansky recalls thinking. "It has to be free, and it has to be secure." Why not provide such a service--and get advertisers to pay for visibility on their network, covering infrastructure costs and leaving a little profit? AnchorFree lumbered into the world in 2005.
In classic entrepreneurial form, they maxed out their credit cards, spending $50,000 or so to finance Wi-Fi antennas in downtown Palo Alto and San Francisco. The ploy snagged a few thousand users and caught the attention of then San Francisco mayor Gavin Newsom, who invited Gorodyansky to advise his tech council, which included Craigslist founder Craig Newmark and Google folks. Through their lawyers, Wilson Sonsini, which took its fees in equity, the founders met former MCI Communications CEO Bert Roberts, who convinced RENN Capital of Dallas to lead a $6 million Series A round in 2006.
Great idea, but little money in it. "The cost of upkeep and infrastructure just doesn't generate enough revenue to pay for itself," explains Malobrodsky. "So we started thinking about what kinds of products would."
AnchorFree jettisoned everything except Hotspot Shield. Here's how it works. When you download and activate the program on desktop, tablet or mobile, you visit websites via the company's servers in the U.S., the Netherlands, Germany, Switzerland and Japan, which scrub any information (including IP addresses) that could determine your location or identity. After you log off, your data are deleted. The free download caught fire. "We had to add servers literally every two days because it would get oversaturated," Malobrodsky recalls.
The slimmed-down company rises in popularity whenever repressive regimes crack down. In 2010, after Chinese authorities blocked the site, AnchorFree figured out a bypass: It sent e-mails to its entire user base with links to download Mac and Windows versions of Hotspot Shield; because Web surfers rode Gorodyansky's servers, they steered clear of the censors. "That helped us quadruple traffic," he says.
During the 2011 Arab Spring, when governments shut down websites like Facebook, YouTube and Twitter, protesters flocked to Hotspot Shield. That January, as crowds in Tahrir Square tried to oust Egyptian president Hosni Mubarak, Hotspot Shield downloads there jumped literally tenfold overnight to 1 million. "We were the only way to get to social media, to communicate and to share," says Gorodyansky. Last year, when Turkish Prime Minister Recep Tayyip Erdogan threatened to raze a park in Istanbul, thousands of people discovered the AnchorFree loophole, boosting usage 1,000% nationwide.
You might think the two ex-Soviet founders had been inspired by legendary dissidents Andrei Sakharov and Natan Sharansky. Gorodyansky, a onetime Forbes.com contributor, shakes his head. "We pretty much grew up here." He points to his paternal grandfather, Aaron Leonid, a Red Army reconnaissance photographer in World War II, who used to tell him, "Don't just stop because there's a wall or a door in front of you. Keep going!" The Arab Spring uprisings, however disappointingly they turned out, clarified AnchorFree's mission. Says Gorodyansky: "We wanted to be a business with a soul and a real social mission, instead of just a financial one."
Making dough sometimes clashes with that higher goal. Hassle-free communication and browsing come with a price--a relentless barrage of ads that follow you like black flies wherever you go on the Web. Some are content teases by publishers; AnchorFree distributes content for the likes of AP, UPI, PC World, Mac World, National Geographic and News Distribution Network, which pay for the service. Many ads are annoying and random--getting hit with an ad for a dating service, say, when you're visiting a musical instrument site, served by an ad network from Google,
But the app can be a challenge for some advertisers, too. Because AnchorFree doesn't collect an individual's data and deletes everything except page cookies, brand advertisers glean only the most minimal information about potential customers. They know you've come to a site via the app and hope they're hitting you with something you'll click on.
AnchorFree may have to reconcile its competing interests at some point. In three rounds of financing it has raised $63 million. Its biggest backer is Goldman Sachs, which led a $52 million Series C round in May 2012, giving AnchorFree a valuation of $250 million. (Goldman declined to comment on its investment.) Half that wad went to pay off some early investors and staffers. Roughly one-third of the equity is still in the hands of the founders and their 70 employees.
Bert Roberts, the onetime MCI chief who owns more than 10% of AnchorFree, is letting his money ride a while. There may be an acquisition of a company or two that develop security and identity management apps for mobile. AnchorFree is also beta testing a portal called KaboomIt.com that lets users express themselves and share information, pictures and videos before disappearing them, la Snapchat. Roberts talks about achieving a user base on a par with some of those other Valley titans trying to change the world. AnchorFree, he insists, "has that kind of potential."
Follow me on Twitter @KarstenStrauss


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ROLL CALL: Quirky Ex-Senator Dashes Democrats' Hopes in South Dakota
July 24th, 2014
Posted in:
This article was written by Colin Diersing and originally appeared in Roll Call.
South Dakota Democrats are playing a tough hand in the Senate race, but they thought they could count on a wild card — former Sen. Larry Pressler — to help the contest break their way.
Pressler seems to have other plans.
Democrats already faced long odds to hold retiring Democratic Sen. Tim Johnson's seat. Obama lost South Dakota by 18 points last cycle, and the state marks the GOP's best pick-up opportunity in its 6-seat quest to win the majority.
The front-runner, popular former GOP Gov. Mike Rounds, faces several foes: Democrat Rick Weiland; state Sen. Gordon Howie, a conservative Republican running as an independent; and Pressler, who served three terms as a Republican but is running as an independent.
Democrats held out hope the race would become competitive if Pressler splintered GOP votes from Rounds. But so far, Pressler is doing the opposite — splitting Democrats and extinguishing the party's remaining hopes of keeping the seat.
"He seems to be veering to the left," said Ben Nesselhuf, former South Dakota Democratic Party chairman, in an interview with Roll Call. "I like this Larry Pressler a lot more than I liked the one in the mid 1990s. … His message and Rick Weiland's message seem to kind of overlap."
According to a Rounds campaign memo obtained by Roll Call, a mid-June internal poll of 500 likely voters found Pressler's supporters were more than twice as likely to be Democrats as Republicans, 48 percent to 22 percent. Also in the survey, a hypothetical head-to-head race showed Rounds with 49 percent, Weiland with 24 percent and Pressler with 15 percent.
There's a reason: Pressler has declared his support for the president's health care law and frequently invites the president to visit the state to lecture on the law. He had previously endorsed Obama for president and talked up his support for gay marriage. In a recent interview with Roll Call, he highlighted his support for raising taxes on estates worth more than $10 million and offering a five-year path to citizenship for immigrants who enter the country illegally.
"This is my last campaign and I'm saying exactly what I believe," Pressler said.
Republicans, who once worried Pressler would peel off support from Rounds, now see his campaign as advantageous to them.
Pressler "is a respected former senator … who's trying to run on issues the Democratic candidate is running on," said Dick Wadhams, a senior adviser to South Dakota Republicans, in an interview with CQ Roll Call.
Rounds said he thinks Republicans will support him over Pressler because the former senator won't disclose which party he will caucus with if elected.
"I want to change the makeup of the Senate," Rounds said. "I'm a Republican, and I'm not going to negotiate with Harry Reid to leave him in power."
Pressler, meanwhile, denies he's courting Democratic voters. He said he can't afford polling to even determine if that would be a good strategy.
To read the rest of the article, click here.


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Maybe someday I will get this monthly update up in a timely manner and not halfway through the next month.
Weight: 12 lbs 14 oz
Height: 24 1/8 inches
Head Size: 15 1/4
Clothes: 0-3
Diapers: size 1
This month Grayson grew out of being so sleepy all the time and is awake more during the day. In fact, he doesn't nap much during the day but luckily he started sleeping completely during the night at 5 weeks and hasn't looked back. That was one week sooner than Elin started sleeping through the night! She started sleeping through the night at 6 weeks and has NEVER looked back. She wakes up maybe once a month (if that) in the middle of the night to go to the bathroom, but that's it. We are hoping he will be another good night sleeper.
About a week into month two he hit a big growth spurt and got really chubby really fast! It was like overnight he just got bigger! He is almost too long for his bassinet stroller and his feet are almost sticking out past his infant carrier! Luckily, he still fits in the bassinet stroller because he loves going for walks! He seems to like the constant motion and the fresh air. He just seems so at peace on walk.
Grayson has found his hands and will hold his hands a lot. He reaches up and bats at toys on his activity gym and he also likes to kick at the little stuffed animals.
He has really taken to his bouncer seat and swing this month. He will often fall asleep in there for little naps throughout the day.
These pictures crack me up that he fell asleep during our little photo shoot!
Elin continues to love her brother so much and loves to sit and "play" with him everyday. He has started watching her more closely and smiling at her when she sits with him.
Angel is still uncertain on her feelings. She seems to want to protect him from Elin when she is loud and running around, but she likes to keep a safe distance from both of them.


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ChartThrob 1.08
I've updated ChartThrob, my little tool for creating digital negatives. The latest edition has some subtle internal tweaks that should enhance its compatibility with Macs (and users who have radically different default Photoshop preferences than my own).
You can find a nice description of how to use ChartThrob in a complete alt-process workflow here on inkjetnegative.com. Props to Michael for creating that page!
January 06, 2010


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Blog Archives
Dermals: Taking Care of Microdermals
Microdermals are beautiful pieces of jewelry. I've gotten dermals done nine times (I still have six) and I love them to pieces but there is not a lot of information circulating about them. How do they stay in? How do you get them? How much do they cost? Can you change them? What if they start to reject? Are they irritated? Getting a new piercing can be confusing but luckily, I'm here to teach you all about them so you don't have to learn the hard way.
Microdermals are small, decorative pieces of jewelry that can be placed virtually anywhere. It's best to get them in low impact areas because they never fully "heal" (they don't develop a fistula like more traditional piercings) therefore they can reject at any point, especially if they're snagged or bumped. Dermals are also semi-permanent because they only have a single entry point and must be removed through small incisions, making them harder to remove in the case of an MRI.
So how does it stay in?
Saint Sabrina's was my go-to guide when I first began to consider dermals. She describes dermals as a leg and a foot, with the foot being the anchor that stays in your skin. The anchor has holes in it to allow the tissue to grow through it and anchor it down. You can change the jewel after 2 – 3 months by simply unscrewing the top.


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Market sentiment firmed up coming into 2013 as U.S. lawmakers increased their efforts to address the public deficit, and the short-term resolution may continue to dampen the appeal of the reserve currency as it fuels risk-taking behavior.
Talking Points
- U.S. Dollar: Fiscal Deal Fuels Risk Appetite, ISM Manufacturing On Tap
- Euro: Maintains Range-Bounce Prices, RSI Divergence In Focus
- British Pound: Hits Five-Month High As U.K. Manufacturing Rebounds
U.S. Dollar: Fiscal Deal Fuels Risk Appetite, ISM Manufacturing On Tap
The greenback struggled to hold its ground on Wednesday, with the Dow Jones-FXCM U.S. Dollar Index (Ticker: USDOLLAR) slipping to a low of 10,000, and the reserve currency may weaken further over the next 24-hours of trading should the Federal Reserve continue to strike a dovish tone for monetary policy.
Indeed, market participants increased their appetite for risk as the U.S. Congress struck a deal to avoid the 'Fiscal Cliff,' and the rise in trader sentiment may gather pace over the remainder of the week should the Federal Open Market Committee (FOMC) Meeting Minutes fuel speculation for additional monetary support.
After expanding the open-ended asset purchase program to $85B/month, the Fed may keep the door open to ease policy further amid the ongoing weakness in the labor market, but we may see the 2013 FOMC strike a more neutral tone as the economic recovery becomes more broad-based. As the ISM Manufacturing report is expected to show a rebound in business outputs, a positive development may curb bets for additional monetary support, and we may see the greenback regain its footing ahead of the highly anticipate U.S. Non-Farm Payrolls report as the fundamental outlook for the world's largest economy improves.
Euro: Maintains Range-Bounce Prices, RSI Divergence In Focus
The Euro maintained the range-bound price action carried over from the previous year as the EURUSD fell back from an overnight high of 1.3292, and the pair appears to be carving out a near-term top ahead of the European Central Bank (ECB) interest rate decision on tap for next week as the Governing Council carries its easing cycle into 2013.
There's speculation that the ECB will continue to shore up the real economy as the region faces a deepening recession, and we may see the central bank lower the benchmark interest rate further over the coming months as the headline reading for inflation is expected to slip below the 2% target this year. As the debt crisis continues to drag on the euro-area, we should see central bank President Mario Draghi preserve a cautious tone in 2013, and the single currency remains poised to face additional headwinds over the near-term as growth and inflation falters.
Beyond the fundamentals, the technical point to a near-term correction for the EURUSD as the relative strength index approaches overbought territory, and we will be keeping a close eye on the oscillator as there appears to be a bearish divergence taking place.
British Pound: Hits Five-Month High As U.K. Manufacturing Rebounds
The British Pound extended the advance from earlier this week, with the GBPUSD climbing to a fresh yearly high of 1.6341, and we will maintain a bullish outlook for the sterling as the fundamental outlook for the U.K. improves.
As a U.K. Manufacturing rebounds in December, the bright signs coming out of the economy should keep the Bank of England (BoE)on the sidelines, and the central bank looks poised to adopt a more hawkish tone for monetary policy as the Monetary Policy Committee sees above-target inflation over the next two-years. In turn, we should see the BoE switch gears in 2013, and the central bank may start to discuss a tentative exit strategy in an effort to balance the risks surrounding the region.
As the GBPUSD finally makes a meaningful push above the 1.6300 figure, we should see the pound-dollar continue to retrace the decline from back in April (1.6744), and the sterling may outperform this year as the BoE slowly moves away from its easing cycle.
FX Upcoming
Construction Spending (MoM) (NOV)
ISM Manufacturing (DEC)
ISM Prices Paid (DEC)
--- Written by David Song, Currency Analyst
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Below are some of the recent health and leisure industry construction projects that we have been involved with:
Sited on the existing hospital site in the Centre of Bristol, this former boiler house was the candidate for transformation into the main IT suite for the NHS trust. With both refurbishment and new build elements Davis & Barrett set straight to work undertaking extensive repairs to the existing masonry. Whilst a second team begun the re-modelling and new build. Location, Location, Location! Access was the main hurdle to jump on this project and the management of Davis & Barrett considered the most appropriate method for every task they did to ensure the safety of their men and compliance with manual handling guidance. This involved utilizing mechanical off load facilities and communicating with the entire site team. Our supervisor shone brightly and allowed D&B to move at the pace required.
This new extension to St Werburghs community centre filled the remaining site, but in doing so provided much needed modern space to groups and voluntary organizations. With plinth brickwork and return piers this project required Davis & Barrett to efficiently undertake there works as not to hinder the other trades progression.Refurbishment of the existing community centre was also undertaken, with structural openings being altered to comply with current legislation, and localized repairs to existing masonry works. This building has nestled into the community well and will hopefully provide comfortable modern spaces to the local community.
Asbestos WarningNB: All Davis and Barrett operatives are trained in Asbestos Awareness by a UKATA trainer
Where to find us:
Unit 14 Creech Mills Business Park, Creech St Michael, Taunton, Somerset TA3 5PX