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Mello GA, Pereira APCDM, Uchimura LYT, Iozzi FL, Demarzo MMP, Viana ALD. O processo de regionalização do SUS: revisão sistemática. CIENCIA & SAUDE COLETIVA 2017; 22:1291-1310. [DOI: 10.1590/1413-81232017224.26522016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/23/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo Nesta revisão foram incluídos apenas estudos específicos sobre o processo de regionalização do SUS, baseados em resultados empíricos e publicados a partir de 2006, já sob o referencial do Pacto pela Saúde. Foi evidenciado que o processo de regionalização é hoje uma realidade em todas as esferas de governo, sujeito a um conjunto de desafios comuns às diversas realidades do país. Entre os principais, os colegiados são valorizados com espaços de inovação, mas ainda em busca da superação da cultura política burocrática e clientelista. A governança regional é ainda prejudicada pela fragmentação do sistema e, em particular, pela histórica deficiência com planejamento, desde o nível local às políticas estratégicas de incorporação tecnológica. As análises permitiram implicar a cultura de amplo privilégio para negociação política em detrimento do planejamento como uma das principais responsáveis por um ciclo vicioso que sustenta a deficiência técnica da gestão.
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Okyere E, Mwanri L, Ward P. Is task-shifting a solution to the health workers' shortage in Northern Ghana? PLoS One 2017; 12:e0174631. [PMID: 28358841 PMCID: PMC5373592 DOI: 10.1371/journal.pone.0174631] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 03/11/2017] [Indexed: 12/04/2022] Open
Abstract
Objective To explore the experiences and perceptions of health workers and implementers of task-shifting in rural health facilities in Upper East Region, Ghana. Methods Data was collected through field interviews. A total of sixty eight (68) in-depth interviews were conducted with health workers’ in primary health care facilities (health centres); Four in-depth interviews with key persons involved in staff management was conducted to understand how task-shifting is organised including its strengths and challenges. The health workers interview guide was designed with the aim of getting data on official tasks of health workers, additional tasks assigned to them, how they perceive these tasks, and the challenges associated with the practice of task-shifting. Findings Task-shifting is a practice being used across the health facilities in the study area to help reduce the impact of insufficient health workers. Generally, health workers had a comprehensive training that supported the organisation of task-shifting. However, staff members’ are sometimes engaged in tasks above their level of training and beyond their actual job descriptions. Adequate training is usually not provided before additional tasks are assigned to staff members. Whilst some health workers perceived the additional tasks they performed as an opportunity to learn new skills, others described these as stressful and overburdening. Conclusion Task-shifting has the potential to contribute to addressing the insufficient health workforce, and thereby improving health delivery system where the procedures are well defined and staff members work in a coordinated and organised manner. The provision of adequate training and supervision for health workers is important in order to improve their expertise before additional tasks are assigned to them so that the quality of care would not be compromised.
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Affiliation(s)
- Eunice Okyere
- Social Science Group, Kintampo Health Research Centre, Kintampo, Ghana Health Service, Ghana
- Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
- * E-mail:
| | - Lillian Mwanri
- Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Paul Ward
- Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
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de Oliveira APC, Dussault G, Craveiro I. Challenges and strategies to improve the availability and geographic accessibility of physicians in Portugal. HUMAN RESOURCES FOR HEALTH 2017; 15:24. [PMID: 28335776 PMCID: PMC5364681 DOI: 10.1186/s12960-017-0194-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/17/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Shortages of physicians in remote, rural and other underserved areas and lack of general practitioners limit access to health services. The aims of this article are to identify the challenges faced by policy and decision-makers in Portugal to guarantee the availability and geographic accessibility to physicians in the National Health Service and to describe and analyse their causes, the strategies to tackle them and their results. We also raise the issue of whether research evidence was used or not in the process of policy development. METHODS We analysed policy and technical documents, peer-reviewed papers and newspaper articles from 1995 to 2015 through a structured search of government websites, Portuguese online newspapers and PubMed and Virtual Health Library (Biblioteca Virtual em Saúde (BVS)) databases; key informants were consulted to validate and complement the documentary search. RESULTS The challenges faced by decision-makers to ensure access to physicians were identified as a forecasted shortage of physicians, geographical imbalances and maldistribution of physicians by level of care. To date, no human resources for health policy has been formulated, in spite of most documents reviewed stating that it is needed. On the other hand, various isolated and ad hoc strategies have been adopted, such as incentives to choose family health as a specialty or to work in an underserved region and recruitment of foreign physicians through bilateral agreements. CONCLUSIONS Health workforce research in Portugal is scarce, and therefore, policy decisions regarding the availability and accessibility of physicians are not based on evidence. The policy interventions described in this paper should be evaluated, which would be a good starting point to inform health workforce policy development.
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Affiliation(s)
- Ana Paula Cavalcante de Oliveira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
| | - Gilles Dussault
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
| | - Isabel Craveiro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
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Pudpong N, Suphanchaimat R, Batra B, Hou J, Vu LTH, Dipika P. A final-year nursing student survey: rural attitudes, perceived competencies and intention to work across five Asian countries. BMC Nurs 2017; 16:13. [PMID: 28344513 PMCID: PMC5361839 DOI: 10.1186/s12912-017-0208-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shortages and maldistribution of nurses remain significant problems in many countries. Having appropriate intervention strategies to retain nurses in underserved areas, where they are most needed, are crucial for health system strengthening. This study aimed to quantify attitudes to working in rural areas, perceived competencies, and intention to work among final-year nursing students, and to analyze the associations between those factors and their background characteristics across five countries in the Asia-Pacific Network for Health Professional Education Reforms (ANHER), namely Bangladesh, China, India, Thailand, and Vietnam. METHODS A descriptive comparative cross-sectional survey was conducted between July 2012 and July 2013, using a self-administered questionnaire to assess students' attitudes towards working in rural areas, their perceived competencies, and their intended job choices. A total of 10,169 final-year nursing students in five countries were selected. Bivariate models were constructed to compare students' characteristics. Statistically significant variables were further analyzed using multivariate models. RESULTS Most nursing students in five countries had rural backgrounds. Students in India (67.1%) and Thailand (65.1%) held more positive attitudes towards working in rural areas. Students in Bangladesh (78.8%) and India (62.6%) believed that their schools prepared them well, and inspired them, to work in rural areas. The 'Lifelong learning' competency was ranked highest by students in all five countries, ranging from 76.2 to 91.7%. Their perceived competencies were significantly related to their background of having graduated from rural high schools and being admitted to study through rural recruitment. Rural upbringing and rural recruitment were significantly associated with more positive attitudes towards rural areas (p-value < 0.5). A majority of students in China (83.8%), Thailand (67.7%) and Vietnam (86.5%) intended to work in the public sector immediately after graduation. CONCLUSIONS These findings from five Asian countries confirm that nursing students with rural upbringing and recruitment had more positive attitudes toward rural areas and were more likely to choose working in rural areas after graduation. This study provides additional evidence from country implementation to support the value of WHO recommendations of effective strategies to address issues of rural retention by focusing on the recruitment of students with a rural background.
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Affiliation(s)
- Nareerut Pudpong
- Healthcare Accreditation Institute (Public Organization), Nonthaburi, Thailand
| | | | - Bipin Batra
- National Board of Examinations, New Delhi, India
| | - Jianlin Hou
- Institute of Medical Education, Peking University, Beijing, China
| | - Lan T H Vu
- Department of Epidemiology, Hanoi school of Public Health, Hanoi, Vietnam
| | - Paul Dipika
- Research, Training and Management (RTM) International, Dhaka, Bangladesh
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Budhathoki SS, Zwanikken PAC, Pokharel PK, Scherpbier AJ. Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review. BMJ Open 2017; 7:e013501. [PMID: 28232465 PMCID: PMC5337703 DOI: 10.1136/bmjopen-2016-013501] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation. DESIGN A systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review. RESULTS A rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas. CONCLUSIONS Medical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern.
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Affiliation(s)
- Shyam Sundar Budhathoki
- School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Paras K Pokharel
- School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Albert J Scherpbier
- Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
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Sawaengdee K, Pudpong N, Wisaijohn T, Suphanchaimat R, Putthasri W, Lagarde M, Blaauw D. Factors associated with the choice of public health service among nursing students in Thailand. BMC Nurs 2017; 16:8. [PMID: 28127257 PMCID: PMC5259999 DOI: 10.1186/s12912-017-0202-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/16/2017] [Indexed: 11/25/2022] Open
Abstract
Background Despite the fact that public and private nursing schools have contributed significantly to the Thai health system, it is not clear whether and to what extent there was difference in job preferences between types of training institutions. This study aimed to examine attitudes towards rural practice, intention to work in public service after graduation, and factors affecting workplace selection among nursing students in both public and private institutions. Methods A descriptive comparative cross-sectional survey was conducted among 3349 students from 36 nursing schools (26 public and 10 private) during February-March 2012, using a questionnaire to assess the association between training institution characteristics and students’ attitudes, job choices, and intention to work in the public sector upon graduation. Comparisons between school types were done using ANOVA, and Bonferroni-adjusted multiple comparisons tests. Principal component analysis (PCA) was used to construct a composite rural attitude index (14 questions). Cronbach’s alpha was used to examine the internal consistency of the scales, and ANOVA was then used to determine the differences. These relationships were further investigated through multiple regression. Results A higher proportion of public nursing students (86.4% from the Ministry of Public Health and 74.1% from the Ministry of Education) preferred working in the public sector, compared to 32.4% of students from the private sector (p = <0.001). Rural upbringing and entering a nursing education program by local recruitment were positively associated with rural attitude. Students who were trained in public nursing schools were less motivated by financial incentive regarding workplace choices relative to students trained by private institutions. Conclusions To increase nursing workforce in the public sector, the following policy options should be promoted: 1) recruiting more students with a rural upbringing, 2) nurturing good attitudes towards working in rural areas through appropriate training at schools, 3) providing government scholarships for private students in exchange for compulsory work in rural areas, and 4) providing a non-financial incentive package (e.g. increased social benefits) in addition to financial incentives for subsequent years of work.
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Affiliation(s)
- Krisada Sawaengdee
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, 11000 Thailand.,Public Health Technical Office, Ministry of Public Health, Nonthaburi, Thailand
| | - Nareerut Pudpong
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, 11000 Thailand
| | - Thunthita Wisaijohn
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, 11000 Thailand
| | - Rapeepong Suphanchaimat
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, 11000 Thailand
| | - Weerasak Putthasri
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, 11000 Thailand
| | - Mylene Lagarde
- London School of Hygiene and Tropical Medicine, London, UK
| | - Duane Blaauw
- Centre for Health Policy (CHP), Wits University, Johannesburg, South Africa
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Puddey IB, Playford DE, Mercer A. Impact of medical student origins on the likelihood of ultimately practicing in areas of low vs high socio-economic status. BMC MEDICAL EDUCATION 2017; 17:1. [PMID: 28056975 PMCID: PMC5215143 DOI: 10.1186/s12909-016-0842-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 12/14/2016] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Medical schools are in general over-represented by students from high socio-economic status backgrounds. The University of Western Australia Medical School has been progressively widening the participation of students from a broader spectrum of the community both through expanded selection criteria and quota-based approaches for students of rural, indigenous and other socio-educationally disadvantaged backgrounds. We proposed that medical students entering medical school from such backgrounds would ultimately be more likely to practice in areas of increased socio-economic disadvantage. METHODS The current practice address of 2829 medical students who commenced practice from 1980 to 2011 was ascertained from the Australian Health Practitioner Regulation Agency (AHPRA) Database. Logistic regression was utilised to determine the predictors of the likelihood of the current practice address being in the lower 8 socio-economic deciles versus the top 2 socio-economic deciles. RESULTS Those who were categorised in the lower 8 socio-economic deciles at entry to medical school had increased odds of a current practice address in the lower 8 socio-economic deciles 5 or more years after graduation (OR 2.05, 95% CI 1.72, 2.45, P < 0.001). Other positive univariate predictors included age at medical degree completion (for those 25 years or older vs those 24 years or younger OR 1.53, 95% CI 1.27, 1.84, P < 0.001), being female (OR 1.26, 95% CI 1.07, 1.48, P = 0.005) and having a general practice versus specialist qualification (OR 4.16, 95% CI 3.33, 5.19, P < 0.001). Negative predictors included having attended an independent school vs a government school (OR 0.77, 95% CI 0.64, 0.92, P < 0.001) or being originally from overseas vs being born in Oceania (OR 0.80, 95% CI 0.67, 0.96, P = 0.017). After adjustment for potential confounders in multivariate logistic regression, those in the lower 8 socio-economic deciles at entry to medical school still had increased odds of having a current practice address in the lower 8 socio-economic deciles (OR 1.63, 95% CI 1.34, 1.99, P < 0.001). CONCLUSION Widening participation in medical school to students from more diverse socio-educational backgrounds is likely to increase the distribution of the medical workforce to ultimate service across areas representative of a broader socio-economic spectrum.
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Affiliation(s)
- Ian B. Puddey
- School of Medicine and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Level 4 RPH MRF Building, Rear 50 Murray St, Perth, WA 6000 Australia
| | - Denese E. Playford
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009 Australia
| | - Annette Mercer
- Faculty Office, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009 Australia
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Hoffman S, Marsiglia FF, Nevarez L, Porta M. Health Literacy among Youth in Guatemala City. SOCIAL WORK IN PUBLIC HEALTH 2017; 32:30-37. [PMID: 27392315 DOI: 10.1080/19371918.2016.1188741] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Health literacy (HL) is recognized as an important health construct that is correlated with various health-related outcomes, but outside of the United States there is limited HL research available, particularly among youth. This study looked at the HL and harmful health behavior (i.e., substance use) of 210 youth across 10 schools in Guatemala City. Based on results from the Newest Vital Sign (NVS) HL assessment, fewer than one third of youth sampled had adequate HL. Training/education to improve adolescent HL is needed in Guatemala City, and the unique skillset of social workers could be an idea method of reaching at-risk youth.
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Affiliation(s)
- Steven Hoffman
- a Department of Social Work , University of Texas at San Antonio , San Antonio , Texas , USA
| | - Flavio F Marsiglia
- b Department of Social Work , Arizona State University , Tempe , Arizona , USA
- c Southwest Interdisciplinary Research Center , Phoenix , Arizona , USA
| | - Lucinda Nevarez
- a Department of Social Work , University of Texas at San Antonio , San Antonio , Texas , USA
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Reeve C, Woolley T, Ross SJ, Mohammadi L, Halili SB, Cristobal F, Siega-Sur JLJ, Neusy AJ. The impact of socially-accountable health professional education: A systematic review of the literature. MEDICAL TEACHER 2017; 39:67-73. [PMID: 27797293 DOI: 10.1080/0142159x.2016.1231914] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This literature review describes the impact of health professional schools with a social accountability mandate by identifying characteristics of medical education found to impact positively on medical students, health workforce, and health outcomes of disadvantaged communities. A critical appraisal tool was used to identify the strengths and weaknesses of the published articles. Data are presented as a narrative synthesis due to the variety of methodologies in the studies, and characterized using a logic model. Health professional schools aiming to improve health outcomes for their disadvantaged local communities described collaborative partnerships with communities, equitable selection criteria, and community-engaged placements in underserved areas as positively impacting the learning and attitudes of students. Students of socially accountable schools were more likely to stay in rural areas and serve disadvantaged communities, and were often more skilled than students from more traditional schools to meet the needs of underserved communities. However, published literature on the impact of socially accountable health professional education on communities and health outcomes is limited, with only one study investigating health outcomes. The findings of this literature review guide schools on the inputs likely to maximize their socially accountability outputs and increase their impact on students, local health workforce and local communities.
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Affiliation(s)
- Carole Reeve
- a School of Medicine, Flinders University , Alice Springs , Australia
| | - Torres Woolley
- b College of Medicine , James Cook University , Townsville , Australia
| | - Simone J Ross
- b College of Medicine , James Cook University , Townsville , Australia
- c The Training for Health Equity Network , Brussels , Belgium
| | - Leila Mohammadi
- a School of Medicine, Flinders University , Alice Springs , Australia
| | - Servando Ben Halili
- d School of Medicine , Ateneo de Zamboanga University , Zamboanga , Philippines
| | - Fortunato Cristobal
- d School of Medicine , Ateneo de Zamboanga University , Zamboanga , Philippines
| | - Jusie Lydia J Siega-Sur
- e School of Health Sciences , University of the Philippines Manila , Palo , Leyte , The Philippines
| | - A-J Neusy
- c The Training for Health Equity Network , Brussels , Belgium
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Seixas PH, Uchimura LYT, Viana ALD, Silva RCD. Physicians’ circularity in health regions in Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2017. [DOI: 10.1590/1806-9304201700s100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to characterize the medical circularity in Brazil and to discuss the case in the North and South Barretos regions, São Paulo. Methods: a cross-sectional study using secondary data from the national registrations and a case study of physician’s sample in the North-Barretos and South-Barretos regions. Results: in the health regions in Brazil, on an average, 45% of the physicians in activities circulate in more than one region. The Capitals of the States have more stable physicians while more than 50% of the medical workforce work in other regions. The professionals with the greatest tendency to move from one work place to another are those who work in surgical specialties in services to uphold the diagnostic and therapy. Conclusions: there is a high circulation of physicians among the regions, with distinct characteristics between geographical and health regions. In case of Barretos area, the professionals move from one workplace to another according to their professional association and specialized practice.
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Qian Y, Yan F, Wang W, Clancy S, Akkhavong K, Vonglokham M, Outhensackda S, Østbye T. Challenges for strengthening the health workforce in the Lao People's Democratic Republic: perspectives from key stakeholders. HUMAN RESOURCES FOR HEALTH 2016; 14:72. [PMID: 27899109 PMCID: PMC5129208 DOI: 10.1186/s12960-016-0167-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 11/19/2016] [Indexed: 06/01/2023]
Abstract
BACKGROUND The Lao People's Democratic Republic is facing a critical shortage and maldistribution of health workers. Strengthening of the health workforce has been adopted as one of the five priorities of the National Health Sector Strategy (2013-2025). This study aims to identify, explore, and better understand the key challenges for strengthening the Laotian health workforce. METHODS This study applied exploratory and descriptive qualitative methods and adapted a working life-span framework. Twenty-three key stakeholders with particular insights into the current situation of the health workforce were purposively recruited for in-depth interviews. Important policy documents were also collected from key informants during the interviews. Thematic analysis was employed for the textual data using MAXQDA 10. RESULTS The overarching problem is that there is a perceived severe shortage of skilled health workers (doctors, nurses, and midwives) and lab technicians, especially in primary health facilities and rural areas. Key informants also identified five problems: insufficient production of health workers both in quantity and quality, a limited national budget to recruit enough health staff and provide sufficient and equitable salaries and incentives, limited management capacity, poor recruitment for work in rural areas, and lack of well-designed continuing education programs for professional development. These problems are interrelated, both in how the issues arise and in the effect they have on one another. CONCLUSIONS To improve the distribution of health workers in rural areas, strategies for increasing production and strengthening retention should be well integrated for better effectiveness. It is also essential to take the Laotian-specific context into consideration during intervention development and implementation. Furthermore, the government should acknowledge the inadequate health management capacity and invest to improve human resource management capacity at all levels. Finally, assessment of interventions for health workforce strengthening should be developed as early as possible to learn from the experiences and lessons in the Lao People's Democratic Republic.
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Affiliation(s)
- Yi Qian
- Department of Social Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032 People’s Republic of China
- Fudan Global Health Institute, Fudan University, Shanghai, 200032 People’s Republic of China
- Key Laboratory of Health Technology Assessment (Ministry of Health), Shanghai, 200032 People’s Republic of China
| | - Fei Yan
- Department of Social Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032 People’s Republic of China
- Fudan Global Health Institute, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Wei Wang
- Department of Social Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032 People’s Republic of China
| | - Shayna Clancy
- Department of Community and Family Medicine, Duke University, Durham, NC United States of America
| | - Kongsap Akkhavong
- National Institute of Public Health, Vientiane Capital, Lao People’s Democratic Republic
| | - Manithong Vonglokham
- National Institute of Public Health, Vientiane Capital, Lao People’s Democratic Republic
| | - Somphou Outhensackda
- National Institute of Public Health, Vientiane Capital, Lao People’s Democratic Republic
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University, Durham, NC United States of America
- Center for Aging Research and Education, Duke-NUS Medical School, Singapore, Singapore
- Duke Global Health Institute, Duke University, Durham, NC United States of America
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McGrail MR, Russell DJ. Australia's rural medical workforce: Supply from its medical schools against career stage, gender and rural-origin. Aust J Rural Health 2016; 25:298-305. [DOI: 10.1111/ajr.12323] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/30/2022] Open
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Finding the "Right-Size" Physical Therapy Workforce: International Perspective Across 4 Countries. Phys Ther 2016; 96:1597-1609. [PMID: 27149960 DOI: 10.2522/ptj.20160014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/28/2016] [Indexed: 02/09/2023]
Abstract
Finding the "right-size" physical therapy workforce is an increasingly important issue, but it has had limited study, particularly across nations. This perspective article provides a comprehensive examination of physical therapy workforce issues across 4 countries (United States, Singapore, Portugal, and Bangladesh), which were deliberately selected to allow consideration of key contextual factors. This investigation provides a theoretical model uniquely adapted to focus on variables most likely to affect physical therapy workforce needs. This theoretical model was used to guide acquisition of public domain data across the respective countries. The data then were used to provide a contextualized interpretation about the physical therapy workforce supply (ie, physical therapists per capita) across the 4 countries in light of the following factors: indicators of physical therapy need, financial and administrative barriers affecting physical therapy access and demand, the proportion of physical therapy graduates (with varying trends over time across the countries), and the role of emigration/immigration in supply inequalities among countries of lower and higher income. In addition, both the physical therapy workforce supply and scope of practice were analyzed in the context of other related professions across the 4 countries. This international comparison indicated that there may not be a "one-size-fits-all" recommendation for physical therapy workforce supply across countries or an ideal formula for its determination. The optimal, country-specific physical therapy workforce supply appears to be affected by discipline-specific health care and contextual factors that may vary across countries, and even within the same country. This article provides a conceptual framework and basis for such contextualized evaluations of the physical therapy workforce.
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Spatial Distribution Balance Analysis of Hospitals in Wuhan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100971. [PMID: 27706069 PMCID: PMC5086710 DOI: 10.3390/ijerph13100971] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
The spatial distribution pattern of hospitals in Wuhan indicates a core in the central urban areas and a sparse distribution in the suburbs, particularly at the center of suburbs. This study aims to improve the gravity and Huff models to analyze healthcare accessibility and resources. Results indicate that healthcare accessibility in central urban areas is better than in the suburbs, where it increasingly worsens for the suburbs. A shortage of healthcare resources is observed in large-scale and high-class hospitals in central urban areas, whereas the resources of some hospitals in the suburbs are redundant. This study proposes the multi-criteria evaluation (MCE) analysis model for the location assessment in constructing new hospitals, which can effectively ameliorate healthcare accessibility in suburban areas. This study presents implications for the planning of urban healthcare facilities.
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Preston R, Larkins S, Taylor J, Judd J. Building blocks for social accountability: a conceptual framework to guide medical schools. BMC MEDICAL EDUCATION 2016; 16:227. [PMID: 27565709 PMCID: PMC5002162 DOI: 10.1186/s12909-016-0741-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 08/15/2016] [Indexed: 05/10/2023]
Abstract
BACKGROUND This paper presents a conceptual framework developed from empirical evidence, to guide medical schools aspiring towards greater social accountability. METHODS Using a multiple case study approach, seventy-five staff, students, health sector representatives and community members, associated with four medical schools, participated in semi-structured interviews. Two schools were in Australia and two were in the Philippines. These schools were selected because they were aspiring to be socially accountable. Data was collected through on-site visits, field notes and a documentary review. Abductive analysis involved both deductive and inductive iterative theming of the data both within and across cases. RESULTS The conceptual framework for socially accountable medical education was built from analyzing the internal and external factors influencing the selected medical schools. These factors became the building blocks that might be necessary to assist movement to social accountability. The strongest factor was the demands of the local workforce situation leading to innovative educational programs established with or without government support. The values and professional experiences of leaders, staff and health sector representatives, influenced whether the organizational culture of a school was conducive to social accountability. The wider institutional environment and policies of their universities affected this culture and the resourcing of programs. Membership of a coalition of socially accountable medical schools created a community of learning and legitimized local practice. Communities may not have recognized their own importance but they were fundamental for socially accountable practices. The bedrock of social accountability, that is, the foundation for all building blocks, is shared values and aspirations congruent with social accountability. These values and aspirations are both a philosophical understanding for innovation and a practical application at the health systems and education levels. CONCLUSIONS While many of these building blocks are similar to those conceptualized in social accountability theory, this conceptual framework is informed by what happens in practice - empirical evidence rather than prescriptions. Consequently it is valuable in that it puts some theoretical thinking around everyday practice in specific contexts; addressing a gap in the medical education literature. The building blocks framework includes guidelines for social accountable practice that can be applied at policy, school and individual levels.
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Affiliation(s)
- Robyn Preston
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Jenni Judd
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
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Fieno JV, Dambisya YM, George G, Benson K. A political economy analysis of human resources for health (HRH) in Africa. HUMAN RESOURCES FOR HEALTH 2016; 14:44. [PMID: 27443146 PMCID: PMC4957394 DOI: 10.1186/s12960-016-0137-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/21/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND Despite a global recognition from all stakeholders of the gravity and urgency of health worker shortage in Africa, little progress has been achieved to improve health worker coverage in many of the African human resources for health (HRH) crisis countries. The problem consists in how policy is made, how leaders are accountable, how the World Health Organization (WHO) and foreign donors encourage (or distort) health policy, and how development objectives are prioritized in these countries. METHODS This paper uses political economy analysis, which stems from a recognition that the solution to the shortage of health workers across Africa involves more than a technical response. A number of institutional arrangements dampen investments in HRH, including a mismatch between officials' tenure in office and program results, the vertical nature of health programming, the modalities of Overseas Development Assistance (ODA) in health, the structures of the global health community, and the weak capacity in HRH units within Ministries of Health. A major change in policymaking would only occur with a disruption to the political or institutional order. RESULTS/CONCLUSIONS The case study of Ethiopia, who has increased its health workforce dramatically over the last 20 years, disrupted previous institutional arrangements through the power of ideas-HRH as a key intermediate development objective. The framing of HRH created the rationale for the political commitment to HRH investment. Ethiopia demonstrates that political will coupled with strong state capacity and adequate resource mobilization can overcome the institutional hurdles above. Donors will follow the lead of a country with long-term political commitment to HRH, as they did in Ethiopia.
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Affiliation(s)
- John Vincent Fieno
- Regional HIV/AIDS Program, U.S. Agency for International Development, Pretoria, South Africa
| | - Yoswa M. Dambisya
- East, Central and Southern Africa Health Community, Arusha, Tanzania
| | - Gavin George
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Kent Benson
- Regional HIV/AIDS Program, U.S. Agency for International Development, Pretoria, South Africa
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Song P, Ren Z, Chang X, Liu X, An L. Inequality of Paediatric Workforce Distribution in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E703. [PMID: 27420083 PMCID: PMC4962244 DOI: 10.3390/ijerph13070703] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/09/2016] [Accepted: 07/07/2016] [Indexed: 11/17/2022]
Abstract
Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of paediatric workforce distribution. This study aimed to analyse the inequality of the distributions of the paediatric workforce (including paediatricians and paediatric nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the paediatric workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the paediatric workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of paediatric nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the paediatric workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the paediatric workforce in China for the first time, substantial inequality of paediatric workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation.
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Affiliation(s)
- Peige Song
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Zhenghong Ren
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Xinlei Chang
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Xuebei Liu
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Lin An
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
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Darvishpour A, Joolaee S, Cheraghi MA, Mokhtari-Lakeh N. Iran's health policymakers' views on barriers and facilitators of nurse prescribing in their context: A qualitative study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:297-305. [PMID: 27186208 PMCID: PMC4857665 DOI: 10.4103/1735-9066.180384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 10/31/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND In most countries, one of the main reasons for developing more advanced roles for nurses is to improve access to care in the context of limited number of doctors. It is considered that the introduction of major policy initiatives, such as nurse prescribing, requires high-level discussion and policy development to ensure successful implementation. This study aimed to identify the barriers and facilitators of nurse prescribing based on policymakers' views in Iran. MATERIALS AND METHODS This qualitative study was based on conventional content analysis approach. A purposeful sample of 14 participants were recruited, including 6 members of the Nursing Board, 6 members of the Iranian Nursing Organization, and 2 senior employees of Iran's Ministry of Health and Medical Education. Data were gathered through in-depth semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. RESULTS The four emerged categories as facilitators of nurse prescribing were labeled "positive views of health policymakers," "human resources capabilities," "non-medical prescribing experiences," and "governmental and non-governmental organizational activities." The four extracted categories as barriers of nurse prescribing were "socio-cultural factors," "organizational factors," "educational barriers," and "human barriers." CONCLUSIONS Barriers and facilitating factors should be considered in order to bring about organizational policy changes and improve perspectives. Nurse prescribing requires the efforts of involved managers and authorities for development and modernization. The results of this study can serve as a compressed resource for policymakers and managers to identify the effective issues on nurse prescribing and can help them to plan for the implementation of nurse prescribing.
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Affiliation(s)
- Azar Darvishpour
- Department of Medical-Surgical Nursing, School of Nursing, Midwifery and Paramedicine, Tehran, Iran
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Tehran, Iran
- Graduated from Department of Medical-Surgical Nursing, University of Medical Science, Tehran, Iran
| | - Soodabeh Joolaee
- Department of Nursing Management, Center for Nursing Care Research, University of Medical Science, Tehran, Iran
| | | | - Nasrin Mokhtari-Lakeh
- Department of Community Health Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Sundmacher L, Ozegowski S. Regional distribution of physicians: the role of comprehensive private health insurance in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:443-451. [PMID: 25924865 DOI: 10.1007/s10198-015-0691-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/08/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE In recent years, the co-existence in Germany of two parallel comprehensive insurance systems-statutory health insurance (SHI) and private health insurance (PHI)-has been posited as a possible cause of a persistent unequal regional distribution of physicians. The present study investigates the effect of the proportion of privately insured patients on the density of SHI-licensed physicians, while controlling for regional variations in the average income from SHI patients. METHODS The proportion of residents in a district with private health insurance is estimated using complete administrative data from the SHI system and the German population census. Missing values are estimated using multiple imputation techniques. All models control for the estimated average income ambulatory physicians generate from treating SHI insured patients and a well-defined set of covariates on the level of districts in Germany in 2010. RESULTS Our results show that every percentage change in the proportion of residents with private health insurance is associated with increases of 2.1 and 1.3 % in the density of specialists and GPs respectively. Higher SHI income in rural areas does not compensate for this effect. CONCLUSION From a financial perspective, it is rational for a physician to locate a new practice in a district with a high proportion of privately insured patients. From the perspective of patients in the SHI system, the incentive effects of PHI presumably contribute to a concentration of health care services in wealthy and urban areas. To date, the needs-based planning mechanism has been unable to address this imbalance.
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Affiliation(s)
- Leonie Sundmacher
- Department of Health Services Management, Munich School of Management, Ludwig Maximilians University Munich, Schackstrasse 4, 80539, Munich, Germany.
| | - Susanne Ozegowski
- Department of Health Services Management, Munich School of Management, Ludwig Maximilians University Munich, Schackstrasse 4, 80539, Munich, Germany
- BMC e.V., Friedrichstrasse 36, 10117, Berlin, Germany
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Groneberg DA, Boll M, Bauer J. Design and methodology of the Geo-social Analysis of Physicians' settlement (GAP-Study) in Germany. J Occup Med Toxicol 2016; 11:14. [PMID: 27034705 PMCID: PMC4815067 DOI: 10.1186/s12995-016-0104-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/24/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Unequally distributed disease burdens within populations are well-known and occur worldwide. They are depending on residents' social status and/or ethnic background. Country-specific health care systems - especially the coverage and distribution of health care providers - are both a potential cause as well as an important solution for health inequalities. METHODS Registers are built of all accredited physicians and psychotherapists within the outpatient care system in German metropolises by utilizing the database of the Associations of Statutory Health Insurance Physicians. The physicians' practice neighborhood will be analyzed under socioeconomic and demographic perspectives. Therefore, official city districts' statistics will be assigned to the physicians and psychotherapists according to their practice location. Averages of neighborhood indicators will be calculated for each specialty. Moreover, advanced studies will inspect differences by physicians' gender or practice type. Geo-spatial analyses of the intra-city practices distribution will complete the settlement characteristics of physicians and psychotherapists within the outpatient care system in German metropolises. RESULTS The project "Geo-social Analysis of Physicians' settlement" (GAP) is designed to elucidate gaps of physician coverage within the outpatient care system, dependent on neighborhood residents' social status or ethnics in German metropolises. CONCLUSION The methodology of the GAP-Study enables the standardized investigation of physicians' settlement behavior in German metropolises and their inter-city comparisons. The identification of potential gaps within the physicians' coverage should facilitate the delineation of approaches for solving health care inequality problems.
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Affiliation(s)
- David A. Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590 Frankfurt/Main, Germany
| | - Michael Boll
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590 Frankfurt/Main, Germany
| | - Jan Bauer
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590 Frankfurt/Main, Germany
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Amalba A, van Mook WNKA, Mogre V, Scherpbier AJJA. The effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in rural communities in Ghana. BMC MEDICAL EDUCATION 2016; 16:79. [PMID: 26931412 PMCID: PMC4774102 DOI: 10.1186/s12909-016-0602-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/17/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND Career choices and placements of healthcare professionals in rural areas are a major problem worldwide, and their recruitment and retention to these areas have become a challenge to the health sector. The purpose of this study was to investigate the effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in a rural area. METHOD This cross sectional survey was conducted among 56 pioneering graduates that followed a Problem Based Learning/Community Based Education and Service (PBL/COBES) curriculum. Using a mixed methods approach, open-and closed-ended questionnaire was administered to 56 graduates. Cross tabulation using Chi-square test were used to compare findings of the quantitative data. All qualitative data analysis was performed using the principles of primary, secondary and tertiary coding. RESULTS All 56 graduates answered and returned the questionnaire giving a 100 % response rate. 57.1 % (32) of them were male. Majority of them lived in towns (41.1 %) and cities (50 %) prior to medical school. A significant number of graduates (53.6 %,) from the cities, without any female or male predominance said COBES had influenced their choice of specialty. Again, a significant proportion of graduates from the towns (60.9 %,) and cities (67.8 %,), indicated that COBES had influenced them to work in the rural area. However, there was no significant difference between males and females from the towns and cities regarding the influence of COBES to work in the rural area. Qualitative data supported the finding that COBES will influence graduates willingness to work in the rural area CONCLUSION The majority of graduates from the towns and cities in Ghana, with a male predominance, indicated that COBES may have influenced their choice of specialty and willingness to practice in the rural areas despite their town or city based upbringing.
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Affiliation(s)
- Anthony Amalba
- University for Development Studies (UDS), School of Medicine and Health Sciences (SMHS), Tamale, Ghana.
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, P. O. Box 1883, Tamale, Ghana.
| | | | - Victor Mogre
- University for Development Studies (UDS), School of Medicine and Health Sciences (SMHS), Tamale, Ghana.
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Kadam S, Nallala S, Zodpey S, Pati S, Hussain MA, Chauhan AS, Das S, Martineau T. A study of organizational versus individual needs related to recruitment, deployment and promotion of doctors working in the government health system in Odisha state, India. HUMAN RESOURCES FOR HEALTH 2016; 14:7. [PMID: 26911674 PMCID: PMC4765090 DOI: 10.1186/s12960-016-0103-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 02/18/2016] [Indexed: 05/26/2023]
Abstract
BACKGROUND An effective health workforce is essential for achieving health-related new Sustainable Development Goals. Odisha, one of the states in India with low health indicators, faces challenges in recruiting and retaining health staff in the public sector, especially doctors. Recruitment, deployment and career progression play an important role in attracting and retaining doctors. We examined the policies on recruitment, deployment and promotion for doctors in the state and how these policies were perceived to be implemented. METHODS We undertook document review and four key informant interviews with senior state-level officials to delineate the policies for recruitment, deployment and promotion. We conducted 90 in-depth interviews, 86 with doctors from six districts and four at the state level to explore the perceptions of doctors about these policies. RESULTS Despite the efforts by the Government of Odisha through regular recruitments, a quarter of the posts of doctors was vacant across all institutional levels in the state. The majority of doctors interviewed were unaware of existing government rules for placement, transfer and promotion. In addition, there were no explicit rules followed in placement and transfer. More than half (57%) of the doctors interviewed from well-accessible areas had never worked in the identified hard-to-reach areas in spite of having regulatory and incentive mechanisms. The average length of service before the first promotion was 26 (±3.5) years. The doctors expressed satisfaction with the recruitment process. They stated concerns over delayed first promotion, non-transparent deployment policies and ineffective incentive system. Almost all doctors suggested having time-bound and transparent policies. CONCLUSIONS Adequate and appropriate deployment of doctors is a challenge for the government as it has to align the individual aspirations of employees with organizational needs. Explicit rules for human resource management coupled with transparency in implementation can improve governance and build trust among doctors which would encourage them to work in the public sector.
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Affiliation(s)
- Shridhar Kadam
- />Indian Institute of Public Health, Bhubaneswar, 2nd & 3rd Floor, JSS Software Technology Park, E1/1, Infocity Road, Patia, Bhubaneswar, 751024 India
| | - Srinivas Nallala
- />Indian Institute of Public Health, Bhubaneswar, 2nd & 3rd Floor, JSS Software Technology Park, E1/1, Infocity Road, Patia, Bhubaneswar, 751024 India
| | - Sanjay Zodpey
- />Public Health Foundation of India, Delhi NCR, Plot No. 47, Sector 44, Institutional Area, Gurgaon, 122002 India
| | - Sanghamitra Pati
- />Indian Institute of Public Health, Bhubaneswar, 2nd & 3rd Floor, JSS Software Technology Park, E1/1, Infocity Road, Patia, Bhubaneswar, 751024 India
| | - Mohammad Akhtar Hussain
- />Division of Epidemiology and Biostatistics, School of Population Health, The University of Queensland, Herston Road, Herston, Brisbane, QLD 4006 Australia
| | - Abhimanyu Singh Chauhan
- />Indian Institute of Public Health, Bhubaneswar, 2nd & 3rd Floor, JSS Software Technology Park, E1/1, Infocity Road, Patia, Bhubaneswar, 751024 India
| | - Sovesh Das
- />Indian Institute of Public Health, Bhubaneswar, 2nd & 3rd Floor, JSS Software Technology Park, E1/1, Infocity Road, Patia, Bhubaneswar, 751024 India
| | - Tim Martineau
- />Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
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Prata N, Downing J, Bell S, Weidert K, Godefay H, Gessessew A. Cost of providing injectable contraceptives through a community-based social marketing program in Tigray, Ethiopia. Contraception 2016; 93:485-91. [PMID: 26872718 DOI: 10.1016/j.contraception.2016.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To provide a cost analysis of an injectable contraceptive program combining community-based distribution and social marketing in Tigray, Ethiopia. METHODS We conducted a cost analysis, modeling the costs and programmatic outcomes of the program's initial implementation in 3 districts of Tigray, Ethiopia. Costs were estimated from a review of program expense records, invoices, and interviews with health workers. Programmatic outcomes include number of injections and couple-year of protection (CYP) provided. We performed a sensitivity analysis on the average number of injections provided per month by community health workers (CHWs), the cost of the commodity, and the number of CHWs trained. RESULTS The average programmatic CYP was US $17.91 for all districts with a substantial range from US $15.48-38.09 per CYP across districts. Direct service cost was estimated at US $2.96 per CYP. The cost per CYP was slightly sensitive to the commodity cost of the injectable contraceptives and the number of CHWs. The capacity of each CHW, measured by the number of injections sold, was a key input that drove the cost per CYP of this model. CONCLUSION With a direct service cost of US $2.96 per CYP, this study demonstrates the potential cost of community-based social marketing programs of injectable contraceptives. The findings suggest that the cost of social marketing of contraceptives in rural communities is comparable to other delivery mechanisms with regards to CYP, but further research is needed to determine the full impact and cost-effectiveness for women and communities beyond what is measured in CYP.
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Affiliation(s)
- Ndola Prata
- Bixby Center for Population, Health and Sustainability, University of California at Berkeley, School of Public Health, 50 University Hall, Berkeley, CA, 94720-6390, United States of America.
| | - Janelle Downing
- Bixby Center for Population, Health and Sustainability, University of California at Berkeley, School of Public Health, 50 University Hall, Berkeley, CA, 94720-6390, United States of America
| | - Suzanne Bell
- Bixby Center for Population, Health and Sustainability, University of California at Berkeley, School of Public Health, 50 University Hall, Berkeley, CA, 94720-6390, United States of America
| | - Karen Weidert
- Bixby Center for Population, Health and Sustainability, University of California at Berkeley, School of Public Health, 50 University Hall, Berkeley, CA, 94720-6390, United States of America
| | - Hagos Godefay
- Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia
| | - Amanuel Gessessew
- Department of Gynecology and Obstetrics, Mekelle University College of Health Sciences, Mekelle, Ethiopia
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Kapanda GE, Muiruri C, Kulanga AT, Tarimo CN, Lisasi E, Mimano L, Mteta K, Bartlett JA. Enhancing future acceptance of rural placement in Tanzania through peripheral hospital rotations for medical students. BMC MEDICAL EDUCATION 2016; 16:51. [PMID: 26861915 PMCID: PMC4746898 DOI: 10.1186/s12909-016-0582-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 02/04/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Mal-distribution of health care workers is a global health challenge that exacerbates health disparities, especially in resource-limited settings. Interventions to mitigate the problem have targeted qualified personnel with little focus on medical students. However, studies have demonstrated that rural rotations positively influence students to practice in rural settings upon graduation. To evaluate the influence of peripheral rotations in a resource-limited setting, the Kilimanjaro Christian Medical University College introduced a 12-week clerkship rotation in peripheral hospitals for third-year medical (MD3) students in 2012. We administered an end-of-rotation survey to assess student perceptions, and attitudes toward rural practice after graduation. METHODS Questionnaires were voluntarily and anonymously administered to MD3 students in April 2014. The questions assessed perceptions of the experience, and attitudes towards rural practice upon graduation. The perceptions were assessed using strength of consensus measures (sCns). The effect of the experience on likelihood for rural practice was assessed using Crude Odds Ratio (COR), and predictors using Adjusted Odds Ratio (AOR) with 95 % Confidence Intervals (CI) tested at a 5 % level of significance. Variation was assessed using Hosmer and Lemeshow test Chi-square. RESULTS 111 out of 148 MD3 students participated; 62 % were male; 62 % <25 years old; and 72 % matriculated directly from secondary school. Overall, 81 % of MD3 students were satisfied with rural rotations (sCns = 83 %). The likelihood of accepting rural practice deployment after graduation was predicted by satisfaction with the peripheral hospital rotation program (AOR, 4.32; 95 % CI, 1.44-12.96; p, 0.009) and being male (AOR, 2.73; 95 % CI, 1.09-6.84; p, 0.032). Students admitted in medical school after health-related practice trended toward a higher likelihood of accepting rural practice after graduation compared to those enrolled directly from secondary school, although the difference was not significant (AOR, 4.99; 95 % CI, 0.88-28.41; p, 0.070). The Hosmer and Lemeshow test p-value was 0.686, indicating a good fit of the model. No significant differences in satisfaction between these two groups were observed, and also no significant differences between students born in rural areas compared to those born in urban areas existed. CONCLUSION Results indicate that satisfaction with rural rotations is associated with increased likelihood of rural practice after graduation. We conclude that opportunities may exist to reduce mal-distribution of healthcare workers through interventions that target medical students.
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Affiliation(s)
| | | | - Ahaz T Kulanga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | | | - Esther Lisasi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Lucy Mimano
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Kien Mteta
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - John A Bartlett
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
- Duke Global Health Institute, Durham, NC, USA.
- Duke University School of Medicine, Durham, NC, USA.
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Bath B, Gabrush J, Fritzler R, Dickson N, Bisaro D, Bryan K, Shah TI. Mapping the Physiotherapy Profession in Saskatchewan: Examining Rural versus Urban Practice Patterns. Physiother Can 2016; 67:221-31. [PMID: 26839448 DOI: 10.3138/ptc.2014-53] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE People living in rural and remote regions need support to overcome difficulties in accessing health care. The objectives of the study were (1) to compare demographic characteristics, professional engagement indicators, and clinical characteristics between physiotherapists practising in rural settings and those practising in urban settings and (2) to map the distribution of physiotherapists in Saskatchewan. METHOD This cross-sectional study used de-identified data collected from the 2013 Saskatchewan College of Physical Therapists membership renewal (n=643), linked with the Saskatchewan Physiotherapy Association's (SPA) 2012 membership list and a list of physiotherapists who had served as clinical instructors. Employment location (rural vs. urban) was determined by postal code. RESULTS Only 11.2% of Saskatchewan physiotherapists listed a rural primary employment location, and a higher density of physiotherapists per 10,000 people work in health regions with large urban centres. Compared with urban physiotherapists, rural physiotherapists are more likely to provide direct patient care, to provide care to people of all ages, and to have a mixed client level, and they are less likely to be SPA members. CONCLUSIONS Rural and urban physiotherapists in Saskatchewan have different practice and professional characteristics. This information may have implications for health human resource recruitment and retention policies as well as advocacy for equitable access to physiotherapy care in rural and remote regions.
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Affiliation(s)
- Brenna Bath
- School of Physical Therapy; Canadian Centre for Health and Safety in Agriculture
| | | | | | | | | | | | - Tayyab I Shah
- School of Physical Therapy; Department of Geography and Planning, University of Saskatchewan, Saskatoon
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Nang Mie Mie Htun, Reyer JA, Yamamoto E, Yoshida Y, Hamajima N. Trends in attrition among medical teaching staff at universities in Myanmar 2009-2013. NAGOYA JOURNAL OF MEDICAL SCIENCE 2016; 78:27-40. [PMID: 27019526 PMCID: PMC4767512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although lack of human resources for health is becoming a global problem, there are few studies on human resources in Myanmar. This study was conducted to investigate the attrition rates of teaching staff from universities for medical professions in Myanmar from 2009 to 2013. The data were collected from administrative records from Department of Medical Sciences, Ministry of Health, Myanmar. Numbers of staff and those who permanently left work (attrition) from 2009 to 2013 were counted. The reasons were classified into two categories; involuntary attrition (death or retirement) and voluntary attrition (resignation or absenteeism). Official records of the attrited staff were reviewed for identifying demographic characteristics. The annual attrition rate for all kinds of health workers was about 4%. Among 494 attrited staff from 2009 to 2013, 357 staff (72.3%) left their work by involuntary attrition, while 137 staff (27.7%) left voluntarily. Doctors left their work with the highest annual rate (6.7%), while the rate for nurses was the lowest (1.1%). Male staff attrited with a higher rate (4.6%) than female staff (2.7%). Staff aged 46-60 years had the highest attrition rate. PhD degree holders had the highest rate (5.9%), while basic degree holders had the second highest rate (3.5%). Associate professors and above showed the highest attrition rate (8.1%). Teaching staff from non-clinical subjects had the higher rates (8.2%). Among 494 attrited staff, significant differences between involuntary attrition and voluntary attrition were observed in age, marital status, education, overseas degree, position, field of teaching, duration of services and duration of non-residential service. These findings indicated the need to develop appropriate policies such as educational reforms, local recruitment plans, transparent regulatory and administrative measures, and professional incentives to retain the job.
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Affiliation(s)
- Nang Mie Mie Htun
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan,Department of Medical Sciences, Ministry of Health, Myanmar
| | - Joshua A. Reyer
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshitoku Yoshida
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Vogt V. The contribution of locational factors to regional variations in office-based physicians in Germany. Health Policy 2016; 120:198-204. [DOI: 10.1016/j.healthpol.2016.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 12/16/2015] [Accepted: 01/03/2016] [Indexed: 11/25/2022]
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Poz MRD, Couto MHC, Franco TDAV. Innovation, development, and financing of institutions of Higher Education in health. CAD SAUDE PUBLICA 2016; 32Suppl 2:e00139915. [DOI: 10.1590/0102-311x00139915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/18/2016] [Indexed: 11/22/2022] Open
Abstract
Abstract: The article analyzes the configuration and trends in institutions of Higher Education and their relationship as components of the Health Economic-Industrial Complex (HEIC). The expansion of higher education is part of the transition from elite to mass systems, with tensions between quantitative and qualitative aspects. Such changes reflect different cultures and are related to international phenomena such as globalization, economic transformations, the development of new information and communication technologies, and the emergence of an international knowledge network. The scale and content of these changes vary according to the expansion and institutional reconfiguration of educational systems, as well as the link between state and society. Market expansion for private higher education stirs competition, shapes business clusters, modifies training processes, and raises new public policy challenges.
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Eyal N, Cancedda C, Kyamanywa P, Hurst SA. Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians. Int J Health Policy Manag 2015; 5:149-53. [PMID: 26927585 PMCID: PMC4770920 DOI: 10.15171/ijhpm.2015.215] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 12/24/2015] [Indexed: 11/09/2022] Open
Abstract
Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of non-physician clinicians (NPCs), resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary - for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health system.
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Affiliation(s)
- Nir Eyal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Corrado Cancedda
- Division of Global Health Equity, Brigham and Women’s Hospital, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Samia A. Hurst
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, Geneva University, Geneva, Switzerland
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230
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Zhou K, Zhang X, Ding Y, Wang D, Lu Z, Yu M. Inequality trends of health workforce in different stages of medical system reform (1985-2011) in China. HUMAN RESOURCES FOR HEALTH 2015; 13:94. [PMID: 26645960 PMCID: PMC4673776 DOI: 10.1186/s12960-015-0089-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 11/15/2015] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The aim of this study was to identify whether policies in different stages of medical system reform had been effective in decreasing inequalities and increasing the density of health workers in rural areas in China between 1985 and 2011. METHODS With data from China Health Statistics Yearbooks from 2004 to 2012, we measured the Gini coefficient and the Theil L index across the urban and rural areas from 1985 to 2011 to investigate changes in inequalities in the distributions of health workers, doctors, and nurses by states, regions, and urban-rural stratum and account for the sources of inequalities. RESULTS We found that the overall inequalities in the distribution of health workers decreased to the lowest in 2000, then increased gently until 2011. Nurses were the most unequally distributed between urban-rural districts among health workers. Most of the overall inequalities in the distribution of health workers across regions were due to inequalities within the rural-urban stratum. DISCUSSIONS AND CONCLUSIONS Different policies and interventions in different stages would result in important changes in inequality in the distribution of the health workforce. It was also influenced by other system reforms, like the urbanization, education, and employment reforms in China. The results are useful for the Chinese government to decide how to narrow the gap of the health workforce and meet its citizens' health needs to the maximum extent.
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Affiliation(s)
- Kaiyuan Zhou
- Department of Aerospace Health Services, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
| | - Xinyi Zhang
- Department of Otolaryngology, Xi'an Children Hospital, Xi'an, Shaanxi Province, China.
| | - Yi Ding
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Zhou Lu
- Department of Health Services, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
| | - Min Yu
- Department of Health Services, Academy of Military Medical Sciences, Beijing, China.
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Yu H, Luo J, Yao L, Qian B, Shi T, Feng Y. Why were doctors unable to accomplish their rural-aid mission in China? A qualitative study. Int J Health Plann Manage 2015; 31:459-469. [PMID: 26549192 DOI: 10.1002/hpm.2324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To alleviate the difficulties of rural residents in receiving timely healthcare, the Chinese government launched a medical rural-aid program that solicited urban medical professionals to go to rural hospitals for a 1-year tenure. However, many of urban doctors did not accomplish this task. In this study, we attempted to investigate the reasons behind the failure to fulfill this program and to explore a more feasible solution. METHODS Eleven doctors and nurses participated in the focus group discussions. Twenty-five interviewees, including health administrative officials, doctors and managers from both urban tertiary hospitals and county-level hospitals, participated in semi-structured in-depth telephone interviews. The interview data were summarized and analyzed using the grounded theory. RESULTS The failure of this program was attributed to multiple causes, such as problems with the recipient hospitals, the support hospitals and the participating doctors, and overall defects in the program strategy itself. One major reason is the competition between the recipient hospitals and the support hospitals, which distorted the original purpose of this rural-aid program. CONCLUSION The rural-aid program strategy should be adjusted. The recipient hospitals should be township-level health centers rather than county-level hospitals. In addition, the relevant policies should be amended and improved accordingly. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hongxing Yu
- Department of Development and Planning, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, Shiyan, China
| | - Jie Luo
- Department of Development and Planning, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, Shiyan, China
| | - Lan Yao
- School of Medicine and Health Management, Huazhong University of Science and Technology, Tongji Medical College, Wuhan, China
| | - Bo Qian
- Department of Medical Affair, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Tianwei Shi
- Department of Dermatology, People's Hospital of Zhengzhou, Zhengzhou, China
| | - Youmei Feng
- Global Health Institute, School of Public Health, Wuhan University, Wuhan, China
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232
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Rafiei S, Arab M, Rashidian A, Mahmoudi M, Rahimi-Movaghar V. Policy interventions to improve rural retention among neurosurgeons in Iran: A discrete choice experiment. IRANIAN JOURNAL OF NEUROLOGY 2015; 14:211-8. [PMID: 26885340 PMCID: PMC4754600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Health workforce shortages in rural and remote areas are a global challenge that almost every health system has to deal with. This study aimed to discover neurosurgeons' job preferences and propose policy interventions that could possibly increase their retention in rural, remote, or underserved areas. METHODS A discrete choice experiment (DCE) was conducted in November 2014 with a sample of Iranian neurosurgeons selected from five contrary's provinces representing the geographical diversity. Job attributes included income, dual practice opportunities, workload, proximity to family, clinical infrastructure, housing, educational facilities, and work location. Probit regression model was used to estimate the importance of different job attributes and examine the extent to which neurosurgeons were willing to tradeoff between monetary and nonmonetary attributes. RESULTS Findings indicated that increased salary, permission to undertake dual practice and access to adequate clinical infrastructure were the most important retention policies. Provision of subsidized housing and educational facilities also increased neurosurgeons' attraction and retention in rural areas. CONCLUSION A range of policy interventions focusing on both monetary and nonmonetary incentives are required to increase neurosurgeons' retention in rural, remote, or underserved areas.
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Affiliation(s)
- Sima Rafiei
- Department of Health Management, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Arab
- Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Mahmoudi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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233
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Anticona Huaynate CF, Pajuelo Travezaño MJ, Correa M, Mayta Malpartida H, Oberhelman R, Murphy LL, Paz-Soldan VA. Diagnostics barriers and innovations in rural areas: insights from junior medical doctors on the frontlines of rural care in Peru. BMC Health Serv Res 2015; 15:454. [PMID: 26438342 PMCID: PMC4595324 DOI: 10.1186/s12913-015-1114-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/24/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Worldwide, rural communities face barriers when accessing health services. In response, numerous initiatives have focused on fostering technological innovations, new management approaches and health policies. Research suggests that the most successful innovations are those involving stakeholders at all levels. However, there is little evidence exploring the opinions of local health providers that could contribute with further innovation development and research. The aims of this study were to explore the perspectives of medical doctors (MDs) working in rural areas of Peru, regarding the barriers impacting the diagnostic process, and ideas for diagnostic innovations that could assist them. METHODS Data gathered through three focus group discussions (FGG) and 18 individual semi-structured interviews (SSI) with MDs who had completed their medical service in rural areas of Peru in the last two years were analyzed using thematic analysis. RESULTS Three types of barriers emerged. The first barrier was the limited access to point of care (POC) diagnostic tools. Tests were needed for: i) the differential diagnosis of malaria vs. pneumonia, ii) dengue vs. leptospirosis, iii) tuberculosis, iv) vaginal infections and cervical cancer, v) neurocysticercosis, and vi) heavy metal toxicity. Ultrasound was needed for the diagnosis of obstetric and intra-abdominal conditions. There were also health system-related barriers such as limited funding for diagnostic services, shortage of specialists, limited laboratory services and access to telecommunications, and lack of institutional support. Finally, the third type of barriers included patient related-barriers to follow through with diagnostic referrals. Ideas for innovations proposed included POC equipment and tests, and telemedicine. CONCLUSIONS MDs at primary health facilities in rural Peru face diagnostic challenges that are difficult to overcome due to a limited access to diagnostic tools. Referrals to specialized facilities are constrained by deficiencies in the organization of health services and by barriers that impede the patients' travel to distant health facilities. Technological innovations suggested by the participants such as POC diagnostic tools and mobile-health (m-health) applications could help address part of the problem. However, other types of innovation to address social, adaptation and policy issues should not be dismissed.
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Affiliation(s)
- Cynthia Fiorella Anticona Huaynate
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Monica Jehnny Pajuelo Travezaño
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Malena Correa
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Holger Mayta Malpartida
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Richard Oberhelman
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
| | - Laura L Murphy
- Department of Global Health Systems & Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
| | - Valerie A Paz-Soldan
- Department of Global Health Systems & Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
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Goetz K, Marx M, Marx I, Brodowski M, Nafula M, Prytherch H, Omogi Awour IKE, Szecsenyi J. Working Atmosphere and Job Satisfaction of Health Care Staff in Kenya: An Exploratory Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:256205. [PMID: 26504793 PMCID: PMC4609329 DOI: 10.1155/2015/256205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/09/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Job satisfaction and working atmosphere are important for optimal health care delivery. The study aimed to document working atmosphere and job satisfaction of health care professionals in Kenya and to explore associations between job satisfaction, staff characteristics, and working atmosphere. METHODS Data from the integrated quality management system (IQMS) for the health sector in Kenya were used. Job satisfaction was measured with 10 items and with additional 5 items adapted to job situation in Kenya. Working atmosphere was measured with 13 item questionnaire. A stepwise linear regression analysis was performed with overall job satisfaction and working atmosphere, aspects of job satisfaction, and individual characteristics. RESULTS Out of 832 questionnaires handed out, 435 questionnaires were completed (response rate: 52.3%). Health care staff indicated high commitment to provide quality services and low levels regarding the adequacy and functionality of equipment at their work station. The aspect "support of the ministry of health" (β = 0.577) showed the highest score of explained variance (32.9%) regarding overall job satisfaction. CONCLUSIONS IQMS which also evaluates job satisfaction and working atmosphere of health care staff provides a good opportunity for strengthening the recruitment and retention of health care staff as well as improving the provision of good quality of care.
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Affiliation(s)
- Katja Goetz
- Department of General Practice and Health Services Research, University of Heidelberg, Vossstrasse 2, 69115 Heidelberg, Germany
| | - Michael Marx
- Evaplan at the University Hospital of Heidelberg, Ringstrasse 19b, 69115 Heidelberg, Germany
| | - Irmgard Marx
- Evaplan at the University Hospital of Heidelberg, Ringstrasse 19b, 69115 Heidelberg, Germany
| | - Marc Brodowski
- AQUA-Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, 37073 Goettingen, Germany
| | - Maureen Nafula
- Institute of Health Policy, Management and Research, NHIF Building, 2nd Floor Ragati Road, Upperhill, P.O. Box 307-00202, Nairobi, Kenya
| | - Helen Prytherch
- Evaplan at the University Hospital of Heidelberg, Ringstrasse 19b, 69115 Heidelberg, Germany
| | | | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Vossstrasse 2, 69115 Heidelberg, Germany
- AQUA-Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, 37073 Goettingen, Germany
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Darkwa EK, Newman MS, Kawkab M, Chowdhury ME. A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh. BMC Health Serv Res 2015; 15:344. [PMID: 26307265 PMCID: PMC4550070 DOI: 10.1186/s12913-015-1012-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background Bangladesh is a highly populous country with three-quarters rural population. Pressing national shortages in health professionals has resulted in high vacancy rates in rural areas. These are compounded by excessive absenteeism and low retention among nurses and doctors posted to rural locations. This study attempts to ascertain reasons for providers’ reluctance to work in rural and remote areas and to identify ways in which these barriers to appropriate staffing might be resolved. Methods This is a qualitative study based on in-depth interviews with healthcare providers (n = 15) and facility managers (n = 4) posted in rural areas, and key informant interviews with health policymakers at the national level (n = 2). Interview guides were written in English and translated and administered in Bengali. The collected data were re-translated and analyzed in English. Braun and Clarke’s thematic analysis approach (data familiarization, coding, identifying and reviewing themes, and producing a final report) was used. Results Participants reported poor living conditions in rural areas (e.g., poor housing facilities and unsafe drinking water); overwhelming workloads with poor safety and insufficient equipment; and a lack of opportunities for career development, and skill enhancement. They reported insufficient wages and inadequate opportunities for private practice in rural areas. Managers described their lack of sufficient authority to undertake disciplinary measures for absenteeism. They also pointed at the lack of fairness in promotion practices of the providers. Policymakers acknowledged unavailability or insufficient allowances for rural postings. There is also a lack of national policy on rural retention. Conclusions The findings revealed a complex interplay of factors influencing doctors’ and nurses’ availability in rural and remote public health facilities from the perspective of different players in the healthcare delivery system of Bangladesh. In addition, the study generated several possibilities for improvement, including increased allowances and incentives for rural posting; a transparent and fair promotion system for serving in rural areas; enhanced authority of the local managers for reducing worker absenteeism; and improved national policies on rural retention.
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Affiliation(s)
| | | | - Mahmud Kawkab
- James P. Grant School of Public Health, BRAC University, ICDDR, B Building, Sixth Floor, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Mahbub Elahi Chowdhury
- Centre for Equity and Health Systems (CEHS), International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh.
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The age profile of the location decision of Australian general practitioners. Soc Sci Med 2015; 142:183-93. [PMID: 26310594 DOI: 10.1016/j.socscimed.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 07/23/2015] [Accepted: 08/03/2015] [Indexed: 11/22/2022]
Abstract
The unbalanced distribution of general practitioners (GPs) across geographic areas has been acknowledged as a problem in many countries around the world. Quantitative information regarding GPs' location decision over their lifecycle is essential in developing effective initiatives to address the unbalanced distribution and retention of GPs. This paper describes the age profile of GPs' location decision and relates it to individual characteristics. I use the Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors (2008-2012) with a sample size of 5810 male and 5797 female GPs. I employ a mixed logit model to estimate GPs' location decision. The results suggest that younger GPs are more prepared to go to rural and remote areas but they tend to migrate back to urban areas as they age. Coming from a rural background increases the likelihood of choosing rural areas, but with heterogeneity: While male GPs from a rural background tend to stay in rural and remote areas regardless of age, female GPs from a rural background are willing to migrate to urban areas as they age. GPs who obtain basic medical degrees overseas are likely to move back to urban areas in the later stage of their careers. Completing a basic medical degree at an older age increases the likelihood of working outside major cities. I also examine factors influencing GPs' location transition patterns and the results further confirm the association of individual characteristics and GPs' location-age profile. The findings can help target GPs who are most likely to practise and remain in rural and remote areas, and tailor policy initiatives to address the undesirable distribution and movement of GPs according to the identified heterogeneous age profile of their location decisions.
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237
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McGrail MR, Humphreys JS. Geographical mobility of general practitioners in rural Australia. Med J Aust 2015; 203:92-6. [DOI: 10.5694/mja14.01375] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
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238
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Qing Y, Hu G, Chen Q, Peng H, Li K, Wei J, Yi Y. Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2015; 12:40. [PMID: 26268830 PMCID: PMC4536338 DOI: 10.3352/jeehp.2015.12.40] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/09/2015] [Indexed: 05/23/2023]
Abstract
PURPOSE To produce competent undergraduate-level medical doctors for rural township health centers (THCs), the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs) starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. METHODS An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. RESULTS Among 4,669 medical students, 1,523 (33%) had a positive attitude and 2,574 (55%) had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary. CONCLUSION Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.
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Affiliation(s)
- Yunbo Qing
- Administration Offices, Guangxi Medical University, Nanning, China
| | - Guijie Hu
- The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qingyun Chen
- First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hailun Peng
- Administration Offices, Guangxi Medical University, Nanning, China
| | - Kailan Li
- Administration Offices, Guangxi Medical University, Nanning, China
| | - Jinling Wei
- Administration Offices, Guangxi Medical University, Nanning, China
| | - Yanhua Yi
- School for International Education, Guangxi Medical University, Nanning, Guangxi, China
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239
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Lori JR, Stalls S, Rominski SD. Strengthening Midwifery to End Preventable Maternal, Child, and Newborn Deaths. J Midwifery Womens Health 2015; 60:343-7. [PMID: 26255797 PMCID: PMC4533120 DOI: 10.1111/jmwh.12341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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240
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Grobler L, Marais BJ, Mabunda S. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev 2015; 2015:CD005314. [PMID: 26123126 PMCID: PMC6791300 DOI: 10.1002/14651858.cd005314.pub3] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The inequitable distribution of health professionals, within countries, poses an important obstacle to the optimal functioning of health services. OBJECTIVES To assess the effectiveness of interventions aimed at increasing the proportion of health professionals working in rural and other underserved areas. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, including specialised register of the Cochrane Effective Practice and Organisation of Care Group; March 2014), MEDLINE (1966 to March 2014), EMBASE (1988 to March 2014), CINAHL (1982 to March 2014), LILACS (February 2014), Science Citation Index and Social Sciences Citation Index (up to April 2014), Global Health (March 2014) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (June 2013). We also searched reference lists of all papers and relevant reviews identified, and contacted authors of relevant papers regarding any further published or unpublished work. SELECTION CRITERIA Randomised trials, non-randomised trials, controlled before-and-after studies and interrupted time series studies evaluating the effects of various interventions (e.g. educational, financial, regulatory or support strategies) on the recruitment or retention, or both, of health professionals in underserved areas. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and assessed full texts of potentially relevant studies for eligibility. Two review authors independently extracted data from eligible studies. MAIN RESULTS For this first update of the original review, we screened 8945 records for eligibility. We retrieved and assessed the full text of 125 studies. Only one study met the inclusion criteria of the review. This interrupted time series study, conducted in Taiwan, found that the implementation of a National Health Insurance scheme in 1995 was associated with improved equity in the geographic distribution of physicians and dentists. We judged the certainty of the evidence provided by this one study very low. AUTHORS' CONCLUSIONS There is currently limited reliable evidence regarding the effects of interventions aimed at addressing the inequitable distribution of health professionals. Well-designed studies are needed to confirm or refute findings of observational studies of educational, financial, regulatory and supportive interventions that might influence healthcare professionals' decisions to practice in underserved areas. Governments and medical schools should ensure that when interventions are implemented, their impacts are evaluated using scientifically rigorous methods to establish the true effects of these measures on healthcare professional recruitment and retention in rural and other underserved settings.
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Affiliation(s)
- Liesl Grobler
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241TygerbergCape TownWestern CapeSouth Africa8000
| | - Ben J Marais
- University of SydneyMarie Bashir Institute for Infectious Diseases and BiosecuritySydneyAustralia
- University of SydneyChildren’s Hospital at WestmeadSydneyAustralia
| | - Sikhumbuzo Mabunda
- University of Cape Town/Western Cape Department of HealthP.O. Box 768RondeboschSouth Africa7701
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241
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Nowrouzi B, Lightfoot N, Larivière M, Carter L, Rukholm E, Schinke R, Belanger-Gardner D. Occupational Stress Management and Burnout Interventions in Nursing and Their Implications for Healthy Work Environments: A Literature Review. Workplace Health Saf 2015; 63:308-15. [PMID: 26084675 DOI: 10.1177/2165079915576931] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reports on a literature review of workplace interventions (i.e., creating healthy work environments and improving nurses' quality of work life [QWL]) aimed at managing occupational stress and burnout for nurses. A literature search was conducted using the keywords nursing, nurses, stress, distress, stress management, burnout, and intervention. All the intervention studies included in this review reported on workplace intervention strategies, mainly individual stress management and burnout interventions. Recommendations are provided to improve nurses' QWL in health care organizations through workplace health promotion programs so that nurses can be recruited and retained in rural and northern regions of Ontario. These regions have unique human resources needs due to the shortage of nurses working in primary care.
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242
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Nallala S, Swain S, Das S, Kasam SK, Pati S. Why medical students do not like to join rural health service? An exploratory study in India. J Family Community Med 2015; 22:111-7. [PMID: 25983608 PMCID: PMC4415126 DOI: 10.4103/2230-8229.155390] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Inadequate, inequitable distribution of the medical workforce remains a challenge across the globe, and India is no exception. Odisha, a state in India faces a major shortage of doctors particularly in rural and remote areas. In order to address this challenge, it is essential to understand medical students’ career plans, specialization preferences, choices of job location and sector, and views on working in rural and remote areas. This study explored the immediate and long-term career plans of final year medical students, their intended practice locations and underlying reasons for the choices. Methodology: A cross-sectional survey was conducted in all the medical colleges (three government and three private) in the state of Odisha. Through the systematic sampling method, data were gathered from 390 final year students. A semi-structured questionnaire was administered to the students and data were analyzed using SPSS version 20. Results: Of the 390 students, 290 (74.35%) were from a government college. The most preferred immediate career goal was postgraduation studies (45.9% of students in government medical schools and 54% in private). About 17% of government students and 9% of private students showed willingness to work in rural areas, in the long run. Nearly 44.5% mentioned opportunities for career growth, followed by the possibilities for higher education (26.8%) as major the factors for preferring an urban posting. Similarly, higher pay scales, better working conditions were major factors for preferring the private sector. Most of the students maintained that good housing, better salaries, and adequate facilities at the workplace would attract more students toward rural service. Conclusion: Since public funded medical students are not motivated to serve in rural settings, increasing the number of places or establishing new medical institutions may not be an effective solution to the issue. Approaches such as extended clinical apprenticeship in rural health facilities, long-term community engagement during medical studentship could be considered.
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Affiliation(s)
- Srinivas Nallala
- Public Health Foundation of India, Indian Institute of Public Health, Bhubaneswar, Odisha, India
| | - Subhashisa Swain
- Public Health Foundation of India, Indian Institute of Public Health, Bhubaneswar, Odisha, India
| | - Sanju Das
- Public Health Division, Indian Institute of Public Health-Bhubaneswar, Odisha, India
| | - Shravan K Kasam
- HIV Division, Public Health Foundation of India, New Delhi, India
| | - Sanghamitra Pati
- Public Health Foundation of India, Indian Institute of Public Health, Bhubaneswar, Odisha, India
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243
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Zheng J, Li J, Jiang X, Zhang B. Sustaining health workforce recruitment and retention in township hospitals: a survey on 110 directors of township hospitals. Front Med 2015; 9:239-50. [PMID: 25893504 DOI: 10.1007/s11684-015-0392-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
Township hospitals, the main provider of rural primary healthcare in China, are severely understaffed. International studies on factors influencing rural working are increasing; however, studies on factors affecting the recruitment and retention of health workers in Chinese township hospitals are limited. The current study aims to understand the motivation of health workers and arrive at a systematic framework of pluralistic factors that would help support health workers in terms of receiving posts and remaining in posts in township hospitals. A three-stage integrated quantitative and qualitative methodology was employed. First, a survey on 120 directors of township hospitals was conducted to learn the latest status of health workers in township hospitals and distinguish existing problems. Second, after sending these problems back to the directors, an open-ended pen-and-paper survey was conducted to ask the directors to identify the factors influencing the attraction and retention of health workers in township hospitals. Third, four focus groups were conducted to gauge the underlying reasons. Five problems from the questionnaire survey were recognized, and numbers of thematic factors were identified at the individual, professional, and treatment environment from the pen-and-paper survey and focus group. Similar to other studies, this framing of both non-financial and financial elements affected the attraction and retention of health workers in township hospitals, thereby filling the gap in a Chinese context. Although several factors had been recognized earlier, our findings further highlighted the importance of these factors. Meanwhile, the factors identified in this study were barely explored in literature. This paper identifies and develops multi-faceted factors to call for a bundled package of multidimensional incentives if decision-makers get interested. The evidence-based findings in our study can be used to provide China-specific policy recommendations on how to recruit and retain health workers in rural areas of China.
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Affiliation(s)
- Jingmin Zheng
- Department of Social Medicine, School of Public Health, Chongqing Medical University, Chongqing, 400016, China
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244
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Buchan J, Couper ID, Tangcharoensathien V, Thepannya K, Jaskiewicz W, Perfilieva G, Dolea C. Early implementation of WHO recommendations for the retention of health workers in remote and rural areas. Bull World Health Organ 2015; 91:834-40. [PMID: 24347707 DOI: 10.2471/blt.13.119008] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/31/2013] [Accepted: 06/06/2013] [Indexed: 11/27/2022] Open
Abstract
The maldistribution of health workers between urban and rural areas is a policy concern in virtually all countries. It prevents equitable access to health services, can contribute to increased health-care costs and underutilization of health professional skills in urban areas, and is a barrier to universal health coverage. To address this long-standing concern, the World Health Organization (WHO) has issued global recommendations to improve the rural recruitment and retention of the health workforce. This paper presents experiences with local and regional adaptation and adoption of WHO recommendations. It highlights challenges and lessons learnt in implementation in two countries - the Lao People's Democratic Republic and South Africa - and provides a broader perspective in two regions - Asia and Europe. At country level, the use of the recommendations facilitated a more structured and focused policy dialogue, which resulted in the development and adoption of more relevant and evidence-based policies. At regional level, the recommendations sparked a more sustained effort for cross-country policy assessment and joint learning. There is a need for impact assessment and evaluation that focus on the links between the rural availability of health workers and universal health coverage. The effects of any health-financing reforms on incentive structures for health workers will also have to be assessed if the central role of more equitably distributed health workers in achieving universal health coverage is to be supported.
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Affiliation(s)
| | - Ian D Couper
- Centre for Rural Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Khampasong Thepannya
- Department of Health Personnel, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Wanda Jaskiewicz
- IntraHealth International, Chapel Hill, North Carolina, United States of America
| | - Galina Perfilieva
- Europe Regional Office, World Health Organization, Copenhagen, Denmark
| | - Carmen Dolea
- Health Systems Policies and Workforce, World Health Organization, 20 avenue Appia, 1211 Geneva, Switzerland
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245
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Rafiei S, Arab M, Rashidian A, Mahmoudi M, Rahimi-Movaghar V. Factors Influencing Neurosurgeons' Decision to Retain in a Work Location: A Qualitative Study. Glob J Health Sci 2015; 7:333-51. [PMID: 26156906 PMCID: PMC4803915 DOI: 10.5539/gjhs.v7n5p333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/10/2014] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Physician retention is a serious concern to have an effective and efficient health system; the key challenge is how best to encourage and retain health providers in their work location. There have been considerable studies on factors influencing physicians' retention but little research has been conducted in Iran. This study aims to determine the affecting factors from neurosurgeons' viewpoint to support policy makers in proposing a sort of evidence based retention strategies. METHODS We conducted semi structured interviews with 17 neurosurgeons working in 9 provinces of Iran between September and November 2014. We included physicians remaining to work in a particular community for at least 3 years and asked them about the factors influenced their decision to retain in a work place. Data were thematically analyzed using "framework approach" for qualitative research. RESULTS Satisfaction with monetary incentives, availability of adequate clinical infrastructure in a community and appropriate working condition were most commonly cited factors mentioned by all participants as key reasons for retention. Furthermore elements which contributed to the quality of living condition, personal background and incentives, family convenience were emphasized by majority of them. A small number of participants mentioned opportunity for continuing learning and updating knowledge as well as supportive organizational policies as important motivators in a workplace. CONCLUSION Ministry of Health and Medical Education (MOHME) should consider a multifaceted and holistic approach to improve neurosurgeons' retention in their work location. Our findings suggests a combination of financial remuneration, establishment of adequate hospitals and clinical facilities, collaborative working environment with reasonable workload, proper living condition, family support and facilities for professional development to be employed as an effective strategy for promoting physicians' retention.
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246
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Manabe YC, Zawedde-Muyanja S, Burnett SM, Mugabe F, Naikoba S, Coutinho A. Rapid improvement in passive tuberculosis case detection and tuberculosis treatment outcomes after implementation of a bundled laboratory diagnostic and on-site training intervention targeting mid-level providers. Open Forum Infect Dis 2015; 2:ofv030. [PMID: 26034778 PMCID: PMC4438908 DOI: 10.1093/ofid/ofv030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/02/2015] [Indexed: 11/25/2022] Open
Abstract
Background. Tuberculosis (TB) control is a public health priority with 3 million cases unrecognized by the public health system each year. We assessed the impact of improved TB diagnostics and on-site training on TB case detection and treatment outcomes in rural healthcare facilities. Methods. Fluorescence microscopy, Xpert MTB/RIF, and on-site training were introduced at 10 healthcare facilities. Using quasi-experimental methods, these 10 intervention healthcare facilities were compared with 2 controls and their own performance the previous year. Results. From January to October 2012, 186 357 and 32 886 outpatients were seen in the 10 intervention and 2 control facilities, respectively. The intervention facilities had a 52.04% higher proportion of presumptive TB cases with a sputum examination (odds ratio [OR] = 12.65; 95% confidence interval [CI], 5.60–28.55). After adjusting for age group and gender, the proportion of smear-positive patients initiated on treatment was 37.76% higher in the intervention than in the control facilities (adjusted OR [AOR], 7.59; 95% CI, 2.19–26.33). After adjusting for the factors above, as well as human immunodeficiency virus and TB retreatment status, the proportion of TB cases who completed treatment was 29.16% higher (AOR, 4.89; 95% CI, 2.24–10.67) and the proportion of TB cases who were lost to follow-up was 66.98% lower (AOR, 0.04; 95% CI, 0.01–0.09). When compared with baseline performance, the intervention facilities had a significantly higher proportion of presumptive TB cases with a sputum examination (64.70% vs 3.44%; OR, 23.95; 95% CI, 12.96–44.25), and these facilities started 56.25% more smear-positive TB cases on treatment during the project period (AOR, 15.36; 95% CI, 6.57–35.91). Conclusions. Optimizing the existing healthcare workforce through a bundled diagnostics and on-site training intervention for nonphysician healthcare workers will rapidly improve TB case detection and outcomes towards global targets.
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Affiliation(s)
- Yukari C Manabe
- Infectious Diseases Institute , Makerere College of Health Sciences , Kampala , Uganda ; Division of Infectious Diseases, Department of Medicine , Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | - Sarah M Burnett
- Accordia Global Health Foundation , Washington, District of Columbia
| | - Frank Mugabe
- National Tuberculosis and Leprosy Program , Uganda Ministry of Health
| | - Sarah Naikoba
- Infectious Diseases Institute , Makerere College of Health Sciences , Kampala , Uganda
| | - Alex Coutinho
- Infectious Diseases Institute , Makerere College of Health Sciences , Kampala , Uganda
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247
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Uemoto A, Kawamoto R, Abe M, Kusunoki T, Kohara K, Miki T. [The differences in speciality preferences and career determinant factors between first- and fifth-year medical school students]. Nihon Ronen Igakkai Zasshi 2015; 52:48-54. [PMID: 25786628 DOI: 10.3143/geriatrics.52.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM In Japan, the imbalance in the medical workforce has caused a deterioration of rural medicine. We explored the differences in speciality preferences and career determinant factors among students to identify keys to increase the recruitment of physicians to rural areas. METHODS We conducted a survey of first- and fifth-year medical students, using a questionnaire enquiring about their specialty preference and career determinant factors. The data were analyzed with a chi-square test. RESULTS A higher percentage of first-year students preferred to be basic medicine scientists, while fifth-year students considered internal medicine subspecialities, obstetrics and gynecology, anesthesia, and ophthalmology to be the most desirable. The factor analysis yielded five factors responsible for these findings; high social approval of the specialty, working hours, income, advice from senior classmates and doctors, and the work environment. The percentage of students who considered rural practice as a choice for thier future plan and had an awareness of the collapse of rural medicine was lower in the fifth-year students than in the first-year students. CONCLUSION To increase the medical work force in provincial areas, it is necessary to strengthen not only the medical system with regard to general medicine, but also to offer better medical education in rural areas. More information about rural practice should therefore be transmitted to medical students.
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248
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Nkoko L, Spiegel J, Rau A, Parent S, Yassi A. Reducing the risks to health care workers from blood and body fluid exposure in a small rural hospital in Thabo-Mofutsanyana, South Africa. Workplace Health Saf 2015; 62:382-8. [PMID: 25650472 DOI: 10.3928/21650799-20140815-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Health care workers in sub-Saharan Africa are at high risk of acquiring bloodborne diseases. A training program was launched to build the capacity of occupational health nurses to design and implement workplace-based projects. The study assessed the knowledge, attitudes, and practices of health care workers regarding blood and body fluid exposures in a small district hospital in a rural area of the Free State in South Africa. Under the guidance of two experienced mentors, an occupational health nurse designed a knowledge, attitudes, and practices questionnaire and distributed itto 101 health care workers at risk throughout the hospital; 88% of questionnaires were returned in sealed envelopes.Limited knowledge and ineffective practices were documented. For example, only 54.3% of the respondents reported that needles should never be recapped. A significant correlation (p < .001) was found between limited knowledge and recent blood and body fluid exposure. The study results provided the occupational health nurse with data to address the knowledge, attitudes, and practices deficits by implementing an injury prevention educational intervention. Such training initiatives can decrease the burden of occupational disease among health care workers in rural low-resourced areas.
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249
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Abimbola S, Olanipekun T, Igbokwe U, Negin J, Jan S, Martiniuk A, Ihebuzor N, Aina M. How decentralisation influences the retention of primary health care workers in rural Nigeria. Glob Health Action 2015; 8:26616. [PMID: 25739967 PMCID: PMC4349907 DOI: 10.3402/gha.v8.26616] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/04/2015] [Accepted: 02/10/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In Nigeria, the shortage of health workers is worst at the primary health care (PHC) level, especially in rural communities. And the responsibility for PHC - usually the only form of formal health service available in rural communities - is shared among the three tiers of government (federal, state, and local governments). In addition, the responsibility for community engagement in PHC is delegated to community health committees. OBJECTIVE This study examines how the decentralisation of health system governance influences retention of health workers in rural communities in Nigeria from the perspective of health managers, health workers, and people living in rural communities. DESIGN The study adopted a qualitative approach, and data were collected using semi-structured in-depth interviews and focus group discussions. The multi-stakeholder data were analysed for themes related to health system decentralisation. RESULTS The results showed that decentralisation influences the retention of rural health workers in two ways: 1) The salary of PHC workers is often delayed and irregular as a result of delays in transfer of funds from the national to sub-national governments and because one tier of government can blame failure on another tier of government. Further, the primary responsibility for PHC is often left to the weakest tier of government (local governments). And the result is that rural PHC workers are attracted to working at levels of care where salaries are higher and more regular - in secondary care (run by state governments) and tertiary care (run by the federal government), which are also usually in urban areas. 2) Through community health committees, rural communities influence the retention of health workers by working to increase the uptake of PHC services. Community efforts to retain health workers also include providing social, financial, and accommodation support to health workers. To encourage health workers to stay, communities also take the initiative to co-finance and co-manage PHC services in order to ensure that PHC facilities are functional. CONCLUSIONS In Nigeria and other low- and middle-income countries with decentralised health systems, intervention to increase the retention of health workers in rural communities should seek to reform and strengthen governance mechanisms, using both top-down and bottom-up strategies to improve the remuneration and support for health workers in rural communities.
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Affiliation(s)
- Seye Abimbola
- National Primary Health Care Development Agency, Abuja, Nigeria.,School of Public Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia;
| | | | | | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Stephen Jan
- School of Public Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Alexandra Martiniuk
- School of Public Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nnenna Ihebuzor
- National Primary Health Care Development Agency, Abuja, Nigeria
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250
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Rehfuess EA, Durão S, Kyamanywa P, Meerpohl JJ, Young T, Rohwer A. An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries. Bull World Health Organ 2015; 94:297-305. [PMID: 27034523 PMCID: PMC4794302 DOI: 10.2471/blt.15.162966] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 11/27/2022] Open
Abstract
To derive evidence-based and stakeholder-informed research priorities for implementation in African settings, the international research consortium Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) developed and applied a pragmatic approach. First, an online survey and face-to-face consultation between CEBHA+ partners and policy-makers generated priority research areas. Second, evidence maps for these priority research areas identified gaps and related priority research questions. Finally, study protocols were developed for inclusion within a grant proposal. Policy and practice representatives were involved throughout the process. Tuberculosis, diabetes, hypertension and road traffic injuries were selected as priority research areas. Evidence maps covered screening and models of care for diabetes and hypertension, population-level prevention of diabetes and hypertension and their risk factors, and prevention and management of road traffic injuries. Analysis of these maps yielded three priority research questions on hypertension and diabetes and one on road traffic injuries. The four resulting study protocols employ a broad range of primary and secondary research methods; a fifth promotes an integrated methodological approach across all research activities. The CEBHA+ approach, in particular evidence mapping, helped to formulate research questions and study protocols that would be owned by African partners, fill gaps in the evidence base, address policy and practice needs and be feasible given the existing research infrastructure and expertise. The consortium believes that the continuous involvement of decision-makers throughout the research process is an important means of ensuring that studies are relevant to the African context and that findings are rapidly implemented.
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Affiliation(s)
- Eva A Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Solange Durão
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | | | | | - Taryn Young
- Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa
| | - Anke Rohwer
- Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa
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