Appealing to altruism: an alternative strategy to address the health workforce crisis in developing countries?

Do nursing students' altruism levels affect their attitudes toward medical errors? A cross-sectional study

AIM

The aim of the current research is to determine nursing students' levels of altruism, attitudes towards medical errors and the effect of altruism on attitudes towards medical errors.

BACKGROUND

Nursing students should be aware of medical errors and have an attitude towards correcting them. Professional values play an essential role in changing, shaping and developing attitudes in nursing students. Altruism is one of the most important determining professional values in students' professional success and development of attitudes towards different situations.

DESING

This study is a descriptive and cross-sectional study.

METHODS

The research was conducted in the Nursing Department of a state university in Turkey and the study population consisted of 2nd, 3rd and 4th year nursing students (N=375) who were continuing their education and clinical practice in the spring semester of the 2022-2023 academic year. The study was completed with 321 students. The data were collected online using the information form, the Altruism Scale and the Scale of Attitudes Towards Medical Errors via Google Forms between 01 and 31 May 2023. Data were analysed using descriptive statistics, Independent-Samples t-test, One-Way ANOVA test, Pearson's correlation analysis and simple linear regression.

RESULTS

Students had a mean score of 69.68 (range 40-98) on the Altruism Scale and 3.82 (range 2.38-4.56) on the Scale of Attitudes Towards Medical Errors. A significant, very weak positive correlation was found between the Altruism Scale and the total mean scores of the Attitudes Towards Medical Errors Scale (p=0.001). Altruism was found to have a significant effect on attitude towards medical errors (p=0.001). The explanatory power of the regression model was 0.101 and altruism explained 10.1 % of the students' attitudes towards medical errors scores.

CONCLUSIONS

Students have positive attitudes towards medical errors, high awareness of the importance of medical errors and error reporting and above average levels of altruism. Altruism has a positive effect on attitudes towards medical errors.

Task-shifting and the recruitment and retention of eye care workers in under-served areas: a qualitative study of optometrists' motivation in Ghana and Scotland

AIM

To assist policy-makers in improving access to eye care in under-served areas by analysing the relationship between motivational factors affecting the uptake of task-shifting in eye care and the recruitment and retention of optometrists in remote and rural areas.

BACKGROUND

The World Health Organization recommends two key strategies in tackling preventable blindness in under-served areas: improving human resources for health and task-shifting. The relationship between task-shifting and recruitment and retention of eye care workers in under-served areas is unknown. Ghana and Scotland are two countries from different levels of economic development that have notably expanded the roles of optometrists and struggle with rural recruitment and retention.

METHODS

Motivation was explored through semi-structured interviews with 19 optometrists in Ghana and Scotland with experience in remote and rural practice. Framework analysis was used to analyse interviews, explore the relationship between task-shifting and recruitment and retention and create recommendations for policy.

FINDINGS

The main motivational considerations included altruism, quality of life, learning and career opportunities, fulfilling potential, remuneration, stress of decision-making and collaboration. Motivational and demotivational factors for task-shifting and recruitment/retention shared many similar aspects.

DISCUSSION

Recruitment and retention in remote and rural areas require staff be incentivised to take up those positions, motivated to remain and given the adequate resources for personal and professional fulfilment. Task-shifting also requires incentivisation, motivation to continue and the resources to be productive. Many motivational factors influencing recruitment/retention and task-shifting are similar suggesting these two strategies can be compatible and complementary in improving access to eye care, although some factors are culture and context specific. Understanding optometrists' motivation can help policy-makers improve rural recruitment and retention and plan services.

The impacts of altruism levels on the job preferences of medical students: a cross-sectional study in China

BACKGROUND

Rational allocation of human resources for health is crucial for ensuring public welfare and equitable access to health services. Understanding medical students' job preferences could help develop effective strategies for the recruitment and retention of the health workforce. Most studies explore the relationship between extrinsic incentives and job choices through discrete choice experiments (DCEs). Little attention has been paid to the influence of intrinsic altruism on job choice. This study aimed to explore the heterogeneous preferences of medical students with different levels of altruism regarding extrinsic job attributes.

METHODS

We conducted an online survey with 925 medical students from six hospitals in Beijing from July to September 2021. The survey combined job-choice scenarios through DCEs and a simulation of a laboratory experiment on medical decision-making behavior. Behavioral data were used to quantify altruism levels by estimating altruistic parameters based on a utility function. We fit mixed logit models to estimate the effects of altruism on job preference.

RESULTS

All attribute levels had the expected effect on job preferences, among which monthly income (importance weight was 30.46%, 95% CI 29.25%-31.67%) and work location (importance weight was 22.39%, 95% CI 21.14%-23.64%) were the most salient factors. The mean altruistic parameter was 0.84 (s.d. 0.19), indicating that medical students' altruism was generally high. The subgroup analysis showed that individuals with higher altruism levels had a greater preference for non-financial incentives such as an excellent work environment, sufficient training and career development opportunities, and a light workload. The change in the rate of the uptake of a rural position by individuals with lower levels of altruism is sensitive to changes in financial incentives.

CONCLUSIONS

Medical students' altruism was generally high, and those with higher altruism paid more attention to non-financial incentives. This suggests that policymakers and hospital managers should further focus on nonfinancial incentives to better motivate altruistic physicians, in addition to appropriate economic incentive when designing recruitment and retention interventions. Medical school administrations could attach importance to the promotion of altruistic values in medical education.

Motivation and competition in health care

Non-pecuniary sources of motivation are a strong feature of the health care sector and the impact of competitive incentives on behavior may be lower where pecuniary motivation is low. This paper measures the marginal utility of income (MUY) of physicians from a stated-choice experiment, and examines whether this measure influences the association between competition faced by physicians and the prices they charge. We find that physicians are more likely to exploit a lack of competition with higher prices if they have a high MUY.

Altruism in nursing from 2012 to 2022: A scoping review

BACKGROUND

Being a nurse with non-altruistic orientation exists and altruism decline is being challenged as never before, which would be a disaster for medicine if left unnoticed.

PURPOSE

To describe the meaning of altruism and altruistic behaviors in nursing, and to discuss dilemmas we face today.

METHOD

Cochrane, PROSPERO, PubMed, Web of Science, CINAHL, Scopus, Embase, ProQuest, and CNKI were searched for original research published in English or Chinese from 2012 to February 2022.

RESULTS

By screening 13 studies came from 12 different countries described altruism and altruistic behavior together were included in. Altruism has been described as value, vocation, or professionalism in nursing which can reflect nurses' compassion, level of expertise, and quality of care. Altruistic nursing care, body donation, financial endowment, volunteering, sharing, benefiting patients maximum, and helping colleagues represented most of the altruistic behaviors in nursing. There is a vacant that not any assessment tool designed for measuring altruism in nurse groups. Interventions from curriculums in class and support of organizations with psychological methods could be helpful to improve the nurses' level of altruism.

CONCLUSION

Altruism and altruistic behaviors in the past decades were described. A new concept of altruism in nursing was proposed based on the original meaning and the current changes, and interventions for promoting altruism and some of the dilemmas faced today were synthesized.

'Feminization' of physician workforce in Bangladesh, underlying factors and implications for health system: Insights from a mixed-methods study

BACKGROUND

Bangladesh is currently faced with an emerging scenario of increased number of female physicians in the health workforce which has health system implications. For a health system to attract and retain female physicians, information is needed regarding their motivation to choose medical profession, real-life challenges encountered in home and workplaces, propensity to choose a few particular specialties, and factors leading to drop-out from the system. This exploratory mixed-methods study attempted to fill-in this knowledge gap and help the policy makers in designing a gender-sensitive health system.

METHODS

Three-hundred and fifteen final year female medical students from four purposively selected medical colleges of Dhaka city (two each from public and private colleges) were included in a quantitative survey using self-administered questionnaire. Besides, 31 in-depth interviews with female students, their parents, and in-service trainee physicians, and two focus group discussions with female students were conducted. Gender disaggregated data of physicians and admitted students were also collected. Data were analysed using Stata version 13 and thematic analysis method, as appropriate.

RESULTS

During 2006-2015, the female physicians outnumbered their male peers (52% vs. 48%), which is also supported by student admission data during 2011-2016 from the sampled medical colleges, (67% in private compared to 52% in public). Majority of the female medical graduates specialized in Obstetrics and Gynaecology (96%). Social status (66%), respect for medical profession (91%), image of a 'noble profession' (91%), and prospects of helping common people (94%) were common motivating factors for them. Gender disparity in work, career and work environment especially in rural areas, and problems of work-home balance, were a few of the challenges mentioned which forced some of them to drop-out. Also, this scenario conditioned them to crowd into a few selected specialties, thereby constraining health system from delivering needed services.

CONCLUSIONS

Increasing number of female physicians in health workforce, outnumbering their male peers, is a fact of life for health system of Bangladesh. It's high time that policy makers pay attention to this and take appropriate remedial measures so that women can pursue their career in an enabling environment and serve the needs and priorities of the health system.

Advancing the science behind human resources for health: highlights from the Health Policy and Systems Research Reader on Human Resources for Health

Health workers are central to people-centred health systems, resilient economies and sustainable development. Given the rising importance of the health workforce, changing human resource for health (HRH) policy and practice and recent health policy and systems research (HPSR) advances, it is critical to reassess and reinvigorate the science behind HRH as part of health systems strengthening and social development more broadly. Building on the recently published Health Policy and Systems Research Reader on Human Resources for Health (the Reader), this commentary reflects on the added value of HPSR underpinning HRH. HPSR does so by strengthening the multi-disciplinary base and rigour of HRH research by (1) valuing diverse research inferences and (2) deepening research enquiry and quality. It also anchors the relevance of HRH research for HRH policy and practice by (3) broadening conceptual boundaries and (4) strengthening policy engagement. Most importantly, HPSR enables us to transform HRH from being faceless numbers or units of health producers to the heart and soul of health systems and vital change agents in our communities and societies. Health workers' identities and motivation, daily routines and negotiations, and training and working environments are at the centre of successes and failures of health interventions, health system functioning and broader social development. Further, in an increasingly complex globalised economy, the expansion of the health sector as an arena for employment and the liberalisation of labour markets has contributed to the unprecedented movement of health workers, many or most of whom are women, not only between public and private health sectors, but also across borders. Yet, these political, human development and labour market realities are often set aside or elided altogether. Health workers' lives and livelihoods, their contributions and commitments, and their individual and collective agency are ignored. The science of HRH, offering new discoveries and deeper understanding of how universal health coverage and the Sustainable Development Goals are dependent on millions of health workers globally, has the potential to overcome this outdated and ineffective orthodoxy.

Advancing the science behind human resources for health: highlights from the Health Policy and Systems Research Reader on Human Resources for Health

Health workers are central to people-centred health systems, resilient economies and sustainable development. Given the rising importance of the health workforce, changing human resource for health (HRH) policy and practice and recent health policy and systems research (HPSR) advances, it is critical to reassess and reinvigorate the science behind HRH as part of health systems strengthening and social development more broadly. Building on the recently published Health Policy and Systems Research Reader on Human Resources for Health (the Reader), this commentary reflects on the added value of HPSR underpinning HRH. HPSR does so by strengthening the multi-disciplinary base and rigour of HRH research by (1) valuing diverse research inferences and (2) deepening research enquiry and quality. It also anchors the relevance of HRH research for HRH policy and practice by (3) broadening conceptual boundaries and (4) strengthening policy engagement. Most importantly, HPSR enables us to transform HRH from being faceless numbers or units of health producers to the heart and soul of health systems and vital change agents in our communities and societies. Health workers' identities and motivation, daily routines and negotiations, and training and working environments are at the centre of successes and failures of health interventions, health system functioning and broader social development. Further, in an increasingly complex globalised economy, the expansion of the health sector as an arena for employment and the liberalisation of labour markets has contributed to the unprecedented movement of health workers, many or most of whom are women, not only between public and private health sectors, but also across borders. Yet, these political, human development and labour market realities are often set aside or elided altogether. Health workers' lives and livelihoods, their contributions and commitments, and their individual and collective agency are ignored. The science of HRH, offering new discoveries and deeper understanding of how universal health coverage and the Sustainable Development Goals are dependent on millions of health workers globally, has the potential to overcome this outdated and ineffective orthodoxy.

Governance and the effectiveness of public health subsidies: Evidence from Ghana, Kenya and Uganda

Distributing subsidized health products through existing health infrastructure could substantially and cost-effectively improve health in sub-Saharan Africa. There is, however, widespread concern that poor governance - in particular, limited health worker accountability - seriously undermines the effectiveness of subsidy programs. We audit targeted bednet distribution programs to quantify the extent of agency problems. We find that around 80% of the eligible receive the subsidy as intended, and up to 15% of subsidies are leaked to ineligible people. Supplementing the program with simple financial or monitoring incentives for health workers does not improve performance further and is thus not cost-effective in this context.

Changing health care provider performance through measurement

Can the quality of care be improved by repeated measurement? We show that measuring protocol adherence repeatedly over ten weeks leads to significant improvements in quality immediately and up to 18 months later without any additional training, equipment, supplies or material incentives. 96 clinicians took part in a study which included information, encouragement, scrutiny and repeated contact with the research team measuring quality. We examine protocol adherence over the course of the study and for 45 of the original clinicians 18 months after the conclusion of the project. Health workers change their behavior significantly over the course of the study, and even eighteen months later demonstrate a five percentage point improvement in quality. The dynamics of clinicians' reactions to this intervention suggest that quality can be improved by the repeated measurement by external peers in a way that provides reminders of expectations.

Altruism, the values dimension of caring self-efficacy concept in Iranian pediatric nurses

BACKGROUND

Self-efficacy is the most influential among factors affecting nurses' performance. Yet, understanding of the constituent elements of the caring self-efficacy concept was not considered. This study was to introduce altruism as one of the main aspects of caring self-efficacy in pediatric nurses.

MATERIALS AND METHODS

This is part of a larger study on the concept of caring self-efficacy conducted with qualitative content analysis approach in Iran. Participants included 27 clinical pediatric nurses and instructors, selected purposively. Data were collected using semi-structured interviews and analyzed using conventional content analysis method.

RESULTS

Theme "altruism" as one of the main themes extracted from the analysis of the interviews in this study. This theme includes two main categories of "humanistic care" and "caring attitude."

CONCLUSIONS

This paper introduces altruism as one of the values aspects of caring self-efficacy in pediatric nurses. Efficient nurse with features Humanistic care, through the provision of maternal care and family-centered care and caring attitudes resulting from religious beliefs and loving children to care for the children.

Valuing the work of unpaid community health workers and exploring the incentives to volunteering in rural Africa

Community health worker (CHW) programmes are currently being scaled-up in sub-Saharan Africa to improve access to healthcare. CHWs are often volunteers; from an economic perspective, this raises considerations whether reliance on an unpaid workforce is sustainable and how to appropriately cost and value the work of CHWs. Both these questions can be informed by an understanding of CHWs' workload, their opportunity costs of time and the perceived benefits of being a CHW. However, to date few studies have fully explored the methodological challenges in valuing CHW time. We examined the costs and benefits of volunteering in a sample of 45 CHWs providing integrated community case management of common childhood illnesses in rural Uganda in February 2012 using different methods. We assessed the value of CHW time using the minimum public sector salary rate and a CHW-elicited replacement wage, as well as the opportunity cost of time based on CHW-estimated annual income and alternative work opportunities, respectively. Reported monthly CHW workload, a median of 19.3 h (range 2.5-57), was valued at USD 6.9 (range 0.9-20.4) per month from the perspective of the healthcare system (applicable replacement wage) and at a median of USD 4.1 (range 0.4-169) from the perspective of the CHWs (individual opportunity cost of time). In a discrete choice experiment on preferred work characteristics, remuneration and community appreciation dominated. We find that volunteering CHWs value the opportunity to make a social contribution, but the decision to volunteer is also influenced by anticipated future rewards. Care must be taken by those costing and designing CHW programmes to acknowledge the opportunity cost of CHWs at the margin and over the long term. Failure to properly consider these issues may lead to cost estimations below the amount necessary to scale up and sustain programmes.

Factors behind job preferences of Peruvian medical, nursing and midwifery students: a qualitative study focused on rural deployment

BACKGROUND

Deployment of health workforce in rural areas is critical to reach universal health coverage. Students' perceptions towards practice in rural areas likely influence their later choice of a rural post. We aimed at exploring perceptions of students from health professions about career choice, job expectations, motivations and potential incentives to work in a rural area.

METHODS

In-depth interviews and focus groups were conducted among medical, nursing and midwifery students from universities of two Peruvian cities (Ica and Ayacucho). Themes for assessment and analysis included career choice, job expectations, motivations and incentives, according to a background theory a priori built for the study purpose.

RESULTS

Preference for urban jobs was already established at this undergraduate level. Solidarity, better income expectations, professional and personal recognition, early life experience and family models influenced career choice. Students also expressed altruism, willingness to choose a rural job after graduation and potential responsiveness to incentives for practising in rural areas, which emerged more frequent from the discourse of nursing and midwifery students and from all students of rural origin. Medical students expressed expectations to work in large urban hospitals offering higher salaries. They showed higher personal, professional and family welfare expectations. Participants consistently favoured both financial and non-financial incentives.

CONCLUSIONS

Nursing and midwifery students showed a higher disposition to work in rural areas than medical doctors, which was more evident in students of rural origin. Our results may be useful to improve targeting and selection of undergraduate students, to stimulate the inclination of students to choose a rural job upon graduation and to reorient school programmes towards the production of socially committed health professionals. Policymakers may also consider using our results when planning and implementing interventions to improve rural deployment of health professionals.

Why sub-Saharan African health workers migrate to European countries that do not actively recruit: a qualitative study post-migration

BACKGROUND

Many studies have investigated the migration intentions of sub-Saharan African medical students and health professionals within the context of a legacy of active international recruitment by receiving countries. However, many health workers migrate outside of this recruitment paradigm. This paper aims to explore the reasons for migration of health workers from sub-Saharan Africa to Belgium and Austria; European countries without a history of active recruitment in sub-Saharan Africa.

METHODS

Data were collected using semistructured interviews. Twenty-seven health workers were interviewed about their migration experiences. Included participants were born in sub-Saharan Africa, had trained as health workers in sub-Saharan Africa, and were currently living in Belgium or Austria, though not necessarily currently working as a health professional.

RESULTS

Both Austria and Belgium were shown not to be target countries for the health workers, who instead moved there by circumstance, rather than choice. Three principal reasons for migration were reported: 1) educational purposes; 2) political instability or insecurity in their country of origin; and 3) family reunification. In addition, two respondents mentioned medical reasons and, although less explicit, economic factors were also involved in several of the respondents' decision to migrate.

CONCLUSION

These results highlight the importance of the broader economic, social, and political context within which migration decisions are made. Training opportunities proved to be an important factor for migration. A further development and upgrade of primary care might help to counter the common desire to specialize and improve domestic training opportunities.